1
|
Inglese M, Ferrante M, Boccato T, Conti A, Pistolese CA, Buonomo OC, D'Angelillo RM, Toschi N. Dynomics: A Novel and Promising Approach for Improved Breast Cancer Prognosis Prediction. J Pers Med 2023; 13:1004. [PMID: 37373993 DOI: 10.3390/jpm13061004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/03/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Traditional imaging techniques for breast cancer (BC) diagnosis and prediction, such as X-rays and magnetic resonance imaging (MRI), demonstrate varying sensitivity and specificity due to clinical and technological factors. Consequently, positron emission tomography (PET), capable of detecting abnormal metabolic activity, has emerged as a more effective tool, providing critical quantitative and qualitative tumor-related metabolic information. This study leverages a public clinical dataset of dynamic 18F-Fluorothymidine (FLT) PET scans from BC patients, extending conventional static radiomics methods to the time domain-termed as 'Dynomics'. Radiomic features were extracted from both static and dynamic PET images on lesion and reference tissue masks. The extracted features were used to train an XGBoost model for classifying tumor versus reference tissue and complete versus partial responders to neoadjuvant chemotherapy. The results underscored the superiority of dynamic and static radiomics over standard PET imaging, achieving accuracy of 94% in tumor tissue classification. Notably, in predicting BC prognosis, dynomics delivered the highest performance, achieving accuracy of 86%, thereby outperforming both static radiomics and standard PET data. This study illustrates the enhanced clinical utility of dynomics in yielding more precise and reliable information for BC diagnosis and prognosis, paving the way for improved treatment strategies.
Collapse
Affiliation(s)
- Marianna Inglese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK
| | - Matteo Ferrante
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Tommaso Boccato
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Allegra Conti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Chiara A Pistolese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Diagnostic Imaging, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Oreste C Buonomo
- U.O.S.D. Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Rolando M D'Angelillo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Radiation Oncology, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA 02129, USA
| |
Collapse
|
2
|
Guida AM, Sensi B, Formica V, D'Angelillo RM, Roselli M, Del Vecchio Blanco G, Rossi P, Capolupo GT, Caricato M, Sica GS. Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview. Biol Direct 2022; 17:16. [PMID: 35698084 PMCID: PMC9195214 DOI: 10.1186/s13062-022-00329-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022] Open
Abstract
Colorectal carcinoma is the second leading cause of cancer-related deaths, and indeed, rectal cancer accounting for approximately one third of newly diagnosed patients. Gold standard in the treatment of rectal cancer is a multimodality approach, aiming at a good control of the local disease. Distant recurrences are the major cause of mortality. Currently, Locally Advanced Rectal Cancer (LARC) patients undergo a combined treatment of chemotherapy and radiotherapy, followed by surgery. Eventually, more chemotherapy, namely adjuvant chemotherapy (aCT), may be necessary. Total Neoadjuvant Therapy (TNT) is an emerging approach aimed to reduce distant metastases and improve local control. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Published results were encouraging, but the heterogeneity of protocols in use, makes the comparison and interpretation of data rather complex. One of the major concerns regarding TNT administration is related to its effect on larger and more advanced cancers that might not undergo similar down-staging as smaller, early-stage tumors. This minireview, based on a systematic literature search of randomized clinical trials and meta-analysis, summarizes current knowledge on TNT. The aim was to confirm or refute whether or not current practice of TNT is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. A tentative grouping of general study characteristics, clinical features and treatments characteristics has been undertaken to evaluate if the reported studies are sufficiently homogeneous in terms of subjects involved, interventions, and outcomes to provide a meaningful idea of which patients are more likely to gain from this treatment.
Collapse
Affiliation(s)
- Andrea M Guida
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | - Rolando M D'Angelillo
- Department of Biomedicine and Prevention, Radiation Oncology, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy
| | | | - Piero Rossi
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Gabriella T Capolupo
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Colorectal Surgery Unit, Campus Bio-Medico University, 00128, Rome, Italy
| | - Giuseppe S Sica
- Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy. .,Department of Surgery, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| |
Collapse
|
3
|
Dionisi F, Scartoni D, Rombi B, Vennarini S, Righetto R, Farace P, Lorentini S, Schwarz M, Di Murro L, Demofonti C, D'Angelillo RM, Petrongari MG, Sanguineti G, Amichetti M. Consolidative active scanning proton therapy for mediastinal lymphoma: selection criteria, treatment implementation and clinical feasibility. Strahlenther Onkol 2022; 198:558-565. [PMID: 35394144 DOI: 10.1007/s00066-022-01918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
AIMS Proton therapy (PT) represents an advanced form of radiotherapy with unique physical properties which could be of great advantage in reducing long-term radiation morbidity for cancer survivors. Here, we aim to describe the whole process leading to the clinical implementation of consolidative active scanning proton therapy treatment (PT) for mediastinal lymphoma. METHODS The process included administrative, technical and clinical issues. Authorization of PT is required in all cases as mediastinal lymphoma is currently not on the list of diseases reimbursable by the Italian National Health Service. Technically, active scanning PT treatment for mediastinal lymphoma is complex, due to the interaction between actively scanned protons and the usually irregular and large volumes to be irradiated, the nearby healthy tissues and the target motion caused by breathing. A road map to implement the technical procedures was prepared. The clinical selection of patients was of utmost importance and took into account both patient and tumor characteristics. RESULTS The first mediastinal lymphoma was treated at our PT center in 2018, four years after the start of the clinical activities. The treatment technique implementation included mechanical deep inspiration breath-hold simulation computed tomography (CT), clinical target volume (CTV)-based multifield optimization planning and plan robustness analysis. The ultimate authorization rate was 93%. In 4 cases a proton-photon plan comparison was required. Between May 2018 and February, 2021, 14 patients were treated with consolidative PT. The main clinical reasons for choosing PT over photons was a bulky disease in 8 patients (57%), patient's age in 11 patients (78%) and the proximity of the lymphoma to cardiac structures in 10 patients (71%). With a median follow-up of 15 months (range, 1-33 months) all patients but one (out-of-field relapse) are without evidence of disease, all are alive and no late toxicities were observed during the follow-up period. CONCLUSIONS The clinical implementation of consolidative active scanning PT for mediastinal lymphoma required specific technical procedures and a prolonged experience with PT treatments. An accurate selection of patients for which PT could be of advantage in comparison with photons is mandatory.
Collapse
Affiliation(s)
- F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy.
| | - D Scartoni
- Proton Therapy unit, APSS, Trento, Italy
| | - B Rombi
- Proton Therapy unit, APSS, Trento, Italy
| | | | - R Righetto
- Proton Therapy unit, APSS, Trento, Italy
| | - P Farace
- Proton Therapy unit, APSS, Trento, Italy
| | | | - M Schwarz
- Proton Therapy unit, APSS, Trento, Italy
| | - L Di Murro
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - C Demofonti
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - R M D'Angelillo
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - M G Petrongari
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - G Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | | |
Collapse
|
4
|
Francolini G, Bellini C, Di Cataldo V, Detti B, Bruni A, Alicino G, Triggiani L, La Mattina S, D'Angelillo RM, Demofonti C, Mazzola R, Cuccia F, Alongi F, Aquilano M, Allegra AG, Ciccone LP, Burchini L, Salvestrini V, Morelli I, Frosini G, Desideri I, Livi L. Pattern of Recurrence After Stereotactic Radiotherapy in Prostate Cancer Patients With Nodal Pelvic Relapse. A Multi-Institutional Retrospective Analysis. Clin Oncol (R Coll Radiol) 2021; 34:57-62. [PMID: 34598843 DOI: 10.1016/j.clon.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
AIMS Currently, when nodal pelvic oligorecurrent disease is detected, no standard treatment option is recommended. One possible salvage option is nodal stereotactic body radiotherapy (SBRT). Here we analysed recurrence patterns after nodal SBRT in patients affected by pelvic oligometastatic relapse after radical prostatectomy, and androgen deprivation therapy (ADT)-free survival in this population. MATERIALS AND METHODS Data on 93 patients consecutively treated in five different institutions for pelvic oligorecurrent disease were reviewed. Inclusion criteria were biochemical recurrence after radical prostatectomy and imaging showing three or fewer metachronous lymphoadenopathies under aortic bifurcation. Patients underwent SBRT on all sites of disease. Concomitant ADT was allowed. RESULTS After a median follow-up of 20 months (interquartile range 11-41), 57 patients had post-SBRT radiological evidence of relapse, for a median disease-free survival (DFS) of 15 months (95% confidence interval 9-24). Concomitant ADT was administered in 20 patients (21.5%). Overall, eight (8.6%), 21 (22.6%) and 28 (30.1%) patients had prostate bed only, pelvic nodal or distant relapse, respectively. The median ADT-free survival was not reached. Concomitant ADT, International Society for Urologic Pathology pattern at diagnosis < or ≥3, time to relapse ≤ or >12 months, prostate-specific antigen at recurrence < or ≥1.10 ng/ml and prostate-specific membrane antigen staging were not significantly associated with DFS. After relapse, 42 patients (45.2%) received a second SBRT course. CONCLUSION Nodal SBRT yielded encouraging DFS and ADT-free survival in this population. Only a minority of patients developed prostate bed recurrence, suggesting that local treatment may be safely avoided. A consistent percentage of patients could be managed with a second SBRT course.
