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Chang SD, Muacevic A, Klein AL, Sherman JH, Romanelli P, Santa Maria PL, Fuerweger C, Bossi Zanetti I, Beltramo G, Vaisbush Y, Tran E, Feng A, Teng H, Meola A, Gibbs I, Tolisano AM, Kutz JW, Wardak Z, Nedzi LA, Hong R, MacRae D, Sohal P, Kapoor E, Sabet-Rasekh P, Maghami S, Moncada PX, Zaleski-King A, Amdur R, Monfared A. Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-Center Study. World Neurosurg 2023; 178:e24-e33. [PMID: 37268187 DOI: 10.1016/j.wneu.2023.05.098] [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: 12/08/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration. METHODS Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990-2020 and had pre- and post-treatment audiograms. RESULTS Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12-60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS. CONCLUSIONS Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.
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Affiliation(s)
- Steven D Chang
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | | | - Andrea L Klein
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Jonathan H Sherman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | | | - Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | | | | | | | | | - Emma Tran
- Stanford University School of Medicine, Stanford, California, USA
| | - Austin Feng
- Stanford University School of Medicine, Stanford, California, USA
| | - Hao Teng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Antonio Meola
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Iris Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Antony M Tolisano
- Department of Otolaryngology, Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Joe Walter Kutz
- Department of Otolaryngology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zabi Wardak
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lucien A Nedzi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Hong
- Virginia Hospital Center, Arlington, Virginia, USA
| | - Don MacRae
- Virginia Hospital Center, Arlington, Virginia, USA
| | - Preet Sohal
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elina Kapoor
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Parisa Sabet-Rasekh
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sam Maghami
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Paola X Moncada
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashley Zaleski-King
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashkan Monfared
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Neurosurgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Klein AL, Chang SD, Muacevic A, Sherman JH, Romanelli P, Maria PS, Fuerweger C, Zanetti IB, Beltramo G, Vaisbuch Y, Tran E, Feng AY, Teng H, Meola A, Gibbs I, Tolisano A, Kutz JW, Wardak Z, Nedzi L, MacRae D, Sohal P, Kapoor E, Sabet-Rasekh P, Moncada P, Zaleski-King A, Monfared A. 214 Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-Center Study. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_214] [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: 03/18/2023] Open
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Romanelli P, Thomas EM. 369 Successful Image-Guided Stereotactic Radiosurgery for Treatment of Spasticity. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_369] [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: 03/18/2023] Open
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4
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Romanelli P, Thomas EM. 528 Robotic Image-Guided LINAC Radiosurgery for Trigeminal Neuralgia: Results After 10 Years. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_528] [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: 03/18/2023] Open
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Ingen-Housz-Oro S, Schmidt V, Ameri MM, Abe R, Brassard A, Mostaghimi A, Paller AS, Romano A, Didona B, Kaffenberger BH, Ben Said B, Thong BYH, Ramsay B, Brezinova E, Milpied B, Mortz CG, Chu CY, Sotozono C, Gueudry J, Fortune DG, Dridi SM, Tartar D, Do-Pham G, Gabison E, Phillips EJ, Lewis F, Salavastru C, Horvath B, Dart J, Setterfield J, Newman J, Schulz JT, Delcampe A, Brockow K, Seminario-Vidal L, Jörg L, Watson MP, Gonçalo M, Lucas M, Torres M, Noe MH, Hama N, Shear NH, O’Reilly P, Wolkenstein P, Romanelli P, Dodiuk-Gad RP, Micheletti RG, Tiplica GS, Sheridan R, Rauz S, Ahmad S, Chua SL, Flynn TH, Pichler W, Le ST, Maverakis E, Walsh S, French LE, Brüggen MC. Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus. Orphanet J Rare Dis 2023; 18:33. [PMID: 36814255 PMCID: PMC9945700 DOI: 10.1186/s13023-023-02631-7] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking. OBJECTIVES We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae. METHODS Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method. RESULTS Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded. CONCLUSIONS Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.
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Affiliation(s)
- S. Ingen-Housz-Oro
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.410511.00000 0001 2149 7878EpiDermE, Université Paris Est Créteil, Créteil, France
| | - V. Schmidt
- grid.410567.1University Hospital Basel, Basel, Switzerland ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - M. M. Ameri
- grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - R. Abe
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A. Brassard
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - A. Mostaghimi
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - A. S. Paller
- grid.16753.360000 0001 2299 3507Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - A. Romano
- grid.419843.30000 0001 1250 7659Oasi Research Institute-IRCCS, Troina, Italy
| | - B. Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.419457.a0000 0004 1758 0179Rare Disease Unit, I Dermatology Division, Istituto Dermopatico Dell’Immacolata, IRCCS, Rome, Italy
| | - B. H. Kaffenberger
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412332.50000 0001 1545 0811The Ohio State University Wexner Medical Center Division of Dermatology, Upper Arlington, OH USA
| | - B. Ben Said
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,Department of Dermatology, CHU Edouard Herriot, Lyon, France
| | - B. Y. H. Thong
- grid.240988.f0000 0001 0298 8161Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - B. Ramsay
- grid.415522.50000 0004 0617 6840Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - E. Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.10267.320000 0001 2194 0956First Department of Dermatovenereology, Masaryk University Faculty of Medicine, St. Ann’s Faculty Hospital in Brno, Brno, Czech Republic
| | - B. Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.412041.20000 0001 2106 639XDepartment of Adult and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France
| | - C. G. Mortz
- grid.7143.10000 0004 0512 5013Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - C. Y. Chu
- grid.19188.390000 0004 0546 0241Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002 Taiwan
| | - C. Sotozono
- grid.272458.e0000 0001 0667 4960Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Hirokoji-Agaru, Kawaramach-Dori, Kamigyo-Ku, Kyoto, 602-0841 Japan
| | - J. Gueudry
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France
| | - D. G. Fortune
- grid.10049.3c0000 0004 1936 9692Department of Psychology, University of Limerick, Limerick, Ireland
| | - S. M. Dridi
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.416670.2MICORALIS Laboratory, Department of Periodontology, Faculty of Dentistry, Côte d’Azur University, Saint Roch Hospital, Nice, France
| | - D. Tartar
- grid.27860.3b0000 0004 1936 9684Department of Dermatology, University of California Davis, Sacramento, CA USA
| | - G. Do-Pham
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.414145.10000 0004 1765 2136Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - E. Gabison
- grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E. J. Phillips
- grid.1025.60000 0004 0436 6763Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA Australia ,grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - F. Lewis
- grid.425213.3St John’s Institute of Dermatology, Guy’s and St Thomas’ Hospital, London, UK
| | - C. Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - B. Horvath
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.4830.f0000 0004 0407 1981Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - J. Dart
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - J. Setterfield
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.420545.20000 0004 0489 3985Department of Oral Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - J. Newman
- grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - J. T. Schulz
- grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, 02114 USA
| | - A. Delcampe
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France ,grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Ophthalmology, CHU Bichat-Claude Bernard, Paris, France
| | - K. Brockow
- grid.6936.a0000000123222966Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - L. Seminario-Vidal
- grid.170693.a0000 0001 2353 285XDepartment of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL USA
| | - L. Jörg
- grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M. P. Watson
- grid.439257.e0000 0000 8726 5837Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - M. Gonçalo
- grid.28911.330000000106861985Department of Dermatology, Coimbra University Hospital Center, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M. Lucas
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA 6009 Australia ,grid.3521.50000 0004 0437 5942Department of Immunology, Sir Charles Gairdner Hospital, Pathwest Laboratory Medicine, Perth, WA 6009 Australia
| | - M. Torres
- grid.452525.1Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - M. H. Noe
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - N. Hama
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N. H. Shear
- grid.17063.330000 0001 2157 2938Department of Dermatology, University of Toronto, Toronto, ON Canada ,grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - P. O’Reilly
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - P. Wolkenstein
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - P. Romanelli
- grid.26790.3a0000 0004 1936 8606Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL USA
| | - R. P. Dodiuk-Gad
- grid.6451.60000000121102151Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, Canada
| | - R. G. Micheletti
- grid.25879.310000 0004 1936 8972Department of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - G. S. Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,2Nd Department of Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - R. Sheridan
- grid.415829.30000 0004 0449 5362Burn Service, Boston Shriners Hospital for Children, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Surgery, Harvard Medical School, Boston, MA USA
| | - S. Rauz
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - S. Ahmad
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - S. L. Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412563.70000 0004 0376 6589Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T. H. Flynn
- grid.460892.10000 0004 0389 5639Ophthalmology, Bon Secours Hospital, Cork, Ireland
| | - W. Pichler
- grid.482939.dADR-AC GmbH, Bern, Switzerland
| | - S. T. Le
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - E. Maverakis
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - S. Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - L. E. French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.411095.80000 0004 0477 2585Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany ,grid.26790.3a0000 0004 1936 8606Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL USA
| | - M. C. Brüggen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
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Romanelli P, Tuniz F, Fabbro S, Beltramo G, Conti A. Image-guided LINAC radiosurgery in hypothalamic hamartomas. Front Neurol 2022; 13:909829. [PMID: 36119668 PMCID: PMC9475216 DOI: 10.3389/fneur.2022.909829] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypothalamic hamartomas (HH) are developmental malformations that are associated with mild to severe drug-refractory epilepsy. Stereotactic radiosurgery (SRS) is an emerging non-invasive option for the treatment of small and medium-sized HH, providing good seizure outcomes without neurological complications. Here, we report our experience treating HH with frameless LINAC SRS. Materials and methods We retrospectively collected clinical and neuroradiological data of ten subjects with HH-related epilepsy that underwent frameless image-guided SRS. Results All patients underwent single-fraction SRS using a mean prescribed dose of 16.27 Gy (range 16–18 Gy). The median prescription isodose was 79% (range 65–81 Gy). The mean target volume was 0.64 cc (range 0.26–1.16 cc). Eight patients experienced complete or near complete seizure freedom (Engel class I and II). Five patients achieved complete seizure control within 4 to 18 months after the treatment. Four patients achieved Engel class II outcome, with stable results. One patient had a reduction of seizure burden superior to 50% (Engel class III). One patient had no benefit at all (Engel class IV) and refused further treatments. Overall, at the last follow-up, three patients experience class I, five class II, one class III and one class IV outcome. No neurological complications were reported. Conclusions Frameless LINAC SRS provides good seizure and long-term neuropsychosocial outcome, without the risks of neurological complications inherently associated with microsurgical resection.
