Giuseppe Minniti

Giuseppe Minniti
Università degli Studi di Siena | UNISI

MD, PhD

About

257
Publications
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Publications

Publications (257)
Article
Background Validation of the 2016 RANO MRI scorecard for leptomeningeal metastasis failed for multiple reasons. Accordingly, this joint EORTC Brain Tumor Group and RANO effort sought to prospectively validate a revised MRI scorecard for response assessment in leptomeningeal metastasis. Methods Coded paired cerebrospinal MRI of 20 patients with lep...
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Background: Anterior cervical corpectomy and plating has been recognized as a valuable approach for the surgical treatment of cervical spinal metastases. This study aimed to report the surgical, clinical and radiological outcomes of anterior carbon-PEEK instrumentations for cervical spinal metastases. Methods: Demographical, clinical, surgical and...
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Purpose Immunotherapy has shown activity in patients with brain metastases (BM) and leptomeningeal disease (LMD). We have evaluated LMD and intraparenchymal control rates for patients with resected BM receiving postoperative stereotactic radiosurgery (SRS) and immunotherapy or postoperative SRS alone. We hypothesize that postoperative SRS and immun...
Article
BACKGROUND Validation of the 2016 LANO MRI scorecard for leptomeningeal metastasis failed for multiple reasons. The objective of this joint EORTC Brain Tumor Group and RANO effort was to validate the feasibility of the revised MRI scorecard for assessing response in leptomeningeal metastasis. METHODS Coded paired cerebrospinal MRI of 20 patients w...
Article
Background Prognostic factors and role of treatments are not well known in isocitrate dehydrogenase (IDH) wild-type (wt) grade 2 astrocytomas. The aim of this study was to define in these tumours clinical features, molecular characteristics and prognostic factors, with particular focus on molecular subgroups defined by cIMPACT-NOW update 3. Method...
Chapter
Although surgical excision is the treatment of choice for accessible skull base meningiomas, a significant subset of complex tumours tightly attached to or encasing neurovascular structures cannot be removed safely via surgery alone. In patients with residual or progressing disease after incomplete tumour resection, adjuvant external beam radiation...
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The present joint European Association of Neuro-Oncology (EANO)–European Society for Medical Oncology (ESMO) recommendations for the diagnosis and treatment of parenchymal brain metastasis (BM) from solid cancers complement the first joint EANO–ESMO guideline on leptomeningeal metastasis from solid cancers.1 These recommendations address BMs from s...
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Meningiomas are the most common intracranial tumors. Yet, only few controlled clinical trials have been conducted to guide clinical decision making, resulting in variations of management approaches across countries and centers. However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic ap...
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The surgical management of Skull Base Meningiomas (SBMs) has radically changed over the last two decades. Extensive surgery for patients with SBMs represents the mainstream treatment; however, it is often challenging due to narrow surgical corridors and proximity to critical neurovascular structures. Novel surgical technologies, including three-dim...
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Background: Minimally invasive spine surgery (MISS) has been progressively accepted as a useful approach for spine tumors. Recently released carbon-PEEK implants have been already reported as effective in open surgeries for spine tumors. This study aimed to evaluate the feasibility, surgical, clinical and radiological outcomes of a new percutaneou...
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Despite complete surgical resection brain metastases are at significant risk of local recurrence without additional radiation therapy. Traditionally, the addition of postoperative whole brain radiotherapy (WBRT) has been considered the standard of care on the basis of randomized studies demonstrating its efficacy in reducing the risk of recurrence...
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The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current st...
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Despite aggressive management consisting of maximal safe surgical resection followed by external beam radiation therapy (60 Gy/30 fractions) with concomitant and adjuvant temozolomide, approximately 90% of WHO grade IV gliomas (glioblastomas, GBM) will recur locally within 2 years. For patients with recurrent GBM, no standard of care exists. Thanks...
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The management of patients with glioma usually requires multimodality treatment including surgery, radiotherapy, and systemic therapy. Accurate neuroimaging plays a central role for radiotherapy planning and follow-up after radiotherapy completion. In order to maximize the radiation dose to the tumor and to minimize toxic effects on the surrounding...
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In response to major changes in diagnostic algorithms and the publication of mature results from various large clinical trials, the European Association of Neuro-Oncology (EANO) recognized the need to provide updated guidelines for the diagnosis and management of adult patients with diffuse gliomas. Through these evidence-based guidelines, a task f...
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Background and Purpose For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors. Material and Methods A comprehensive literature search wa...
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BACKGROUND IDH-wild type diffuse astrocytomas with pTERT mutation have been suggested by cIMPACT-NOW update 3 to share a poor prognosis with glioblastoma (GBM). In a previous series of the Italian Association of Neuro-Oncology, we reported that IDH-wild type grade II astrocytomas benefit from gross total resection. However, the impact of surgery in...
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Background The evolution of radiation necrosis (RN) varies depending on the combination of radionecrotic tissue and active tumor cells. In this study, we characterized the long-term metabolic evolution of RN by sequential PET/CT imaging with 3,4‑dihydroxy‑6‑[ 18F]‑fluoro-l‑phenylalanine (F-DOPA) in patients with brain metastases following stereotac...
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Objectives: The prognosis of brain metastatic colorectal cancer patients (BMCRC) is poor. Several local treatments have been used, but the optimal treatment choice remains an unresolved issue. We evaluated the clinical outcomes of a large series of BMCRC patients treated in several Italian centers using stereotactic radiosurgery (SRS). Methods:...
Chapter
Surgical excision is the treatment of choice for accessible skull base meningiomas. Nevertheless, a significant subset of complex tumors tightly attached to or encasing neurovascular structures cannot be removed safely. In such patients with residual or progressing disease after incomplete tumor resection, adjuvant external beam radiation therapy (...
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Full-text available
Objectives To evaluate the efficacy of a second course of fractionated stereotactic radiotherapy (re-SRT) and temozolomide (TMZ) as salvage treatment option in patients with aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs).Patients and Methods Twenty-one patients with recurrent or progressive APTs (n = 17) and PCs (n = 4) who recei...
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Purpose To assess the clinical outcomes and target positioning accuracy of frameless linear accelerator (LINAC) single-isocenter multiple-target (SIMT) dynamic conformal arc (DCA) stereotactic radiosurgery (SRS) for multiple brain metastases (BM). Patients and Methods Between October 2016 and September 2018, thirty-one consecutive patients ≥18 yea...
Chapter
Stereotactic radiosurgery (SRS), given in a single or few fractions (2–5), is the recommended treatment for patients with a limited number of brain metastases. Both single-fraction and multi-fraction SRS are effective treatment options for patients with brain metastases, with a relative risk of neurological complications. The end points typically u...
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Background: In recent years, novel radiation therapy techniques have moved clinical practice toward tailored medicine. An essential role is played by the decision support system, which requires a standardization of data collection. The Aim of the Prediction Models In Stereotactic External radiotherapy (PRE.M.I.S.E.) project is the implementation o...
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Background: During these last years, new agents have dramatically improved the survival of the metastatic patients. Oligometastases represent a continuous field of interest in which the integration of metastases-directed therapy and drugs could further improve the oncologic outcomes. Herein a narrative review is performed regarding the main ration...
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Purpose: To assess the neurocognitive function and neurological toxicity of frameless linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in patients with 10 or more brain metastases (BM). Patients and methods: Forty consecutive adult patients who received SRS for ten or more 10 BM < 3 cm in maximum size were evaluated. All plans we...
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The differentiation between radiation-induced changes and tumor recurrence is a major pitfall of magnetic resonance imaging, which can be overcome by the use of PET. Although amino-acid PET tracers showed several advantages over F-fluorodeoxyglucose in neurooncology, studies comparing these 2 types of radiopharmaceuticals in previously irradiated b...
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In 2018 the SINch (Italian Society of Neurosurgery) Neuro-Oncology section, AINO (Italian Association of Neuro-Oncology) and SIN (Italian Association of Neurology) Neuro-Oncology section formed a collaborative Task Force to look at the diagnosis and treatment of low-grade gliomas (LGGs). The Task Force included neurologists, neurosurgeons, neuro-on...
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Glioblastomas are the most common form of malignant primary brain tumor and an important cause of morbidity and mortality. In recent years there have been important advances in understanding the molecular pathogenesis and biology of these tumors, but this has not translated into significantly improved outcomes for patients. In this consensus review...
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The incidence of brain metastasis is increasing as improvements in systemic therapy lead to increased survival. This provides new and challenging clinical decisions for patients who are trying to balance the risk of recurrence or progression with treatment-related side effects, and it requires appropriate management strategies from multidisciplinar...
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Parasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogen...
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Purpose To investigate the efficacy and safety of concurrent stereotactic radiosurgery (SRS) and ipilimumab or nivolumab in patients with untreated melanoma brain metastases. Patients and Methods Eighty consecutive patients with 326 melanoma brain metastases receiving SRS in combination with ipilimumab or nivolumab were identified from an institut...
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INTRODUCTION Malignant gliomas are aggressive primitive brain tumor in adults. Today, the standard of care is Temozolomide (TMZ) administered daily with radiation therapy, followed by adjuvant TMZ. TMZ treatment has been considered to have a low toxicity profile. However, during concomitant treatment some patient may develop a severe myelosuppressi...
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Background: Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) are well established local treatment approaches in several cancer settings. Although SBRT is still under investigation for spinal metastases, promising results in terms of a high effectiveness and optimal tolerability have been recently published on this topic. F...
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BACKGROUND Malignant gliomas are aggressive primitive brain tumor in adults. Today, the standard of care is Temozolomide (TMZ) administered daily with radiation therapy, followed by adjuvant TMZ. TMZ treatment has been considered to have a low toxicity profile. However, during concomitant treatment some patient may develop a severe myelosuppression...
Chapter
Fractionated stereotactic radiosurgery (SRS) is emerging as an effective treatment option for relatively large intracranial tumors, with the aim of improving the balance between tumor control and normal tissue toxicity over single-fraction SRS, particularly for large lesions or lesions located in critical areas of the brain. Several published studi...
Article
Radiation therapy (RT) is an effective treatment for patients with either nonfunctioning or secreting pituitary adenomas unsuccessfully treated by surgery and/or medical therapy, resulting in local control of 90–95% at 5–10 years and variable normalization of hormonal hypersecretion for patients with GH-, ACTH-, and prolactin-secreting adenomas in...
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Purpose: to investigate clinical outcomes in patients with large brain metastases from non-small-cell lung cancer (NSCLC) who received surgical resection and postoperative stereotactic radiosurgery or SRS alone. Patients and methods: Two hundred and twenty-two patients with 241 large brain metastases (2-4 cm in size) who received surgery and mul...
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The incidence of glioblastoma (GBM) in the elderly population is slowly increasing in Western countries. Current management includes surgery, radiation therapy (RT) and chemotherapy; however, survival is significantly worse than that observed in younger patients and the optimal treatment in terms of efficacy and safety remains a matter of debate. S...
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Introduction The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patient...
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Purpose of review To give an overview on the current evidence for stereotactic radiosurgery of brain metastases with a special focus on multiple brain metastases. Recent findings While the use of stereotactic radiosurgery in patients with limited brain metastases has been clearly defined, its role in patients with multiple lesions (> 4) is still a...
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Background: Orbital radiotherapy (RT) is an effective and consolidate treatment for steroid-refractory Graves' ophthalmopathy (GO); however, long term effects are not well known. Objectives: The aim of this study was to evaluate the long term efficacy and toxicity of orbital RT plus concomitant systemic steroids in a population of patients with...
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Objective The role of amino acid positron emission tomography (PET) in glioma grading and outcome prognostication has not yet been well established. This is particularly true in the context of the new WHO 2016 classification, which introduced a definition of glioma subtypes primarily based on molecular fingerprints. The aim of the present study was...
Chapter
In 2016 the World Health Organization released an update of the classification of brain tumors, based on the increased understanding, over the past two decades, of the genetic basis of tumorigenesis. The new classification, for the first time, integrated both genotypic and phenotypic parameters, leading to a molecular stratification of brain tumors...
Article
Purpose A commercial planning software using this technique, called Multiple Brain Mets SRS (MBM) Element from Brainlab AG (Feldkirchen, Germany), version 1.5, has been installed in our institution. It uses a preconfigured set of dynamic noncoplanar, conformal arcs to treat up to 15 brain-metastases with a single isocenter. It optimizes the weight...
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Purpose Recently an increase in radiosurgery treatments for multiple metastases has been observed. Traditionally these lesions were treated using one isocenter for each target and the patient had to be shifted during a single session for repositioning.The implementation of single-isocenter volumetric modulated arc therapy (VMAT) radiosurgery techni...
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BACKGROUND Information regarding clinical characteristics and response to treatments of IDH-wild type grade II gliomas are still lacking. MATERIAL AND METHODS We performed a retrospective study on patients with WHO grade II IDH wild type gliomas recruited from 1999 to 2017 in six Italian Institutions. IDH mutation was assessed by either immunohist...
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Radiation therapy plays a critical role in the management of brain tumors. Recent advances in radiation techniques include the use of intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT) and stereotactic radiosurgery (SRS). All of these techniques allow the delivery of higher radiation doses to the target volume, at the...
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Background The aim of our study was to evaluate feasibility, toxicity profile and local control of salvage intensity modulated radiotherapy (IMRT) delivered with simultaneous integrated boost (SIB) associated or not to concomitant weekly cisplatin in patients affected by NSCLC with mediastinal nodal recurrence after surgery. Patterns of recurrence,...
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Purpose: Standard treatment for locally advanced rectal cancer consists of neoadjuvant radiochemotherapy with concomitant fluoropyrimidine or oxaliplatin and surgery with curative intent. Pathological complete response has shown to be predictive for better outcome and survival; nevertheless there are no biological or genetic factors predictive for...
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Background The role of re-irradiation is still under investigation, particularly regarding to the appropriate patients selection, the time interval between the first and second irradiation, and the optimal RT schedule. The aim of the present study was to evaluate clinical outcome of patients with recurrent glioma underwent re-irradiation in 13 Ital...