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Pavarini M, Alborghetti L, Aimonetto S, Maggio A, Landoni V, Ferrari P, Bianculli A, Petrucci E, Cicchetti A, Farina B, Ubeira-Gabellini MG, Salmoiraghi P, Moretti E, Avuzzi B, Giandini T, Munoz F, Magli A, Sanguineti G, Magdalena Waskiewicz J, Rago L, Cante D, Girelli G, Vavassori V, Di Muzio NG, Rancati T, Cozzarini C, Fiorino C. Pelvic bone marrow dose-volume predictors of late lymphopenia following pelvic lymph node radiation therapy for prostate cancer. Radiother Oncol 2024; 195:110230. [PMID: 38503355 DOI: 10.1016/j.radonc.2024.110230] [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: 02/02/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND PURPOSE Given the substantial lack of knowledge, we aimed to assess clinical/dosimetry predictors of late hematological toxicity on patients undergoing pelvic-nodes irradiation (PNI) for prostate cancer (PCa) within a prospective multi-institute study. MATERIALS AND METHODS Clinical/dosimetry/blood test data were prospectively collected including lymphocytes count (ALC) at baseline, mid/end-PNI, 3/6 months and every 6 months up to 5-year after PNI. DVHs of the Body, ileum (BMILEUM), lumbosacral spine (BMLS), lower pelvis (BMPELVIS), and whole pelvis (BMTOT) were extracted. Current analysis focused on 2-year CTCAEv4.03 Grade ≥ 2 (G2+) lymphopenia (ALC < 800/μL). DVH parameters that better discriminate patients with/without toxicity were first identified. After data pre-processing to limit overfitting, a multi-variable logistic regression model combining DVH and clinical information was identified and internally validated by bootstrap. RESULTS Complete data of 499 patients were available: 46 patients (9.2 %) experienced late G2+ lymphopenia. DVH parameters of BMLS/BMPELVIS/BMTOT and Body were associated to increased G2+ lymphopenia. The variables retained in the resulting model were ALC at baseline [HR = 0.997, 95 %CI 0.996-0.998, p < 0.0001], smoke (yes/no) [HR = 2.9, 95 %CI 1.25-6.76, p = 0.013] and BMLS-V ≥ 24 Gy (cc) [HR = 1.006, 95 %CI 1.002-1.011, p = 0.003]. When acute G3+ lymphopenia (yes/no) was considered, it was retained in the model [HR = 4.517, 95 %CI 1.954-10.441, p = 0.0004]. Performances of the models were relatively high (AUC = 0.87/0.88) and confirmed by validation. CONCLUSIONS Two-year lymphopenia after PNI for PCa is largely modulated by baseline ALC, with an independent role of acute G3+ lymphopenia. BMLS-V24 was the best dosimetry predictor: constraints for BMTOT (V10Gy < 1520 cc, V20Gy < 1250 cc, V30Gy < 850 cc), and BMLS (V24y < 307 cc) were suggested to potentially reduce the risk.
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Affiliation(s)
- Maddalena Pavarini
- IRCCS San Raffaele Scientific Institute, Medical Physics Dept, Milano, Italy
| | - Lisa Alborghetti
- IRCCS San Raffaele Scientific Institute, Medical Physics Dept, Milano, Italy
| | - Stefania Aimonetto
- Ospedale Regionale Parini-AUSL Valle d'Aosta, Medical Physics Dept, Aosta, Italy
| | - Angelo Maggio
- Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Medical Physics Dept, Candiolo, Italy
| | - Valeria Landoni
- IRCCS Istituto Nazionale Tumori Regina Elena, UOSD Laboratorio di Fisica Medica e Sistemi Esperti, Roma, Italy
| | - Paolo Ferrari
- Comprensorio Sanitario di Bolzano, Medical Physics Dept, Bolzano, Italy
| | | | | | - Alessandro Cicchetti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Unit of Data Science, Milano, Italy
| | - Bruno Farina
- Ospedale degli Infermi, Medical Physics Dept, Biella, Italy
| | | | | | - Eugenia Moretti
- Azienda sanitaria universitaria Friuli Centrale, Medical Physics Department, Udine, Italy
| | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy Department, Milano, Italy
| | - Tommaso Giandini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Physics Department, Milano, Italy
| | - Fernando Munoz
- Ospedale Regionale Parini-AUSL Valle d'Aosta, Department of Radiation Oncology, Aosta, Italy
| | - Alessandro Magli
- Azienda Ospedaliero Universitaria S. Maria della Misericordia, Department of Radiotherapy, Udine, Italy
| | - Giuseppe Sanguineti
- IRCCS Regina Elena National Cancer Institute, Department of Radiation Oncology, Roma, Italy
| | | | - Luciana Rago
- IRCCS Crob, Radiotherapy, Rionero in Vulture, Italy
| | | | - Giuseppe Girelli
- Ospedale degli Infermi, Department of Radiotherapy, Biella, Italy
| | | | - Nadia Gisella Di Muzio
- Vita-Salute San Raffaele University, Milano, Italy; IRCCS San Raffaele Scientific Institute, Department of Radiation Oncology, Milano, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Unit of Data Science, Milano, Italy
| | - Cesare Cozzarini
- IRCCS San Raffaele Scientific Institute, Department of Radiation Oncology, Milano, Italy
| | - Claudio Fiorino
- IRCCS San Raffaele Scientific Institute, Medical Physics Dept, Milano, Italy.
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Della Corte A, Mori M, Calabrese F, Palumbo D, Ratti F, Palazzo G, Pellegrini A, Santangelo D, Ronzoni M, Spezi E, Del Vecchio A, Fiorino C, Aldrighetti L, De Cobelli F. Preoperative MRI radiomic analysis for predicting local tumor progression in colorectal liver metastases before microwave ablation. Int J Hyperthermia 2024; 41:2349059. [PMID: 38754994 DOI: 10.1080/02656736.2024.2349059] [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: 12/19/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Radiomics may aid in predicting prognosis in patients with colorectal liver metastases (CLM). Consistent data is available on CT, yet limited data is available on MRI. This study assesses the capability of MRI-derived radiomic features (RFs) to predict local tumor progression-free survival (LTPFS) in patients with CLMs treated with microwave ablation (MWA). METHODS All CLM patients with pre-operative Gadoxetic acid-MRI treated with MWA in a single institution between September 2015 and February 2022 were evaluated. Pre-procedural information was retrieved retrospectively. Two observers manually segmented CLMs on T2 and T1-Hepatobiliary phase (T1-HBP) scans. After inter-observer variability testing, 148/182 RFs showed robustness on T1-HBP, and 141/182 on T2 (ICC > 0.7).Cox multivariate analysis was run to establish clinical (CLIN-mod), radiomic (RAD-T1, RAD-T2), and combined (COMB-T1, COMB-T2) models for LTPFS prediction. RESULTS Seventy-six CLMs (43 patients) were assessed. Median follow-up was 14 months. LTP occurred in 19 lesions (25%).CLIN-mod was composed of minimal ablation margins (MAMs), intra-segment progression and primary tumor grade and exhibited moderately high discriminatory power in predicting LTPFS (AUC = 0.89, p = 0.0001). Both RAD-T1 and RAD-T2 were able to predict LTPFS: (RAD-T1: AUC = 0.83, p = 0.0003; RAD-T2: AUC = 0.79, p = 0.001). Combined models yielded the strongest performance (COMB-T1: AUC = 0.98, p = 0.0001; COMB-T2: AUC = 0.95, p = 0.0003). Both combined models included MAMs and tumor regression grade; COMB-T1 also featured 10th percentile of signal intensity, while tumor flatness was present in COMB-T2. CONCLUSION MRI-based radiomic evaluation of CLMs is feasible and potentially useful for LTP prediction. Combined models outperformed clinical or radiomic models alone for LTPFS prediction.
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Affiliation(s)
- Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Martina Mori
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Gabriele Palazzo
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Monica Ronzoni
- Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, UK
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | | | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- University Vita-Salute San Raffaele, Milan, Italy
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Cicchetti A, Mangili P, Fodor A, Gabellini MGU, Chiara A, Deantoni C, Mori M, Pasetti M, Palazzo G, Rancati T, Del Vecchio A, Gisella Di Muzio N, Fiorino C. Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy. Radiother Oncol 2024; 194:110183. [PMID: 38423138 DOI: 10.1016/j.radonc.2024.110183] [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: 10/10/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors. METHODS The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output. RESULTS The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy. CONCLUSIONS The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. Few clinical factors heavily modulate the risk.
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Affiliation(s)
- Alessandro Cicchetti
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Data Science Unit, Milan, Italy.
| | - Paola Mangili
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
| | - Andrei Fodor
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | | | - Anna Chiara
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | - Chiara Deantoni
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | - Martina Mori
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
| | - Marcella Pasetti
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | - Gabriele Palazzo
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Data Science Unit, Milan, Italy
| | | | | | - Claudio Fiorino
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
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Fiorino C, Palumbo D, Mori M, Palazzo G, Pellegrini AE, Albarello L, Belardo A, Canevari C, Cossu A, Damascelli A, Elmore U, Mazza E, Pavarini M, Passoni P, Puccetti F, Slim N, Steidler S, Del Vecchio A, Di Muzio NG, Chiti A, Rosati R, De Cobelli F. Early regression index (ERI) on MR images as response predictor in esophageal cancer treated with neoadjuvant chemo-radiotherapy: Interim analysis of the prospective ESCAPE trial. Radiother Oncol 2024; 194:110160. [PMID: 38369025 DOI: 10.1016/j.radonc.2024.110160] [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: 11/07/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The early regression index (ERI) predicts treatment response in rectal cancer patients. Aim of current study was to prospectively assess tumor response to neoadjuvant chemo-radiotherapy (nCRT) of locally advanced esophageal cancer using ERI, based on MRI. MATERIAL AND METHODS From January 2020 to May 2023, 30 patients with esophageal cancer were enrolled in a prospective study (ESCAPE). PET-MRI was performed: i) before nCRT (tpre); ii) at mid-radiotherapy, tmid; iii) after nCRT, 2-6 weeks before surgery (tpost); nCRT delivered 41.4 Gy/23fr with concurrent carboplatin and paclitaxel. For patients that skipped surgery, complete clinical response (cCR) was assessed if patients showed no local relapse after 18 months; patients with pathological complete response (pCR) or with cCR were considered as complete responders (pCR + cCR). GTV volumes were delineated by two observers (Vpre, Vmid, Vpost) on T2w MRI: ERI and other volume regression parameters at tmid and tpost were tested as predictors of pCR + cCR. RESULTS Complete data of 25 patients were available at the time of the analysis: 3/25 with complete response at imaging refused surgery and 2/3 were cCR; in total, 10/25 patients showed pCR + cCR (pCR = 8/22). Both ERImid and ERIpost classified pCR + cCR patients, with ERImid showing better performance (AUC:0.78, p = 0.014): A two-variable logistic model combining ERImid and Vpre improved performances (AUC:0.93, p < 0.0001). Inter-observer variability in contouring GTV did not affect the results. CONCLUSIONS Despite the limited numbers, interim analysis of ESCAPE study suggests ERI as a potential predictor of complete response after nCRT for esophageal cancer. Further validation on larger populations is warranted.