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Affiliation(s)
- Pantaleo Romanelli
- Cyberknife Center, Italian Diagnostic Center (CDI), Milan, Italy
- *Correspondence: Pantaleo Romanelli
| | - Francesco Tuniz
- Department of Neurosurgery, ASUFC “Santa Maria della Misericordia”, Udine, Italy
| | - Sara Fabbro
- Department of Neurosurgery, ASUFC “Santa Maria della Misericordia”, Udine, Italy
| | | | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), IRCCS Istituto delle Scienze Neurologiche di Bologna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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Lin D, Revah S, Abdo Abujamra B, Romanelli P, Jozic I. 833 Reintroduction of caveolin-1 scaffolding domain improves pathogenesis of psoriasiform dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.847] [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: 10/17/2022]
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Romanelli P, Beltramo G. Image-Guided Stereotactic Radiosurgery for the Treatment of Spasticity and Pain: A Preliminary Experience. Cureus 2022; 14:e24021. [PMID: 35463564 PMCID: PMC9001805 DOI: 10.7759/cureus.24021] [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] [Accepted: 04/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background Spasticity is a major health problem worldwide. Response to current medical and rehabilitation treatments is often poor. Surgical treatment is available only for a very limited number of patients. Aim We recently reported the application of stereotactic radiosurgery as a treatment option for spasticity and related pain. This paper describes a larger experience using image-guided stereotactic radiosurgery targeting the cervical or lumbar spinal roots to relieve spasticity and pain in four patients. Methods All the patients had refractory spasticity and related pain, one patient had additional paroxystic neuralgic pain. The cause of spasticity and pain was a traumatic brain and/or spinal cord injury, brain and/or spinal cord surgery, and stroke. Symptoms affected the right superior limb in one patient, and the inferior limbs in three patients (unilaterally in two, bilaterally in one). According to the symptoms, one patient was treated at the cervical level (C7 right sensory root) and three patients at lumbar level (right L4, left S1, and L2 roots bilaterally). The target was selected on constructive interference in steady-state (CISS) MR, focusing the irradiation on the postganglionic sensory segment of the cervical root or the intra-foraminal dorsolateral sensory portion of the lumbar roots. Appropriate spasticity and pain scales were used to assess the patient’s status after the treatment. Results The treatments were tolerated well. Marked symptomatic relief was found in all the treated patients. Improvements in spasticity and pain scales were observed up to the latest follow-up. After 2 years, the mean reduction of the visual analog scale (VAS) and Modified Ashworth Scale (MAS) was 64.3% and 43.7%, respectively, while the median reduction of MAS score was 50%. Conclusions Except for a previous case report, this is the first study describing a novel noninvasive technique based on image-guided radiosurgery to treat severe spasticity and pain due to brain and spinal cord injury. This novel technique appears to be safe and effective and deserves to be studied further.
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Wright MD, Romanelli P, Bravin A, Le Duc G, Brauer-Krisch E, Requardt H, Bartzsch S, Hlushchuk R, Laissue JA, Djonov V. Non-conventional Ultra-High Dose Rate (FLASH) Microbeam Radiotherapy Provides Superior Normal Tissue Sparing in Rat Lung Compared to Non-conventional Ultra-High Dose Rate (FLASH) Radiotherapy. Cureus 2021; 13:e19317. [PMID: 35223216 PMCID: PMC8864723 DOI: 10.7759/cureus.19317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 12/12/2022] Open
Abstract
Conventional radiotherapy is a widely used non-invasive form of treatment for many types of cancer. However, due to a low threshold in the lung for radiation-induced normal tissue damage, it is of less utility in treating lung cancer. For this reason, surgery is the preferred treatment for lung cancer, which has the detriment of being highly invasive. Non-conventional ultra-high dose rate (FLASH) radiotherapy is currently of great interest in the radiotherapy community due to demonstrations of reduced normal tissue toxicity in lung and other anatomy. This study investigates the effects of FLASH microbeam radiotherapy, which in addition to ultra-high dose rate incorporates a spatial segmentation of the radiation field, on the normal lung tissue of rats. With a focus on fibrotic damage, this work demonstrates that FLASH microbeam radiotherapy provides an order of magnitude increase in normal tissue radio-resistance compared to FLASH radiotherapy. This result suggests FLASH microbeam radiotherapy holds promise for much improved non-invasive control of lung cancer.
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Affiliation(s)
- Michael D Wright
- Ginzton Technology Center, Varian Medical Systems, Palo Alto, USA.,Research & Development Center, Avail Medical Devices, Roseville, USA
| | | | - Alberto Bravin
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Geraldine Le Duc
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA.,Pharmaceutics, NH TherAguix, Lyon, FRA
| | - Elke Brauer-Krisch
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Herwig Requardt
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, FRA
| | - Stefan Bartzsch
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Munich, DEU.,Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, DEU
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10
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Nicosia L, Romanelli P, Ferrari F, Marchioretto F, Zamperini M, De Simone A, Ruggieri R, Alongi F, Avesani R. PD-0804 Therapeutic use of Linac-based SRS in the treatment of malignant spasticity. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07083-3] [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: 11/28/2022]
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11
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Brüggen MC, Le ST, Walsh S, Toussi A, de Prost N, Ranki A, Didona B, Colin A, Horváth B, Brezinova E, Milpied B, Moss C, Bodemer C, Meyersburg D, Salavastru C, Tiplica GS, Howard E, Bequignon E, Bouwes Bavinck JN, Newman J, Gueudry J, Nägeli M, Zaghbib K, Pallesen K, Bygum A, Joly P, Wolkenstein P, Chua SL, Le Floch R, Shear NH, Chu CY, Hama N, Abe R, Chung WH, Shiohara T, Ardern-Jones M, Romanelli P, Phillips EJ, Stern RS, Cotliar J, Micheletti RG, Brassard A, Schulz JT, Dodiuk-Gad RP, Dominguez AR, Paller AS, Seminario-Vidal L, Mostaghimi A, Noe MH, Worswick S, Tartar D, Sheridan R, Kaffenberger BH, Shinkai K, Maverakis E, French LE, Ingen-Housz-Oro S. Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus. Br J Dermatol 2021; 185:616-626. [PMID: 33657677 DOI: 10.1111/bjd.19893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. OBJECTIVES Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. METHODS Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. RESULTS Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. CONCLUSIONS We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.
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Affiliation(s)
- M-C Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France
| | - S T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - S Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology, King's College Hospital, London, UK
| | - A Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - N de Prost
- Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France
| | - A Ranki
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Skin and Allergic Diseases, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,First Dermatology Division, Institute Dermopatico dell'Immacolata (I.D.I.) - IRCCS, Via Monti di Creta 104, Rome, 00167, Italy
| | - A Colin
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - B Horváth
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatovenereology, St Ann's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - B Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, CHU Bordeaux, Bordeaux, France
| | - C Moss
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Birmingham Children's Hospital and University of Birmingham, Birmingham, UK
| | - C Bodemer
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, AP-HP, Necker Hospital, Paris, France
| | - D Meyersburg
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G-S Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology II, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - E Howard
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Birmingham Children's Hospital and University of Birmingham, Birmingham, UK
| | - E Bequignon
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, AP-HP, Henri Mondor Hospital, Créteil, France
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Newman
- Macmillan Skin Cancer CNS, Normanby Building, Denmark Hill, London, UK
| | - J Gueudry
- Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Ophthalmology Department, Hospital Charles Nicolle, EA7510, UFR Santé, Rouen University, Rouen, France
| | - M Nägeli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - K Zaghbib
- Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Psychiatry, AP-HP, Henri Mondor-Albert Chenevier Hospitals, Cr, France
| | - K Pallesen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology, Aarhus University Hospital, Palle Juul-Jensens, Aarhus, Denmark
| | - A Bygum
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Clinical Institute, University of Southern Denmark, Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - P Joly
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, CHU Charles, Nicolle, Rouen, France
| | - P Wolkenstein
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S-L Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Le Floch
- Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Réanimation Chirurgicale et des Brûlés, PTMC, CHU Nantes, Nantes, France
| | - N H Shear
- Division of Clinical Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C-Y Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - N Hama
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - R Abe
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - W-H Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - T Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - M Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P Romanelli
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - E J Phillips
- Department of Medicine & Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R S Stern
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - R G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A Brassard
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - J T Schulz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R P Dodiuk-Gad
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A R Dominguez
- Department of Dermatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Seminario-Vidal
- Department of Dermatology, University of South Florida, Cutaneous Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - A Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M H Noe
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Worswick
- Keck-USC School of Medicine, Los Angeles, CA, USA
| | - D Tartar
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - R Sheridan
- Burn Surgery Service, Shriners Burns Hospital, Sumner Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - B H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, Ohio State University, Columbus, OH, USA
| | - K Shinkai
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - E Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - L E French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Dermatology and Allergy, University Hospital of Munich, LMU, Munich, Germany
| | - S Ingen-Housz-Oro
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Universit, EpiDermE, Créteil, France
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12
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Ganzinelli M, Linardou H, Alvisi MF, Caiola E, Lo Russo G, Cecere FL, Bettini AC, Psyrri A, Milella M, Rulli E, Fabbri A, De Maglie M, Romanelli P, Murray S, Broggini M, Marabese M, Garassino MC. Single-arm, open label prospective trial to assess prediction of the role of ERCC1/XPF complex in the response of advanced NSCLC patients to platinum-based chemotherapy. ESMO Open 2021; 6:100034. [PMID: 33422766 PMCID: PMC7809372 DOI: 10.1016/j.esmoop.2020.100034] [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: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/05/2022] Open
Abstract
Background Platinum-based therapy, combined or not with immune checkpoint inhibitors, represents a front-line choice for patients with non-small-cell lung cancer (NSCLC). Despite the improved outcomes in the last years for this malignancy, only a sub-group of patients have long-term benefit. Excision repair cross-complementation group 1 (ERCC1) has been considered a potential biomarker to predict the outcome of platinum-based chemotherapy in NSCLC. However, the ERCC1 gene is transcribed in four splice variants where the isoform 202 was described as the only one active and able to complex Xeroderma pigmentosum group F-complementing protein (XPF). Here, we prospectively investigated if the active form of ERCC1, as assessed by the ERCC1/XPF complex (ERCC1/XPF), could predict the sensitivity to platinum compounds. Patients and methods Prospectively enrolled, patients with advanced NSCLC treated with a first-line regimen containing platinum were centrally evaluated for ERCC1/XPF by a proximity ligation assay. Overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) were analyzed. Results The absence of the ERCC1/XPF in the tumor suggested a trend of worst outcomes in terms of both OS [hazard ratio (HR) 1.41, 95% confidence interval (CI) 0.67-2.94, P = 0.373] and PFS (HR 1.61, 95% CI 0.88-3.03, P = 0.123). ORR was marginally influenced in ERCC1/XPF-negative and -positive groups [odds ratio (stable disease + progressive disease versus complete response + partial response) 0.87, 95% CI 0.25-3.07, P = 0.832]. Conclusion The lack of ERCC1/XPF complex in NSCLC tumor cells might delineate a group of patients with poor outcomes when treated with platinum compounds. ERCC1/XPF absence might well identify patients for whom a different therapeutic approach could be necessary. This is the first study investigating the ERCC1/XPF complex as a platinum-based therapy response biomarker in NSCLC. The lack of ERCC1/XPF complex might delineate a group of patients with poor outcomes when treated with platinum compounds. ERCC1/XPF absence might identify tumors for whom a different therapeutic approach than platinum compounds could be necessary.
