71 results on '"Scarzello G"'
Search Results
2. PO-1712 Quality Assurance of Pediatric Radiotherapy: a KBP multicentric cooperative initiative
- Author
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Scaggion, A., primary, Meroni, S., additional, Cavagnetto, F., additional, Barra, S., additional, Bovo, E., additional, Cavinato, S., additional, Cirone, A., additional, Levrero, F., additional, Giannelli, F., additional, Giandini, T., additional, Pozzo, E., additional, Pecori, E., additional, Scarzello, G., additional, Turazzi, M., additional, and Paiusco, M., additional
- Published
- 2023
- Full Text
- View/download PDF
3. Mitigating negative emotions through virtual reality and embodiment
- Author
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Sansoni, M, Scarzello, G, Serino, S, Groff, E, Riva, G, Sansoni M., Scarzello G., Serino S., Groff E., Riva G., Sansoni, M, Scarzello, G, Serino, S, Groff, E, Riva, G, Sansoni M., Scarzello G., Serino S., Groff E., and Riva G.
- Abstract
Oncological treatments are responsible for many of the physical changes (aesthetic and functional) associated with cancer. Because of this, cancer patients are at high risk of developing mental health problems. The aim of this study is to propose an innovative Virtual Reality (VR) training that uses a somatic technique (i.e., embodiment) to create a bridge with the bodily dimension of cancer. After undergoing a psycho-educational procedure, a combination of exposure, out-of-body experience, and body swapping will gradually train the patient to cope with cancer-related difficulties, increasing stress tolerance, and patient empowerment. The most engaging step of this advanced form of Stress Inoculation Training is the body swapping experience, which will guide the patient in embodying a resilient cancer patient who is facing similar difficulties. Through the VR ability to simulate the human brain functioning, and the potential of embodiment to hook to the somatic dimension of illness, we expect that once the concepts endured through the patient’s experience of resilience are triggered, the patient will be more prone to implement functional coping strategies in real life, reaching empowerment and adjusting to the post-treatment difficulties. When the scenarios are built and the training tested, our intervention could be used to support patients with different oncological diseases and who are treated in different cancer hospitals, as well as patients with other non-oncological problems (e.g., social anxiety). Future research should focus on using our paradigm for other clinical populations, and supporting cancer patients in coping with different distressing situations.
- Published
- 2022
4. A multicenter LArge retrospectIve daTabase on the personalization of stereotactic ABlative radiotherapy use in lung metastases from colon-rectal cancer: The LaIT-SABR study
- Author
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Nicosia, L, Franceschini, D, Perrone-Congedi, F, Casamassima, F, Gerardi, M, Rigo, M, Mazzola, R, Perna, M, Scotti, V, Fodor, A, Iurato, A, Pasqualetti, F, Gadducci, G, Chiesa, S, Niespolo, R, Bruni, A, Alicino, G, Frassinelli, L, Borghetti, P, Di Marzo, A, Ravasio, A, De Bari, B, Sepulcri, M, Aiello, D, Mortellaro, G, Sangalli, C, Franceschini, M, Montesi, G, Aquilanti, F, Lunardi, G, Valdagni, R, Fazio, I, Scarzello, G, Corti, L, Vavassori, V, Maranzano, E, Magrini, S, Arcangeli, S, Gambacorta, M, Valentini, V, Paiar, F, Ramella, S, Di Muzio, N, Livi, L, Jereczek-Fossa, B, Osti, M, Scorsetti, M, Alongi, F, Nicosia L., Franceschini D., Perrone-Congedi F., Casamassima F., Gerardi M. A., Rigo M., Mazzola R., Perna M., Scotti V., Fodor A., Iurato A., Pasqualetti F., Gadducci G., Chiesa S., Niespolo R. M., Bruni A., Alicino G., Frassinelli L., Borghetti P., Di Marzo A., Ravasio A., De Bari B., Sepulcri M., Aiello D., Mortellaro G., Sangalli C., Franceschini M., Montesi G., Aquilanti F. M., Lunardi G., Valdagni R., Fazio I., Scarzello G., Corti L., Vavassori V., Maranzano E., Magrini S. M., Arcangeli S., Gambacorta M. A., Valentini V., Paiar F., Ramella S., Di Muzio N. G., Livi L., Jereczek-Fossa B. A., Osti M. F., Scorsetti M., Alongi F., Nicosia, L, Franceschini, D, Perrone-Congedi, F, Casamassima, F, Gerardi, M, Rigo, M, Mazzola, R, Perna, M, Scotti, V, Fodor, A, Iurato, A, Pasqualetti, F, Gadducci, G, Chiesa, S, Niespolo, R, Bruni, A, Alicino, G, Frassinelli, L, Borghetti, P, Di Marzo, A, Ravasio, A, De Bari, B, Sepulcri, M, Aiello, D, Mortellaro, G, Sangalli, C, Franceschini, M, Montesi, G, Aquilanti, F, Lunardi, G, Valdagni, R, Fazio, I, Scarzello, G, Corti, L, Vavassori, V, Maranzano, E, Magrini, S, Arcangeli, S, Gambacorta, M, Valentini, V, Paiar, F, Ramella, S, Di Muzio, N, Livi, L, Jereczek-Fossa, B, Osti, M, Scorsetti, M, Alongi, F, Nicosia L., Franceschini D., Perrone-Congedi F., Casamassima F., Gerardi M. A., Rigo M., Mazzola R., Perna M., Scotti V., Fodor A., Iurato A., Pasqualetti F., Gadducci G., Chiesa S., Niespolo R. M., Bruni A., Alicino G., Frassinelli L., Borghetti P., Di Marzo A., Ravasio A., De Bari B., Sepulcri M., Aiello D., Mortellaro G., Sangalli C., Franceschini M., Montesi G., Aquilanti F. M., Lunardi G., Valdagni R., Fazio I., Scarzello G., Corti L., Vavassori V., Maranzano E., Magrini S. M., Arcangeli S., Gambacorta M. A., Valentini V., Paiar F., Ramella S., Di Muzio N. G., Livi L., Jereczek-Fossa B. A., Osti M. F., Scorsetti M., and Alongi F.
- Abstract
Introduction: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD). Material and methods: The study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for freedom from local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC). Results: Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED < 00 Gy, 100–124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p = 0.000). Two-year FLP for lesion measuring ≤10 mm, 10–20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p = 0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11–0.51; p = 0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2–3 or 4–5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p = 0.035). Conclusion: The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.
- Published
- 2022
5. CO-06.3 - A MULTICENTRIC COOPERATIVE EFFORT ON A SHARED CLOUD-BASED PLATFORM FOR PEDIATRIC RADIOTHERAPY QA
- Author
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Scaggion, A., Meroni, S., Cavagnetto, F., Barra, S., Bovo, E., Cavinato, S., Cirone, A., Levrero, F., Giannelli, F., Giandini, T., Pozzo, E., Pecori, E., Scarzello, G., Turazzi, M., and Paiusco, M.
- Published
- 2023
- Full Text
- View/download PDF
6. Mitigating negative emotions through virtual reality and embodiment
- Author
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Sansoni M., Scarzello G., Serino S., Groff E., Riva G., Sansoni, M, Scarzello, G, Serino, S, Groff, E, and Riva, G
- Subjects
body illusion ,emotion regulation ,body experience ,embodiment ,negative emotion ,psycho-oncology ,virtual reality ,well-being ,Behavioral Neuroscience ,Psychiatry and Mental health ,Neuropsychology and Physiological Psychology ,Neurology ,Settore M-PSI/01 - PSICOLOGIA GENERALE ,M-PSI/01 - PSICOLOGIA GENERALE ,Biological Psychiatry - Abstract
Oncological treatments are responsible for many of the physical changes (aesthetic and functional) associated with cancer. Because of this, cancer patients are at high risk of developing mental health problems. The aim of this study is to propose an innovative Virtual Reality (VR) training that uses a somatic technique (i.e., embodiment) to create a bridge with the bodily dimension of cancer. After undergoing a psycho-educational procedure, a combination of exposure, out-of-body experience, and body swapping will gradually train the patient to cope with cancer-related difficulties, increasing stress tolerance, and patient empowerment. The most engaging step of this advanced form of Stress Inoculation Training is the body swapping experience, which will guide the patient in embodying a resilient cancer patient who is facing similar difficulties. Through the VR ability to simulate the human brain functioning, and the potential of embodiment to hook to the somatic dimension of illness, we expect that once the concepts endured through the patient’s experience of resilience are triggered, the patient will be more prone to implement functional coping strategies in real life, reaching empowerment and adjusting to the post-treatment difficulties. When the scenarios are built and the training tested, our intervention could be used to support patients with different oncological diseases and who are treated in different cancer hospitals, as well as patients with other non-oncological problems (e.g., social anxiety). Future research should focus on using our paradigm for other clinical populations, and supporting cancer patients in coping with different distressing situations.
- Published
- 2022
7. Treatment and outcome of intracranial ependymoma after first relapse in the 2nd AIEOP protocol
- Author
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Massimino, M., Barretta, F., Modena, P., Johann, P., Ferroli, P., Antonelli, M., Gandola, L., Garre, M. L., Bertin, D., Mastronuzzi, A., Mascarin, M., Quaglietta, L., Viscardi, E., Sardi, I., Ruggiero, Antonio, Boschetti, L., Giagnacovo, M., Biassoni, V., Schiavello, E., Chiapparini, L., Erbetta, A., Mussano, A., Giussani, C., Mura, R. M., Barra, S., Scarzello, G., Scimone, G., Carai, A., Giangaspero, F., Buttarelli, F. R., Ruggiero A. (ORCID:0000-0002-6052-3511), Massimino, M., Barretta, F., Modena, P., Johann, P., Ferroli, P., Antonelli, M., Gandola, L., Garre, M. L., Bertin, D., Mastronuzzi, A., Mascarin, M., Quaglietta, L., Viscardi, E., Sardi, I., Ruggiero, Antonio, Boschetti, L., Giagnacovo, M., Biassoni, V., Schiavello, E., Chiapparini, L., Erbetta, A., Mussano, A., Giussani, C., Mura, R. M., Barra, S., Scarzello, G., Scimone, G., Carai, A., Giangaspero, F., Buttarelli, F. R., and Ruggiero A. (ORCID:0000-0002-6052-3511)
- Abstract
Background: More than 40% of patients with intracranial ependymoma need a salvage treatment within 5 years after diagnosis, and no standard treatment is available as yet. We report the outcome after first relapse of 64 patients treated within the 2nd AIEOP protocol. Methods: We considered relapse sites and treatments, that is, various combinations of complete/incomplete surgery, if followed by standard or hypofractionated radiotherapy (RT) ± chemotherapy (CT). Molecular analyses were available for 38/64 samples obtained at first diagnosis. Of the 64 cases, 55 were suitable for subsequent analyses. Results: The median follow-up was 147 months after diagnosis, 84 months after first relapse, 5-year EFS/OS were 26.2%/30.8% (median EFS/OS 13/32 months) after relapse. For patients with a local relapse (LR), the 5-year cumulative incidence of second LRs was 51.6%, with a 5-year event-specific probability of being LR-free of 40.0%. Tumor site/grade, need for shunting, age above/below 3 years, molecular subgroup at diagnosis, had no influence on outcomes. Due to variation in the RT dose/fractionation used and the subgroup sizes, it was not possible to assess the impact of the different RT modalities. Multivariable analyses identified completion of surgery, the absence of symptoms at relapse, and female sex as prognostically favorable. Tumors with a 1q gain carried a higher cumulative incidence of dissemination after first relapse. Conclusions: Survival after recurrence was significantly influenced by symptoms and completeness of surgery. Only a homogeneous protocol with well-posed, randomized questions could clarify the numerous issues, orient salvage treatment, and ameliorate prognosis for this group of patients.
- Published
- 2022
8. Merkel Cell Carcinoma: Evaluation of the Clinico-Pathological Characteristics, Treatment Strategies and Prognostic Factors in a Monocentric Retrospective Series (n=143)
- Author
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Rastrelli, M., Del Fiore, P., Russo, I., Tartaglia, J., Dal Monico, A., Cappellesso, R., Nicole, L., Piccin, L., Fabozzi, A., Biffoli, B., Di Prata, C., Ferrazzi, B., Dall'Olmo, L., Vecchiato, A., Spina, R., Russano, F., Bezzon, E., Cingarlini, S., Mazzarotto, R., Parisi, A., Scarzello, G., Pigozzo, J., Brambullo, T., Tropea, S., Vindigni, V., Bassetto, F., Bertin, D., Gregianin, M., Dei Tos, A. P., