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Oncology (Williston Park, N.Y.) 09/2012; 26(9):872. · 1.03 Impact Factor
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[show abstract]
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ABSTRACT: The optimal approach to the diagnosis and treatment of locally advanced rectal cancer involves multidisciplinary, integrated management. In the past 30 years, survival and freedom from disease have increased, but the ideal multidisciplinary management remains to be determined. The preferred integrated treatment modality is preoperative radio(chemo)therapy followed by total mesorectal excision. Certain aspects of this standard are still debated, and the European and American approaches vary. The chief recommendations per international guidelines are summarized, and the next generation of integrated treatments for locally advanced rectal cancer is discussed.
Oncology (Williston Park, N.Y.) 08/2012; 26(8):730-5, 741. · 1.03 Impact Factor
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Mario Balducci,
Silvia Chiesa,
Stefania Manfrida,
Elena Rossi,
Tommaso Za,
Vincenzo Frascino,
Berardino De Bari,
Stefan Hohaus, Francesco Cellini,
Giovanna Mantini,
Giuseppe Roberto D’Agostino,
Maria Antonietta Gambacorta,
Antonello Leone,
Vincenzo Valentini,
Valerio De Stefano
[show abstract]
[hide abstract]
ABSTRACT: Purpose:
To evaluate the impact of radiotherapy on pain relief and on recalcification in patients with osteolytic lesions due to plasma
cell neoplasm.
Patients and Methods:
Pain relief was evaluated according to a 0–10 verbal numerical rating scale (NRS) and recalcification was measured using radiological
imaging.
Results:
From 1996–2007, 52 patients were treated (Table 1). Median total dose was 38 Gy (range, 16–50 Gy). Pain be-fore radiotherapy
was reported by 45 of 52 (86.5%) patients (Table 2) as being severe (8 ≤ NRS ≤ 10) in 5 (11%), moderate (5 ≤ NRS ≤ 7) in 27
(60%), and mild in 13 (29%). Pain relief was achieved in 41 of 45 patients (91%): complete relief was ob-tained in 21 (51.2%)
and partial relief in 20 patients (48.8%); patients with severe pain experienced resolution and none present-ed an increase
of pain. Drugs reduction/suspension was achieved in 7 of the 21 patients with complete response. Of 42 patients evaluable
for recalcification (Table 3), 21 (50%) presented a radiological response, which was identified as complete in 16 (38%).
Conclusion:
Our data confirm the effectiveness of radiotherapy for pain relief, including a reduction in drug intake, and on recalcification,
thus, supporting its use in a multidisciplinary approach.
Ziel:
Beurteilung der Wirkung der Strahlentherapie auf Schmerzlinderung und Rekalzifizierung bei Patienten mit Osteolysen auf Grund
von malignen Plasmazellerkrankungen.
Patienten und Methodik:
Die Schmerzlinderung wurde anhand einer 0–10 numerischen Verbalskala (NVS) beurteilt, während die Rekalzifizierungsrate mittels
radiologischer bildgebender Verfahren gemessen wurde.
Ergebnisse:
Von 1996 bis 2007 wurden 52 Patienten behandelt (Tabelle 1). Die mittlere Bestrahlungsdosis betrug 38 Gy (range 16–50 Gy).
Schmerzen wurden vor der Strahlentherapie von 45 der 52 (86,5%) Patienten beurteilt (Tablle 2): als schwer (8 ≤ NVS ≤ 10)
von 5 (11%), als mittelgradig (5 ≤ NRS ≤ 7) von 27 (60%) und als leicht von 13/45 (29%). Eine Schmerzlinderung wurde bei 41
der 45 (91%) Patienten erreicht: eine vollständige Schmerzkontrolle bei 21 (51,2%) und eine teilweise Linderung bei 20 Patienten
(48,8%); alle Patienten mit ausgeprägter Schmerzsymptomatik erfuhren eine Reduktion der Schmerzen, und bei keinem Patienten
nahmen die Schmerzen zu. Die Schmerzmedikation konnte bei 7/21 Patienten mit vollständiger Schmerzkontrolle verringert oder
abgesetzt werden. Eine Rekalzifizierung wurde bei 42 Patienten radiologisch beurteilt (Tabelle 3): 21 (50%) zeigten eine Verbesserung,
eine komplette Rekalzifizierung wurde bei 16 (38%) Patienten beobachtet.