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Affiliation(s)
- C Fiorino
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy.
| | - D Palumbo
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy
| | - M Mori
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - G Palazzo
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | | | - L Albarello
- Pathology, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Belardo
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - C Canevari
- Nuclear Medicine, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Cossu
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Damascelli
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy
| | - U Elmore
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy
| | - E Mazza
- Oncology, IRCCS San Raffaele Hospital, Milano, Italy
| | - M Pavarini
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - P Passoni
- Radiotherapy, IRCCS San Raffaele Hospital, Milano, Italy
| | - F Puccetti
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy
| | - N Slim
- Radiotherapy, IRCCS San Raffaele Hospital, Milano, Italy
| | - S Steidler
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Del Vecchio
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - N G Di Muzio
- Radiotherapy, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
| | - A Chiti
- Nuclear Medicine, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
| | - R Rosati
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
| | - F De Cobelli
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
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Castriconi R, Tudda A, Placidi L, Benecchi G, Cagni E, Dusi F, Ianiro A, Landoni V, Malatesta T, Mazzilli A, Meffe G, Oliviero C, Rambaldi Guidasci G, Scaggion A, Trojani V, Del Vecchio A, Fiorino C. Inter-institutional variability of knowledge-based plan prediction of left whole breast irradiation. Phys Med 2024; 120:103331. [PMID: 38484461 DOI: 10.1016/j.ejmp.2024.103331] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Within a multi-institutional project, we aimed to assess the transferability of knowledge-based (KB) plan prediction models in the case of whole breast irradiation (WBI) for left-side breast irradiation with tangential fields (TF). METHODS Eight institutions set KB models, following previously shared common criteria. Plan prediction performance was tested on 16 new patients (2 pts per centre) extracting dose-volume-histogram (DVH) prediction bands of heart, ipsilateral lung, contralateral lung and breast. The inter-institutional variability was quantified by the standard deviations (SDint) of predicted DVHs and mean-dose (Dmean). The transferability of models, for the heart and the ipsilateral lung, was evaluated by the range of geometric Principal Component (PC1) applicability of a model to test patients of the other 7 institutions. RESULTS SDint of the DVH was 1.8 % and 1.6 % for the ipsilateral lung and the heart, respectively (20 %-80 % dose range); concerning Dmean, SDint was 0.9 Gy and 0.6 Gy for the ipsilateral lung and the heart, respectively (<0.2 Gy for contralateral organs). Mean predicted doses ranged between 4.3 and 5.9 Gy for the ipsilateral lung and 1.1-2.3 Gy for the heart. PC1 analysis suggested no relevant differences among models, except for one centre showing a systematic larger sparing of the heart, concomitant to a worse PTV coverage, due to high priority in sparing the left anterior descending coronary artery. CONCLUSIONS Results showed high transferability among models and low inter-institutional variability of 2% for plan prediction. These findings encourage the building of benchmark models in the case of TF-WBI.
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Affiliation(s)
- Roberta Castriconi
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Alessia Tudda
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanna Benecchi
- Medical Physics Dept, University Hospital of Parma AOUP, Parma, Italy
| | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Anna Ianiro
- IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Valeria Landoni
- IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Tiziana Malatesta
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina - Gemelli Isola, Roma, Italy
| | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Parma, Italy
| | - Guenda Meffe
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Claudio Fiorino
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Deantoni CL, Mirabile A, Chiara A, Giannini L, Midulla M, Del Vecchio A, Fiorino C, Fodor A, Di Muzio NG, Dell’Oca I. Impact of low skeletal muscle mass in oropharyngeal cancer patients treated with radical chemo-radiotherapy: A mono-institutional experience. Tumori 2024; 110:116-123. [PMID: 37978342 PMCID: PMC11005313 DOI: 10.1177/03008916231212382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/10/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
AIMS Low skeletal muscle mass index (SMI) has recently emerged as an independent prognostic factor in oncological patients and it is linked with poor survival and higher treatment toxicity. The present study aims to determine the possible impact of low SMI on survival and acute toxicity in oropharyngeal patients. METHODS Seventy-six patients with locally advanced oropharyngeal squamous cell carcinoma (stage III-IVC) were treated in our institution with Helical TomoTherapy® (HT - Accuray, Maddison, WI, USA) between 2005 and 2021. All patients received concomitant platinum-based chemotherapy (CT) (at least 200 mg/m2). The SMI was determined using the calculation of cross-sectional area at C3. Twenty patients (26%) presented pre-treatment low SMI, according to Chargi definitions. RESULTS All patients concluded the treatment. Thirteen patients with low SMI (65%) and 22 patients with normal SMI (39%) presented acute toxicity greater than or equal to grade 3, but this difference was not statistically significant (p-value = 0.25). Overall survival was analyzed in 65 patients, excluding those who finished CT-RT less than six months before the analysis. Overall survival was significantly lower in low SMI versus normal SMI patients (p-value = 0.035). Same difference was observed in N0-N2a patients, suggesting an important role of SMI also in lower nodal burden and putatively better prognosis. CONCLUSIONS Although the results are limited to a small population, our case series has the advantage to be very homogeneous in patients and treatment characteristics. In our setting, SMI demonstrated a crucial impact on overall survival. Further investigation with larger samples is necessary to confirm our results to improve patient outcomes.
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Affiliation(s)
- Chiara L. Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Aurora Mirabile
- Department Unit of Oncology, Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Università Vita-Salute, Milano
| | - Anna Chiara
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Giannini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Midulla
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Del Vecchio
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia G. Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Italo Dell’Oca
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Boldrini L, Chiloiro G, Cusumano D, Yadav P, Yu G, Romano A, Piras A, Votta C, Placidi L, Broggi S, Catucci F, Lenkowicz J, Indovina L, Bassetti MF, Yang Y, Fiorino C, Valentini V, Gambacorta MA. Radiomics-enhanced early regression index for predicting treatment response in rectal cancer: a multi-institutional 0.35 T MRI-guided radiotherapy study. Radiol Med 2024; 129:615-622. [PMID: 38512616 DOI: 10.1007/s11547-024-01761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/03/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The accurate prediction of treatment response in locally advanced rectal cancer (LARC) patients undergoing MRI-guided radiotherapy (MRIgRT) is essential for optimising treatment strategies. This multi-institutional study aimed to investigate the potential of radiomics in enhancing the predictive power of a known radiobiological parameter (Early Regression Index, ERITCP) to evaluate treatment response in LARC patients treated with MRIgRT. METHODS Patients from three international sites were included and divided into training and validation sets. 0.35 T T2*/T1-weighted MR images were acquired during simulation and at each treatment fraction. The biologically effective dose (BED) conversion was used to account for different radiotherapy schemes: gross tumour volume was delineated on the MR images corresponding to specific BED levels and radiomic features were then extracted. Multiple logistic regression models were calculated, combining ERITCP with other radiomic features. The predictive performance of the different models was evaluated on both training and validation sets by calculating the receiver operating characteristic (ROC) curves. RESULTS A total of 91 patients was enrolled: 58 were used as training, 33 as validation. Overall, pCR was observed in 25 cases. The model showing the highest performance was obtained combining ERITCP at BED = 26 Gy with a radiomic feature (10th percentile of grey level histogram, 10GLH) calculated at BED = 40 Gy. The area under ROC curve (AUC) of this combined model was 0.98 for training set and 0.92 for validation set, significantly higher (p = 0.04) than the AUC value obtained using ERITCP alone (0.94 in training and 0.89 in validation set). CONCLUSION The integration of the radiomic analysis with ERITCP improves the pCR prediction in LARC patients, offering more precise predictive models to further personalise 0.35 T MRIgRT treatments of LARC patients.
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Affiliation(s)
- Luca Boldrini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | | | - Poonam Yadav
- Northwestern Memorial Hospital, Northwestern University Feinberg, Chicago, IL, USA
| | - Gao Yu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Angela Romano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy
| | - Claudio Votta
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Luca Indovina
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Michael F Bassetti
- Department of Human Oncology, School of Medicine and Public Heath, University of Wisconsin - Madison, Madison, USA
| | - Yingli Yang
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
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8
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Sanguineti G, Pavarini M, Munoz F, Magli A, Cante D, Garibaldi E, Gebbia A, Noris Chiorda B, Girelli G, Villa E, Faiella A, Magdalena Waskiewicz J, Avuzzi B, Pastorino A, Moretti E, Rago L, Statuto T, Gatti M, Rancati T, Valdagni R, Luigi Vavassori V, Gisella Di Muzio N, Fiorino C, Cozzarini C. Worsening of 2-year patient-reported intestinal functionality after radiotherapy for prostate cancer including pelvic node irradiation. Radiother Oncol 2024; 192:110088. [PMID: 38199284 DOI: 10.1016/j.radonc.2024.110088] [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: 07/11/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND PURPOSE To quantify patient-reported 2-year intestinal toxicity (IT) from pelvic nodal irradiation (PNI) for prostate cancer. The association between baseline/acute symptoms and 2-year worsening was investigated. MATERIALS AND METHODS Patient-reported IT was prospectively assessed through the Inflammatory Bowel Disease Questionnaire (IBDQ), filled in at baseline, radiotherapy mid-point and end, at 3 and 6 months and every 6 months until 5 years. Two-year deterioration of IBDQ scores relative to the Bowel Domain was investigated for 400 patients with no severe baseline symptoms and with questionnaires available at baseline, 2 years, RT mid-point and/or end and at least three follow-ups between 3 and 18 months. The significance of the 2-year differences from baseline was tested. The association between baseline values and ΔAcute (the worst decline between baseline and RT mid-point/end) was investigated. RESULTS In the IBDQ lower scores indicate worse symptoms. A significant (p < 0.0001) 2-year mean worsening, mostly in the range of -0.2/-0.4 points on a 1-7 scale, emerged excepting one question (IBDQ29, "nausea/feeling sick"). This decline was independent of treatment intent while baseline values were associated with 2-year absolute scores. The ΔAcute largely modulated 2-year worsening: patients with ΔAcute greater than the first quartile (Q1) and ΔAcute less or equal than Q1 showed no/minimal and highly significant (p < 0.0001) deterioration, respectively. Rectal incontinence, urgency, frequency and abdominal pain showed the largest mean changes (-0.5/-1): risk of severe worsening (deemed to be of clinical significance if ≤ 2) was 3-5 fold higher in the ΔAcute ≤ Q1 vs ΔAcute > Q1 group (p < 0.0001). CONCLUSION A modest but significant deterioration of two-year patient-reported intestinal symptoms from PNI compared to baseline was found. Patients experiencing more severe acute symptoms are at higher risk of symptom persistence at 2 years, with a much larger prevalence of clinically significant symptoms.
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Affiliation(s)
- Giuseppe Sanguineti
- Radiotherapy, IRCCS Istituto Nazionale dei Tumori "Regina Elena", Roma, Italy
| | | | - Fernando Munoz
- Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Alessandro Magli
- Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | | | | | - Andrea Gebbia
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Elisa Villa
- Radiotherapy, Cliniche Gavazzeni-Humanitas, Bergamo, Italy
| | - Adriana Faiella
- Radiotherapy, IRCCS Istituto Nazionale dei Tumori "Regina Elena", Roma, Italy
| | | | - Barbara Avuzzi
- Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Eugenia Moretti
- Medical Physics, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Luciana Rago
- Radiotherapy, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy
| | - Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS - CROB), Rionero in Vulture, Italy
| | - Marco Gatti
- Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy
| | - Tiziana Rancati
- Unit of Data Science, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Riccardo Valdagni
- Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Nadia Gisella Di Muzio
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy; Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Cesare Cozzarini
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy.