Collapse
Affiliation(s)
- G Francolini
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - C Bellini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | | | - B Detti
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
| | - A Bruni
- Radiation Oncology Unit, Modena Hospital, Modena, Italy
| | - G Alicino
- Radiation Oncology Unit, Modena Hospital, Modena, Italy
| | - L Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - S La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - R M D'Angelillo
- Department of Radiation Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - C Demofonti
- Department of Radiation Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - R Mazzola
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - F Cuccia
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - F Alongi
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - M Aquilano
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - A G Allegra
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L Burchini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - I Morelli
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - G Frosini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - I Desideri
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| |
Collapse
|
5
|
DE Angeli M, Anzellini D, Arcangeli G, Bianchi P, Chiostrini C, Ciabattoni A, Costa AM, Del Bufalo S, Deodato F, DE Paula U, D'Ugo C, Fedele F, Genovesi D, Gentile P, Gravina GL, Marmiroli L, Mirri MA, Ramella S, Rosetto ME, Santarelli M, Tombolini V, Trodella L, Valentini V, Osti MF, D'Angelillo RM. Resilience in Radiotherapy Services During the COVID-19 Emergency: Collaboration Between the Regional Radiation Oncology Departments of Lazio, Abruzzo and Molise. Anticancer Res 2021; 41:3561-3565. [PMID: 34230151 DOI: 10.21873/anticanres.15143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022]
Abstract
AIM Radiation therapy is a cornerstone of oncological treatment and oncological patients show greater risk of developing complications related to COVID-19 infection. Stringent social restrictions have ensured a significant reduction in the spread of the virus, but also gave rise to a number of critical issues for radiation oncology wards. For this reason, the Directors of the Radiation Oncology Departments (RODs) of Lazio, Abruzzo and Molise regions shared their experience and ideas in order to create a common document that may assist in facing the negative impacts of the pandemic on radiation oncology wards and patients. PATIENTS AND METHODS The study was conducted according to the Estimate-Talk-Estimate method. Five issues were proposed and rated. Among approved issues, statements were proposed anonymously, then harmonized and finally voted on according to a Likert scale from 1 to 9. Those for which an agreement of 7-9 was observed were finally approved. RESULTS The document was developed with 42 statements dealing about safety measures for patients and staff, organization of clinical and work activities, usage of Information Technology systems for meetings/smart working. An agreement was recorded for 34 statements. CONCLUSION This document sets out some recommendations for RODs and can provide valuable management information for Oncological Radiotherapy wards.
Collapse
Affiliation(s)
- Martina DE Angeli
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy;
| | - Dimitri Anzellini
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Arcangeli
- Department of Radiation Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Cinzia Chiostrini
- Department of Radiation Oncology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | | | | | - Francesco Deodato
- Radiation Oncology Unit, Fondazione Giovanni Paolo II, Catholic University of Sacred Heart, Campobasso, Italy
| | - Ugo DE Paula
- Department of Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Carlo D'Ugo
- Radiotherapy Unit, Department of Oncology, AUSL 04, Teramo, Italy
| | | | - Domenico Genovesi
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Piercarlo Gentile
- Department of Radiation Oncology, San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Giovanni L Gravina
- Department of Radiation Oncology, Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Marmiroli
- U.O.C. Radiotherapy, S. Giovanni Calibita Fatebenefratelli Hospital - Amethyst Radioterapia Italia, Rome, Italy
| | - Maria A Mirri
- Department of Radiation Oncology, San Filippo Neri Hospital, Rome, Italy
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Maria E Rosetto
- Department of Radiation Oncology, Belcolle Hospital, Viterbo, Italy
| | - Mario Santarelli
- Department of Radiation Oncology, Ospedale San Camillo de Lellis, Rieti, Italy
| | - Vincenzo Tombolini
- Department of Radiation Oncology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Lucio Trodella
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Valentini
- Radiation Oncology Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mattia F Osti
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rolando M D'Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
6
|
Bottero M, Borzillo V, Pergolizzi S, Jereczek-Fossa BA, Ippolito E, Frezza GP, Fortunato L, Corvò R, Pappagallo GL, Arcangeli S, Magrini SM, D'Angelillo RM. The Italian Association of Radiotherapy and Oncology Recommendation for Breast Tumor Recurrence: Grades of Recommendation, Assessment, Development and Evaluation Criteria. J Breast Cancer 2021; 24:241-252. [PMID: 34128365 PMCID: PMC8250101 DOI: 10.4048/jbc.2021.24.e27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/10/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
Salvage mastectomy is currently considered the standard of care for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and postoperative radiotherapy (RT). Alternative treatment options for these patients, such as a second BCS followed by repeated RT, have been suggested. The panel of the Italian Association of Radiotherapy and Clinical Oncology developed clinical recommendations for second BCS followed by re-irradiation over mastectomy alone for women with IBTR using the Grades of Recommendation, Assessment, Development, and Evaluation methodology and the evidence to decision framework. The following outcomes were identified by the panel: locoregional control, metastasis-free survival, overall survival, and cancer-specific survival; acute and late toxicity, specific late toxicity, second locoregional tumor, and death related to treatment. An Embase and PubMed literature search was performed by two independent authors. Five retrospective observational studies were eligible for inclusion in the present analysis. According to the reports in the literature and our analysis, the advantages of second quadrantectomy and re-irradiation (re-QUART) outweigh its side effects, with overall good rates of survival and adequate toxicity without increasing costs. Given the very low level of evidence, the panel stated that a second BCS plus re-irradiation can be considered as an alternative to salvage mastectomy for selected patients with IBTR.
Collapse
Affiliation(s)
- Marta Bottero
- Department of Radiation Oncology, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Valentina Borzillo
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale - Napoli, Italy.
| | - Stefano Pergolizzi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Edy Ippolito
- Radioterapia Oncologica, Università Campus Bio-Medico, Roma, Italy
| | | | - Lucio Fortunato
- Centro di Senologia Azienda Ospedaliera San Giovanni-Addolorata, Roma, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, National Cancer Research Institute and University, Genova, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca," Milan, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, University of Brescia, Brescia, Italy
| | - Rolando M D'Angelillo
- Radioterapia, Dipartimento di Biomedicina e prevenzione, Università degli Studi di Roma Tor Vergata, Roma, Italy
| |
Collapse
|
7
|
Dicuonzo S, Pedretti S, Mangoni M, Monari F, Fanetti G, Borsatti E, Lombardi D, Vianello F, Iacobone M, Corvò R, Magrini SM, Pappagallo G, Arcangeli S, D'Angelillo RM. Adjuvant radiotherapy and radioiodine treatment for locally advanced differentiated thyroid cancer: systematic review and meta-analysis. Tumori 2021; 107:489-497. [PMID: 33722108 DOI: 10.1177/0300891621996817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment for locally advanced differentiated thyroid cancer is surgery followed by radioiodine while the role of adjuvant external beam radiotherapy (EBRT) is debated. METHODS The panel of the Italian Association of Radiotherapy and Clinical Oncology developed a clinical recommendation on the addition of EBRT to radioiodine after surgery for locally advanced differentiated thyroid cancer by using the Grades of Recommendation, Assessment, Development, and Evaluation methodology and the Evidence to Decision framework. A systematic review with meta-analysis about this topic was conducted with a focus on outcome of benefits and toxicity. RESULTS Locoregional control was improved by EBRT while no considerable toxicity impact was reported. CONCLUSION The panel judged uncertain the benefit/harms balance; final recommendation was conditional both for EBRT + radioiodine and radioiodine alone in the adjuvant setting.