Schlussfolgerung:
Unsere Daten bestätigen die Wirksamkeit der Strahlentherapie, die in einer multidisziplinären Strategie bei malignen Plasmazellerkrankungen
eingesetzt werden kann, um eine Schmerzlinderung mit Reduzierung der Schmerzmittelmedikation und eine Rekalzifizierung zu
erreichen.
Key Words:
Plasma cell neoplasm–Radiotherapy–Pain relief–Recalcification
Schlüsselwörter:
Multiples Myelom Plasmozytom–Strahlentherapie–Scherzlinderung–Rekalzifizierung
Strahlentherapie und Onkologie 04/2012; 187(2):114-119. · 3.56 Impact Factor
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Sara Ramella,
Lucio Trodella,
Edy Ippolito,
Michele Fiore, Francesco Cellini,
Gerardina Stimato,
Diego Gaudino,
Carlo Greco,
Sara Ramponi,
Eugenio Cammilluzzi,
Claudio Cesarini,
Angelo Piermattei,
Alfredo Cesario,
Rolando Maria D'Angelillo
[show abstract]
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ABSTRACT: To select among breast cancer patients and according to breast volume size those who may benefit from 3D conformal radiotherapy after conservative surgery applied with prone-position technique. Thirty-eight patients with early-stage breast cancer were grouped according to the target volume (TV) measured in the supine position: small (≤400 mL), medium (400-700 mL), and large (≥700 ml). An ad-hoc designed and built device was used for prone set-up to displace the contralateral breast away from the tangential field borders. All patients underwent treatment planning computed tomography in both the supine and prone positions. Dosimetric data to explore dose distribution and volume of normal tissue irradiated were calculated for each patient in both positions. Homogeneity index, hot spot areas, the maximum dose, and the lung constraints were significantly reduced in the prone position (p < 0.05). The maximum heart distance and the V(5Gy) did not vary consistently in the 2 positions (p = 0.06 and p = 0.7, respectively). The number of necessary monitor units was significantly higher in the supine position (312 vs. 232, p < 0.0001). The subgroups analysis pointed out the advantage in lung sparing in all TV groups (small, medium and large) for all the evaluated dosimetric constraints (central lung distance, maximum lung distance, and V(5Gy), p < 0.0001). In the small TV group, a dose reduction in nontarget areas of 22% in the prone position was detected (p = 0.056); in the medium and high TV groups, the difference was of about -10% (p = NS). The decrease in hot spot areas in nontarget tissues was 73%, 47%, and 80% for small, medium, and large TVs in the prone position, respectively. Although prone breast radiotherapy is normally proposed in patients with breasts of large dimensions, this study gives evidence of dosimetric benefit in all patient subgroups irrespective of breast volume size.
Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2011; 37(2):186-91. · 1.26 Impact Factor
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Mario Balducci,
Silvia Chiesa,
Stefania Manfrida,
Elena Rossi,
Tommaso Za,
Vincenzo Frascino,
Berardino De Bari,
Stefan Hohaus, Francesco Cellini,
Giovanna Mantini,
Giuseppe Roberto D'Agostino,
Maria Antonietta Gambacorta,
Antonello Leone,
Vincenzo Valentini,
Valerio De Stefano
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the impact of radiotherapy on pain relief and on recalcification in patients with osteolytic lesions due to plasma cell neoplasm.