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9
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Ubeira-Gabellini MG, Mori M, Palazzo G, Cicchetti A, Mangili P, Pavarini M, Rancati T, Fodor A, Del Vecchio A, Di Muzio NG, Fiorino C. Comparing Performances of Predictive Models of Toxicity after Radiotherapy for Breast Cancer Using Different Machine Learning Approaches. Cancers (Basel) 2024; 16:934. [PMID: 38473296 DOI: 10.3390/cancers16050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Different ML models were compared to predict toxicity in RT on a large cohort (n = 1314). METHODS The endpoint was RTOG G2/G3 acute toxicity, resulting in 204/1314 patients with the event. The dataset, including 25 clinical, anatomical, and dosimetric features, was split into 984 for training and 330 for internal tests. The dataset was standardized; features with a high p-value at univariate LR and with Spearman ρ>0.8 were excluded; synthesized data of the minority were generated to compensate for class imbalance. Twelve ML methods were considered. Model optimization and sequential backward selection were run to choose the best models with a parsimonious feature number. Finally, feature importance was derived for every model. RESULTS The model's performance was compared on a training-test dataset over different metrics: the best performance model was LightGBM. Logistic regression with three variables (LR3) selected via bootstrapping showed performances similar to the best-performing models. The AUC of test data is slightly above 0.65 for the best models (highest value: 0.662 with LightGBM). CONCLUSIONS No model performed the best for all metrics: more complex ML models had better performances; however, models with just three features showed performances comparable to the best models using many (n = 13-19) features.
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Affiliation(s)
| | - Martina Mori
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gabriele Palazzo
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandro Cicchetti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maddalena Pavarini
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Andrei Fodor
- Radiotherapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | - Nadia Gisella Di Muzio
- Radiotherapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Radiotherapy, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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10
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Maggio A, Rancati T, Gatti M, Cante D, Avuzzi B, Bianconi C, Badenchini F, Farina B, Ferrari P, Giandini T, Girelli G, Landoni V, Magli A, Moretti E, Petrucci E, Salmoiraghi P, Sanguineti G, Villa E, Waskiewicz JM, Guarneri A, Valdagni R, Fiorino C, Cozzarini C. Quality of Life Longitudinal Evaluation in Prostate Cancer Patients from Radiotherapy Start to 5 Years after IMRT-IGRT. Curr Oncol 2024; 31:839-848. [PMID: 38392056 PMCID: PMC10887595 DOI: 10.3390/curroncol31020062] [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: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The purpose of this study is to study the evolution of quality of life (QoL) in the first 5 years following Intensity-modulated radiation therapy (IMRT) for prostate cancer (PCa) and to determine possible associations with clinical/treatment data. MATERIAL AND METHODS Patients were enrolled in a prospective multicentre observational trial in 2010-2014 and treated with conventional (74-80 Gy, 1.8-2 Gy/fr) or moderately hypofractionated IMRT (65-75.2 Gy, 2.2-2.7 Gy/fr). QoL was evaluated by means of EORTC QLQ-C30 at baseline, at radiation therapy (RT) end, and every 6 months up to 5 years after IMRT end. Fourteen QoL dimensions were investigated separately. The longitudinal evaluation of QoL was analysed by means of Analysis of variances (ANOVA) for multiple measures. RESULTS A total of 391 patients with complete sets of questionnaires across 5 years were available. The longitudinal analysis showed a trend toward the significant worsening of QoL at RT end for global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. QoL worsening was recovered within 6 months from RT end, with the only exception being physical functioning. Based on ANOVA, the most impaired time point was RT end. QoL dimension analysis at this time indicated that acute Grade ≥ 2 gastrointestinal (GI) toxicity significantly impacted global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. Acute Grade ≥ 2 genitourinary (GU) toxicity resulted in lower role functioning and higher pain. Prophylactic lymph-nodal irradiation (WPRT) resulted in significantly lower QoL for global health, fatigue, appetite loss, and diarrhoea; lower pain with the use of neoadjuvant/concomitant hormonal therapy; and lower fatigue with the use of an anti-androgen. CONCLUSIONS In this prospective, longitudinal, observational study, high radiation IMRT doses delivered for PCa led to a temporary worsening of QoL, which tended to be completely resolved at six months. Such transient worsening was mostly associated with acute GI/GU toxicity, WPRT, and higher prescription doses.
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Affiliation(s)
- Angelo Maggio
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Marco Gatti
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Domenico Cante
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Cinzia Bianconi
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Fabio Badenchini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Bruno Farina
- Ospedale degli Infermi, 13875 Biella, Italy; (B.F.); (G.G.)
| | - Paolo Ferrari
- Comprensorio Sanitario di Bolzano, 39100 Bolzano, Italy; (P.F.); (J.M.W.)
| | - Tommaso Giandini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | | | - Valeria Landoni
- IRCCS Istituto Tumori Regina Elena, 00144 Roma, Italy; (V.L.); (G.S.)
| | | | | | - Edoardo Petrucci
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | | | | | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, 24121 Bergamo, Italy; (P.S.); (E.V.)
| | | | - Alessia Guarneri
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milano, Italy
| | - Claudio Fiorino
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Cesare Cozzarini
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
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11
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Fodor A, Brombin C, Deantoni CL, Giannini L, Ferrario F, Villa SL, Mangili P, Rancoita PMV, Cozzarini C, Picchio M, Del Vecchio A, Fiorino C, Di Serio MCS, Chiti A, Di Muzio NG. Extended nodal radiotherapy for prostate cancer relapse guided with [11C]-choline PET/CT: ten-year results in patients enrolled in a prospective trial. Eur J Nucl Med Mol Imaging 2024; 51:590-603. [PMID: 37747578 DOI: 10.1007/s00259-023-06445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
AIMS To report long-term outcomes of relapsed prostate cancer (PC) patients treated in a prospective single-arm study with extended-nodal radiotherapy (ENRT) and [11C]-choline positron emission tomography (PET)/computed tomography (CT)-guided simultaneous integrated boost (SIB) to positive lymph nodes (LNs). METHODS From 12/2009 to 04/2015, 60 PC patients with biochemical relapse and positive LNs only were treated in this study. ENRT at a median total dose (TD) = 51.8 Gy/28 fr and PET/CT-guided SIB to positive LNs at a median TD = 65.5 Gy was prescribed. Median PSA at relapse was 2.3 (interquartile range, IQR:1.3-4.0) ng/ml. Median number of positive LNs: 2 (range: 1-18). Androgen deprivation therapy (ADT) was prescribed for 48 patients for a median of 30.7 (IQR: 18.5-43.1) months. RESULTS Median follow-up from the end of salvage treatment was 121.8 (IQR: 116.1, 130.9) months; 3-, 5-, and 10-year BRFS were 45.0%, 36.0%, and 24.0%, respectively; DMFS: 67.9%, 57.2%, and 45.2%; CRFS: 62.9%, 53.9%, and 42.0%; and OS: 88.2%, 76.3%, and 47.9%, respectively. Castration resistance (p < 0.0001) and ≥ 6 positive LN (p = 0.0024) significantly influenced OS at multivariate analysis. Castration resistance (p < 0.0001 for both) influenced DMFS and CRFS in multivariate analysis. CONCLUSIONS In PC relapsed patients treated with ENRT and [11C]-choline-PET/CT-guided SIB for positive LNs, with 10-year follow-up, a median Kaplan-Meier estimate CRFS of 67 months and OS of 110 months were obtained. These highly favorable results should be confirmed in a prospective, randomized trial.
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Affiliation(s)
- A Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - C Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - C L Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Giannini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Ferrario
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S L Villa
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P M V Rancoita
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - C Cozzarini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Picchio
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Del Vecchio
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M C S Di Serio
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - A Chiti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - N G Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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12
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Spampinato S, Rancati T, Waskiewicz JM, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Cante D, Girelli G, Gatti M, Noris Chiorda B, Rago L, Ferrari P, Piva C, Pavarini M, Valdagni R, Vavassori V, Munoz F, Sanguineti G, Di Muzio N, Kirchheiner K, Fiorino C, Cozzarini C. Patient-reported persistent symptoms after radiotherapy and association with quality of life for prostate cancer survivors. Acta Oncol 2023; 62:1440-1450. [PMID: 37801288 DOI: 10.1080/0284186x.2023.2259597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL). MATERIALS AND METHODS Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010-2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0-100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs. RESULTS The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences. CONCLUSIONS The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL.
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Affiliation(s)
- Sofia Spampinato
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Tiziana Rancati
- Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisabetta Garibaldi
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Adriana Faiella
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Elisa Villa
- Department of Radiotherapy, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Magli
- Department of Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Domenico Cante
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Giuseppe Girelli
- Department of Radiotherapy, Ospedale degli Infermi, Biella, Italy
| | - Marco Gatti
- Department of Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy
| | - Barbara Noris Chiorda
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciana Rago
- Department of Radiotherapy, IRCCS CROB, Rionero in Vulture, Italy
| | - Paolo Ferrari
- Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Cristina Piva
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Maddalena Pavarini
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Valdagni
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Fernando Munoz
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute and Università Vita Salute San Raffaele, Milan, Italy
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Cicchetti A, Mangili P, Fodor A, Mori M, Chiara A, Deantoni C, Pasetti M, Palazzo G, Ubeira Gabellini MG, Rancati T, Del Vecchio A, Muzio NGD, Fiorino C. Dosimetry Predictors of Late Skin Reactions after Whole Breast Radiotherapy on a Large Mono-Institutional Cohort of Patients. Int J Radiat Oncol Biol Phys 2023; 117:e171. [PMID: 37784780 DOI: 10.1016/j.ijrobp.2023.06.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To develop an NTCP model predicting late skin toxicity using dosimetric parameters from the breast dermis to identify possible RT constraints on such a structure. MATERIALS/METHODS The skin structure was defined as the 5 mm inner isotropic expansion from the outer CT body contour. It was retrospectively segmented on a large mono-Institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions without a RT boost. Toxicity was reported during FU using SOMA/LENT scoring. The study endpoint was moderate-severe late toxicity consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G2+) developed within 42 months after RT completion. Automatic delineation of skin and DVH extraction were accomplished by scripting using the MIM_assistant software. Also, the impact of changes in the dose calculation algorithms during enrolment time was quantified. A logistic model was created by combining multifactorial variables, considering both clinical factors and the absolute skin DVH (cc). Variance Inflation Factor (VIF) was performed to reduce the multicollinearity. Repeated 5-fold cross-validation with SMOTE approach to overcome the class unbalance was applied for model feature selection. The predictive model was then developed on the entire population due to the limited G2+ events. RESULTS The FATP G2+ rate was 3.8% with 40/1066 experiencing late toxicity. Among them, a 40% had already developed acute symptoms after RT completion showing a consequential effect. The multicollinearity analysis selected 27 clinical-treatment-dosimetric factors. After repeated (20 times) 5-fold cross-validation, the best-performing model included Post-Surgery Cosmetic alterations, Aromatase Inhibitors (as a protective factor), V20 Gy (50% of the prescribed dose - DVH plateau region) and V42 Gy (105% of the prescribed dose - DVH high-dose tail). Accuracy and f1-score were 0.76 and 0.58 in both training and test sets, providing good reliability for selected variables. AUC for the final model on the entire population was 0.76+/-0.04. CONCLUSION We quantified the association between fibrosis and skin DVH when delivering 40 Gy in 15fr. The model suggested an independent role of V20 and V42 Gy and a heavy risk modulation by surgical effects and aromatase inhibitors. This last factor could interfere with adipose tissue and water-content distribution within the breast. For this purpose, a CT-based densitometry characterization of toxicity patients is ongoing.
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Affiliation(s)
- A Cicchetti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| | - P Mangili
- San Raffaele Scientific Institute, Milan, Italy
| | - A Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Mori
- San Raffaele Scientific Institute - IRCCS, Milano, Italy
| | - A Chiara
- San Raffaele Scientific Institute, Milan, Italy
| | - C Deantoni
- San Raffaele Scientific Institute, Milan, Italy
| | - M Pasetti
- San Raffaele Scientific Institute, Milano, Italy
| | - G Palazzo
- San Raffaele Scientific Institute, Milan, Italy
| | | | - T Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| | | | - N G Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- San Raffaele Scientific Institute - IRCCS, Milano, Italy
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Alborghetti L, Castriconi R, Sosa Marrero C, Tudda A, Ubeira-Gabellini MG, Broggi S, Pascau J, Cubero L, Cozzarini C, De Crevoisier R, Rancati T, Acosta O, Fiorino C. Selective sparing of bladder and rectum sub-regions in radiotherapy of prostate cancer combining knowledge-based automatic planning and multicriteria optimization. Phys Imaging Radiat Oncol 2023; 28:100488. [PMID: 37694264 PMCID: PMC10482897 DOI: 10.1016/j.phro.2023.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Purpose The association between dose to selected bladder and rectum symptom-related sub-regions (SRS) and late toxicity after prostate cancer radiotherapy has been evidenced by voxel-wise analyses. The aim of the current study was to explore the feasibility of combining knowledge-based (KB) and multi-criteria optimization (MCO) to spare SRSs without compromising planning target volume (PTV) dose delivery, including pelvic-node irradiation. Materials and Methods Forty-five previously treated patients (74.2 Gy/28fr) were selected and SRSs (in the bladder, associated with late dysuria/hematuria/retention; in the rectum, associated with bleeding) were generated using deformable registration. A KB model was used to obtain clinically suitable plans (KB-plan). KB-plans were further optimized using MCO, aiming to reduce dose to the SRSs while safeguarding target dose coverage, homogeneity and avoiding worsening dose volume histograms of the whole bladder, rectum and other organs at risk. The resulting MCO-generated plans were examined to identify the best-compromise plan (KB + MCO-plan). Results The mean SRS dose decreased in almost all patients for each SRS. D1% also decreased in the large majority, less frequently for dysuria/bleeding SRS. Mean differences were statistically significant (p < 0.05) and ranged between 1.3 and 2.2 Gy with maximum reduction of mean dose up to 3-5 Gy for the four SRSs. The better sparing of SRSs was obtained without compromising PTVs coverage. Conclusions Selectively sparing SRSs without compromising PTV coverage is feasible and has the potential to reduce toxicities in prostate cancer radiotherapy. Further investigation to better quantify the expected risk reduction of late toxicities is warranted.
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Affiliation(s)
- Lisa Alborghetti
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
| | | | - Carlos Sosa Marrero
- CLCC Eugène Marquis, INSERM, LTSI—UMR1099, F-35000, Univ Rennes, Rennes, France
| | - Alessia Tudda
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
| | | | - Sara Broggi
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
| | - Javier Pascau
- Universidad Carlos III de Madrid, Bioengineering Department, Madrid, Spain
| | - Lucia Cubero
- Universidad Carlos III de Madrid, Bioengineering Department, Madrid, Spain
| | - Cesare Cozzarini
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milano, Italy
| | | | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Progetto Prostata, Milano, Italy
| | - Oscar Acosta
- CLCC Eugène Marquis, INSERM, LTSI—UMR1099, F-35000, Univ Rennes, Rennes, France
| | - Claudio Fiorino
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
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Palazzo G, Mangili P, Deantoni C, Fodor A, Broggi S, Castriconi R, Ubeira Gabellini MG, del Vecchio A, Di Muzio NG, Fiorino C. Real-world validation of Artificial Intelligence-based Computed Tomography auto-contouring for prostate cancer radiotherapy planning. Phys Imaging Radiat Oncol 2023; 28:100501. [PMID: 37920450 PMCID: PMC10618761 DOI: 10.1016/j.phro.2023.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
Background and purpose Artificial Intelligence (AI)-based auto-contouring for treatment planning in radiotherapy needs extensive clinical validation, including the impact of editing after automatic segmentation. The aims of this study were to assess the performance of a commercial system for Clinical Target Volumes (CTVs) (prostate/seminal vesicles) and selected Organs at Risk (OARs) (rectum/bladder/femoral heads + femurs), evaluating also inter-observer variability (manual vs automatic + editing) and the reduction of contouring time. Materials and methods Two expert observers contoured CTVs/OARs of 20 patients in our Treatment Planning System (TPS). Computed Tomography (CT) images were sent to the automatic contouring workstation: automatic contours were generated and sent back to TPS, where observers could edit them if necessary. Inter- and intra-observer consistency was estimated using Dice Similarity Coefficients (DSC). Radiation oncologists were also asked to score the quality of automatic contours, ranging from 1 (complete re-contouring) to 5 (no editing). Contouring times (manual vs automatic + edit) were compared. Results DSCs (manual vs automatic only) were consistent with inter-observer variability (between 0.65 for seminal vesicles and 0.94 for bladder); editing further improved performances (range: 0.76-0.94). The median clinical score was 4 (little editing) and it was <4 in 3/2 patients for the two observers respectively. Inter-observer variability of automatic + editing contours improved significantly, being lower than manual contouring (e.g.: seminal vesicles: 0.83vs0.73; prostate: 0.86vs0.83; rectum: 0.96vs0.81). Oncologist contouring time reduced from 17 to 24 min of manual contouring time to 3-7 min of editing time for the two observers (p < 0.01). Conclusion Automatic contouring with a commercial AI-based system followed by editing can replace manual contouring, resulting in significantly reduced time for segmentation and better consistency between operators.
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Affiliation(s)
- Gabriele Palazzo
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Nadia G. Di Muzio
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Sosa-Marrero C, Acosta O, Pasquier D, Thariat J, Delpon G, Fiorino C, Rancatti T, Malard O, Foray N, de Crevoisier R. Voxel-wise analysis: A powerful tool to predict radio-induced toxicity and potentially perform personalised planning in radiotherapy. Cancer Radiother 2023; 27:638-642. [PMID: 37517974 DOI: 10.1016/j.canrad.2023.06.024] [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: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
Dose - volume histograms have been historically used to study the relationship between the planned radiation dose and healthy tissue damage. However, this approach considers neither spatial information nor heterogenous radiosensitivity within organs at risk, depending on the tissue. Recently, voxel-wise analyses have emerged in the literature as powerful tools to fully exploit three-dimensional information from the planned dose distribution. They allow to identify anatomical subregions of one or several organs in which the irradiation dose is associated with a given toxicity. These methods rely on an accurate anatomical alignment, usually obtained by means of a non-rigid registration. Once the different anatomies are spatially normalised, correlations between the three-dimensional dose and a given toxicity can be explored voxel-wise. Parametric or non-parametric statistical tests can be performed on every voxel to identify the voxels in which the dose is significantly different between patients presenting or not toxicity. Several anatomical subregions associated with genitourinary, gastrointestinal, cardiac, pulmonary or haematological toxicity have already been identified in the literature for prostate, head and neck or thorax irradiation. Voxel-wise analysis appears therefore first particularly interesting to increase toxicity prediction capability by identifying specific subregions in the organs at risk whose irradiation is highly predictive of specific toxicity. The second interest is potentially to decrease the radio-induced toxicity by limiting the dose in the predictive subregions, while not decreasing the dose in the target volume. Limitations of the approach have been pointed out.
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Affiliation(s)
- C Sosa-Marrero
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - O Acosta
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - D Pasquier
- Radiotherapy Department, centre Oscar-Lambret, 59000 Lille, France; Université de Lille, CNRS, école centrale de Lille, Cristal UMR 9189, Lille, France
| | - J Thariat
- Department of Radiation Oncology, centre François-Baclesse, 14000 Caen, France
| | - G Delpon
- Medical physics department, institut de cancérologie de l'Ouest, IMT Atlantique, Nantes université, CNRS/IN2P3, Subatech, Nantes, France
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132 Milan, Italy
| | - T Rancatti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O Malard
- Service de chirurgie oto-rhinolaryngologique (ORL) et chirurgie cervicofaciale, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - N Foray
- Centre Léon-Bérard, Inserm U1296 "Radiation: Defense/Health/Environment", 69008 Lyon, France
| | - R de Crevoisier
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France.
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Iacovacci J, Palorini F, Cicchetti A, Fiorino C, Rancati T. Dependence of the AUC of NTCP models on the observational dose-range highlights cautions in comparison of discriminative performance. Phys Med 2023; 113:102654. [PMID: 37579522 DOI: 10.1016/j.ejmp.2023.102654] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/19/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Normal tissue complication probability (NTCP) models are probabilistic models that describe the risk of radio-induced toxicity in tissues or organs. In the field of radiotherapy, the area under the ROC curve (AUC) is widely used to estimate the performance in risk prediction of NTCP models. METHODS In this work, we derived an analytical expression of the AUC for the logistic NTCP model in the case of both symmetrical and asymmetrical dose (to the normal tissue) windows around D50. Using numerical simulations, we studied the behavior of the AUC in general clinical settings, enforcing non-logistic NTCP models (Lyman-Kutcher-Burman and LogEUD) and including risk factors beyond the dose. We validated our findings using real-world radiotherapy data sets of prostate cancer patients. RESULTS Our analytical expression of the AUC made explicit the dependence on both the steepness of the logistic curve (β) and the dose window width (w), showing that an increase of w pushes AUC towards higher values. Increasing values of the AUC with increasing values of w were consistently observed across simulated data sets with diverse clinical settings from published studies and real clinical data sets. CONCLUSION Our results reveal that the AUC of NTCP models inherits intrinsic characteristics from the clinical setting of the data set on which the models are developed, and warn against the use of the AUC to compare the performance of models constructed upon data from trials in which substantially different dose ranges were administered or accounting for different risk factors beyond the dose.