Collapse
Affiliation(s)
- Samantha Dicuonzo
- Department of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Pedretti
- Department of Radiation Oncology, ASST Spedali Civili, Brescia, Italy
| | - Monica Mangoni
- Radiotherapy Unit, Department of Biomedical Experimental and Clinical Sciences University of Florence
| | - Fabio Monari
- Department of Radiation Oncology, Policlinico S. Orsola-Malpighi IRCCS AOSP, Bologna, Italy
| | - Giuseppe Fanetti
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano CRO IRCCS, Aviano, Italy
| | - Eugenio Borsatti
- Division of Nuclear Medicine, Centro di Riferimento Oncologico di Aviano CRO IRCCS, Aviano, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Federica Vianello
- Department of Radiation Oncology, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, Università degli Studi di Genova and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, University of Brescia, Brescia, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, ASST Monza and University of Milan Bicocca, Milan, Italy
| | - Rolando M D'Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| |
Collapse
|
8
|
de Paula U, D'Angelillo RM. In Reply to Sharma and Izzuddeen. Int J Radiat Oncol Biol Phys 2021; 109:1127. [PMID: 33610296 DOI: 10.1016/j.ijrobp.2020.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Ugo de Paula
- Department of Radiation Oncology, San Giovanni - Addolorata Hospital, Rome, Italy
| | - Rolando M D'Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome - Tor Vergata, Rome, Italy
| |
Collapse
|
9
|
Fiore M, Greco C, Coppola A, Caricato M, Caputo D, Trecca P, Floreno B, Rinaldi CG, Ippolito E, Capolupo GT, Grippo R, Beomonte Zobel B, D'Angelillo RM, Trodella L, Ramella S. Long-Term Results of a Prospective Phase 2 Study on Volume De-Escalation in Neoadjuvant Chemoradiotherapy of Rectal Cancer. Pract Radiat Oncol 2021; 11:e186-e194. [PMID: 33002647 DOI: 10.1016/j.prro.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE In the current study, we evaluated whether neoadjuvant chemoradiotherapy with reduced treatment volumes due to the exclusion of elective pelvic nodal irradiation is a feasible strategy for selected patients with locally advanced rectal cancer. METHODS AND MATERIALS Patients with T2 low-lying/T3, N0-N1 rectal lesions without evidence of disease in the lateral lymph nodes were prospectively recruited. All patients underwent pretreatment testing, including computed tomography imaging of the chest, abdomen, and pelvis with intravenous contrast, pelvic magnetic resonance imaging with intravenous contrast, and 18-fluorodeoxyglucose positron emission/computed tomography. The clinical target volume included the primary tumor and the mesorectum with vascular supply containing the perirectal and presacral nodes, with the upper border at the S2/S3 interspace. The total radiation dose was 50.4 Gy, and fluoropyrimidine-based chemotherapy was associated concomitantly. The primary endpoint of the study was the reduction of gastrointestinal (GI) toxicity, and the secondary endpoints were pathologic complete response, local control, overall survival, and disease-free survival. RESULTS Fifty-two patients (30 men, 22 women) with a median age of 67 years (range, 45-85 years) were enrolled in the study. Acute grade 3 GI toxicity was 7.6%, and there were no cases of grade 4 toxicity. Three patients (5.7%) developed a local recurrence. No relapse occurred in the lateral lymph nodes. The local control rate at 5 years was 96.1%. With a median follow-up time of 72.9 months (range, 2.5-127.6 months), the 3- and 5-year overall survival rates were 89.4% and 87%, respectively. The 3- and 5-year disease-free survival rates were 82.4% and 82.4%, respectively. CONCLUSIONS De-escalation of radiation therapy target volume reduces GI side effects without compromising efficacy in patients with rectal cancer. These results cannot be clearly extended to high-risk disease and need further evaluation in future randomized trials.
Collapse
Affiliation(s)
- Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy.
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Marco Caricato
- Geriatric Surgery, Campus Bio-Medico University, Rome, Italy
| | - Damiano Caputo
- General Surgery, Campus Bio-Medico University, Rome, Italy
| | - Pasquale Trecca
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Barnaba Floreno
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Carla G Rinaldi
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Raffaele Grippo
- Diagnostic Imaging, Campus Bio-Medico University, Rome, Italy
| | | | | | - Lucio Trodella
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| |
Collapse
|
10
|
Francolini G, Borghesi S, Fersino S, Magli A, Jereczek-Fossa BA, Cristinelli L, Rizzo M, Corvò R, Pappagallo GL, Arcangeli S, Magrini SM, D'Angelillo RM. Treatment of muscle-invasive bladder cancer in patients without comorbidities and fit for surgery: Trimodality therapy vs radical cystectomy. Development of GRADE (Grades of Recommendation, Assessment, Development and Evaluation) recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Crit Rev Oncol Hematol 2021; 159:103235. [PMID: 33493633 DOI: 10.1016/j.critrevonc.2021.103235] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/09/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
AIM To compare trimodality therapy (TMT) versus radical cystectomy (RC) and develop GRADE (Grades of Recommendation, Assessment, Development and Evaluation) Recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) for treatment of muscle-invasive bladder cancer (MIBC). MATERIAL AND METHODS Prospective and retrospective studies comparing TMT and RC for MIBC patients were included. Qualitative and quantitative evaluation of evidence was made. RESULTS Ten studies were included in the analysis. Pooled analysis showed salvage cystectomy and pathological complete response rates after TMT of 12 % and 72-77.5 %, respectively. Pooled rates of G3-G4 GU toxicity and serious toxicity rate were 18 vs 3% and 45 vs 29 % for patients undergoing TMT vs RC, respectively. The panel assessed a substantial equivalence in terms of OS and CSS at 5 years between TMT and RC. CONCLUSIONS TMT could be suggested as an alternative treatment to RC in non-metastatic MIBC patients, deemed fit for surgery.
Collapse
Affiliation(s)
- Giulio Francolini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Simona Borghesi
- Radiation Oncology Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy.
| | - Sergio Fersino
- Radiotherapy Division, Santa Chiara Hospital, Trento, Italy
| | - Alessandro Magli
- Department of Radiation Oncology, Udine General Hospital, Udine, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Luca Cristinelli
- Urology Department, ASST Spedali Civili di Brescia, Brescia University, Italy
| | - Mimma Rizzo
- Division of Translational Oncology, IRCCS ICS Maugeri, Pavia, Italy
| | - Renzo Corvò
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino - Genoa and University of Genoa, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, Ospedale S. Gerardo and University of Milan Bicocca, Milan, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, ASST Spedali Civili di Brescia, Brescia University, Italy
| | - Rolando M D'Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
11
|
Marino L, Lancellotta V, Franco P, Meattini I, Meduri B, Bernini M, Fabi A, Corvò R, Magrini SM, Pappagallo GL, Arcangeli S, D'Angelillo RM. Loco-regional adjuvant radiation therapy in breast cancer patients with positive axillary lymph-nodes at diagnosis (CN2) undergoing preoperative chemotherapy and with complete pathological lymph-nodes response. Development of GRADE (Grades of recommendation, assessment, Development and Evaluation) recommendation by the Italian Association of radiation therapy and Clinical Oncology (AIRO). Breast 2021; 55:119-127. [PMID: 33445150 PMCID: PMC7808946 DOI: 10.1016/j.breast.2020.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To perform a meta-analysis to determine the effect of loco-regional radiation therapy (RT) compared to no loco-regional RT for operated patients in clinical stage cN2 breast cancer at diagnosis and ypN0 after preoperative chemotherapy (PST). Material and Methods Eligible studies were identified through a systematic search of the medical literature performed independently by two researchers using a validated search strategy. An electronic search of Medline via PubMed and Embase (Breast cancer AND preoperative chemotherapy AND radiation therapy) was conducted with no language or publication status restrictions. The effect of loco-regional RT on overall (OS), disease free (DFS), loco-regional recurrence-free (LRRFS) survival and local recurrence was evaluated. An electronic search of Medline via PubMed and Embase (Toxicity AND radiation therapy breast cancer AND preoperative therapy; toxicity AND breast surgery AND preoperative chemotherapy) was conducted for outcomes of harm: major acute and late skin toxicity, lymphedema and cardiac events. Results Of 333 studies identified, 4 retrospective studies reporting on a total of 1107 patients were included in the meta-analysis. Six and 3 reported data of acute and late skin toxicity, while 2 studies provided information on cardiac events. Pooled results showed no difference in terms of hazard ratio for loco-regional RT versus no loco-regional RT [hazard ratio (HR) = 0.82, 95% confidence interval (CI) 0.63–1.68]. Loco-regional RT was associated with an OS benefit in the subgroup analysis: IIIB-C (loco-regional RT 79.3% vs no loco-regional RT 71.2%, p = 0.027) and T3-T4 (loco-regional RT 82.6% vs no loco-regional RT 76.6%, p = 0.025). No difference was shown in terms of 5-year DFS (loco-regional RT 91.2% vs no loco-regional RT 83%, p = 0.441) and LRRFS (loco-regional RT 98.1% vs no loco-regional RT 92.3%, p = 0.148). There was no significant difference between the groups in terms of acute and late skin toxicities, lymphedema and cardiac events. Conclusions Because of the limitations due to the small number of studies and heterogeneity in the analysis, the present study does not allow to draw any definitive conclusion, highlighting the need for well-controlled trials to determine the effect of loco-regional RT in patients with cN2 having a pathological complete response in the axillary nodes after preoperative chemotherapy. The prognostic impact of pCR after primary systemic therapy on DFS and OS has been shown in meta-analyses of randomized phase III trials. The association of treatment response with loco-regional recurrence has been studied only in retrospective reports. RNI should be strongly considered in patients with clinically involved lymph nodes regardless of the response to primary systemic therapy, especially in the presence of further risk factors. In patients with cN2 at diagnosis and ypN0 at surgery after PST, loco-regional RT should be evaluated for each patient in the multidisciplinary team.
Collapse
Affiliation(s)
- Lorenza Marino
- Radiotherapy Oncology Department, Humanitas-Istituto Clinico Catanese, Misterbianco (CT), Italy
| | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Roma, Italy.
| | - Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, School of Medicine, University of Turin, Turin, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Bruno Meduri
- Radiation Oncology Unit, University Hospital of Modena, Modena, Italy
| | - Marco Bernini
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Alessandra Fabi
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy; La Sapienza University, Rome, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Genoa, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, ASST Ospedali Civili and Brescia University, Brescia, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca", Milan, Italy
| | - Rolando M D'Angelillo
- Radiotherapy, Dipartimento di Biomedicina e Prevenzione, Università Degli Studi di Roma Tor Vergata, Rome, Italy
| |
Collapse
|
12
|
Santini D, Cinieri S, Gasparro D, Bordonaro R, Guglielmini PF, Chiuri VE, D'Angelillo RM, Ceresoli GL, Fagnani D, Acquati M, Mencoboni M, Lanzetta G, Sartori D, Carlini P, Panebianco F, Beccaglia P, Procopio G. Effects of abiraterone acetate plus prednisone on bone turnover markers in chemotherapy-naïve mCRPC patients after ADT failure: A prospective analysis of the italian real-world study ABITUDE. J Bone Oncol 2020; 26:100341. [PMID: 33425672 PMCID: PMC7779770 DOI: 10.1016/j.jbo.2020.100341] [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: 07/21/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022] Open
Abstract
Bone remodeling is disrupted in metastatic disease, affecting > 70% of mCRPC men. In metastatic disease, abnormal levels of specific BTMs are released. We prospectively measured four BTMs markers in chemotherapy-naïve mCRPC men on AAP therapy. AAP seems to act on the microenvironment of metastatic but not of normal bone. This action likely contributes to the antitumoral activity of AAP.
Background Bone remodeling is disrupted in metastatic disease, which affects > 70% of metastatic castration-resistant prostate cancer (mCRPC) patients. As a result, abnormal levels of specific bone turnover biomarkers (BTMs) are released. In this prospective ancillary analysis of the Italian real-world study ABITUDE, four markers were measured during abiraterone acetate plus prednisone (AAP) treatment in chemotherapy-naïve mCRPC men failing androgen-deprivation therapy. Methods Patients were enrolled if a blood sample was obtained before the first administration of abiraterone (baseline); ad-hoc blood samples were withdrawn during routine tests after 3, 6, and 12 months. A centralized lab measured bone alkaline phosphatase (BALP, osteoblast activity marker), type-I collagen-C-telopeptide (CTX-1, bone resorption marker), parathyroid hormone (PTH) and vitamin D (vitD). At each time point, intra-patient variations vs baseline were compared by the signed-rank test (statistical significance: P-value < 0.05). Results Of 481 patients enrolled in ABITUDE, 186 (median age: 76 [range: 53–93] years) met the substudy criteria: 74.7% had bone metastases, 11.8% were on bone-targeted therapies (BTT) and 14.0% on vitD supplementation. BALP decreased significantly at month 6 (P = 0.0010) and 12 (P < 0.0001) and CTX-1 at month 6 (P = 0.0028); PTH increased at month 3 (P < 0.0001); no significant difference in vitD levels was observed. Similar findings were observed in BTT-untreated patients. The reduction in BALP and CTX-1 levels was more pronounced in patients with than without bone metastases; in the latter group, no significant variation in BALP and CTX-1 levels was observed. Conclusions AAP seems to exert an effect on the microenvironment of metastatic but not of normal bone, which likely contributes to its antitumoral activity.
Collapse
Affiliation(s)
- Daniele Santini
- Department of Oncology, Campus Bio-Medico University, Rome, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Antonio Perrino Hospital, Brindisi, Italy
| | - Donatello Gasparro
- Medical Oncology Unit, Department of General & Specialistic Medicine, University Hospital of Parma, Italy
| | | | | | | | | | | | | | - Mirko Acquati
- Unit of Medical Oncology, Azienda Ospedaliera San Gerardo, Monza, Italy
| | | | - Gaetano Lanzetta
- Department Oncology and Palliative Care, INI Grottaferrata, Rome, Italy
| | | | - Paolo Carlini
- Division of Medical Oncology 1, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabiana Panebianco
- Medical Affairs Department, Oncology, Janssen-Cilag SpA, Cologno Monzese, Milan, Italy
| | - Patrizia Beccaglia
- Medical Affairs Department, Oncology, Janssen-Cilag SpA, Cologno Monzese, Milan, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
13
|
Ramella S, D'Angelillo RM. Proton beam or photon beam radiotherapy in the treatment of non-small-cell lung cancer. Lancet Oncol 2020; 21:873-875. [PMID: 32615102 DOI: 10.1016/s1470-2045(20)30246-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Sara Ramella
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome 00168, Italy.
| | | |
Collapse
|
14
|
Fiore M, Trecca P, Perrone G, Amato M, Righi D, Trodella L, D'Angelillo RM, Ramella S. Histologic transformation to small-cell lung cancer following gefitinib and radiotherapy in a patient with pulmonary adenocarcinoma. Tumori 2019; 105:NP12-NP16. [PMID: 30799776 DOI: 10.1177/0300891619832261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Targeted therapies against epidermal growth factor receptor (EGFR) have revolutionized the treatment of a subset of lung adenocarcinomas that have EGFR-activating mutations; however, all patients treated with EGFR tyrosine kinase inhibitors (TKIs) ultimately develop resistance. Histologic transformation of EGFR-mutant adenocarcinoma to small cell lung cancer (SCLC) is a resistance mechanism rarely reported in the literature. CASE PRESENTATION We describe the case of a woman with metastatic lung cancer adenocarcinoma with mutated EGFR with an initial response to gefitinib and radiation therapy, who progressed after 18 months due to the development of a resistance mechanism. The new biopsy performed after progression highlighted histologic transformation to SCLC, while maintaining the original EGFR mutation. CONCLUSIONS To better identify patients who progress after TKIs and radiation therapy, it is important to perform tumor rebiopsy and collect data to study mechanisms of acquired EGFR TKI resistance.
Collapse
Affiliation(s)
- Michele Fiore
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Pasquale Trecca
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Perrone
- Anatomical Pathology Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Michelina Amato
- Anatomical Pathology Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Daniela Righi
- Anatomical Pathology Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Lucio Trodella
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | | | - Sara Ramella
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| |
Collapse
|
15
|
Affiliation(s)
| | - Sara Ramella
- Department of Radiation Oncology, Università Campus Bio-Medico, Rome, Italy
| |
Collapse
|
16
|
Ramella S, Ippolito E, Fiore M, Greco C, Iurato A, Trodella LE, Floreno B, Di Donato A, D'Angelillo RM, Trodella L. The Role of Mammography after Breast-Conserving Surgery and Adjuvant Chemotherapy. Tumori 2018; 99:199-203. [DOI: 10.1177/030089161309900213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To investigate the impact of postchemotherapy mammography on radiotherapy timing and detection of early locoregional recurrences in breast cancer patients treated with breast-conserving surgery and adjuvant chemotherapy. Methods Bilateral mammography was performed before radiotherapy. Mammogram assessments were collected using the Breast Imaging Reporting and Data System (BI-RADS) scale. Differences in waiting times for radiotherapy between patients who needed further evaluation after mammograms and who did not were tested by the nonparametric Mann-Whitney U test. Results A total of 277 patients who underwent locoregional restaging after conservative surgery and adjuvant chemotherapy were evaluated. All patients had surgical margins greater than 2 mm. No locoregional recurrences were detected. Only in 2 patients (0.7%) did preradiotherapy mammograms reveal a contralateral breast cancer, which was histologically confirmed. After chemotherapy, the waiting times for radiotherapy were not different between patients who needed further imaging evaluation and patients who did not (34 days, 95% CI: 29–65 vs 38 days, 95% CI: 32–39; P = NS). Conclusion According to these data, postchemotherapy mammography detected a contralateral breast cancer in very few cases (0.7%); thus, even if performing these exams did not delay the start of radiotherapy, we believe that preradiotherapy mammograms are not necessary for patients undergoing adjuvant chemotherapy after breast-conserving surgery.
Collapse
Affiliation(s)
- Sara Ramella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Edy Ippolito
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Michele Fiore
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Carlo Greco
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Aurelia Iurato
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Luca E Trodella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Barnaba Floreno
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Alessia Di Donato
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | | | - Lucio Trodella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| |
Collapse
|
17
|
Detti B, D'Angelillo RM, Ingrosso G, Olmetto E, Francolini G, Triggiani L, Bruni A, Borghesi S, Fondelli S, Carfagno T, Santini R, Santoni R, Trodella LE, Livi L. Combining Abiraterone and Radiotherapy in Prostate Cancer Patients Who Progressed During Abiraterone Therapy. Anticancer Res 2017; 37:3717-3722. [PMID: 28668865 DOI: 10.21873/anticanres.11744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This multicenter, retrospective, 'field-practice' study investigated treatment outcomes of ongoing abiraterone therapy with the addition of radiotherapy (RT) - initiated for oligoprogression or with a palliative intent. PATIENTS AND METHODS Consecutive patients affected by metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate were considered if they had received RT after the initiation of abiraterone treatment. RESULTS A total of 32 patients were enrolled in the study. Median duration of abiraterone treatment was 13.0 months (range=3.8-40.9 months). Median duration of abiraterone treatment before RT was 5.9 months (range=0.4-40.0 months), and 7.2 months after RT (range=0.1-29.7 months). Median progression-free survival (PFS) was 12.6 months (95%CI=10.5-14.7) from the initiation of abiraterone treatment. From RT administration, PFS was 9.6 months (95%CI=6.4-12.9). Median overall survival (OS) since abiraterone initiation was 18.9 months (95%CI=4.7-33.0). CONCLUSION RT prolongs abiraterone treatment in mCRPC patients leading to better clinical outcomes with this molecule.
Collapse
Affiliation(s)
- Beatrice Detti
- Department of Radiation Oncology, AOU Careggi, Florence, Italy
| | | | - Gianluca Ingrosso
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | | | | | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Alessio Bruni
- Department of Radiation Oncology, AOU Policlinico di Modena, Modena, Italy
| | - Simona Borghesi
- Department of Radiation Oncology, Ospedale San Donato Arezzo, Arezzo, Italy
| | - Simona Fondelli
- Department of Radiation Oncology, Azienda USL Toscana-Centro, Ospedale S. Maria Annunziata, Florence, Italy
| | - Tommaso Carfagno
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Roberto Santini
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Riccardo Santoni
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Luca E Trodella
- Department of Radiation Oncology, University Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, AOU Careggi, Florence, Italy
| |
Collapse
|
18
|
DE Paula U, D'Angelillo RM, Barbara R, Caruso C, Gomellini S, Caccavari A, Costarelli L, Scavina P, Mauri M, Santini E, Antonaci A, Cavaliere F, LA Pinta M, Loreti A, Fortunato L. Once Daily Accelerated Partial Breast Irradiation: Preliminary Results with Helical Tomotherapy®. Anticancer Res 2016; 36:3035-3039. [PMID: 27272823] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) is becoming an option for patients with low-risk breast cancer. The current practice is 38.5 Gy in 10 fractions b.i.d. over 5 days. This fractionation has a higher bioequivalent dose compared to the standard schedule. We report on preliminary results of once-daily APBI in patients treated with TomoTherapy®. PATIENTS AND METHODS Patients with unifocal-breast disease who underwent breast-conserving surgery were enrolled in the study. Treatment was administered with TomoTherapy, by contouring in accordance with the NSABP B-39/RTOG 0413 APBI protocol. Treatment schedule was 38.5 Gy in 10 once-daily fractions. EORTC Cosmetic Rating System was adopted for cosmetic outcome. RESULTS From 2010 to 2013, 111 patients were treated. With a median follow-up of 34 months, no ipsilateral breast recurrence was observed. Very few patients (1-4%) assessed their cosmetic outcome as fair or poor during follow-up. CONCLUSION Once-daily APBI with TomoTherapy yielded good cosmetic results without compromising local control efficacy.
Collapse
Affiliation(s)
- Ugo DE Paula
- Department of Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Raffaele Barbara
- Department of Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Cristina Caruso
- Department of Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Sara Gomellini
- Department of Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Aurelia Caccavari
- Department of Medical Physics, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Paola Scavina
- Department of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Maria Mauri
- Department of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Elena Santini
- Department of Radiology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Adriana Antonaci
- Department of Physical and Rehabilitation Medicine, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Francesco Cavaliere
- Breast Unit-Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Massimo LA Pinta
- Breast Unit-Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Andrea Loreti
- Department of Plastic Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Lucio Fortunato
- Breast Unit-Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| |
Collapse
|
19
|
Infusino E, Trodella L, Ramella S, D'Angelillo RM, Greco C, Iurato A, Trodella LE, Nacca A, Cornacchione P, Mameli A. Estimation of patient setup uncertainty using BrainLAB Exatrac X-Ray 6D system in image-guided radiotherapy. J Appl Clin Med Phys 2015; 16:5102. [PMID: 26103179 PMCID: PMC5690103 DOI: 10.1120/jacmp.v16i2.5102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 05/26/2014] [Revised: 11/18/2014] [Accepted: 11/10/2014] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate setup uncertainties for brain sites with ExacTrac X‐Ray 6D system and to provide optimal margin guidelines. Fifteen patients with brain tumor were included in this study. Two X‐ray images with ExacTrac X‐Ray 6D system were used to verify patient position and tumor target localization before each treatment. The 6D fusion software first generates various sets of DRRs with position variations in both three translational and three rotational directions (six degrees of freedom) for the CT images. Setup variations (translation and rotation) after correction were recorded and corrected before treatment. The 3D deviations are expressed as mean±standard deviation. The random error (Σ(σi)), systematic error (μi), and group systematic error (M(μi)) for the different X‐ray were calculated using the definitions of van Herk.(1) Mean setup errors were calculated from X‐ray images acquired after all fractions. There is moderate patient‐to‐patient variation in the vertical direction and small variations in systematic errors and magnitudes of random errors are smaller. The global systematic errors were measured to be less than 2.0 mm in each direction. Random component of all patients are smaller ranging from 0.1–0.3 mm small. The safety margin (SM) to the lateral, is 0.5 mm and 2.6 mm for van Herk(1) and Stroom et al.,(2) respectively, craniocaudal axis is 1.5 mm and 3.4 mm, respectively, and with respect to the antero–posterior axis, 2.3 mm and 3.9 mm. Daily X‐ray imaging is essential to compare and assess the accuracy of treatment delivery to different anatomical locations. PACS number: 87.55.D
Collapse
|
20
|
Minniti G, D'Angelillo RM, Scaringi C, Trodella LE, Clarke E, Matteucci P, Osti MF, Ramella S, Enrici RM, Trodella L. Fractionated stereotactic radiosurgery for patients with brain metastases. J Neurooncol 2014; 117:295-301. [PMID: 24488446 DOI: 10.1007/s11060-014-1388-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
Stereotactic radiosurgery (SRS) delivered in 2-5 fractions (multi-fraction SRS) has been employed in patients with brain metastases as an alternative to single-fraction SRS with the aim to reduce late radiation-induced toxicity while maintaining high local control rate. In the present study we have evaluated the efficacy and toxicity of multi-fraction SRS in patients with 1-3 brain metastases. Between March 2006 and October 2012, 135 patients (63 men and 72 women) with 171 brain metastases have been treated with multi-fraction SRS (3 × 9 Gy or 3 × 12 Gy). At a median follow-up of 11.4 months, 16 lesions recurred locally. The 1- and 2-year local control rates were 88 and 72 %, respectively. The 1- and 2-year survival rates were 57 and 25 %, and respective distant failure rates were 52 and 73 %. Seventy-eight percent of patients succumbed to their extracranial disease and 22 % died of progressive intracranial disease. Multivariate analysis showed that melanoma histology was predictive of local failure (p = 0.02; HR 6.1, 95 % CI 1.5-24). Specifically, the 1-year local control rates were 68 % for melanoma, 92 % for breast carcinoma, and 88 % for NSCLC, respectively. Stable extracranial disease (p = 0.004) and Karnofsky performance status (p = 0.01) were predictive of longer survival. Radiologic changes suggestive of radionecrosis occurred in 12 (7 %) out of 171 lesions, with an actuarial risk of 9 % at 1 year and 17 % at 2 years, respectively. In conclusion, multi-fraction SRS appears to be an effective and safe treatment modality for brain metastases. It may represent an alternative to single-dose SRS for patients with large lesions or lesions located near critical structures.
Collapse
Affiliation(s)
- Giuseppe Minniti
- Radiation Oncology Unit, Sant' Andrea Hospital, University "Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ramella S, Ippolito E, Fiore M, Greco C, Iurato A, Trodella LE, Floreno B, Di Donato A, D'Angelillo RM, Trodella L. The role of mammography after breast-conserving surgery and adjuvant chemotherapy. Tumori 2013. [PMID: 23748814 DOI: 10.1700/1283.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND To investigate the impact of postchemotherapy mammography on radiotherapy timing and detection of early locoregional recurrences in breast cancer patients treated with breast-conserving surgery and adjuvant chemotherapy. METHODS Bilateral mammography was performed before radiotherapy. Mammogram assessments were collected using the Breast Imaging Reporting and Data System (BI-RADS) scale. Differences in waiting times for radiotherapy between patients who needed further evaluation after mammograms and who did not were tested by the nonparametric Mann-Whitney U test. RESULTS A total of 277 patients who underwent locoregional restaging after conservative surgery and adjuvant chemotherapy were evaluated. All patients had surgical margins greater than 2 mm. No locoregional recurrences were detected. Only in 2 patients (0.7%) did preradiotherapy mammograms reveal a contralateral breast cancer, which was histologically confirmed. After chemotherapy, the waiting times for radiotherapy were not different between patients who needed further imaging evaluation and patients who did not (34 days, 95% CI: 29-65 vs 38 days, 95% CI: 32-39; P = NS). CONCLUSION According to these data, postchemotherapy mammography detected a contralateral breast cancer in very few cases (0.7%); thus, even if performing these exams did not delay the start of radiotherapy, we believe that preradiotherapy mammograms are not necessary for patients undergoing adjuvant chemotherapy after breast-conserving surgery.
Collapse
Affiliation(s)
- Sara Ramella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Ramella S, Trodella L, Mineo TC, Pompeo E, Gambacorta MA, Cellini F, Ciresa M, Fiore M, Greco C, Gaudino D, Stimato G, Piermattei A, Cesario A, D'Angelillo RM. Beams Arrangement in Non-Small Cell Lung Cancer (NSCLC) According to PTV and Dosimetric Parameters Predictive of Pneumonitis. Med Dosim 2010; 35:169-78. [DOI: 10.1016/j.meddos.2009.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 02/09/2009] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
|
23
|
Margaritora S, Cesario A, Cusumano G, Cafarotti S, Corbo GM, Ferri L, Ceppi M, Meacci E, Valente S, D'Angelillo RM, Russo P, Porziella V, Bonassi S, Pasqua F, Sterzi S, Granone P. Is pulmonary function damaged by neoadjuvant lung cancer therapy? A comprehensive serial time-trend analysis of pulmonary function after induction radiochemotherapy plus surgery. J Thorac Cardiovasc Surg 2010; 139:1457-63. [PMID: 20363001 DOI: 10.1016/j.jtcvs.2009.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 08/19/2009] [Accepted: 10/08/2009] [Indexed: 11/30/2022]
Affiliation(s)
- S Margaritora
- Division of General Thoracic Surgery, Catholic University, 00168 Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Ramella S, Trodella L, Mineo TC, Pompeo E, Stimato G, Gaudino D, Valentini V, Cellini F, Ciresa M, Fiore M, Piermattei A, Russo P, Cesario A, D'Angelillo RM. Adding ipsilateral V20 and V30 to conventional dosimetric constraints predicts radiation pneumonitis in stage IIIA-B NSCLC treated with combined-modality therapy. Int J Radiat Oncol Biol Phys 2010; 76:110-5. [PMID: 19619955 DOI: 10.1016/j.ijrobp.2009.01.036] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 01/20/2009] [Accepted: 01/21/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine lung dosimetric constraints that correlate with radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional radiation therapy and concurrent chemotherapy. METHODS AND MATERIALS Between June 2002 and December 2006, 97 patients with locally advanced non-small-cell lung cancer were treated with concomitant radiochemotherapy. All patients underwent complete three-dimensional treatment planning (including dose-volume histograms), and patients were treated only if the percentage of total lung volume exceeding 20 Gy (V(20)) and 30 Gy (V(30)), and mean lung dose (MLD) had not exceeded the constraints of 31%, 18%, and 20 Gy, respectively. The total and ipsilateral lung dose-volume histogram parameters, planning target volume, and total dose delivered were analyzed and correlated with pneumonitis incidence. RESULTS If dose constraints to the total lung were respected, the most statistically significant factors predicting pneumonitis were the percentage of ipsilateral lung volume exceeding 20 Gy (V(20)ipsi), percentage of ipsilateral lung volume exceeding 30 Gy (V(30)ipsi), and planning target volume. These parameters divided the patients into low- and high-risk groups: if V(20)ipsi was 52% or lower, the risk of pneumonitis was 9%, and if V(20)ipsi was greater than 52%, the risk of pneumonitis was 46%; if V(30)ipsi was 39% or lower, the risk of pneumonitis was 8%, and if V(30)ipsi was greater than 39%, the risk of pneumonitis was 38%. Actuarial curves of the development of pneumonitis of Grade 2 or higher stratified by V(20)ipsi and V(30)ipsi were created. CONCLUSIONS The correlation between pneumonitis and dosimetric constraints has been validated. Adding V(20)ipsi and V(30)ipsi to the classical total lung constraints could reduce pulmonary toxicity in concurrent chemoradiation treatment. V(20)ipsi and V(30)ipsi are important if the V(20) to the total lung, V(30) to the total lung, and mean lung dose have not exceeded the constraints of 31%, 18%, and 20 Gy, respectively.
Collapse
Affiliation(s)
- Sara Ramella
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
D'Angelillo RM, Trodella L, Ramella S, Cellini N, Balducci M, Mantini G, Cellini F, Ciresa M, Fiore M, Evoli A, Sterzi S, Russo P, Grozio A, Cesario A, Granone P. Novel prognostic groups in thymic epithelial tumors: assessment of risk and therapeutic strategy selection. Int J Radiat Oncol Biol Phys 2007; 71:420-7. [PMID: 18164843 DOI: 10.1016/j.ijrobp.2007.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 10/01/2007] [Accepted: 10/06/2007] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess the role of multimodality treatment on patients with thymic epithelial tumors (TETs) (i.e., thymomas and thymic squamous cell carcinoma) and to define the prognostic classes according to the Masaoka and World Health Organization histologic classification systems. METHODS AND MATERIALS Primary surgery was the mainstay of therapy. Extended thymectomy was performed in all cases. The cases were primarily staged according to the Masaoka system. Adjuvant radiotherapy was given to patients diagnosed with Masaoka Stage II, III, and IVA TET. Adjuvant chemotherapy was administered in selected cases. RESULTS We reviewed the records of 120 patients with TETs, with a mean follow-up of 13.8 years. Of the 120 patients, 98 (81.6%) received adjuvant radiotherapy. Of these 98 patients, Grade 1-2 pulmonary or esophageal toxicity was acute in 12 (12.2%) and late in 8 (8.2%). The median overall survival was 21.6 years. Of the 120 patients, 106 were rediagnosed and reclassified according to the World Health Organization system, and the survival rate was correlated with it. Three different prognostic classes were defined: favorable, Masaoka Stage I and histologic grade A, AB, B1, B2 or Masaoka Stage II and histologic grade A, AB, B1; unfavorable, Stage IV disease or histologic grade C or Stage III and histologic grade B3; intermediate, all other combinations. The 10- and 20-year survival rate was 95% and 81% for the favorable group, 90% and 65% for the intermediate group, and 50% and 0% for the unfavorable group, respectively. Local recurrence, distant recurrence, and tumor-related deaths were also evaluated. CONCLUSION The analysis of our experience singled out three novel prognostic classes and the assessment of risk identified treatment selection criteria.
Collapse
|
26
|
Trodella L, De Marinis F, D'Angelillo RM, Ramella S, Cesario A, Valente S, Nelli F, Migliorino MR, Margaritora S, Corbo GM, Porziella V, Ciresa M, Cellini F, Bonassi S, Russo P, Cortesi E, Granone P. Induction cisplatin-gemcitabine-paclitaxel plus concurrent radiotherapy and gemcitabine in the multimodality treatment of unresectable stage IIIB non-small cell lung cancer. Lung Cancer 2006; 54:331-8. [PMID: 17011065 DOI: 10.1016/j.lungcan.2006.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 06/20/2006] [Accepted: 07/24/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate feasibility and safety of induction three-drugs combination chemotherapy and concurrent radio-chemotherapy in stage IIIB NSCLC. PATIENTS AND METHODS Patients with stage IIIB NSCLC were treated with three courses of induction chemotherapy, cisplatin 50 mg/m(2), paclitaxel 125 mg/m(2) and gemcitabine 1000 mg/m(2) on days 1,8 of every 21 day cycle. Patients without distant progressive disease were then treated with radiotherapy and concurrent weekly gemcitabine (250 mg/m(2)). Toxicity and response of radio-chemotherapy treatment have been assessed. RESULTS Between Jan 01 and Nov 02, 46 patients were enrolled. Grade 3+ hematological and non-hematological toxicity during the induction phase were 41.3% and 13.1%, respectively. In 38 patients a Clinical Response or Stable Disease was recorded and these patients underwent to concurrent radio-chemotherapy. Grade 3+ hematological and non-hematological toxicities were 8.2% in this group. Further response was observed in 66% of patients. Overall median survival time was 17.8 months, with a 3-year survival rates of 23%. CONCLUSION Three-drugs induction chemotherapy and concurrent radio-chemotherapy with weekly gemcitabine in locally advanced stage IIIB NSCLC is feasible and safe.
Collapse
Affiliation(s)
- L Trodella
- Radiotherapy Unit, University Campus Bio-Medico, Via E. Longoni 49, 00155 Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Trodella L, D'Angelillo RM, Ramella S, Cellini F, Ciresa M, Cesario A, Granone P. Chemo-radiotherapy in non-small cell lung cancer: the role of gemcitabine. Ann Oncol 2006; 17 Suppl 5:v52-4. [PMID: 16807463 DOI: 10.1093/annonc/mdj950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gemcitabine (2'-2'-difluorodeoxycytidine) is a well-known cytotoxic drug and a potent radio-enhancer. We herein report the in vitro evidence of its activity, and the clinical experiences when this drug is administered concurrently with radiation. The phase I-II trials are analyzed, focusing on the recent ability to deliver irradiation with low incidence of side effects.
Collapse
Affiliation(s)
- L Trodella
- Radiotherapy Unit, University Campus Bio-Medico, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
28
|
Trodella L, D'Angelillo RM, Ramella S, Granone P. Multimodality treatment in locally advanced non-small cell lung cancer. Ann Oncol 2006; 17 Suppl 2:ii32-33. [PMID: 16608977 DOI: 10.1093/annonc/mdj917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Trodella
- Radioterapia Oncologica, Università Campus Bio-Medico di Roma, Italy
| | | | | | | |
Collapse
|
29
|
Galetta D, Cesario A, Margaritora S, Porziella V, Piraino A, D'Angelillo RM, Gambacorta MA, Ramella S, Trodella L, Valente S, Corbo GM, Macis G, Mulè A, Cardaci V, Sterzi S, Granone P, Russo P. Multimodality treatment of unresectable stage III non–small cell lung cancer: Interim analysis of a phase II trial with preoperative gemcitabine and concurrent radiotherapy. J Thorac Cardiovasc Surg 2006; 131:314-21. [PMID: 16434259 DOI: 10.1016/j.jtcvs.2005.07.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Revised: 07/02/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We report the preliminary results of a phase II trial undertaken to determine the feasibility and efficacy of gemcitabine and concurrent radiotherapy in patients with inoperable stage III non-small cell lung cancer. METHODS Between February 2001 and June 2003, a total of 46 patients (37 male and 9 female, median age 64 years) with clinical stage III non-small cell lung cancer (41 cIIIA and 5 cIIIB) were enrolled in a combined chemoradiation protocol with gemcitabine as the chemotherapeutic agent. Gemcitabine (350 mg/m2) was administered weekly for 5 consecutive weeks as a 30-minute intravenous infusion before radiotherapy (total dose 50.4 Gy, 1.8 Gy/d). Toxicity was routinely assessed. Those patients with disease judged to be resectable at restaging underwent surgery. RESULTS Toxicity was moderate, with the exception of 1 grade 3 thrombocytopenia. All but 5 patients were available for restaging. No complete responses were observed. Thirty-four patients (82.9%) had partial responses, 5 (12.2%) had stable disease, and 2 (4.9%) had progressive disease. Twenty-nine of 46 patients (63%, 27 cIIIA and 2 cIIIB) underwent surgery. Radical resection was possible in all cases. Surgery included 17 lobectomies, 4 bilobectomies, and 8 pneumonectomies. There were no deaths. Morbidity was 13.8% (4/29). Pathologic downstaging to stage 0 or I was observed in 18 patients (39%, 18/46). After a median follow-up of 13 months (range 2-28 months), 24 of the patients who had undergone operation (86.2%) were alive, with a median disease-free survival of 16 months. Overall 2-year survival was 66.1%, with a significant difference between resected and unresected disease (82% vs 36%, P = .0002). CONCLUSION The results of this induction trial confirm the feasibility and the efficacy of gemcitabine with concurrent radiotherapy.
Collapse
Affiliation(s)
- Domenico Galetta
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Granone P, Trodella L, D'Angelillo RM, Ramella S, Margaritora S, Porziella V, Russo P, Cesario A. Comment on "Post-operative radiotherapy in non small cell lung cancer: update of individual patient data" [Lung Cancer 2005;47(1):81-83]. Lung Cancer 2005; 50:277-8; author reply 279. [PMID: 16076510 DOI: 10.1016/j.lungcan.2005.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 04/27/2005] [Indexed: 11/22/2022]
|
31
|
Trodella L, Ramella S, Salvi G, Arcangeli S, Ciresa M, Massaccesi M, Macchia G, D'Angelillo RM. Dose and volume as predictive factors of pulmonary toxicity. Rays 2005; 30:175-80. [PMID: 16294911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Dose and volume and their correlation with the development of pulmonary toxicity are among the most widely studied and validated factors in radiotherapy. Most common treatment planning systems allow prompt assessment of Vdose and Mean Lung Dose (MLD). The former represents the percentage of normal lung parenchyma receiving a dose equal to or higher than the established threshold dose; the latter corresponds to the mean dose delivered to the normal lung parenchyma. Most important studies reported on the subject and threhold values recommended for Vdose and MLD are analyzed. The monitoring system of late toxicity used by the authors is presented.
Collapse
Affiliation(s)
- Lucio Trodella
- Cattedra di Radioterapia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Ramella S, Ciresa M, Massaccesi M, Franceschini G, D'Angelillo RM, Trodella L. Neoadjuvant concurrent chemotherapy and radiotherapy in non-small cell lung cancer. Rays 2004; 29:439-43. [PMID: 15852733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Abstract. Radiotherapy was the standard treatment for patients with locally advanced non-small cell lung cancer until the mid 1990s. Chemotherapy was added in order to improve outcome, and during the last decade sequential, concurrent or mixed modalities have been extensively explored and discussed. Goals of neoadjuvant chemoradiation are resecability and downstaging. Recent published experiences evidenced that neoadjuvant chemoradiotherapy is feasible if delivered with low total dose and limited volume; pathological downstaging to stage 0-I could be a reasonable surrogate end-point for overall and disease free survival and for distant metastasis.
Collapse
Affiliation(s)
- Sara Ramella
- Istituto di Radiologia, Cattedra Radioterapia, Università Cattolica del S.Cuore, Policlinico "A. Gemelli", Roma, Italy.
| | | | | | | | | | | |
Collapse
|
33
|
D'Angelillo RM, Trodella L, Ramella S. Assessing the value of neoadjuvant chemoradiotherapy and pathologic downstaging in the treatment of non–small cell lung cancer. J Thorac Cardiovasc Surg 2004; 128:489-90. [PMID: 15354115 DOI: 10.1016/j.jtcvs.2004.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
34
|
Trodella L, D'Angelillo RM, Ramella S, Ciresa M, Massaccesi M. Dose fractionation and biological optimization in lung cancer. Rays 2004; 29:319-26. [PMID: 15603304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The treatment of choice of patients with locally advanced non-small cell lung cancer is radiotherapy combined or not with chemotherapy. Only 30% of lung cancer patients are operable for cure at diagnosis. Consequently the knowledge of the radiobiological basis and of clinical outcomes achieved with radiation therapy is of the utmost importance. Total dose, fractionation, concomitant chemotherapy are the main factors to be examined. In order to improve local control several attempts are reported in the literature. They concern: changes in fractionation and total dose; the use of radiosensitizers and radioprotectors; combined chemoradiation and molecular therapies.
Collapse
Affiliation(s)
- Lucio Trodella
- Cattedra di Radioterapia, Università Cattolica del S Cuore, Policlinico A Gemelli, Roma, Italy.
| | | | | | | | | |
Collapse
|
35
|
Trodella L, Granone P, Valente S, Margaritora S, Macis G, Cesario A, D'Angelillo RM, Valentini V, Corbo GM, Porziella V, Ramella S, Tonini G, Galetta D, Ciresa M, Vincenzi B, Cellini N. Neoadjuvant concurrent radiochemotherapy in locally advanced (IIIA–IIIB) non-small-cell lung cancer: long-term results according to downstaging. Ann Oncol 2004; 15:389-98. [PMID: 14998840 DOI: 10.1093/annonc/mdh099] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To report the efficacy of induction treatment (IT) protocol with concurrent radiochemotherapy in locally advanced non-small-cell lung cancer (NSCLC), and to analyze downstaging as a surrogate end point. PATIENTS AND METHODS Patients with histo- or cytologically confirmed stage IIIA or IIIB NSCLC were treated according to an IT protocol followed by surgery. Downstaging was assessed for all resected patients. RESULTS In the period between February 1992 and July 2000, 92 patients were enrolled in the study (57 IIIA, 35 IIIB). Response was observed in 63 patients; 56 patients underwent radical resection. Patients downstaged to stage 0-I (DS 0-I) showed a statistically significant improved disease-free survival (26.2 months pStage 0-I versus 11.2 months pStage II-III; P=0.0116) and overall survival (median 32.5 months pStage 0-I versus 18.3 months pStage II-III; P=0.025). Patients with DS 0-I had a significantly lower probability (P=0.0353) of developing distant metastases estimated in 0.2963 odds ratio. CONCLUSION Neoadjuvant radiochemotherapy is feasible with good pathological DS results. Pathological downstaging was confirmed to have high predictive value. Its use is suggested in the short-term evaluation of induction protocols efficacy in locally advanced NSCLC.
Collapse
Affiliation(s)
- L Trodella
- Department of Radiation Oncology, Università Cattolica del S Cuore, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Galetta D, Cesario A, Margaritora S, Porziella V, Macis G, D'Angelillo RM, Trodella L, Sterzi S, Granone P. Enduring challenge in the treatment of nonsmall cell lung cancer with clinical stage IIIB: results of a trimodality approach. Ann Thorac Surg 2003; 76:1802-8; discussion 1808-9. [PMID: 14667587 DOI: 10.1016/s0003-4975(03)01063-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Stage IIIb (T4/N3) non-small-cell lung cancer (NSCLC) is considered an inoperable disease and treatment is an enduring challenge. Surgery after induction therapy seems to improve locoregional control. We report the results of a phase II prospective trimodality trial (chemotherapy and concomitant radiotherapy plus surgery) in patients with stage IIIb NSCLC. METHODS From November 1992 to June 2000, 39 patients (37 men and 2 women, mean age 65 years) with clinical stage IIIb (34 T4N0 to 2, 4 T2 to 3N3, 1 T4N3, excluding T4 for malignant pleural effusion) entered the study. They received intravenous infusions of cisplatin 20 mg/m(2) and 5-fluorouracil 1,000 mg/m(2) (days 1 to 4 and 25 to 28) combined with a total dose of 50.4 Gy radiotherapy delivered over 4 weeks (1.8 Gy daily). Upon clinical restaging responders underwent surgery. RESULTS All patients were available for clinical restaging. No complete response was observed. Twenty-one patients had partial response (53.8%), 16 had stable disease (41%), and 2 had progressive disease (5.2%). Hematologic toxicity was moderate. Twenty-two patients (56.4%), 21 with partial response and 1 with stable disease, underwent surgery with no perioperative death. A radical resection was possible in 21 cases. Nine lobectomies, 3 bilobectomies, and 9 pneumonectomies were performed. Complications occurred in 5 patients (23.6%). Fourteen of the patients who underwent surgery (66.6%) showed a pathologic downstaging. A complete pathologic response was obtained in 9 cases (49%). Overall 5-year survival (Kaplan-Meier) was 23%. Resected versus non-resected patients showed a significant difference: 38% versus 5.6% (p = 0.028, log rank). CONCLUSIONS This trimodal approach for stage IIIb NSCLC appears safe and effective. It provides good therapeutic results with acceptable morbidity in surgical cases.
Collapse
Affiliation(s)
- Domenico Galetta
- Department of Surgical Sciences, Catholic University, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Valentini V, Cellini F, D'Angelillo RM. Combined treatments in gastric cancer: radiotherapy. Suppl Tumori 2003; 2:S39-44. [PMID: 12914389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
In the past decades radiation oncologists have not had a major interest in the treatment of gastric cancer. The concern on major toxicity related to an extended irradiation of the upper abdomen limited the experience in the treatment of this disease; therefore few data were available to evaluate any advantage of the use of radiation therapy. The results of the Gastrointestinal Intergroup Study promoted a new interest in the irradiation of gastric cancer. The analysis of the outcomes of the Intergroup Study supported the role of locoregional control in promoting better survival for patients treated with adjuvant chemoradiation vs resected patients (81% vs 71%). The studies reported in the last years on the use of radiotherapy in gastric carcinoma are reviewed.
Collapse
Affiliation(s)
- Vincenzo Valentini
- Cattedra Radioterapia, Istituto di Radiologia, Policlinico Università A Gemelli Università Cattolica S Cuore, Largo F Vito 1, 00168 Roma, Italy.
| | | | | |
Collapse
|
38
|
Vincenzi B, Santini D, Spoto S, Finolezzi E, D'Angelillo RM, La Cesa A, Tonini G. The antineoplastic treatment in the elderly. Clin Ter 2002; 153:207-15. [PMID: 12161983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
More than 550,000 American people died for cancer only in 1998 and more than third of them were over 65 years of age. According to recent data in next decade more than 70% of all the deaths for tumour will be verified in the population over 65 years. The cancers mostly frequently associated with the deaths in the elderly population are the tumour of the lung, colon, prostate and breast. Therefore the geriatrics oncology is progressively assuming a central and essential role within the medical oncology. One of the aspects of great interest in the treatment of the cancers of the elderly patient (> 65 years) is the study about some pharmacokinetic modifications of the antitumour medicines in such band of age, and the study about some pattern of toxicity characteristics in the elderly patients. In this ambit there are a few studies in literature devoted specifically to such aspect. This study represents an attempt of revision of the literature finalized to analyse the toxicological and pharmacokinetic characteristics of the principal chemotherapeutic agents used in the therapy of elderly patients affected with cancer. In the last part of the review we have tried to synthesize the state of the art of the achieved results about the medicines that have shown a better therapeutic index and a better impact on the clinical benefit in such population of patients.
Collapse
Affiliation(s)
- B Vincenzi
- Università Campus Bio-Medico, Rome, Via E. Longoni 69, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
39
|
Santini D, Vincenzi B, Fossati C, D'Angelillo RM, Patti G, Bianco V, Avvisati G, Tonini G. Prevention of delayed emesis induced by moderately emetogenic chemotherapy in patients with acute emesis: a pilot study with ACTH-Depot plus tropisetron. Med Oncol 2002; 18:131-5. [PMID: 11778758 DOI: 10.1385/mo:18:2:131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The rates of delayed nausea and vomiting by moderately emetogenic chemotherapy in patients with previous experience of acute emesis are usually quite high. This is a pilot study aiming to evaluate the safety of a new antiemetic schedule to prevent delayed emesis in this subset of patients. During 5 consecutive cycles of moderately emetogenic chemotherapy, we evaluated 50 patients (15 males) who experienced acute emesis in the first cycle of treatment. The regimen for prevention of delayed emesis consisted of daily tropisetron (5 mg orally from d 2 to d 6 of each chemotherapeutic cycle) associated to ACTH-Depot (1 mg intramuscularly 24 and 68 h after the initiation of chemotherapy). In 77% of chemotherapy cycles, there was a total elimination of nausea and vomiting, whereas in the remaining 23% of cycles, there was a major response defined as < or = 2 vomiting episodes per cycle or nausea grade 1 according to the WHO. The efficacy of the antiemetic regimen persisted during the entire treatment program without the appearance of toxic effects. The proposed antiemetic regimen is highly active in preventing delayed nausea and vomiting episodes in patients receiving moderately emetogenic chemotherapy. Moreover, no toxic effects were observed. These promising results require confirmation by a randomized trial.
Collapse
Affiliation(s)
- D Santini
- Campus Bio-Medico University, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Trodella L, Granone P, Valente S, Turriziani A, Macis G, Corbo GM, Margaritora S, Cesario A, D'Angelillo RM, Gualano G, Ramella S, Galetta D, Cellini N. Phase I trial of weekly gemcitabine and concurrent radiotherapy in patients with inoperable non-small-cell lung cancer. J Clin Oncol 2002; 20:804-10. [PMID: 11821464 DOI: 10.1200/jco.2002.20.3.804] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To report the evidence of a phase I trial planned to determine the maximum-tolerated dose (MTD) and related toxicity of weekly gemcitabine (GEM) and concurrent radiotherapy in patients with non--small-cell lung cancer (NSCLC). In addition, the response to treatment was evaluated and reported. PATIENTS AND METHODS Thirty-six patients with histologically confirmed NSCLC deemed unresectable because of advanced stage were observed and treated according to a combined chemoradiation protocol with GEM as chemotherapeutic agent. GEM was given weekly for 5 consecutive weeks as a 30-minute intravenous infusion concurrent with radiotherapy (1.8 Gy/d; total dose, 50.4 Gy). The initial dose was 100 mg/m(2). Pulmonary, esophageal, cardiac, hematologic, and skin toxicities were assessed. The dose of GEM was increased by 50 mg/m(2) up to a dose of 250 mg/m(2); an additional increase by 25 mg/m(2) up to the MTD was planned and realized. Three patients were enrolled for each dose level. RESULTS Dose-limiting toxicity was identified for the 375-mg/m(2) level with two episodes of grade 2 esophagitis and two of grade 3 pulmonary actinic interstitial disease. The weekly dose of GEM 350 mg/m(2) was well tolerated. CONCLUSION A weekly GEM dose of 350 mg/m(2) concurrent with radiotherapy was well tolerated. Promising results regarding response to treatment were observed and reported.
Collapse
Affiliation(s)
- Lucio Trodella
- Department of Radiation Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Trodella L, Granone P, Valente S, Valentini V, Balducci M, Mantini G, Turriziani A, Margaritora S, Cesario A, Ramella S, Corbo GM, D'Angelillo RM, Fontana A, Galetta D, Cellini N. Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Radiother Oncol 2002; 62:11-9. [PMID: 11830308 DOI: 10.1016/s0167-8140(01)00478-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the benefits and the drawbacks of post-operative radiotherapy in completely resected Stage I (a and b) non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients with pathological Stages Ia and Ib NSCLC have been randomized into two groups: Group 1 (G1) received adjuvant radiotherapy, Group 0 (G0) the control group did not receive any adjuvant therapy. Local control, toxicity and survival have been evaluated. RESULTS Between July 1989 and June 1997, 104 patients with pathological stage I NSCLC have been enrolled in this study. Fifty-one patients were randomized to G1 and 53 to G0. Six patients have been excluded from the study due to incomplete follow-up data. Regarding local control, one patient in the G1 group had a local recurrence (2.2%) while in the G0 12 local recurrences have been observed (23%). Seventy-one percent of patients are disease-free at 5 years in G1 and 60% in G0 (P=0.039). Overall 5-year survival (Kaplan-Meier) showed a positive trend in the treated group: 67 versus 58% (P=0.048). Regarding toxicity in G1, six patients experienced a grade 1 acute toxicity. Radiological evidence of long-term lung toxicity, with no significant impairment of the respiratory function, has been detected in 18 of the 19 patients who have been diagnosed as having a post-radiation lung fibrosis. CONCLUSIONS Adjuvant radiotherapy gave good results in terms of local control in patients with completely resected NSCLC with pathological Stage I. Overall 5-year survival and disease-free survival showed a promising trend. Treatment-related toxicity is acceptable.
Collapse
Affiliation(s)
- Lucio Trodella
- Department of Radiation Oncology, 'Universita' Cattolica del S. Cuore', Largo A. Gemelli 8, 00168, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|