Pain relief was evaluated according to a 0-10 verbal numerical rating scale (NRS) and recalcification was measured using radiological imaging.
From 1996-2007, 52 patients were treated (Table 1). Median total dose was 38 Gy (range, 16-50 Gy). Pain be-fore radiotherapy was reported by 45 of 52 (86.5%) patients (Table 2) as being severe (8 ≤ NRS ≤ 10) in 5 (11%), moderate (5 ≤ NRS ≤ 7) in 27 (60%), and mild in 13 (29%). Pain relief was achieved in 41 of 45 patients (91%): complete relief was obtained in 21 (51.2%) and partial relief in 20 patients (48.8%); patients with severe pain experienced resolution and none present-ed an increase of pain. Drugs reduction/suspension was achieved in 7 of the 21 patients with complete response. Of 42 patients evaluable for recalcification (Table 3), 21 (50%) presented a radiological response, which was identified as complete in 16 (38%).
Our data confirm the effectiveness of radiotherapy for pain relief, including a reduction in drug intake, and on recalcification, thus, supporting its use in a multidisciplinary approach.
Strahlentherapie und Onkologie 02/2011; 187(2):114-9. · 3.56 Impact Factor
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Rolando M D'Angelillo,
Lucio Trodella,
Marzia Ciresa, Francesco Cellini,
Michele Fiore,
Carlo Greco,
Eugenio Pompeo,
Tommaso Claudio Mineo,
Laura Paleari,
Pierluigi Granone,
Sara Ramella,
Alfredo Cesario
[show abstract]
[hide abstract]
ABSTRACT: We report the results of a phase II trial exploring the efficacy and the feasibility of combination of gemcitabine and cisplatin concurrent with radiotherapy followed by surgery in patients with stage III non-small cell lung cancer.
Patients with histocytologically confirmed non-small cell lung cancer were treated with cisplatin 80 mg/sqm/wk of 1 and 4 or 20 mg/sqm/d of weeks 1 and 4 and weekly gemcitabine at 300 to 350 mg/m2 plus involved field radiotherapy. A 3D-conformal radiotherapy was delivered up to 50.4 Gy, with daily fractionation of 1.8 Gy. After clinical, radiologic, and pneumological reassessment, patients who reentered criteria for resectability were operated.
The stage at diagnosis was IIIA-N2 in 29 patients and IIIB-T4N0-2 for vascular direct infiltration for the remaining 21. Fifteen patients (30%) experienced acute grade 3 to 4 hematological toxicity, whereas acute grade 3 esophageal toxicity was recorded in three patients (6%). One patient developed a grade 4 pulmonary toxicity (2%). Clinical response was 40 (80%) partial response, one (2%) stable disease, and nine (18%) progressive disease. Thirty-six patients (72%) underwent surgery. Final pathology showed a downstaging to stage 0 to I in 25 cases (50%). Median overall survival for all patients was 21.8 months, with a 3-year survival of 40.2%.
The results of this phase II trial confirm the feasibility and the efficacy of concurrent chemoradiotherapy followed by surgery.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 10/2009; 4(12):1517-23. · 4.55 Impact Factor
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Vincenzo Valentini, Francesco Cellini,
Bruce D Minsky,
Gian Carlo Mattiucci,
Mario Balducci,
Giuseppe D'Agostino,
Elisa D'Angelo,
Nicola Dinapoli,
Nicola Nicolotti,
Chiara Valentini,
Giuseppe La Torre
[show abstract]
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ABSTRACT: A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer.
Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or intraoperative), was compared with surgery alone or surgery plus chemotherapy in resectable gastric cancer were identified by searching web-based databases and supplemented by manual examination of reference lists. Meta-analysis was performed using Risk Ratios (RRs). Random or fixed effects models were used to combine data. The methodological quality was evaluated by Chalmers' score.