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Affiliation(s)
- J Iacovacci
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Palorini
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Cicchetti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Fiorino
- Medical Physics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - T Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Loi S, Mori M, Palumbo D, Crippa S, Palazzo G, Spezi E, Del Vecchio A, Falconi M, De Cobelli F, Fiorino C. Limited impact of discretization/interpolation parameters on the predictive power of CT radiomic features in a surgical cohort of pancreatic cancer patients. Radiol Med 2023:10.1007/s11547-023-01649-y. [PMID: 37289267 DOI: 10.1007/s11547-023-01649-y] [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] [Grants] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To explore the variation of the discriminative power of CT (Computed Tomography) radiomic features (RF) against image discretization/interpolation in predicting early distant relapses (EDR) after upfront surgery. MATERIALS AND METHODS Data of 144 patients with pre-surgical high contrast CT were processed consistently with IBSI (Image Biomarker Standardization Initiative) guidelines. Image interpolation/discretization parameters were intentionally changed, including cubic voxel size (0.21-27 mm3) and binning (32-128 grey levels) in a 15 parameter's sets. After excluding RF with poor inter-observer delineation agreement (ICC < 0.80) and not negligible inter-scanner variability, the variation of 80 RF against discretization/interpolation was first quantified. Then, their ability in classifying patients with early distant relapses (EDR, < 10 months, previously assessed at the first quartile value of time-to-relapse) was investigated in terms of AUC (Area Under Curve) variation for those RF significantly associated to EDR. RESULTS Despite RF variability against discretization/interpolation parameters was large and only 30/80 RF showed %COV < 20 (%COV = 100*STDEV/MEAN), AUC changes were relatively limited: for 30 RF significantly associated with EDR (AUC values around 0.60-0.70), the mean values of SD of AUC variability and AUC range were 0.02 and 0.05 respectively. AUC ranges were between 0.00 and 0.11, with values ≤ 0.05 in 16/30 RF. These variations were further reduced when excluding the extreme values of 32 and 128 for grey levels (Average AUC range 0.04, with values between 0.00 and 0.08). CONCLUSIONS The discriminative power of CT RF in the prediction of EDR after upfront surgery for pancreatic cancer is relatively invariant against image interpolation/discretization within a large range of voxel sizes and binning.
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Affiliation(s)
- Sara Loi
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132, Milan, Italy
| | - Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132, Milan, Italy
| | | | - Stefano Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute, Milan, Italy
| | - Gabriele Palazzo
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132, Milan, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - Antonella Del Vecchio
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute, Milan, Italy
| | - Francesco De Cobelli
- San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132, Milan, Italy.
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Monticelli D, Castriconi R, Tudda A, Fodor A, Deantoni C, Gisella Di Muzio N, Mangili P, Del Vecchio A, Fiorino C, Broggi S. Knowledge-based plan optimization for prostate SBRT delivered with CyberKnife according to RTOG0938 protocol. Phys Med 2023; 110:102606. [PMID: 37196603 DOI: 10.1016/j.ejmp.2023.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To extend the knowledge-based (KB) automatic planning approach to CyberKnife in the case of Stereotactic Body Radiation Therapy (SBRT) for prostate cancer. METHODS Seventy-two clinical plans of patients treated according to the RTOG0938 protocol (36.25 Gy/5fr) with CyberKnife were exported from the CyberKnife system to Eclipse to train a KB-model using the Rapid Plan tool. The KB approach provided dose-volume objectives for specific OARs only and not PTV. Bladder, rectum and femoral heads were considered in the model. The KB-model was successfully trained on 51 plans and then validated on 20 new patients. A KB-based template was tuned in the Precision system for both sequential optimization (SO) and VOLO optimization algorithms. Plans of the validation group were re-optimized (KB-TP) using both algorithms without any operator intervention and compared against the original plans (TP) in terms of OARs/PTV dose-volume parameters. Paired Wilcoxon signed-rank tests were performed to assess statistically significant differences (p < 0.05). RESULTS Regarding SO, automatic KB-TP plans were generally better than or equivalent to TP plans. PTVs V95% was slightly worse while OARs sparing for KB-TP was significantly improved. Regarding VOLO optimization, the PTVs coverage was significantly better for KB-TP while there was a limited worsening in the rectum. A significant improvement was observed in the bladder in the range of low-intermediate doses. CONCLUSIONS An extension of the KB optimization approach to the CyberKnife system has been successfully developed and validated in the case of SBRT prostate cancer.
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Affiliation(s)
- Davide Monticelli
- Università degli Studi di Milano, Milano, Italy; Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Roberta Castriconi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Alessia Tudda
- Università degli Studi di Milano, Milano, Italy; Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Nadia Gisella Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudio Fiorino
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Mori M, Deantoni C, Olivieri M, Spezi E, Chiara A, Baroni S, Picchio M, Del Vecchio A, Di Muzio NG, Fiorino C, Dell'Oca I. External validation of an 18F-FDG-PET radiomic model predicting survival after radiotherapy for oropharyngeal cancer. Eur J Nucl Med Mol Imaging 2023; 50:1329-1336. [PMID: 36604325 DOI: 10.1007/s00259-022-06098-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE/OBJECTIVE The purpose of the study is to externally validate published 18F-FDG-PET radiomic models for outcome prediction in patients with oropharyngeal cancer treated with chemoradiotherapy. MATERIAL/METHODS Outcome data and pre-radiotherapy PET images of 100 oropharyngeal cancer patients (stage IV:78) treated with concomitant chemotherapy to 66-69 Gy/30 fr were available. Tumors were segmented using a previously validated semi-automatic method; 450 radiomic features (RF) were extracted according to IBSI (Image Biomarker Standardization Initiative) guidelines. Only one model for cancer-specific survival (CSS) prediction was suitable to be independently tested, according to our criteria. This model, in addition to HPV status, SUVmean and SUVmax, included two independent meta-factors (Fi), resulting from combining selected RF clusters. In a subgroup of 66 patients with complete HPV information, the global risk score R was computed considering the original coefficients and was tested by Cox regression as predictive of CSS. Independently, only the radiomic risk score RF derived from Fi was tested on the same subgroup to learn about the radiomics contribution to the model. The metabolic tumor volume (MTV) was also tested as a single predictor and its prediction performances were compared to the global and radiomic models. Finally, the validation of MTV and the radiomic score RF were also tested on the entire dataset. RESULTS Regarding the analysis of the subgroup with HPV information, with a median follow-up of 41.6 months, seven patients died due to cancer. R was confirmed to be associated to CSS (p value = 0.05) with a C-index equal 0.75 (95% CI=0.62-0.85). The best cut-off value (equal to 0.15) showed high ability in patient stratification (p=0.01, HR=7.4, 95% CI=1.6-11.4). The 5-year CSS for R were 97% (95% CI: 93-100%) vs 74% (56-92%) for low- and high-risk groups, respectively. RF and MTV alone were also significantly associated to CSS for the subgroup with an almost identical C-index. According to best cut-off value (RF>0.12 and MTV>15.5cc), the 5-year CSS were 96% (95% CI: 89-100%) vs 65% (36-94%) and 97% (95% CI: 88-100%) vs 77% (58-93%) for RF and MTV, respectively. Results regarding RF and MTV were confirmed in the overall group. CONCLUSION A previously published PET radiomic model for CSS prediction was independently validated. Performances of the model were similar to the ones of using only the MTV, without improvement of prediction accuracy.
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Affiliation(s)
- Martina Mori
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Michela Olivieri
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, UK
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | - Anna Chiara
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Simone Baroni
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Nadia Gisella Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
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Cubero L, García-Elcano L, Mylona E, Boue-Rafle A, Cozzarini C, Ubeira Gabellini MG, Rancati T, Fiorino C, de Crevoisier R, Acosta O, Pascau J. Deep learning-based segmentation of prostatic urethra on computed tomography scans for treatment planning. Phys Imaging Radiat Oncol 2023; 26:100431. [PMID: 37007914 PMCID: PMC10064422 DOI: 10.1016/j.phro.2023.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background and purpose The intraprostatic urethra is an organ at risk in prostate cancer radiotherapy, but its segmentation in computed tomography (CT) is challenging. This work sought to: i) propose an automatic pipeline for intraprostatic urethra segmentation in CT, ii) analyze the dose to the urethra, iii) compare the predictions to magnetic resonance (MR) contours. Materials and methods First, we trained Deep Learning networks to segment the rectum, bladder, prostate, and seminal vesicles. Then, the proposed Deep Learning Urethra Segmentation model was trained with the bladder and prostate distance transforms and 44 labeled CT with visible catheters. The evaluation was performed on 11 datasets, calculating centerline distance (CLD) and percentage of centerline within 3.5 and 5 mm. We applied this method to a dataset of 32 patients treated with intensity-modulated radiation therapy (IMRT) to quantify the urethral dose. Finally, we compared predicted intraprostatic urethra contours to manual delineations in MR for 15 patients without catheter. Results A mean CLD of 1.6 ± 0.8 mm for the whole urethra and 1.7 ± 1.4, 1.5 ± 0.9, and 1.7 ± 0.9 mm for the top, middle, and bottom thirds were obtained in CT. On average, 94% and 97% of the segmented centerlines were within a 3.5 mm and 5 mm radius, respectively. In IMRT, the urethra received a higher dose than the overall prostate. We also found a slight deviation between the predicted and manual MR delineations. Conclusion A fully-automatic segmentation pipeline was validated to delineate the intraprostatic urethra in CT images.
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Affiliation(s)
- Lucía Cubero
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Laura García-Elcano
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
| | | | - Adrien Boue-Rafle
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Cesare Cozzarini
- Department of Radiation Oncology, San Raffaele Scientific Institute - IRCCS, Milan, Italy
| | | | - Tiziana Rancati
- Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute - IRCCS, Milan, Italy
| | - Renaud de Crevoisier
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Oscar Acosta
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Javier Pascau
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Corresponding author at: Departamento de Bioingeniería, Universidad Carlos III de Madrid, Madrid, Spain.
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Cicchetti A, Fiorino C, Ebert MA, Iacovacci J, Kennedy A, Joseph DJ, Denham JW, Vavassori V, Fellin G, Cozzarini C, Degli Esposti C, Gabriele P, Munoz F, Avuzzi B, Valdagni R, Rancati T. Validation of prediction models for radiation-induced late rectal bleeding: evidence from a large pooled population of prostate cancer patients. Radiother Oncol 2023; 183:109628. [PMID: 36934896 DOI: 10.1016/j.radonc.2023.109628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/03/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE To validate published models for the risk estimate of grade≥1 (G1+), grade≥2 (G2+) and grade=3 (G3) late rectal bleeding (LRB) after radical radiotherapy for prostate cancer in a large pooled population from three prospective trials. MATERIALS AND METHODS The external validation population included patients from Europe, and Oceanian centres enrolled between 2003 and 2014. Patients received 3DCRT or IMRT at doses between 66-80 Gy. IMRT was administered with conventional or hypofractionated schemes (2.35-2.65 Gy/fr). LRB was prospectively scored using patient-reported questionnaires (LENT/SOMA scale) with a 3-year follow-up. All Normal Tissue Complication Probability (NTCP) models published until 2021 based on the Equivalent Uniform Dose (EUD) from the rectal Dose Volume Histogram (DVH) were considered for validation. Model performance in validation was evaluated through calibration and discrimination. RESULTS Sixteen NTCP models were tested on data from 1633 patients. G1+ LRB was scored in 465 patients (28.5%), G2+ in 255 patients (15.6%) and G3 in 112 patients (6.8%). The best performances for G2+ and G3 LRB highlighted the importance of the medium-high doses to the rectum (volume parameters n=0.24 and n=0.18, respectively). Good performance was seen for models of severe LRB. Moreover, a multivariate model with two clinical factors found the best calibration slope. CONCLUSION Five published NTCP models developed on non-contemporary cohorts were able to predict a relative increase in the toxicity response in a more recent validation population. Compared to QUANTEC findings, dosimetric results pointed toward mid-high doses of rectal DVH. The external validation cohort confirmed abdominal surgery and cardiovascular diseases as risk factors.
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Affiliation(s)
- Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Martin A Ebert
- University of Western Australia, Perth, Western Australia; Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia; 5D Clinics, Claremont, Western Australia
| | - Jacopo Iacovacci
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angel Kennedy
- Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - David J Joseph
- University of Western Australia, Perth, Western Australia; 5D Clinics, Claremont, Western Australia; GenesisCare, Perth, Western Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | | | - Gianni Fellin
- Radiation Oncology, Ospedale Santa Chiara, Trento, Italy
| | - Cesare Cozzarini
- Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Pietro Gabriele
- Radiation Oncology, Istituto di Candiolo- Fondazione del Piemonte per l'Oncologia IRCCS, Torino, Italy
| | - Fernando Munoz
- Radiation Oncology, Azienda Ospedaliera di Aosta, Aosta, Italy
| | - Barbara Avuzzi
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Oncology and Hemato-Oncology, Università degli Studi,Milano, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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23
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Nuccio A, Torrisi M, Ogliari F, Giannini L, Pasetti M, Fodor A, Gigliotti C, Fiorino C, Arcangeli S, Bulotta A, Dell'Oca I, Cascinu S, Di Muzio N. 105P Thoracic radiotherapy and tyrosine kinase inhibitors association: Results from a monoinstitutional experience. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100963] [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: 04/05/2023] Open
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24
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Mori M, Palumbo D, De Cobelli F, Fiorino C. Does radiomics play a role in the diagnosis, staging and re-staging of gastroesophageal junction adenocarcinoma? Updates Surg 2023; 75:273-279. [PMID: 36114920 DOI: 10.1007/s13304-022-01377-4] [Citation(s) in RCA: 1] [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: 07/01/2022] [Accepted: 09/04/2022] [Indexed: 01/24/2023]
Abstract
Radiomics is an emerging field of investigation in medicine consisting in the extraction of quantitative features from conventional medical images and exploring their potentials in improving diagnosis, prognosis and outcome prediction after therapy. Clinical applications are still limited, mostly due to reproducibility and repeatability issues as well as to limited interpretability of predictive radiomic-based features/signatures. In the specific case of gastroesophageal junction (GEJ) adenocarcinoma, the expectancies are particularly high, mainly due to its increasing incidence and to the limited performance of conventional imaging techniques in assessing correct diagnosis and accurate pre-surgical tumor characterization. Accordingly, current literature was reviewed, emphasizing the methodological quality. In addition, papers were scored according to the Radiomic Quality Score (RQS), weighting more the clinical applicability and generalizability of the resulting models. According to the criteria of the search, only two papers were retained: the resulting technical quality was relatively high for both, while the corresponding RQS were 15 and 19 (on a scale of 31). Although the potentials of radiomics in the setting of GEJ adenocarcinoma are relevant, they remain largely unexplored, warranting an urgent need of high-quality, possibly prospective, multicenter studies.
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Affiliation(s)
- Martina Mori
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Fiorino
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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25
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Orsi G, Abati M, Palumbo D, Pavarini M, Burini A, Cardellini S, Macchini M, Mori M, Fiorino C, Peretti U, Valente MM, Militello AM, Briccolani MA, Mele R, Falconi M, Cascinu S, Capurso G, Reni M. Prognostic role of a novel clinical-nutritional index in pancreatic ductal adenocarcinoma: The Pancreatic Adenocarcinoma Nutritional-Clinical Index (PANCIN). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
697 Background: Impaired nutritional status is often associated with Pancreatic Ductal Adenocarcinoma (PDAC) and poor prognosis. Little is known on the prognostic role of nutritional variables in PDAC patients (pts) receiving chemotherapy (CT). Methods: Locally advanced or metastatic PDAC pts enrolled at our Institute in a prospective observational study (PAC-MAIN) and treated with 1st-line CT between April 2019 and July 2021 were included in the analysis. Clinical and nutritional variables entailed biohumoral parameters, bioimpedance vector analysis (BIVA)- and Computed Tomography-derived body composition. Progression-free and Overall survival (PFS and OS) were calculated from CT start to progression or death. A Multivariate Cox proportional-hazards model for PFS prediction was generated by backward selection of features with a p-value (p) ≤ 0.06. The resultant index, named PANCIN, was calculated as linear combination of the covariates (Xi are the N) and the b Cox coefficients (bi), according to the formula: PANCIN = ∑Ni=1 bi Xi Kaplan–Meier test was performed to assess the ability of PANCIN to stratify pts according to its median value for PFS and OS prediction. Results: 74 pts were included in the study. The variables retained in the model were: serum Vitamin B12 (pg/ml) [Hazard Ratio (HR)= 1.001, 95% Confidence Interval (CI) 1.0004-1.0016, p=0.002]; BIVA-derived Body Cell Mass (%) [HR= 0.94, 95% CI 0.887-1.002, p=0.058]; ECOG Performance Status (0 vs 1-2) [HR= 3.25, 95% CI 1.048-10.077, p=0.041]; Albumin (g/L) [HR= 0.91, 95% CI 0.86-0.97, p=0.002]; FAACT Score [HR= 1.041, 95% CI 1.006-1.077, p=0.022]. Median PFS was 15.3 (95% CI 7.6-21.8) and 5.8 months (95% CI 2.7-9.0) for pts with PANCIN < or ≥ -1.7768 median value respectively [HR= 3.7, 95% CI 1.9-7.0, p=0.0001]. Median OS was 23.8 (95% CI 12.6-33.3) and 10.0 months (95% CI 5.7-12.7) for pts with PANCIN < or ≥ -1.7768 respectively [HR= 4.1, 95% CI 2.1-7.9, p<0.0001]. Conclusions: PANCIN is a novel nutritional-clinical index able to predict outcome of advanced PDAC pts receiving CT. If furtherly validated, it may represent a stratification tool both in clinical practice and in prospective trials. Our findings also support the relevance of a baseline comprehensive nutritional assessment, to define tailored nutritional interventions.[Table: see text]
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Affiliation(s)
- Giulia Orsi
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Abati
- Nutritional Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Pavarini
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alice Burini
- Nutritional Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Cardellini
- Nutritional Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Macchini
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Mori
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Peretti
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Maddalena Valente
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Maria Militello
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Assunta Briccolani
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Mele
- Nutritional Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reni
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Broggi S, Passoni P, Tiberio P, Cicchetti A, Cattaneo GM, Longobardi B, Mori M, Reni M, Slim N, Del Vecchio A, Di Muzio NG, Fiorino C. Stomach and duodenum dose-volume constraints for locally advanced pancreatic cancer patients treated in 15 fractions in combination with chemotherapy. Front Oncol 2023; 12:983984. [PMID: 36761419 PMCID: PMC9902495 DOI: 10.3389/fonc.2022.983984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/19/2022] [Indexed: 01/25/2023] Open
Abstract
Purpose To assess dosimetry predictors of gastric and duodenal toxicities for locally advanced pancreatic cancer (LAPC) patients treated with chemo-radiotherapy in 15 fractions. Methods Data from 204 LAPC patients treated with induction+concurrent chemotherapy and radiotherapy (44.25 Gy in 15 fractions) were available. Forty-three patients received a simultaneous integrated boost of 48-58 Gy. Gastric/duodenal Common Terminology Criteria for Adverse Events v. 5 (CTCAEv5) Grade ≥2 toxicities were analyzed. Absolute/% duodenal and stomach dose-volume histograms (DVHs) of patients with/without toxicities were compared: the most predictive DVH points were identified, and their association with toxicity was tested in univariate and multivariate logistic regressions together with near-maximum dose (D0.03) and selected clinical variables. Results Toxicity occurred in 18 patients: 3 duodenal (ulcer and duodenitis) and 10 gastric (ulcer and stomatitis); 5/18 experienced both. At univariate analysis, V44cc (duodenum: p = 0.02, OR = 1.07; stomach: p = 0.01, OR = 1.12) and D0.03 (p = 0.07, OR = 1.19; p = 0.008, OR = 1.12) were found to be the most predictive parameters. Stomach/duodenum V44Gy and stomach D0.03 were confirmed at multivariate analysis and found to be sufficiently robust at internal, bootstrap-based validation; the results regarding duodenum D0.03 were less robust. No clinical variables or %DVH was significantly associated with toxicity. The best duodenum cutoff values were V44Gy < 9.1 cc (and D0.03 < 47.6 Gy); concerning the stomach, they were V44Gy < 2 cc and D0.03 < 45 Gy. The identified predictors showed a high negative predictive value (>94%). Conclusion In a large cohort treated with hypofractionated radiotherapy for LAPC, the risk of duodenal/gastric toxicities was associated with duodenum/stomach DVH. Constraining duodenum V44Gy < 9.1 cc, stomach V44Gy < 2 cc, and stomach D0.03 < 45 Gy should keep the toxicity rate at approximately or below 5%. The association with duodenum D0.03 was not sufficiently robust due to the limited number of events, although results suggest that a limit of 45-46 Gy should be safe.
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Affiliation(s)
- Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Paolo Passoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Paolo Tiberio
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Alessandro Cicchetti
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy,Unit of Data Science, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Michele Reni
- Oncology, San Raffaele Scientific Institute, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Najla Slim
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | - Nadia G. Di Muzio
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy,*Correspondence: Claudio Fiorino,
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Mori M, Palumbo D, Muffatti F, Partelli S, Mushtaq J, Andreasi V, Prato F, Ubeira MG, Palazzo G, Falconi M, Fiorino C, De Cobelli F. Prediction of the characteristics of aggressiveness of pancreatic neuroendocrine neoplasms (PanNENs) based on CT radiomic features. Eur Radiol 2022; 33:4412-4421. [PMID: 36547673 DOI: 10.1007/s00330-022-09351-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To predict tumor grade (G1 vs. G2/3), presence of distant metastasis (M+), metastatic lymph nodes (N+), and microvascular invasion (VI) of pancreatic neuroendocrine neoplasms (PanNEN) based on preoperative CT radiomic features (RFs), by applying a machine learning approach aimed to limit overfit. METHODS This retrospective study included 101 patients who underwent surgery for PanNEN; the entire population was split into training (n = 70) and validation cohort (n = 31). Based on a previously validated methodology, after tumor segmentation on contrast-enhanced CT, RFs were extracted from unenhanced CT images. In addition, conventional radiological and clinical features were combined with RFs into multivariate logistic regression models using minimum redundancy and a bootstrap-based machine learning approach. For each endpoint, models were trained and validated including only RFs (RF_model), and both (radiomic and clinicoradiological) features (COMB_model). RESULTS Twenty-five patients had G2/G3 tumor, 37 N+, and 14 M+ and 38 were shown to have VI. From a total of 182 RFs initially extracted, few independent radiomic and clinicoradiological features were identified. For M+ and G, the resulting models showed moderate to high performances: areas under the curve (AUC) for training/validation cohorts were 0.85/0.77 (RF_model) and 0.81/0.81 (COMB_model) for M+ and 0.67/0.72 and 0.68/0.70 for G. Concerning N+ and VI, only the COMB_model could be built, with poorer performance for N+ (AUC = 0.72/0.61) compared to VI (0.82/0.75). For all endpoints, the negative predictive value was good (≥ 0.75). CONCLUSIONS Combining few radiomic and clinicoradiological features resulted in presurgical prediction of histological characteristics of PanNENs. Despite the limited risk of overfit, external validations are warranted. KEY POINTS • Histology is the only tool currently available allowing characterization of PanNEN biological characteristics important for prognostic assessment; significant limitations to this approach exist. • Based upon preoperative contrast-enhanced CT images, a machine learning approach optimized to favor models' generalizability was successfully applied to train predictive models for tumor grading (G1 vs. G2/3), microvascular invasion, metastatic lymph nodes, and distant metastatic spread. • Moderate to high discriminative models (AUC: 0.67-0.85) based on few parameters (≤ 3) showing high negative predictive value (0.75-0.98) were generated and then successfully validated.
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Meffe G, Castriconi R, Nardini M, Tudda A, Boldrini L, Indovina L, Fiorino C, Placidi L. KNOWLEDGE-BASED (KB) MODEL FROM SINGLE PATIENT INTER-FRACTIONS ADAPTIVE MAGNETIC RESONANCE GUIDED RADIOTHERAPY (MRGRT) PLAN. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Tudda A, Castriconi R, Benecchi G, Cagni E, Cicchetti A, Dusi F, Esposito P, Guidasci GR, Guernieri M, Ianiro A, Landoni V, Mazzilli A, Moretti E, Oliviero C, Placidi L, Rancati T, Trojani V, Scaggion A, Fiorino C. TRANSFERABILITY OF KNOWLEDGE BASED (KB) PLAN PREDICTION MODELS FOR RIGHT-WHOLE BREAST IRRADIATION (R-WBI). Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Fodor A, Brombin C, Mangili P, Fiorino C, Di Muzio N. In Regard to Zureick et al. Int J Radiat Oncol Biol Phys 2022; 114:554-555. [PMID: 36152645 DOI: 10.1016/j.ijrobp.2022.06.066] [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] [Received: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Chiara Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Joseph N, Cicchetti A, McWilliam A, Webb A, Seibold P, Fiorino C, Cozzarini C, Veldeman L, Bultijnck R, Fonteyne V, Talbot CJ, Symonds PR, Johnson K, Rattay T, Lambrecht M, Haustermans K, De Meerleer G, Elliott RM, Sperk E, Herskind C, Veldwijk M, Avuzzi B, Giandini T, Valdagni R, Azria D, Jacquet MPF, Charissoux M, Vega A, Aguado-Barrera ME, Gómez-Caamaño A, Franco P, Garibaldi E, Girelli G, Iotti C, Vavassori V, Chang-Claude J, West CML, Rancati T, Choudhury A. High weekly integral dose and larger fraction size increase risk of fatigue and worsening of functional outcomes following radiotherapy for localized prostate cancer. Front Oncol 2022; 12:937934. [PMID: 36387203 PMCID: PMC9645430 DOI: 10.3389/fonc.2022.937934] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction We hypothesized that increasing the pelvic integral dose (ID) and a higher dose per fraction correlate with worsening fatigue and functional outcomes in localized prostate cancer (PCa) patients treated with external beam radiotherapy (EBRT). Methods The study design was a retrospective analysis of two prospective observational cohorts, REQUITE (development, n=543) and DUE-01 (validation, n=228). Data were available for comorbidities, medication, androgen deprivation therapy, previous surgeries, smoking, age, and body mass index. The ID was calculated as the product of the mean body dose and body volume. The weekly ID accounted for differences in fractionation. The worsening (end of radiotherapy versus baseline) of European Organisation for Research and Treatment of Cancer EORTC) Quality of Life Questionnaire (QLQ)-C30 scores in physical/role/social functioning and fatigue symptom scales were evaluated, and two outcome measures were defined as worsening in ≥2 (WS2) or ≥3 (WS3) scales, respectively. The weekly ID and clinical risk factors were tested in multivariable logistic regression analysis. Results In REQUITE, WS2 was seen in 28% and WS3 in 16% of patients. The median weekly ID was 13.1 L·Gy/week [interquartile (IQ) range 10.2-19.3]. The weekly ID, diabetes, the use of intensity-modulated radiotherapy, and the dose per fraction were significantly associated with WS2 [AUC (area under the receiver operating characteristics curve) =0.59; 95% CI 0.55-0.63] and WS3 (AUC=0.60; 95% CI 0.55-0.64). The prevalence of WS2 (15.3%) and WS3 (6.1%) was lower in DUE-01, but the median weekly ID was higher (15.8 L·Gy/week; IQ range 13.2-19.3). The model for WS2 was validated with reduced discrimination (AUC=0.52 95% CI 0.47-0.61), The AUC for WS3 was 0.58. Conclusion Increasing the weekly ID and the dose per fraction lead to the worsening of fatigue and functional outcomes in patients with localized PCa treated with EBRT.
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Affiliation(s)
- Nuradh Joseph
- Department of Clinical Oncology, District General Hambantota, Hambantota, Sri Lanka
- Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Maharagama, Sri Lanka
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Hambantota, Italy
| | - Alan McWilliam
- Department of Medical Physics, University of Manchester, Manchester, United Kingdom
| | - Adam Webb
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute - IRCCS, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiation Oncology, San Raffaele Scientific Institute - IRCCS, Milan, Italy
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Christopher J. Talbot
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Paul R. Symonds
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Kerstie Johnson
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Tim Rattay
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Rebecca M. Elliott
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marlon Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barbara Avuzzi
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Giandini
- Department of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Hambantota, Italy
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - David Azria
- Department of Radiation Oncology, University Federation of Radiation Oncology, Montpellier Cancer Institute, Univ Montpellier MUSE, Grant INCa_Inserm_DGOS_12553, Inserm U1194, Montpellier, France
| | | | - Marie Charissoux
- University Federation of Radiation Oncology of Mediterranean Occitanie, ICM Montpellier, Univ Montpellier, Montpellier, France
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Miguel E. Aguado-Barrera
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complejo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Pierfrancesco Franco
- Department of Radiation Oncology, Ospedale Regionale U. Parini-AUSL Valle d’Aosta, Aosta, Italy
| | - Elisabetta Garibaldi
- Department of Radiation Oncology, Istituto di Candiolo - Fondazione del Piemonte per l’Oncologia IRCCS, Candiolo, Italy
| | | | - Cinzia Iotti
- Department of Radiation Oncology, Azienda USL – IRCCS di Reggio Emilia, Emilia-Romagna, Italy
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharine M. L. West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Hambantota, Italy
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, and The Christie NHS Foundation Trust, Manchester, United Kingdom
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Shakarami Z, Broggi S, Vecchio AD, Fiorino C, Spinelli AE. Radioluminescence imaging feasibility for robotic radiosurgery field size quality assurance. Med Phys 2022; 49:6588-6598. [PMID: 35946490 DOI: 10.1002/mp.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To investigate the feasibility of radioluminescence imaging (RLI) as a novel 2D quality assurance (QA) dosimetry system for CyberKnife®. METHODS We developed a field size measurement system based on a commercial complementary metal oxide semiconductor (CMOS) camera facing a radioluminescence screen located at the isocenter normal to the beam axis. The radioluminescence light collected by a lens was used to measure 2D dose distributions. An image transformation procedure, based on two reference phantoms, was developed to correct for projective distortion due to the angle (15°) between the optical and beam axis. Dose profiles were measured for field sizes ranging from 5 mm to 60 mm using fixed circular and iris collimators and compared against gafchromic (GC) film. The corresponding full width at half maximum (FWHM) was measured using RLI and benchmarked against GC film. A small shift in the source-to-surface distance (SSD) of the measurement plane was intentionally introduced to test the sensitivity of the RLI system to field size variations. To assess reproducibility, the entire RLI procedure was tested by acquiring the 60 mm circle field three times on two consecutive days. RESULTS The implemented procedure for perspective image distortion correction showed improvements of up to 1 mm using the star phantom against the square phantom. The FWHM measurements using the RLI system indicated a strong agreement with GC film with maximum absolute difference equal to 0.131 mm for fixed collimators and 0.056 mm for the iris. A 2D analysis of RLI with respect to GC film showed that the differences in the central region are negligible, while small discrepancies are in the penumbra region. Changes in field sizes of 0.2 mm were detectable by RLI. Repeatability measurements of the beam FWHM have shown a standard deviation equal to 0.11 mm. CONCLUSIONS The first application of a RLI approach for CyberKnife® field size measurement was presented and tested. Results are in agreement with GC film measurements. Spatial resolution and immediate availability of the data indicate that RLI is a feasible technique for robotic radiosurgery QA.
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Affiliation(s)
- Zahra Shakarami
- Experimental Imaging Centre, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Sara Broggi
- Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonella Del Vecchio
- Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Claudio Fiorino
- Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonello E Spinelli
- Experimental Imaging Centre, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Tudda A, Castriconi R, Benecchi G, Cagni E, Cicchetti A, Dusi F, Esposito PG, Guernieri M, Ianiro A, Landoni V, Mazzilli A, Moretti E, Oliviero C, Placidi L, Rambaldi Guidasci G, Rancati T, Scaggion A, Trojani V, Fiorino C. Knowledge-based multi-institution plan prediction of whole breast irradiation with tangential fields. Radiother Oncol 2022; 175:10-16. [PMID: 35868603 DOI: 10.1016/j.radonc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify inter-institute variability of Knowledge-Based (KB) models for right breast cancer patients treated with tangential fields whole breast irradiation (WBI). MATERIALS AND METHODS Ten institutions set KB models by using RapidPlan (Varian Inc.), following previously shared methodologies. Models were tested on 20 new patients from the same institutes, exporting DVH predictions of heart, ipsilateral lung, contralateral lung, and contralateral breast. Inter-institute variability was quantified by the inter-institute SDint of predicted DVHs/Dmean. Association between lung sparing vs PTV coverage strategy was also investigated. The transferability of models was evaluated by the overlap of each model's geometric Principal Component (PC1) when applied to the test patients of the other 9 institutes. RESULTS The overall inter-institute variability of DVH/Dmean ipsilateral lung dose prediction, was less than 2% (20%-80% dose range) and 0.55 Gy respectively (1SD) for a 40 Gy in 15 fraction schedule; it was < 0.2 Gy for other OARs. Institute 6 showed the lowest mean dose prediction value and no overlap between PTV and ipsilateral lung. Once excluded, the predicted ipsilateral lung Dmean was correlated with median PTV D99% (R2 = 0.78). PC1 values were always within the range of applicability (90th percentile) for 7 models: for 2 models they were outside in 1/18 cases. For the model of institute 6, it failed in 7/18 cases. The impact of inter-institute variability of dose calculation was tested and found to be almost negligible. CONCLUSIONS Results show limited inter-institute variability of plan prediction models translating in high inter-institute interchangeability, except for one of ten institutes. These results encourage future investigations in generating benchmarks for plan prediction incorporating inter-institute variability.
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Affiliation(s)
- Alessia Tudda
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | | | | | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Marika Guernieri
- Department of Medical Physics, University Hospital, Udine, Italy
| | - Anna Ianiro
- Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Italy
| | - Eugenia Moretti
- Department of Medical Physics, University Hospital, Udine, Italy
| | | | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Rambaldi Guidasci
- Amethyst Radioterapia Italia, Medical Physics Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Fiorino
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy
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Esposito PG, Castriconi R, Mangili P, Broggi S, Fodor A, Pasetti M, Tudda A, Di Muzio NG, del Vecchio A, Fiorino C. Knowledge-based automatic plan optimization for left-sided whole breast tomotherapy. Phys Imaging Radiat Oncol 2022; 23:54-59. [PMID: 35814259 PMCID: PMC9256826 DOI: 10.1016/j.phro.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background/Purpose Tomotherapy may deliver high-quality whole breast irradiation at static angles. The aim of this study was to implement Knowledge-Based (KB) automatic planning for left-sided whole breast using this modality. Materials/Methods Virtual volumetric plans were associated to the dose distributions of 69 Tomotherapy (TT) clinical plans of previously treated patients, aiming to train a KB-model using a commercial tool completely implemented in our treatment planning system. An individually optimized template based on the resulting KB-model was generated for automatic plan optimization. Thirty patients of the training set and ten new patients were considered for internal/external validation. Fully-automatic plans (KB-TT) were generated and compared using the same geometry/number of fields of the corresponding clinical plans. Results KB-TT plans were successfully generated in 26/30 and 10/10 patients of the internal/external validation sets; for 4 patients whose original plans used only two fields, the manual insertion of one/two fields before running the automatic template was sufficient to obtain acceptable plans. Concerning internal validation, planning target volume V95%/D1%/dose distribution standard deviation improved by 0.9%/0.4Gy/0.2Gy (p < 0.05) against clinical plans; Organs at risk mean doses were also slightly improved (p < 0.05) by 0.07/0.4/0.2/0.01 Gy for left lung/heart/right breast/right lung respectively. Similarly satisfactory results were replicated in the external validation set. The resulting treatment duration was 8 ± 1 min, consistent with our clinical experience. The active planner time per patient was 5–10 minutes. Conclusion Automatic TT left-sided breast KB-plans are comparable to or slightly better than clinical plans and can be obtained with limited planner time. The approach is currently under clinical implementation.
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Mori M, Alborghetti L, Palumbo D, Broggi S, Raspanti D, Rovere Querini P, Del Vecchio A, De Cobelli F, Fiorino C. Atlas-Based Lung Segmentation Combined With Automatic Densitometry Characterization In COVID-19 Patients: Training, Validation And First Application In A Longitudinal Study. Phys Med 2022; 100:142-152. [PMID: 35839667 PMCID: PMC9250926 DOI: 10.1016/j.ejmp.2022.06.018] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To develop and validate an automated segmentation tool for COVID-19 lung CTs. To combine it with densitometry information in identifying Aerated, Intermediate and Consolidated Volumes in admission (CT1) and follow up CT (CT3). Materials and Methods An Atlas was trained on manually segmented CT1 of 250 patients and validated on 10 CT1 of the training group, 10 new CT1 and 10 CT3, by comparing DICE index between automatic (AUTO), automatic-corrected (AUTOMAN) and manual (MAN) contours. A previously developed automatic method was applied on HU lung density histograms to quantify Aerated, Intermediate and Consolidated Volumes. Volumes of subregions in validation CT1 and CT3 were quantified for each method. Results In validation CT1/CT3, manual correction of automatic contours was not necessary in 40% of cases. Mean DICE values for both lungs were 0.94 for AUTOVsMAN and 0.96 for AUTOMANVsMAN. Differences between Aerated and Intermediate Volumes quantified with AUTOVsMAN contours were always < 6%. Consolidated Volumes showed larger differences (mean: −95 ± 72 cc). If considering AUTOMANVsMAN volumes, differences got further smaller for Aerated and Intermediate, and were drastically reduced for consolidated Volumes (mean: −36 ± 25 cc). The average time for manual correction of automatic lungs contours on CT1 was 5 ± 2 min. Conclusions An Atlas for automatic segmentation of lungs in COVID-19 patients was developed and validated. Combined with a previously developed method for lung densitometry characterization, it provides a fast, operator-independent way to extract relevant quantitative parameters with minimal manual intervention.
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Affiliation(s)
- Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| | - Lisa Alborghetti
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Diego Palumbo
- Radiology, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Patrizia Rovere Querini
- Internal Medecine, San Raffaele Scientific Institute, Milano, Italy; Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Francesco De Cobelli
- Radiology, San Raffaele Scientific Institute, Milano, Italy; Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Redegalli M, Schiavo Lena M, Cangi MG, Smart CE, Mori M, Fiorino C, Arcidiacono PG, Balzano G, Falconi M, Reni M, Doglioni C. Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC). Ann Surg Oncol 2022; 29:3492-3502. [PMID: 35230580 PMCID: PMC9072515 DOI: 10.1245/s10434-022-11413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. PATIENTS AND METHODS The study population was composed of 69 patients with resectable or borderline resectable PDAC treated with preoperative NACT (neoadjuvant group) and 36 patients submitted to upfront surgery (upfront-surgery group). A comprehensive histological assessment on hematoxylin and eosin (H&E) stained sections evaluated 20 morphological parameters. The association between patient survival and morphological variables was evaluated to generate a prognostic index. RESULTS The distribution of morphological parameters evaluated was significantly different between upfront-surgery and neoadjuvant groups, demonstrating the effect of NACT on tumor morphology. On multivariate analysis for patients that received NACT, the predictors of shorter overall survival (OS) and disease-free survival (DFS) were perineural invasion and lymph node ratio. Conversely, high stroma to neoplasia ratio predicted longer OS and DFS. These variables were combined to generate a semiquantitative prognostic index based on both OS and DFS, which significantly distinguished patients with poor outcomes from those with a good outcome. Bootstrap analysis confirmed the reproducibility of the model. CONCLUSIONS The pathologic prognostic index proposed is mostly quantitative in nature, easy to use, and may represent a reliable tumor regression grading system to predict patient outcomes after NACT followed by surgery for PDAC.
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Affiliation(s)
- M Redegalli
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Schiavo Lena
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M G Cangi
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - C E Smart
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Mori
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - P G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - G Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Pancreas Translational and Clinical Research Centre, Milan, Italy.
| | - C Doglioni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Faiella A, Gebbia A, Villa E, Waskiewicz J, Magli A, Avuzzi B, Garibaldi E, Cante D, Girelli G, Gatti M, Ferella L, Noris Chiorda B, Rago L, Ferrari P, Bresolin A, Piva C, Badenchini F, Rancati T, Valdagni R, Vavassori V, Munoz F, Sanguineti G, Di Muzio N, Fiorino C, Cozzarini C. PD-0414 Trend over time of patient-reported QoL domains after pelvic nodal irradiation for prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fodor A, Deantoni C, Fiorino C, Cozzarini C, Dell'Oca I, Mangili P, Tummineri R, Zerbetto F, Sanchez Galvan A, Mandurino G, Villa S, Baroni S, Saddi J, Pacifico P, Perna L, Broggi S, Del Vecchio A, Picchio M, Gianolli L, Di Muzio N. MO-0553 ENRT+ PET-guided SIB for prostate cancer lymph nodal relapses: long-term outcomes. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gebbia A, Munoz F, Magli A, Cante D, Garibaldi E, Noris Chiorda B, Girelli G, Villa E, Faiella A, Waskiewicz J, Avuzzi B, Pastorino A, Moretti E, Rago L, Bresolin A, Bianconi C, Badenchini F, Rancati T, Valdagni R, Vavassori V, Gatti M, Sanguineti G, Di Muzio N, Fiorino C, Cozzarini C. PD-0415 Pelvic RT in prostate cancer: late intestinal toxicity is modulated by severity of acute symptoms. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Castriconi R, Marrazzo L, Calusi S, Esposito P, Tudda A, Broggi S, Mangili P, del Vecchio A, Pallotta S, Fiorino C. MO-0789 Improving Knowledge-based planning for right-side whole-breast tangential field-like delivery. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02425-2] [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: 10/18/2022]
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Sanchez Galvan A, Fodor A, Fiorino C, Mangilli P, Deantoni C, Cozzarini C, Tummineri R, Baroni S, Villa S, Mandurino G, Pacifico P, Arcangeli S, Di Muzio N. PO-1372 Robotic stereotactic body radiotherapy for prostate cancer : an initial monoistitutional experience. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03336-9] [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: 10/18/2022]
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deantoni C, Chiara A, Mirabile A, Broggi S, Fiorino C, Fodor A, Pasetti M, Tummineri R, Zerbetto F, Baroni S, Sanchez Galvan A, Gregorc V, Dell'Oca I, Di Muzio N. PO-1100 Impact of sarcopenia in oropharyngeal cancer patients treated with radical chemo-radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Vago R, Zuppone S, Colciago G, Fallara G, Gebbia A, Di Muzio N, Spinelli A, Fiorino C, Cozzarini C. OC-0098 Preclinical assessment of protective role of anti-androgens in reducing RT-induced bladder toxicity. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02474-4] [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: 10/18/2022]
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44
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Esposito P, Castriconi R, Mangili P, Broggi S, Fodor A, Pasetti M, Tudda A, Di Muzio N, del Vecchio A, Fiorino C. MO-0790 Knowledge-Based automatic plan optimization for left-sided whole breast tomotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02426-4] [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: 10/18/2022]
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45
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Olivieri M, Cozzarini C, Magli A, Cante D, Noris Chiorda B, Munoz F, Faiella A, Olivetta E, Signor M, Piva C, Avuzzi B, Ferella L, Pastorino A, Garibaldi E, Gatti M, Rago L, Statuto T, Broggi S, Fodor A, Deantoni C, Rancati T, Sanguineti G, Valdagni R, Di Muzio N, Fiorino C. OC-0457 Modeling outcome after salvage post-prostatectomy radiotherapy: impact of pelvic nodes irradiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02593-2] [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: 11/16/2022]
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46
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Mori M, Deantoni C, Olivieri M, Spezi E, Chiara A, Baroni S, Picchio M, Del Vecchio A, Di Muzio N, Fiorino C, Dell'Oca I. PO-1760 Independent validation of a PET radiomic model predicting outcome after Radiotherapy for HN cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03724-0] [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: 10/18/2022]
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tudda A, Castriconi R, Benecchi G, Cagni E, Dusi F, Esposito P, Rambaldi Guidasci G, Guernieri M, Ianiro A, Landoni V, Mazzilli A, Moretti E, Oliviero C, Placidi L, Rancati T, Trojani V, Scaggion A, Fiorino C. PD-0733 Parameters influencing inter-Institute variability in KB plan prediction models for whole breast RT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02928-0] [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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48
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Fiorino C, Rancati T. Artificial intelligence applied to medicine: There is an "elephant in the room". Phys Med 2022; 98:8-10. [PMID: 35462274 DOI: 10.1016/j.ejmp.2022.04.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Claudio Fiorino
- Medical Physics Department, San Raffaele Scientific Institute, Milano Italy.
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Redegalli M, Schiavo Lena M, Cangi MG, Smart CE, Mori M, Fiorino C, Arcidiacono PG, Balzano G, Falconi M, Reni M, Doglioni C. ASO Visual Abstract: Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Spinelli A, Fiorino C, Schwarz M, Tommasino F, Bellinzona E, Del Vecchio A, Mangili P, Shakarami Z, Deantoni C, Cianchetti M, Attili A, Galli R, Bisio A, Perani L, Simoniello P, Fuss M, Pawelke J, Wong J, Durante M, Scifoni E. FLASH Mechanisms Track (Oral Presentations) ADVANCED DOSIMETRY AND BIOPHYSICAL MODELING FOR PRECLINICAL FLASH RADIOTHERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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