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Affiliation(s)
- M Ganzinelli
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - H Linardou
- 4th Oncology Department, Metropolitan Hospital, Athens, Greece
| | - M F Alvisi
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E Caiola
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Lo Russo
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F L Cecere
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A C Bettini
- UO Oncologia Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Psyrri
- Section of Oncology, Department of Internal Medicine, Attikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - M Milella
- Department of Medicine, Section of Medical Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - E Rulli
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M De Maglie
- Mouse and Animal Pathology Lab, Fondazione Filarete, Milan, Italy; Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - P Romanelli
- Mouse and Animal Pathology Lab, Fondazione Filarete, Milan, Italy; Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - S Murray
- Biomarker Solutions Ltd, London, UK
| | - M Broggini
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - M Marabese
- Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M C Garassino
- Unit of Thoracic Oncology, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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13
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Fox JD, Aramin H, Ghiam N, Freedman JB, Romanelli P. Secukinumab-associated localized granuloma annulare (SAGA): a case report and review of the literature. Dermatol Online J 2020; 26:13030/qt1nd6p108. [PMID: 32941717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023] Open
Abstract
Granuloma annulare (GA) is a benign, usually self-limited inflammatory skin dermatosis characterized clinically by pink-red to brown dermal papules or annular plaques. The main histologic feature is the presence of palisading or interstitial granulomas composed of necrobiotic collagen, elastic fibers, and mucin surrounded by a lymphohistiocytic infiltrate. Granuloma annulare is commonly associated with trauma, infections, diabetes mellitus, dyslipidemia, malignancy, thyroid disease, and a variety of medications. Two cases of GA have been reported in association with the use of secukinumab, a monoclonal antibody directed against interleukin 17A (IL17A), for the treatment of moderate-to-severe plaque psoriasis. We report the third case of secukinumab-associated GA in a 52-year-old woman with a history of diabetes mellitus type II, dyslipidemia, and non-alcoholic steatohepatitis. After four months of therapy with secukinumab, she presented with pink papules coalescing to plaques involving the antecubital fossae. Histology demonstrated a lymphohistiocytic palisading granuloma with central necrobiotic collagen and mucin, consistent with GA. Physicians should be aware of the possibility of GA developing in patients receiving secukinumab, especially in those with predisposing factors for GA. A better understanding of secukinumab-associated GA may lead to discoveries in GA pathogenesis and reveal broader immunomodulatory effects of secukinumab.
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Affiliation(s)
| | | | | | | | - P Romanelli
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL.
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14
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Griffin RJ, Ahmed MM, Amendola B, Belyakov O, Bentzen SM, Butterworth KT, Chang S, Coleman CN, Djonov V, Formenti SC, Glatstein E, Guha C, Kalnicki S, Le QT, Loo BW, Mahadevan A, Massaccesi M, Maxim PG, Mohiuddin M, Mohiuddin M, Mayr NA, Obcemea C, Petersson K, Regine W, Roach M, Romanelli P, Simone CB, Snider JW, Spitz DR, Vikram B, Vozenin MC, Abdel-Wahab M, Welsh J, Wu X, Limoli CL. Understanding High-Dose, Ultra-High Dose Rate, and Spatially Fractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:766-778. [PMID: 32298811 DOI: 10.1016/j.ijrobp.2020.03.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Radiation Research Program, in collaboration with the Radiosurgery Society, hosted a workshop called Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy on August 20 and 21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically based clinical trials.
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Affiliation(s)
- Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mansoor M Ahmed
- Division of Cancer Treatment and Diagnosis, Rockville, Maryland
| | | | - Oleg Belyakov
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland, Baltimore, Maryland
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Valentin Djonov
- Bern Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Sylvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Health Systems, Danville, Pennsylvania
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Peter G Maxim
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Nina A Mayr
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | | | - Kristoffer Petersson
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Roach
- Department of Radiation Oncology & Urology, University of California, San Francisco, San Francisco, California
| | | | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas R Spitz
- Free Radical & Radiation Biology Program, University of Iowa, Iowa City, Iowa
| | | | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital, Switzerland
| | - May Abdel-Wahab
- International Atomic Energy Agency Headquarters, Vienna International Centre, Vienna, Austria
| | - James Welsh
- Edward Hines VA Medical Center and Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Xiaodong Wu
- Executive Medical Physics Associates, Miami, Florida; Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Charles L Limoli
- Department of Radiation Oncology, University of California-Irvine, Irvine, California.
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15
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Romanelli P, Chuang C, Meola A, Bodduluri RM, Adler JR. ZAP-X: A Novel Radiosurgical Device for the Treatment of Trigeminal Neuralgia. Cureus 2020; 12:e8324. [PMID: 32617203 PMCID: PMC7325335 DOI: 10.7759/cureus.8324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction The treatment of trigeminal neuralgia (TN) is one of the most demanding of all radiosurgery procedures, requiring accurate delivery and sharp dose fall off. ZAP-X®, a new, innovative frameless radiosurgical device, maybe an attractive platform for the treatment of TN and other functional brain disorders. Here, we compared the dosimetry of ZAP-X plans for a single patient to that generated by a well-established dedicated radiosurgery device, the CyberKnife. Methods Radiosurgery plans that delineated the cranial nerve from a single patient's fused computed tomography and magnetic resonance imaging (CT-MR) data set were planned on both the ZAP-X and CyberKnife, with the latter serving as a validated benchmark. The same target and treatment planning constraints were applied. Plans were evaluated by a physician with experience treating TN and a medical physicist. The ZAP-X treatment plan used two isocenters delivered through 4-mm collimators based on a non-isocentric plan that delivered 29,441 MU through 81 beams. The CyberKnife plans used a 5-mm collimator for a non-isocentric plan that delivered 17,880 MU through 88 beams. Results Based on visual inspection, the isodose volumes covered by ZAP-X and CyberKnife were similar at the prescription isodose (70% and 80%, respectively, with a maximum dose (Dmax) of 7500 cGy. The conformality index was better for the CyberKnife as compared to ZAP-X. However, the irradiated volumes were smaller at the 50%, 20%, and 10% isodoses for ZAP-X (0.12 cc, 0.57 cc, and 1.69 for ZAP-X; 0.18 cc, 0.91 cc, and 3.41 cc for CyberKnife). In particular, the 20% and 10% isodose volumes were much smaller for ZAP-X, especially on the axial and sagittal planes. Conclusions ZAP-X treatment planning for TN compares favorably with equivalent planning on CyberKnife. The brain volumes containing the 20% and 10% isodoses are smaller using ZAP-X, thus relatively sparing critical structures close to the target, including the Gasserian ganglion and brainstem. This feature could be of clinical relevance by potentially reducing treatment-related complications.
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Affiliation(s)
- Pantaleo Romanelli
- Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | - Cynthia Chuang
- Department of Radiation Oncology - Radiation Physics, Stanford University School of Medicine, Palo Alto, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, USA
| | | | - John R Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
- Radiation Oncology, Stanford University Medical Center, Stanford, USA
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Abstract
Selective dorsal rhizotomy is an established surgical treatment to improve the neurological and functional status of children with spastic cerebral palsy and adults with spasticity and pain caused by a variety of brain and spinal injuries. This procedure requires a dorsolumbar laminectomy to expose the appropriate dorsal rootlets, which are sectioned according to the presence of sustained electromiographic discharges. Image-guided robotic radiosurgery targeting the intracisternal sensory root of the trigeminal nerve has been described as a safe and effective non-invasive treatment for trigeminal neuralgia, a paroxystic pain disorder which often responds poorly to medical therapy. Image-guided radiosurgery requires no frame placement and can treat brain or spinal targets with submillimetric precision. This technique can be used to treat cervical or lumbar dorsal roots. A 44-year-old patient with von Hippel-Lindau disease developed severe spastic tetraparesis following multiple brain and spinal procedures. Spasticity and related pain mostly affected the right leg, with sustained electromiographic discharges originating from the right L4 nerve root. Response to medical therapy with baclofen and cannabinoids was poor. Due to geographical and logistical issues, the patient declined the placement of an intrathecal baclofen pump. Considering the poor general condition of the patient and his decision to avoid invasive procedures, a novel treatment option was offered to provide relief from spasticity and pain: stereotactic image-guided irradiation delivered to the sensory root. The patient underwent a right intraforaminal dorsolateral L4 root stereotactic irradiation with a delivered dose of 45 Gy prescribed to the 82% isodose. The treatment was well tolerated, without side effects. Resolution of spasticity and related pain in the right leg was found six months after the procedure. A marked reduction of spasticity and pain was also evident in the contralateral leg. These improvements have been stable over the last 18 months. So far, two additional patients underwent stereotactic dorsolateral spinal root irradiation (one delivered to a cervical, the other to a lumbar), with similar positive outcomes. These preliminary results suggest that spinal root stereotactic image-guided irradiation, a novel treatment option in the neurosurgical armamentarium, is a safe and effective procedure and deserves further investigation.
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Affiliation(s)
- Pantaleo Romanelli
- Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | - Giancarlo Beltramo
- Radiation Oncology, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
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Conti A, Acker G, Pontoriero A, Hardt J, Kluge A, Cacciola A, Iatì G, Kufeld M, Budach V, Vajkoczy P, Beltramo G, Pergolizzi S, Bergantin A, Loebel F, Parisi S, Senger C, Romanelli P. Factors affecting outcome in frameless non-isocentric stereotactic radiosurgery for trigeminal neuralgia: a multicentric cohort study. Radiat Oncol 2020; 15:115. [PMID: 32443978 PMCID: PMC7243318 DOI: 10.1186/s13014-020-01535-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an effective treatment for trigeminal neuralgia (TN). Nevertheless, a proportion of patients will experience recurrence and treatment-related sensory disturbances. In order to evaluate the predictors of efficacy and safety of image-guided non-isocentric radiosurgery, we analyzed the impact of trigeminal nerve volume and the nerve dose/volume relationship, together with relevant clinical characteristics. METHODS Two-hundred and ninety-six procedures were performed on 262 patients at three centers. In 17 patients the TN was secondary to multiple sclerosis (MS). Trigeminal pain and sensory disturbances were classified according to the Barrow Neurological Institute (BNI) scale. Pain-free-intervals were investigated using Kaplan Meier analyses. Univariate and multivariate Cox regression analyses were performed to identify predictors. RESULTS The median follow-up period was 38 months, median maximal dose 72.4 Gy, median target nerve volume 25 mm3, and median prescription dose 60 Gy. Pain control rate (BNI I-III) at 6, 12, 24, 36, 48, and 60 months were 96.8, 90.9, 84.2, 81.4, 74.2, and 71.2%, respectively. Overall, 18% of patients developed sensory disturbances. Patients with volume ≥ 30 mm3 were more likely to maintain pain relief (p = 0.031), and low integral dose (< 1.4 mJ) tended to be associated with more pain recurrence than intermediate (1.4-2.7 mJ) or high integral dose (> 2.7 mJ; low vs. intermediate: log-rank test, χ2 = 5.02, p = 0.019; low vs. high: log-rank test, χ2 = 6.026, p = 0.014). MS, integral dose, and mean dose were the factors associated with pain recurrence, while re-irradiation and MS were predictors for sensory disturbance in the multivariate analysis. CONCLUSIONS The dose to nerve volume ratio is predictive of pain recurrence in TN, and re-irradiation has a major impact on the development of sensory disturbances after non-isocentric SRS. Interestingly, the integral dose may differ significantly in treatments using apparently similar dose and volume constraints.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. .,Unit of Neurosurgery, IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Gueliz Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin, 10178, Germany
| | | | - Juliane Hardt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin AND Berlin Institute of Health , Berlin, Germany.,Clinical Research Unit (CRU), Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Fakultät III, Dep. Information & Communication, Medical Information Management, Hochschule Hannover - University of Applied Sciences and Arts, Expo Plaza 12, 30539, Hannover, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Markus Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Volker Budach
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | | | | | | | - Franziska Loebel
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Silvana Parisi
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Fox JD, Aramin H, Ghiam N, Freedman JB, Romanelli P. Secukinumab-associated localized granuloma annulare (SAGA): a case report and review of the literature. Dermatol Online J 2020. [DOI: 10.5070/d3268049888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Introduction Image-guided robotic radiosurgery is an emerging minimally-invasive treatment option for trigeminal neuralgia (TN). Our group has treated 560 cases up to date, and report here the clinical outcomes of 387 treatments with three years follow-up. This study represents the largest single-center experience on CyberKnife radiosurgery for the treatment of TN so far reported. Methods CyberKnife radiosurgery treatment was offered to patients with drug-resistant TN, after the failure of other treatments or refusal of invasive procedures. A second treatment was offered to patients with a poor response after the first treatment or with recurrent pain. Treatment protocol required the non-isocentric delivery of 60 Gy prescribed to the 80% isodose to a 6 mm retrogasserian segment of the affected trigeminal nerve. Retreatments typically received 45 Gy, again prescribed to the 80% isodose. The final plan was developed accordingly to individual anatomy and dose distribution over the trigeminal nerve, gasserian ganglion, and brainstem. Clinical outcomes such as pain control and hypoesthesia/numbness have been evaluated after 6, 12, 24, and 36 months. Results Our group has treated 527 patients with Cyberknife radiosurgery at Centro Diagnostico Italiano (CDI), Milan, Italy, during the last decade. A minimum follow-up of six months was available on 496 patients. These patients received 560 treatments: 435 patients (87.7%) had a single treatment, 60 patients (12.1%) had two treatments, and one patient (0.2%) had five treatments (two on the right side, three on the left side). Twenty four patients had multiple sclerosis (4.8%). Four hundred and forty-three patients (84%) received the treatment without previous procedures, while 84 patients (16%) underwent radiosurgery after the failure of other treatments. A neurovascular conflict was identified in 59% of the patients. Three hundred and forty-three patients (receiving a total of 387 treatments) had a minimum of 36 months follow up. Pain relief rate at 6, 12, 18, 24, 30 and 36 months was respectively 92, 87, 87, 82, 78 and 76%. Forty-four patients out of 343 (12.8%) required a second treatment during the observed period. At 36 months post-treatment, 21 patients (6,1%) reported the presence of bothering facial hypoesthesia. Eighteen patients out of 21 (85.7%) developed this complication after a repeated treatment. Conclusions Frameless image-guided robotic radiosurgery in experienced hands is a safe and effective procedure for the treatment of TN, providing excellent pain control rates in the absence of major neurological complications. Repeated treatments due to recurrent pain are associated with restored pain control but at the price of a higher rate of sensory complications.
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Affiliation(s)
- Pantaleo Romanelli
- Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Irene Redaelli
- Medical Physics, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Achille Bergantin
- Medical Physics, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Giancarlo Beltramo
- Radiation Oncology, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
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Romanelli P, Valiante TA, Seri S, Puttilli C, Picciafuoco M, Jakobs M, Lozano A. A Wireless Neuroprosthesis for Patients with Drug-refractory Epilepsy: A Proof-of-Concept Study. Cureus 2019; 11:e5868. [PMID: 31763091 PMCID: PMC6834104 DOI: 10.7759/cureus.5868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective Acute or protracted cortical recording may be necessary for patients with drug-refractory epilepsy to identify the ictogenic regions before undergoing resection. Currently, these invasive recording techniques present certain limitations, one of which is the need for cables connecting the recording electrodes placed in the intracranial space with external devices displaying the recorded electrocorticographic signals. This equates to a direct connection between the sterile intracranial space with the non-sterile environment. Due to the increasing likelihood of infections with time, subdural grids are typically removed a few days after implantation, a limiting factor in localizing the epileptogenic zone if seizures are not frequent enough to be captured within this time-frame. Furthermore, patients are bound to stay in the hospital, connected by the wires to the recording device, thus increasing substantially the treatment costs. To address some of the current shortcomings of invasive monitoring, we developed a neuroprosthesis made of a subdural silicone grid connected to a wireless transmitter allowing prolonged electrocorticografic recording and direct cortical stimulation. This device consists of a silicone grid with 128-platinum/iridium contacts, connected to an implantable case providing wireless recording and stimulation. The case also houses a wirelessly rechargeable battery for chronic long-term implants. We report the results of the first human proof-of-concept trial for wireless transmission of electrocorticographic recordings using a device suited for long-term implantation in three patients with drug-refractory epilepsy. Methods Three patients with medically refractory epilepsy underwent the temporary intraoperative placement of the subdural grid connected to the wireless device for recording and transmission of electrocorticographic signals for a duration of five minutes before the conventional recording electrodes were placed or the ictal foci were resected. Results Wireless transmission of brain signals was successfully achieved. The wireless electrocorticographic signal was judged of excellent quality by a blinded neurophysiologist. Conclusions This preliminary experience reports the first successful placement of a wireless electrocorticographic recording device in humans. Long-term placement for prolonged wireless electrocorticographic recording in epilepsy patients will be the next step.
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Affiliation(s)
- Pantaleo Romanelli
- Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Stefano Seri
- Clinical Neurophysiology, Aston University, Birmingham, GBR
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Chimento S, Billero V, Cavallin L, Romanelli M, Nadji M, Romanelli P. Evaluation of osteopontin expression in chronic wounds: a potential prognostic and therapeutic biomarker. J Wound Care 2019; 26:S4-S8. [PMID: 28880752 DOI: 10.12968/jowc.2017.26.sup9.s4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Osteopontin (OPN) is abundantly expressed during tissue repair, acting as a powerful chemokine that recruits inflammatory cells such as neutrophils, macrophages, and Langerhans cells. The role of OPN in chronic wounds has not been explored. In this study, we assess the expression levels of OPN in chronic wounds to assess its potential contribution to the exacerbated inflammation seen in chronic ulcers, which is thought to contribute to poor healing. METHODS This retrospective study included archived biopsies of chronic wounds from several aetiologies. Immunohistochemical staining and blind analysis of OPN expression were carried out. RESULTS We assessed biopsies from venous leg ulcers (n=5), diabetic foot ulcers (n=5), pyoderma gangrenosum (n=5), squamous cell carcinoma ulcers (n=4), and calciphylaxis ulcers (n=3). The data revealed that all these sets of chronic ulcers expressed high levels of OPN. CONCLUSION This study provides strong histopathologic evidence that OPN expression is significantly increased in chronic wounds, suggesting that its upregulation could contribute to the exacerbated inflammation. Furthermore, further characterisation of the role of OPN in wound healing could aid the development of specific and efficient anti-OPN therapies for the treatment of chronic wounds.
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Affiliation(s)
- S Chimento
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US
| | - V Billero
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US
| | - L Cavallin
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US
| | - M Romanelli
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US
| | - M Nadji
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US
| | - P Romanelli
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, US.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, US
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Romanelli P, Piangerelli M, Ratel D, Gaude C, Costecalde T, Puttilli C, Picciafuoco M, Benabid A, Torres N. A novel neural prosthesis providing long-term electrocorticography recording and cortical stimulation for epilepsy and brain-computer interface. J Neurosurg 2019:1-14. [DOI: 10.3171/2017.10.jns17400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/16/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWireless technology is a novel tool for the transmission of cortical signals. Wireless electrocorticography (ECoG) aims to improve the safety and diagnostic gain of procedures requiring invasive localization of seizure foci and also to provide long-term recording of brain activity for brain-computer interfaces (BCIs). However, no wireless devices aimed at these clinical applications are currently available. The authors present the application of a fully implantable and externally rechargeable neural prosthesis providing wireless ECoG recording and direct cortical stimulation (DCS). Prolonged wireless ECoG monitoring was tested in nonhuman primates by using a custom-made device (the ECoG implantable wireless 16-electrode [ECOGIW-16E] device) containing a 16-contact subdural grid. This is a preliminary step toward large-scale, long-term wireless ECoG recording in humans.METHODSThe authors implanted the ECOGIW-16E device over the left sensorimotor cortex of a nonhuman primate (Macaca fascicularis), recording ECoG signals over a time span of 6 months. Daily electrode impedances were measured, aiming to maintain the impedance values below a threshold of 100 KΩ. Brain mapping was obtained through wireless cortical stimulation at fixed intervals (1, 3, and 6 months). After 6 months, the device was removed. The authors analyzed cortical tissues by using conventional histological and immunohistological investigation to assess whether there was evidence of damage after the long-term implantation of the grid.RESULTSThe implant was well tolerated; no neurological or behavioral consequences were reported in the monkey, which resumed his normal activities within a few hours of the procedure. The signal quality of wireless ECoG remained excellent over the 6-month observation period. Impedance values remained well below the threshold value; the average impedance per contact remains approximately 40 KΩ. Wireless cortical stimulation induced movements of the upper and lower limbs, and elicited fine movements of the digits as well. After the monkey was euthanized, the grid was found to be encapsulated by a newly formed dural sheet. The grid removal was performed easily, and no direct adhesions of the grid to the cortex were found. Conventional histological studies showed no cortical damage in the brain region covered by the grid, except for a single microscopic spot of cortical necrosis (not visible to the naked eye) in a region that had undergone repeated procedures of electrical stimulation. Immunohistological studies of the cortex underlying the grid showed a mild inflammatory process.CONCLUSIONSThis preliminary experience in a nonhuman primate shows that a wireless neuroprosthesis, with related long-term ECoG recording (up to 6 months) and multiple DCSs, was tolerated without sequelae. The authors predict that epilepsy surgery could realize great benefit from this novel prosthesis, providing an extended time span for ECoG recording.
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Affiliation(s)
| | - Marco Piangerelli
- 2Computer Science Division, School of Science and Technology, University of Camerino, Italy; and
| | - David Ratel
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | - Christophe Gaude
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | - Thomas Costecalde
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | | | | | - Alim Benabid
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | - Napoleon Torres
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
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Frassanito M, Restini E, Capozzo A, Romanelli P. 165. Periheral dose in a Cyberknife treatment: The case of a pregnant woman. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.176] [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: 10/27/2022] Open
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Volpe S, Jereczek-Fossa BA, Zerini D, Rojas DP, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Dicuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. Case series on multiple prostate re-irradiation for locally recurrent prostate cancer: something ventured, something gained. Neoplasma 2018; 66:308-314. [PMID: 30509110 DOI: 10.4149/neo_2018_180723n520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/16/2018] [Indexed: 11/08/2022]
Abstract
The aim is to present the technical feasibility and efficacy of multiple re-irradiation (re-EBRT) for local recurrence of prostate cancer (PCa) using retrospective analysis of an updated series of patients who received ablative re-EBRT with stereotactic image-guided technique for isolated local recurrence of PCa. Eight patients received three RT courses (2 re-RTs); of those 2 received 4 RT courses (3 re-RTs). Local relapse in the prostate was assessed by multiparametric magnetic resonance and/ or choline positron emission tomography. Before treatment planning, all patients had been evaluated for late toxicity from previous RT according to RTOG/EORTC. Biochemical control was assessed according to Phoenix definition. Mean age at the third RT course was 68 (standard deviation, SD: 7.2); all patients had a good performance status. At diagnosis, four cases were classified as high risk PCa, three as intermediate and one as low per NCCN 2017. Biochemical progression free interval after first and second RT-course were 74 (IQR: 59.3-133.6) months and 33 (IQR: 20.8-53.1) months, respectively. Biochemical and radiological response was registered in all patients. At present, seven out of eight patients are disease free. Overall toxicity profile was good; no severe acute or late genitourinary or gastrointestinal events were recorded. Multiple RT courses with high precision technology and image guidance can be proposed as a possible salvage therapy for locally recurrent, low-burden PCa recurrence in adequately selected patients. Deeper understanding of radiobiological effects of hypofractionation and larger series of patients are warranted to fully evaluate the applicability of multiple RT courses in the setting of locally recurrent PCa.
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Affiliation(s)
- S Volpe
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - B Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - D Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - D Patricia Rojas
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - P Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Vigorito
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - P De Marco
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | | | - G Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - G Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Scientific Directorate, European Institute of Oncology, Milan, Italy
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Romanelli P, Conti A, Bianchi L, Bergantin A, Martinotti A, Beltramo G. Image-Guided Robotic Radiosurgery for Trigeminal Neuralgia. Neurosurgery 2018; 83:1023-1030. [PMID: 29294132 PMCID: PMC6195178 DOI: 10.1093/neuros/nyx571] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 12/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frameless, non-isocentric irradiation of an extended segment of the trigeminal nerve introduces new concepts in stereotactic radiosurgery for medically resistant trigeminal neuralgia (TN). OBJECTIVE To report the results of the largest single-center experience about image-guided robotic radiosurgery for TN. METHODS A cohort of 138 patients treated with CyberKnife® (Accuray Incorporated, Sunnyvale, California) radiosurgery with a minimum follow-up of 36 mo were recruited. Pain relief, medications, sensory disturbances, rate and time of pain recurrence were prospectively analyzed. RESULTS Median follow-up was 52.4 mo; median dose 75 Gy; median target length 5.7-mm; median target volume 40 mm³; median prescription dose 60 Gy (80% isodose line). Actuarial pain control rate (Barrow Neurological Institute [BNI] class I-IIIa) at 6, 12, 24, and 36 mo were 93.5%, 85.8%, 79.7%, and 76%, respectively. Overall, 33 patients (24%) required a second treatment. Overall, 18.1% developed sensory disturbances after 16.4 ± 8.7 mo. One patient (0.7%) developed BNI grade IV dysfunction; 6 (4.3%) developed BNI grade III (somewhat bothersome) hypoesthesia after retreatment; BNI grade II (not bothersome) hypoesthesia was reported by 18 patients (11 after retreatment). Shorter nerve length (<6 mm vs 6 mm), smaller nerve volume (<30 mm3 vs >30 mm3), and lower prescription dose (<58 vs >58 Gy) were associated with treatment failure (P = .01, P = .02, P = .03, respectively). Re-irradiation independently predicted sensory disturbance (P < .001). CONCLUSION Targeting a 6-mm segment of the trigeminal nerve with a prescribed dose of 60 Gy appears safe and effective. Persistent pain control was achieved in most patients with acceptable risk of sensory complications, which were typically found after re-irradiation.
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Affiliation(s)
| | - Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
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Pantelis E, Moutsatsos A, Antypas C, Zoros E, Pantelakos P, Lekas L, Romanelli P, Zourari K, Hourdakis CJ. On the total system error of a robotic radiosurgery system: phantom measurements, clinical evaluation and long-term analysis. Phys Med Biol 2018; 63:165015. [PMID: 30033940 DOI: 10.1088/1361-6560/aad516] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The total system error (TSE) of a CyberKnife® system was measured using two phantom-based methods and one patient-based method. The standard radiochromic film (RCF) end-to-end (E2E) test using an anthropomorphic head and neck phantom and isocentric treatment delivery was used with the 6Dskull, Fiducial and Xsight® spine (XST) tracking methods. More than 200 RCF-based E2E results covering the period from installation in 2006 until 2017 were analyzed with respect to tracking method, system hardware and software versions, secondary collimation system, and years since installation. An independent polymer gel E2E method was also applied, involving a 3D printed head phantom and multiple spherical target volumes widely distributed within the brain. Finally, the TSE was assessed by comparing the delineated target in the planning computed tomography images of a patient treated for a thalamic functional target with the radiation-induced lesion defined on the six-month follow-up magnetic resonance (MR) images. Statistical analysis of the RCF-based TSE results showed mean ± standard deviation values of 0.40 ± 0.18 mm, 0.40 ± 0.19 mm, and 0.55 ± 0.20 mm for the 6Dskull, Fiducial, and XST tracking methods, respectively. Polymer gel TSE values smaller than 0.66 mm were found for seven targets distributed within the brain, showing that the targeting accuracy of the system is sustained even for targets situated up to 80 mm away from the center of the skull. An average clinical TSE value of 0.87 ± 0.25 mm was also measured using the FSE T2 and FLAIR post-treatment MR image data. Analysis of the long-term RCF-based E2E tests showed no changes of TSE over time. This study is the first to report long-term (>10 years) analysis of TSE, TSE measurement for targets positioned at large distances from the virtual machine isocenter, or a clinical assessment of TSE for the CyberKnife system. All of these measurements demonstrate TSE consistently < 1 mm.
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Affiliation(s)
- E Pantelis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece. CyberKnife and TomoTherapy department, Iatropolis Clinic, 54-56 Ethnikis Antistaseos, 15231 Athens, Greece
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Abstract
Hypothalamic hamartomas (HH) are deep-seated lesions often associated with catastrophic epilepsy (an epileptic syndrome characterized by severe, drug-refractory seizures eventually leading to mental retardation and death). Radical microsurgical resection is not feasible for lesions located within the wall of the third ventricle inside the hypothalamus. Frame-based stereotactic radiosurgery has been reported as an effective treatment modality for small- to medium-size intrahypothalamic hamartomas, providing excellent seizure outcomes without lasting complications. This report describes the use of frameless image-guided robotic radiosurgery (CyberKnife® Radiosurgery System) as a first-line treatment in two children with catastrophic epilepsy induced by HH. Both patients experienced multiple-daily complex partial and gelastic seizures, as well as almost daily generalized seizures. The prescribed dose was 16 Gy (to the 65% isodose for case I; to the 70% isodose for case II). Lesional volume was 11.5 cc (case I) and 8.9 cc (case II). A steady reduction of the seizure frequency and severity was achieved after the treatment, starting about three months after the treatment. The generalized seizures disappeared within one year, while complete resolution of the gelastic seizures required up to 18 months. No seizure recurrence and no radiation-induced side effects or complications were witnessed over a follow-up period of ten years and eight months (case I) and nine years and seven months (case II) since the treatment. CyberKnife radiosurgery proved to be a safe and effective non-invasive first-line treatment in these two children with catastrophic epilepsy caused by HH.
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Brueggen M, Djamei V, Oro S, Wolkenstein P, Kabashima K, Li Y, Galimberti F, Romanelli P, French L. 435 IRTEN - An international registry for toxic epidermal necrolysis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cavallin L, Ma Q, Naipauer J, Romanelli P, Goldschmidt P, Mesri E. 145 Kshv-dependent activation of PDGF receptor-α signaling is an oncogenic driver in kaposi's sarcoma. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barbone GE, Bravin A, Romanelli P, Mittone A, Bucci D, Gaaβ T, Le Duc G, Auweter S, Reiser MF, Kraiger MJ, Hrabě de Angelis M, Battaglia G, Coan P. Micro-imaging of Brain Cancer Radiation Therapy Using Phase-contrast Computed Tomography. Int J Radiat Oncol Biol Phys 2018; 101:965-984. [PMID: 29976510 DOI: 10.1016/j.ijrobp.2018.03.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Experimental neuroimaging provides a wide range of methods for the visualization of brain anatomic morphology down to subcellular detail. Still, each technique-specific detection mechanism presents compromises among the achievable field-of-view size, spatial resolution, and nervous tissue sensitivity, leading to partial sample coverage, unresolved morphologic structures, or sparse labeling of neuronal populations and often also to obligatory sample dissection or other sample invasive manipulations. X-ray phase-contrast imaging computed tomography (PCI-CT) is an experimental imaging method that simultaneously provides micrometric spatial resolution, high soft-tissue sensitivity, and ex vivo full organ rodent brain coverage without any need for sample dissection, staining or labeling, or contrast agent injection. In the present study, we explored the benefits and limitations of PCI-CT use for in vitro imaging of normal and cancerous brain neuromorphology after in vivo treatment with synchrotron-generated x-ray microbeam radiation therapy (MRT), a spatially fractionated experimental high-dose radiosurgery. The goals were visualization of the MRT effects on nervous tissue and a qualitative comparison of the results to the histologic and high-field magnetic resonance imaging findings. METHODS AND MATERIALS MRT was administered in vivo to the brain of both healthy and cancer-bearing rats. At 45 days after treatment, the brain was dissected out and imaged ex vivo using propagation-based PCI-CT. RESULTS PCI-CT visualizes the brain anatomy and microvasculature in 3 dimensions and distinguishes cancerous tissue morphology, necrosis, and intratumor accumulation of iron and calcium deposits. Moreover, PCI-CT detects the effects of MRT throughout the treatment target areas (eg, the formation of micrometer-thick radiation-induced tissue ablation). The observed neurostructures were confirmed by histologic and immunohistochemistry examination and related to the micro-magnetic resonance imaging data. CONCLUSIONS PCI-CT enabled a unique 3D neuroimaging approach for ex vivo studies on small animal models in that it concurrently delivers high-resolution insight of local brain tissue morphology in both normal and cancerous micro-milieu, localizes radiosurgical damage, and highlights the deep microvasculature. This method could assist experimental small animal neurology studies in the postmortem evaluation of neuropathology or treatment effects.
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Affiliation(s)
- Giacomo E Barbone
- Department of Physics, Ludwig Maximilians University, Garching, Germany
| | - Alberto Bravin
- European Synchrotron Radiation Facility, Grenoble, France
| | | | | | - Domenico Bucci
- Department of Molecular Pathology, Neuropharmacology Section, I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - Thomas Gaaβ
- Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | | | - Sigrid Auweter
- Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | - Maximilian F Reiser
- Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | - Markus J Kraiger
- Institute of Experimental Genetics and German Mouse Clinic, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics and German Mouse Clinic, German Research Center for Environmental Health, Neuherberg, Germany; Department of Experimental Genetics, School of Life Science Weihenstephan, Technical University of Munich, Freising, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Giuseppe Battaglia
- Department of Molecular Pathology, Neuropharmacology Section, I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - Paola Coan
- Department of Physics, Ludwig Maximilians University, Garching, Germany; Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany.
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Volpe S, Jereczek Fossa B, Zerini D, Rojas D, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Di Cuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. EP-1555: Multiple re-irradiation for locally recurrent prostate cancer: proof of concept and clinical outcome. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Marvaso G, Fanetti G, Fodor C, Ricotti R, Ciardo D, Riva G, Volpe S, Rojas D, Zerini D, Romanelli P, Cambria R, Pansini F, Jereczek-Fossa B. PO-1084: Short-term RT for early PCa with concomitant boost to the DIL : QoL after the end of the accrual. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31394-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: 11/24/2022]
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33
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Romanelli P, Paiano M, Crocamo V, Beltramo G, Bergantin A, Pantelis E, Antypas C, Clerico A. Staged Image-guided Robotic Radiosurgery and Deferred Chemotherapy to Treat a Malignant Glioma During and After Pregnancy. Cureus 2018; 10:e2141. [PMID: 29632751 PMCID: PMC5880588 DOI: 10.7759/cureus.2141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 26-year-old pregnant woman with a fast-growing malignant deep-seated brain glioma was offered a therapeutic abortion to allow subsequent surgical resection. This option was refused by the mother, but the fast tumor growth placed the life of both mother and child at risk. A staged CyberKnife radiosurgery treatment was then planned, aiming to provide at least temporary tumor growth control and allow a safe delivery while keeping the doses received by the fetus well below the allowed doses. Growth control and the safe delivery of a healthy child were achieved after this first treatment. An intensive chemotherapy program based on the combination of Avastin, irinotecan, and Temodal was then started. Recurring tumor growth was treated with a second CyberKnife procedure while continuing the above chemotherapy protocol. At 43 months after the second CyberKnife procedure, the tumor had disappeared on magnetic resonance imaging. Neither mother nor child showed the neurological sequelae. Staged radiosurgery and deferred chemotherapy proved to be a safe and effective treatment to allow the delivery of a healthy child and the long-term control of an aggressive brain glioma.
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Fardone E, Pouyatos B, Bräuer-Krisch E, Bartzsch S, Mathieu H, Requardt H, Bucci D, Barbone G, Coan P, Battaglia G, Le Duc G, Bravin A, Romanelli P. Synchrotron-generated microbeams induce hippocampal transections in rats. Sci Rep 2018; 8:184. [PMID: 29317649 PMCID: PMC5760574 DOI: 10.1038/s41598-017-18000-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/04/2017] [Indexed: 12/22/2022] Open
Abstract
Synchrotron-generated microplanar beams (microbeams) provide the most stereo-selective irradiation modality known today. This novel irradiation modality has been shown to control seizures originating from eloquent cortex causing no neurological deficit in experimental animals. To test the hypothesis that application of microbeams in the hippocampus, the most common source of refractory seizures, is safe and does not induce severe side effects, we used microbeams to induce transections to the hippocampus of healthy rats. An array of parallel microbeams carrying an incident dose of 600 Gy was delivered to the rat hippocampus. Immunohistochemistry of phosphorylated γ-H2AX showed cell death along the microbeam irradiation paths in rats 48 hours after irradiation. No evident behavioral or neurological deficits were observed during the 3-month period of observation. MR imaging showed no signs of radio-induced edema or radionecrosis 3 months after irradiation. Histological analysis showed a very well preserved hippocampal cytoarchitecture and confirmed the presence of clear-cut microscopic transections across the hippocampus. These data support the use of synchrotron-generated microbeams as a novel tool to slice the hippocampus of living rats in a minimally invasive way, providing (i) a novel experimental model to study hippocampal function and (ii) a new treatment tool for patients affected by refractory epilepsy induced by mesial temporal sclerosis.
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Affiliation(s)
- Erminia Fardone
- European Synchrotron Radiation Facility (ESRF), Grenoble, France.,Department of Biological Science and Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Benoît Pouyatos
- Grenoble Institut des Neurosciences, Inserm U836, Université Joseph Fourier, Grenoble, France
| | | | - Stefan Bartzsch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,The Institute of Cancer Research, London, United Kingdom
| | - Hervè Mathieu
- Grenoble Institut des Neurosciences, Inserm U836, Université Joseph Fourier, Grenoble, France
| | - Herwig Requardt
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | | | - Giacomo Barbone
- Department of Physics, Ludwig Maximilians University, Garching, Germany
| | - Paola Coan
- Department of Physics, Ludwig Maximilians University, Garching, Germany.,Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
| | | | - Geraldine Le Duc
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | - Alberto Bravin
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | - Pantaleo Romanelli
- Brain Radiosurgery, Cyberknife Center, Centro Diagnostico Italiano (CDI), Milano, Italy.
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35
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Fardone E, Bravin A, Conti A, Bräuer-Krisch E, Requardt H, Bucci D, Le Duc G, Battaglia G, Romanelli P. Rat sensorimotor cortex tolerance to parallel transections induced by synchrotron-generated X-ray microbeams. Sci Rep 2017; 7:14290. [PMID: 29085040 PMCID: PMC5662592 DOI: 10.1038/s41598-017-14757-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/09/2017] [Indexed: 11/21/2022] Open
Abstract
Microbeam radiation therapy is a novel preclinical technique, which uses synchrotron-generated X-rays for the treatment of brain tumours and drug-resistant epilepsies. In order to safely translate this approach to humans, a more in-depth knowledge of the long-term radiobiology of microbeams in healthy tissues is required. We report here the result of the characterization of the rat sensorimotor cortex tolerance to microradiosurgical parallel transections. Healthy adult male Wistar rats underwent irradiation with arrays of parallel microbeams. Beam thickness, spacing and incident dose were 100 or 600 µm, 400 or 1200 µm and 360 or 150 Gy, respectively. Motor performance was carried over a 3-month period. Three months after irradiation rats were sacrificed to evaluate the effects of irradiation on brain tissues by histology and immunohistochemistry. Microbeam irradiation of sensorimotor cortex did not affect weight gain and motor performance. No gross signs of paralysis or paresis were also observed. The cortical architecture was not altered, despite the presence of cell death along the irradiation path. Reactive gliosis was evident in the microbeam path of rats irradiated with 150 Gy, whereas no increase was observed in rats irradiated with 360 Gy.
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Affiliation(s)
- Erminia Fardone
- European Synchrotron Radiation Facility, Grenoble, France.,Department of Biological Science and Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Alberto Bravin
- European Synchrotron Radiation Facility, Grenoble, France.
| | - Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
| | | | | | | | | | | | - Pantaleo Romanelli
- Centro Diagnostico Italiano, Brain Radiosurgery, Cyberknife Center, Milano, Italy. .,AB Medica, Lainate, Italy.
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Orecchia R, Surgo A, Muto M, Ferrari A, Piperno G, Gerardi MA, Comi S, Garibaldi C, Ciardo D, Bazani A, Golino F, Pansini F, Fodor C, Romanelli P, Maestri D, Scroffi V, Mazza S, Jereczek-Fossa BA. VERO® radiotherapy for low burden cancer: 789 patients with 957 lesions. Ecancermedicalscience 2016; 10:677. [PMID: 27729942 PMCID: PMC5045299 DOI: 10.3332/ecancer.2016.677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this retrospective study is to evaluate patient profile, feasibility, and acute toxicity of RadioTherapy (RT) delivered by VERO® in the first 20 months of clinical activity. Methods Inclusion criteria: 1) adult patients; 2) limited volume cancer (M0 or oligometastatic); 3) small extracranial lesions; 4) treatment between April 2012 and December 2013 and 5) written informed consent. Two techniques were employed: intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT). Toxicity was evaluated using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results Between April 2012 and December 2013, 789 consecutive patients (957 lesions) were treated. In 84% of them one lesion was treated and in 16% more than one lesion were treated synchronously/metachronously; first radiotherapy course in 85%, re-irradiation in 13%, and boost in 2% of cases. The treated region included pelvis 46%, thorax 38%, upper abdomen 15%, and neck 1%. Radiotherapy schedules included <5 and >5 fractions in 75% and 25% respectively. All patients completed the planned treatment and an acceptable acute toxicity was observed. Conclusions RT delivered by VERO® was administrated predominantly to thoracic and pelvic lesions (lung and urologic tumours) using hypofractionation. It is a feasible approach for limited burden cancer offering short and well accepted treatment with favourable acute toxicity profile. Further investigation including dose escalation and other available VERO® functionalities such as real-time dynamic tumour tracking is warranted in order to fully evaluate this innovative radiotherapy system.
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Affiliation(s)
- R Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy; Equally contributed to the article
| | - A Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Equally contributed to the article; Affiliation at the time of the study
| | - M Muto
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Affiliation at the time of the study
| | - A Ferrari
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - G Piperno
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - M A Gerardi
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Garibaldi
- Unit of Radiation Research, European Institute of Oncology, Milan, Italy
| | - D Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Bazani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Golino
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Pansini
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - P Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - D Maestri
- University of Milan, Milan, Italy; Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - V Scroffi
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Mazza
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - B A Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy
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Blanck O, Wang L, Baus W, Grimm J, Lacornerie T, Nilsson J, Luchkovskyi S, Cano IP, Shou Z, Ayadi M, Treuer H, Viard R, Siebert FA, Chan MKH, Hildebrandt G, Dunst J, Imhoff D, Wurster S, Wolff R, Romanelli P, Lartigau E, Semrau R, Soltys SG, Schweikard A. Inverse treatment planning for spinal robotic radiosurgery: an international multi-institutional benchmark trial. J Appl Clin Med Phys 2016; 17:313-330. [PMID: 27167291 PMCID: PMC5690905 DOI: 10.1120/jacmp.v17i3.6151] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/19/2016] [Accepted: 01/18/2016] [Indexed: 11/23/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is the accurate, conformal delivery of high‐dose radiation to well‐defined targets while minimizing normal structure doses via steep dose gradients. While inverse treatment planning (ITP) with computerized optimization algorithms are routine, many aspects of the planning process remain user‐dependent. We performed an international, multi‐institutional benchmark trial to study planning variability and to analyze preferable ITP practice for spinal robotic radiosurgery. 10 SRS treatment plans were generated for a complex‐shaped spinal metastasis with 21 Gy in 3 fractions and tight constraints for spinal cord (V14Gy<2 cc, V18Gy<0.1 cc) and target (coverage >95%). The resulting plans were rated on a scale from 1 to 4 (excellent‐poor) in five categories (constraint compliance, optimization goals, low‐dose regions, ITP complexity, and clinical acceptability) by a blinded review panel. Additionally, the plans were mathematically rated based on plan indices (critical structure and target doses, conformity, monitor units, normal tissue complication probability, and treatment time) and compared to the human rankings. The treatment plans and the reviewers' rankings varied substantially among the participating centers. The average mean overall rank was 2.4 (1.2‐4.0) and 8/10 plans were rated excellent in at least one category by at least one reviewer. The mathematical rankings agreed with the mean overall human rankings in 9/10 cases pointing toward the possibility for sole mathematical plan quality comparison. The final rankings revealed that a plan with a well‐balanced trade‐off among all planning objectives was preferred for treatment by most participants, reviewers, and the mathematical ranking system. Furthermore, this plan was generated with simple planning techniques. Our multi‐institutional planning study found wide variability in ITP approaches for spinal robotic radiosurgery. The participants', reviewers', and mathematical match on preferable treatment plans and ITP techniques indicate that agreement on treatment planning and plan quality can be reached for spinal robotic radiosurgery. PACS number(s): 87.55.de
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Affiliation(s)
- Oliver Blanck
- University Medical Center Schleswig-Holstein; Saphir Radiosurgery Cente.
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Piccolo F, Romano A, Rese A, D'Ippolito E, Pastore F, Romanelli P, Faraci L, Toska E, De Chiara V, Farella A, Solla R, Conson M, Liuzzi R, Cella L, Pacelli R. PO-0734: Justgin in the prevention of radio-induced vaginal mucositis. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rese A, D'Ippolito E, Piccolo F, Romanelli P, Romano A, Faraci L, Toska E, Pastore F, De Chiara V, Coppa L, Salzano G, Farella A, Solla R, Conson M, Cella L, Pacelli R. EP-1187: T-lysyal based cream (Repalysyal) in the prevention of acute skin toxicity in breast cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barbone G, Bravin A, Brun B, Mittone A, Le Duc G, Battaglia G, Romanelli P, Coan P. X-Ray Phase contrast micro-imaging in neuroscience. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Di Pietro P, Bucci D, De Fusco A, Le Duc G, Bräuer-Krisch E, Battaglia G, Romanelli P, Bravin A. Evaluation of long-term effects of synchrotron-generated microbeams on rat hippocampal neurogenesis. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pantelis E, Antypas C, Frassanito MC, Sideri L, Salvara K, Lekas L, Athanasiou O, Piperis M, Salvaras N, Romanelli P. Radiation dose to the fetus during CyberKnife radiosurgery for a brain tumor in pregnancy. Phys Med 2016; 32:237-41. [DOI: 10.1016/j.ejmp.2015.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022] Open
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Zippo AG, Romanelli P, Torres Martinez NR, Caramenti GC, Benabid AL, Biella GEM. A novel wireless recording and stimulating multichannel epicortical grid for supplementing or enhancing the sensory-motor functions in monkey (Macaca fascicularis). Front Syst Neurosci 2015; 9:73. [PMID: 26029061 PMCID: PMC4429233 DOI: 10.3389/fnsys.2015.00073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/22/2015] [Indexed: 02/03/2023] Open
Abstract
Artificial brain-machine interfaces (BMIs) represent a prospective step forward supporting or replacing faulty brain functions. So far, several obstacles, such as the energy supply, the portability and the biocompatibility, have been limiting their effective translation in advanced experimental or clinical applications. In this work, a novel 16 channel chronically implantable epicortical grid has been proposed. It provides wireless transmission of cortical recordings and stimulations, with induction current recharge. The grid has been chronically implanted in a non-human primate (Macaca fascicularis) and placed over the somato-motor cortex such that 13 electrodes recorded or stimulated the primary motor cortex and three the primary somatosensory cortex, in the deeply anaesthetized animal. Cortical sensory and motor recordings and stimulations have been performed within 3 months from the implant. In detail, by delivering motor cortex epicortical single spot stimulations (1-8 V, 1-10 Hz, 500 ms, biphasic waves), we analyzed the motor topographic precision, evidenced by tunable finger or arm movements of the anesthetized animal. The responses to light mechanical peripheral sensory stimuli (blocks of 100 stimuli, each single stimulus being <1 ms and interblock intervals of 1.5-4 s) have been analyzed. We found 150-250 ms delayed cortical responses from fast finger touches, often spread to nearby motor stations. We also evaluated the grid electrical stimulus interference with somatotopic natural tactile sensory processing showing no suppressing interference with sensory stimulus detection. In conclusion, we propose a chronically implantable epicortical grid which can accommodate most of current technological restrictions, representing an acceptable candidate for BMI experimental and clinical uses.
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Affiliation(s)
- Antonio G Zippo
- Institute of Molecular Bioimaging and Physiology, National Research Council Segrate, Italy
| | | | - Napoleon R Torres Martinez
- Commissariat à l'Energie Atomique et aux Energies Alternatives, Laboratoire d' Électronique des Technologies de l'Information, CLINATEC Grenoble, France
| | | | - Alim L Benabid
- Commissariat à l'Energie Atomique et aux Energies Alternatives, Laboratoire d' Électronique des Technologies de l'Information, CLINATEC Grenoble, France
| | - Gabriele E M Biella
- Institute of Molecular Bioimaging and Physiology, National Research Council Segrate, Italy
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Piangerelli M, Ciavarro M, Paris A, Marchetti S, Cristiani P, Puttilli C, Torres N, Benabid AL, Romanelli P. A fully integrated wireless system for intracranial direct cortical stimulation, real-time electrocorticography data transmission, and smart cage for wireless battery recharge. Front Neurol 2014; 5:156. [PMID: 25202300 PMCID: PMC4142710 DOI: 10.3389/fneur.2014.00156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/31/2014] [Indexed: 11/18/2022] Open
Abstract
Wireless transmission of cortical signals is an essential step to improve the safety of epilepsy procedures requiring seizure focus localization and to provide chronic recording of brain activity for Brain Computer Interface (BCI) applications. Our group developed a fully implantable and externally rechargeable device, able to provide wireless electrocorticographic (ECoG) recording and cortical stimulation (CS). The first prototype of a wireless multi-channel very low power ECoG system was custom-designed to be implanted on non-human primates. The device, named ECOGIW-16E, is housed in a compact hermetically sealed Polyether ether ketone (PEEK) enclosure, allowing seamless battery recharge. ECOGIW-16E is recharged in a wireless fashion using a special cage designed to facilitate the recharge process in monkeys and developed in accordance with guidelines for accommodation of animals by Council of Europe (ETS123). The inductively recharging cage is made up of nylon and provides a thoroughly novel experimental setting on freely moving animals. The combination of wireless cable-free ECoG and external seamless battery recharge solves the problems and shortcomings caused by the presence of cables leaving the skull, providing a safer and easier way to monitor patients and to perform ECoG recording on primates. Data transmission exploits the newly available Medical Implant Communication Service band (MICS): 402–405 MHz. ECOGIW-16E was implanted over the left sensorimotor cortex of a macaca fascicularis to assess the feasibility of wireless ECoG monitoring and brain mapping through CS. With this device, we were able to record the everyday life ECoG signal from a monkey and to deliver focal brain stimulation with movement elicitation.
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Affiliation(s)
- Marco Piangerelli
- Computer Science Division, School of Science and Technology, University of Camerino , Camerino , Italy
| | | | | | | | | | | | - Napoleon Torres
- Clinatec, Laboratoire d' Électronique des Technologies de l'Information (LETI), Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) , Grenoble , France
| | - Alim Louis Benabid
- Clinatec, Laboratoire d' Électronique des Technologies de l'Information (LETI), Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) , Grenoble , France
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Antypas C, Pantelis E, Sideri L, Salvara K, Lekas L, Romanelli P, Tzouras A, Salvaras N. Fetal dose measurement on a pregnant patient undergoing single fraction CyberKnife radiosurgery. Phys Med 2014. [DOI: 10.1016/j.ejmp.2014.07.211] [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: 11/29/2022] Open
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Striano P, Pezzella M, Malova M, Consales A, Romanelli P. Stereotactic radiosurgery for treatment of drug-resistant epilepsy: state of the art and emerging applications. Cureus 2013. [DOI: 10.7759/cureus.148] [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: 11/05/2022] Open
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Anschel D, Romanelli P, Bravin A, Qhanum F, Bräuer-Krisch E, Le Duc G. Video-EEG Analysis Following Microradiosurgical Transections of Rat Sensorimotor Cortex Seizure Focus. Cureus 2013. [DOI: 10.7759/cureus.145] [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: 11/05/2022] Open
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Romanelli P, Nishimoto R, Suarez R, Decia R, Abreu D, Machado M, Arroyo C, Campolo H, Campos E, Carlos A, Tobias-Machado M. Video endoscopic inguinal lymphadenectomy: surgical and oncological results. Actas Urol Esp 2013; 37:305-10. [PMID: 23433745 DOI: 10.1016/j.acuro.2012.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/27/2012] [Indexed: 02/05/2023]
Abstract
INTRODUCTION We evaluated the reproducibility of video endoscopic inguinal lymphadenectomy (VEIL) and we report our initial experience in the treatment of penile cancer with palpable inguinal lymph nodes. MATERIAL AND METHODS From July 2006 to November 2010 were conducted 33 VEIL in 20 patients as complementary treatment for penile cancer in two referral hospitals in Latin America. We analyzed the epidemiological and clinical characteristics of patients and surgical and oncologic outcomes. RESULTS Fifty-five percent of the patients included were clinical stage N0 and 45% were N +. Thirteen patients underwent bilateral VEIL and the remaining seven underwent VEIL unilateral and conventional open surgery in the contralateral limb. The average operative time for VEIL was 119 minutes and mean resected lymph nodes was 8 per lymphadenectomy. The overall complication rate was 33.2%. No patient had skin necrosis. The lymphatic complication rate was 27.2%. Of the 6 cases in which the saphenous vein was preserved (18.2%) there were no lymphatic complications (P=,2). The overall survival rate was 80% and cancer-specific survival was 90%. Mean follow-up was 20 months. CONCLUSIONS VEIL in the adjunctive treatment of penile cancer is safe, reproducible and may be an alternative to conventional lymphadenectomy. Patients with palpable lymphadenopathy also may benefit from this technique. Oncological results seem to be adequate however require longer follow-up to be confirmed.
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Bijlani A, Aguzzi G, Schaal DW, Romanelli P. Stereotactic radiosurgery and stereotactic body radiation therapy cost-effectiveness results. Front Oncol 2013; 3:77. [PMID: 23580234 PMCID: PMC3619246 DOI: 10.3389/fonc.2013.00077] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/27/2013] [Indexed: 12/24/2022] Open
Abstract
Objective: To describe and synthesize the current stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) cost-effectiveness research to date across several common SRS and SBRT applications. Methods: This review was limited to comparative economic evaluations of SRS, SBRT, and alternative treatments (e.g., other radiotherapy techniques or surgery). Based on PubMed searches using the terms, “stereotactic,” “SRS,” “stereotactic radiotherapy,” “stereotactic body radiotherapy,” “SBRT,” “stereotactic ablative radiotherapy,” “economic evaluation,” “quality adjusted life year (QALY),” “cost,” “cost-effectiveness,” “cost-utility,” and “cost analysis,” published studies of cost-effectiveness and health economics were obtained. Included were articles in peer-reviewed journals that presented a comparison of costs between treatment alternatives from January 1997 to November 2012. Papers were excluded if they did not present cost calculations, therapeutic cost comparisons, or health economic endpoints. Results: Clinical outcomes and costs of SRS and SBRT were compared to other therapies for treatment of cancer in the brain, spine, lung, prostate, and pancreas. Treatment outcomes for SRS and SBRT are usually superior or comparable, and cost-effective, relative to alternative techniques. Conclusion: Based on the review of current SRS and SBRT clinical and health economic literature, from a patient perspective, SRS and SBRT provide patients a clinically effective treatment option, while from the payer and provider perspective, SRS and SBRT demonstrate cost savings.
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