Radiotherapy had a significant impact on 5-year survival. Using an intent to treat (ITT) and a Per Protocol (PP) analysis, the overall 5-year RR was 1.26 (95% CI: 1.08-1.48; NNT=17) and 1.31 (95% CI: 1.04-1.66; NNT=13), respectively. Although the quality of the studies was variable, the data were consistent and no clear publication bias was found.
This meta-analysis showed a statistically significant 5-year survival benefit with the addition of radiotherapy in patients with resectable gastric cancer. Radiotherapy remains a standard component in the treatment of resectable gastric cancer and new RCTs need to address the impact of new conformal radiotherapy technologies.
Radiotherapy and Oncology 09/2009; 92(2):176-83. · 5.58 Impact Factor
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Sara Ramella,
Lucio Trodella,
Tommaso Claudio Mineo,
Eugenio Pompeo,
Gerardina Stimato,
Diego Gaudino,
Vincenzo Valentini, Francesco Cellini,
Marzia Ciresa,
Michele Fiore,
Angelo Piermattei,
Patrizia Russo,
Alfredo Cesario,
Rolando M D'Angelillo
[show abstract]
[hide abstract]
ABSTRACT: 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.
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.
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.
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.
International journal of radiation oncology, biology, physics 08/2009; 76(1):110-5. · 4.59 Impact Factor
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Nature Reviews Gastroenterology & Hepatology 07/2009; 6(6):327-9. · 8.10 Impact Factor
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Sara Ramella,
Lucio Trodella,
Tommaso Claudio Mineo,
Eugenio Pompeo,
Maria A Gambacorta, Francesco Cellini,
Marzia Ciresa,
Michele Fiore,
Carlo Greco,
Diego Gaudino,
Gerardina Stimato,
Angelo Piermattei,
Alfredo Cesario,
Rolando M D'Angelillo
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study is to propose and validate an original new class of solutions for three-dimensional conformal radiation therapy (3DCRT) treatment planning for non-small cell lung cancer (NSCLC) according to the different patterns of disease presentation (on the basis of tumor location and volume) and to explore beams arrangement (planar or no-planar solutions) to respect dose constraints to the lung parenchyma. Benchmarks matched to validate the new approach are interuser reproducibility and saving on planning time. Tumor location was explored and specific categories created according to the tumor volume and location. Therefore, by applying planar and no-planar 3D plans, we searched for an optimization of the beams arrangement for each category. Dose-volume histograms (DVHs) were analyzed and a plan comparison performed. Results were then validated (class solution planning confirmation) by applying the same strategy to another group of patients. This has been realized at two dose levels (50.4 and 59.4 Gy). Fifty-nine patients were enrolled in this dosimetric study. In the first 27 patients ("exploratory sample") three main planning target volume location categories were identified according to the pattern of the disease presentation: (1) centrally located; (2) peripheral T and mediastinal N (P+N); and (3) superior sulcus. Original class solutions were proposed for each location category. On the next 32 patients ("validation sample"), the treatment planning started directly with the recommended approach. Mean V(20 Gy) value was 18.8% (SD +/- 7.25); mean V(30 Gy):12% (SD +/- 4.05); and mean lung dose: 11.6 Gy (SD +/- 5.77). No differences between the two total dose level groups were observed. These results suggest a simple and reproducible tool for treatment planning in NSCLC, allowing interuser reproducibility and cutting down on planning time.
Medical dosimetry: official journal of the American Association of Medical Dosimetrists 06/2009; 35(3):169-78. · 1.26 Impact Factor
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ABSTRACT: A 46-year-old woman with IgA-lambda myeloma in partial remission, after a tandem autologous hematopoietic stem cells transplantation, complained of progressive lower back pain associated with paraplegia and neurological bladder 6 months after the second transplant. A lumbar puncture revealed atypical malignant plasma cells in the cerebral spinal fluid associated with multiple foci of altered signal intensity of brain and spinal cord demonstrated by magnetic resonance. Considering the lack of efficacious chemotherapies for neurological myeloma, an experimental systemic treatment with topotecan, temozolamide, and dexamethasone associated with concurrent radiotherapy of brain and spinal cord was initiated. During this treatment, the patient rapidly improved with disappearance of back pain, paresthesia, and urinary incontinence lasting 5 months, before dying of progressive disease. The proposed systemic chemotherapy associated with concurrent radiotherapy may have an antitumor activity against MM with CNS involvement.
International journal of hematology 04/2009; 89(4):513-6. · 1.17 Impact Factor
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Angelo Piermattei,
Andrea Fidanzio,
Luigi Azario,
Francesca Greco,
Alessandra Mameli,
Savino Cilla,
Luca Grimaldi,
Guido D'Onofrio,
Boris Giuseppe Augelli,
Gerardina Stimato,
Diego Gaudino,
Sara Ramella,
Rolando D'Angelillo, Francesco Cellini,
Lucio Trodella
[show abstract]
[hide abstract]
ABSTRACT: An amorphous silicon (a-Si) electronic portal imaging device (EPID) was implemented to perform transit in vivo dosimetry for dynamic conformal arc therapy (DCAT). A set of images was acquired for each arc irradiation using the EPID cine acquisition mode, that supplies a frame acquisition rate of one image every 1.66 s, with a monitor unit rate equal to 100 UM/min. In these conditions good signal stability, +/-1% (2SD) evaluated during 3 months, signal reproducibility within +/-0.8% (2SD) and linearity with dose and dose rate within +/-1% (2SD) were obtained. The transit signal, S (t), due to the transmitted radiotherapy beam below a solid phantom, measured by the EPID cine acquisition mode was used to determine, (1) a set of correlation functions, F(w, L), defined as the ratio between S (t) and the dose at half thickness, D (m), measured in solid water phantoms of different thicknesses, w and with square fields of side L, (2) a set of factors, f(d, L), that take into account the different x-ray scatter contribution from the phantom to the S (t) signal as a function of the variation, d, of the air gap between the phantom and the EPID. The reconstruction of the isocenter dose, D (iso), for DCAT was obtained convolving the transit signal values, obtained at different gantry angles, with the respective reconstruction factors determined by a house-made software. The method was applied to a first patient and the results show that the reconstructed D (iso) values can be obtained with an accuracy within +/-5%. In conclusion, it was assessed that an a-Si EPID with the cine acquisition mode is suitable to perform transit in vivo dosimetry for the DCAT therapy.
Medical & Biological Engineering 03/2009; 47(4):425-33. · 1.76 Impact Factor
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Rolando M D'Angelillo,
Lucio Trodella,
Sara Ramella,
Numa Cellini,
Mario Balducci,
Giovanna Mantini, Francesco Cellini,
Marzia Ciresa,
Michele Fiore,
Amelia Evoli,
Silvia Sterzi,
Patrizia Russo,
Alessia Grozio,
Alfredo Cesario,
Pierluigi Granone
[show abstract]
[hide abstract]
ABSTRACT: 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.
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.
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.
The analysis of our experience singled out three novel prognostic classes and the assessment of risk identified treatment selection criteria.
International Journal of Radiation OncologyBiologyPhysics 07/2008; 71(2):420-7. · 4.11 Impact Factor
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Angelo Piermattei,
Gerardina Stimato,
Diego Gaudino,
Sara Ramella,
Rolando Maria D'Angelillo, Francesco Cellini,
Lucio Trodella,
Guido D'Onofrio,
Luca Grimaldi,
Savino Cilla,
Andrea Fidanzio,
Elisa Placidi,
Luigi Azario
[show abstract]
[hide abstract]
ABSTRACT: A method for the determination of the in vivo isocenter dose, D(iso), has been applied to the dynamic conformal are therapy (DCAT) for thoracic tumors. The method makes use of the transmitted signal, S(t,alpha), measured at different gantry angles, a, by a small ion chamber positioned on the electronic portal imaging device. The in vivo method is implemented by a set of correlation functions obtained by the ratios between the transmitted signal and the midplane dose in a solid phantom, irradiated by static fields. The in vivo dosimetry at the isocenter for the DCAT requires the convolution between the signals, S(t,alpha), and the dose reconstruction factors, C(alpha), that depend on the patient's anatomy and on its tissue inhomogeneities along the beam central axis in the a direction. The C(alpha) factors are obtained by processing the patient's computed tomography scan. The method was tested by taking measurements in a cylindrical phantom and in a Rando Alderson phantom. The results show that the difference between the convolution calculations and the phantom measurements is within +/-2%. The in vivo dosimetry of the stereotactic DCAT for six lung tumors, irradiated with three or four arcs, is reported. The isocenter dose up to 17 Gy per therapy fraction was delivered on alternating days for three fractions. The agreement obtained in this pilot study between the total in vivo dose D(iso) and the planned dose D(iso,TPS) at the isocenter is +/-4%. The method has been applied on the DCAT obtaining a more extensive monitoring of possible systematic errors, the effect of which can invalidate the current therapy which uses a few high-dose fractions.
Medical Physics 06/2008; 35(5):1830-9. · 2.83 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Gastric cancer is still a major problem for oncologists. Surgery is the main therapeutic approach; a complete surgical resection is usually necessary to offer potentially curative therapy to patients with adenocarcinoma of the stomach. However, many patients with more locally advanced tumors will experience local and distal recurrences. When a recurrence occurs, only palliative therapy is possible. In operable gastric cancer, both the extent of surgery and the value of adjuvant treatment remain subject to considerable international controversies. To improve local control, surgeons address the role of standardized surgery and of more extended surgery. Radiotherapy appears to improve local control and survival in the adjuvant arms, but perspective randomized trials are scarce and reported over many years. Retrospective experience demonstrated a low local recurrence rate, but was affected by large heterogeneity. However, evidence published in the last few years, improved radiotherapy technologies, better knowledge of the at-risk areas (enabling smaller radiotherapy volumes) and growing interest in neoadjuvant approaches support the role of radiotherapy in gastric cancer.
Expert Review of Anti-infective Therapy 11/2007; 7(10):1379-93. · 2.65 Impact Factor
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Angelo Piermattei,
Andrea Fidanzio,
Luigi Azario,
Luca Grimaldi,
Guido D'Onofrio,
Savino Cilla,
Gerardina Stimato,
Diego Gaudino,
Sara Ramella,
Rolando D'Angelillo, [......],
Luciano Iadanza,
Sergio Zucca,
Vincenzo Fusco,
Nicola Di Napoli,
Maria Antonietta Gambacorta,
Mario Balducci,
Numa Cellini,
Francesco Deodato,
Gabriella Macchia,
Alessio G Morganti
[show abstract]
[hide abstract]
ABSTRACT: This work reports the results of the application of a practical method to determine the in vivo dose at the isocenter point, D(iso), of brain thorax and pelvic treatments using a transit signal S(t). The use of a stable detector for the measurement of the signal S(t) (obtained by the x-ray beam transmitted through the patient) reduces many of the disadvantages associated with the use of solid-state detectors positioned on the patient as their periodic recalibration, and their positioning is time consuming. The method makes use of a set of correlation functions, obtained by the ratio between S(t) and the mid-plane dose value, D(m), in standard water-equivalent phantoms, both determined along the beam central axis. The in vivo measurement of D(iso) required the determination of the water-equivalent thickness of the patient along the beam central axis by the treatment planning system that uses the electron densities supplied by calibrated Hounsfield numbers of the computed tomography scanner. This way it is, therefore, possible to compare D(iso) with the stated doses, D(iso,TPS), generally used by the treatment planning system for the determination of the monitor units. The method was applied in five Italian centers that used beams of 6 MV, 10 MV, 15 MV x-rays and (60)Co gamma-rays. In particular, in four centers small ion-chambers were positioned below the patient and used for the S(t) measurement. In only one center, the S(t) signals were obtained directly by the central pixels of an EPID (electronic portal imaging device) equipped with commercial software that enabled its use as a stable detector. In the four centers where an ion-chamber was positioned on the EPID, 60 pelvic treatments were followed for two fields, an anterior-posterior or a posterior-anterior irradiation and a lateral-lateral irradiation. Moreover, ten brain tumors were checked for a lateral-lateral irradiation, and five lung tumors carried out with three irradiations with different gantry angles were followed. One center used the EPID as a detector for the S(t) measurement and five pelvic treatments with six fields (many with oblique incidence) were followed. These last results are reported together with those obtained in the same center during a pilot study on ten pelvic treatments carried out by four orthogonal fields. The tolerance/action levels for every radiotherapy fraction were 4% and 5% for the brain (symmetric inhomogeneities) and thorax/pelvic (asymmetric inhomogeneities) irradiations, respectively. This way the variations between the total measured and prescribed doses at the isocenter point in five fractions were well within 2% for the brain treatment, and 4% for thorax/pelvic treatments. Only 4 out of 90 patients needed new replanning, 2 patients of which needed a new CT scan.
Physics in Medicine and Biology 09/2007; 52(16):5101-17. · 2.83 Impact Factor
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Vincenzo Valentini,
Claudio Coco,
Aurelio Picciocchi,
Alessio G Morganti,
Lucio Trodella,
Antonella Ciabattoni, Francesco Cellini,
Brunella Barbaro,
Santa Cogliandolo,
Gennaro Nuzzo,
Gian Battista Doglietto,
Fabrizio Ambesi-Impiombato,
Maurizio Cosimelli
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the impact of tumor response; tumor and nodal downstaging; and cTNM, yTNM (clinical stage after chemoradiation, based on preoperative imaging), and pTNM classifications on long-term outcome in patients with rectal cancer treated with preoperative 5-fluorouracil (5-FU)-based concurrent chemoradiation.
Between January 1990 and March 1998, 165 consecutive patients with locally advanced extraperitoneal cancer of the rectum were treated with preoperative chemoradiation. Four patients had a cT2 lesion (2.5%), 120 had a cT3 lesion (74.5%), and 41 had a cT4 lesion (23%). The nodal involvement at combined imaging was cN0 in 21%, cN1 in 41%, cN2 in 34%, and cN3 in 4%. Preoperative chemoradiation was delivered according to 1 of 3 schedules: (1) FUMIR-T3 (from 1990 to 1995) for patients with cT3N0-2 or cT2N1-2 rectal carcinoma (82 patients): 37.8 Gy (1.8 Gy/fraction) plus 5-FU, 1 g/m(2)/d on Days 1-4, continuous infusion, and mitomycin-C, 10 mg/m(2)/d on Day 1; (2) FUMIR-T4 (from 1990 to 1999) for patients with cT4N0-3 or cT3-4N3 rectal carcinoma (40 patients): 45 Gy (1.8 Gy/fraction) plus 5-FU, 1 g/m(2)/d on Days 1-4 and 29-32, continuous infusion, and mitomycin-C, 10 mg/m(2)/d on Days 1 and 29; and (3) PLAFUR-4 (from 1995 to 1998) for patients with cT3N0-2 or cT2N1-2 rectal carcinoma (42 patients): 50.4 Gy (1.8 Gy/fraction) plus 5-FU, 1 g/m(2)/d on Days 1-4 and 29-32, continuous infusion, and cisplatin, 60 mg/m(2)/d on Days 1 and 29. Four to five weeks after chemoradiation, patients were reevaluated for clinical response by imaging studies (CT scan, transrectal ultrasonography, barium enema, liver ultrasonography, chest X-rays) and restaged (yTNM). Surgery was performed 6-8 weeks after chemoradiation. Adjuvant chemotherapy (5-FU + l-folinic acid) was delivered to 26 patients in the FUMIR-T4 protocol group. Local control (LC), freedom from distant metastases (FDM), disease-free survival, and overall survival (OS) were evaluated according to the clinical response and cTNM, yTNM, and pTNM classification. The median follow-up was 67 months.
The 5-year survival rate was 100% for cT2, 77% for cT3, and 62% for cT4 (p = 0.0497); after chemoradiation, it ranged between 81% and 91% for pT0-pT2 and dropped to 66% for pT3 and 47% for pT4 (p = 0.014). The 5-year local control rate was, at the first staging, 84% for cT3 and 72% for cT4; after chemoradiation, the pT stage correlated significantly with LC (p = 0.0012): 100% for pT0, 83% for pT1, 88% for pT2, 79% for pT3, and 46% for pT4. N stage was statistically significant in predicting FDM and OS at any staging step. A significant impact of tumor response, tumor downstaging, and nodal downstaging on LC, FDM, disease-free survival, and OS was also recorded. If the residual tumor, before surgery, had a tumor index <30 (i.e., width less than one-quarter of rectal circumference and length in its caudocranial axis < or =30 mm), the 5-year LC, FDM, disease-free survival, and OS rates were significantly higher at both the univariate and the multivariate analyses. The surgical procedure was tailored according to tumor downstaging, and thus the choice of sphincter-preserving surgery was based on the distance between the lower pole of the tumor and the anorectal ring "after" chemoradiation. In 36 patients with the lower pole of the lesion in the range of 0-30 mm from the anorectal ring, 16 patients (44%) underwent a sphincter-saving procedure. All clinical outcomes were similar compared with 20 patients with tumor located at the same rectum level who received an abdominoperineal resection.
After preoperative chemoradiation, clinical response and tumor/nodal pathologic downstaging showed a close correlation with improved outcomes. The better 5-year survival and local control in pT0-2 patients regardless of their initial stage seems to confirm a heterogeneity in rectal cancer patients. The responder population showed a behavior similar to rectal cancer diagnosed at Stage cT1-2 and treated with conservative surgery alone. Additional studies aimed at improving local tumor response seem justified. Trials of sphincter-saving surgery after a major response are warranted.
International Journal of Radiation OncologyBiologyPhysics 07/2002; 53(3):664-74. · 4.11 Impact Factor
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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.
I supplementi di Tumori : official journal of Società italiana di cancerologia ... [et al.]. 2(5):S39-44.
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ABSTRACT: There is a relationship between a given radiation dose and the resulting biological effect in the management of head and neck cancer. Radiation mucositis represents a frequent complication in cancer chemoradiation. Its prevention and treatment are major goals in radiation therapy schedules. Critical tissues can be spared using high conformal radiation therapy (3DCRT) based on consensus guidelines for target volume. Current approaches to radiation mucositis with respect to the dose and volume impact are illustrated. The monitoring system of late toxicity used by the authors is presented.
Rays 30(2):137-44.
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ABSTRACT: Biologic factors affect the ability of radiation to effectively treat all patients with prostate cancer. The use of prognostic and genetic markers (12 lipoxygenase, p53, bc1-2 genes, ploidy) may aid in the development of treatments for these patients. Particularly, several studies have shown that p53 tumor suppressor gene mutations are infrequent in prostate cancer and are associated with advanced disease. Recent efforts have been directed toward novel therapeutic modalities, especially in combination with standard irradiation of prostate carcinoma. These modalities are based on an improved knowledge of these biological factors involved in the progression and diffusion of the tumor, especially p53. Several authors evaluated the predictive and prognostic role of p53 in patients with prostatic cancer treated with radiotherapy. An extensive review of international reports on the subject is provided.
Rays 27(3):205-14.
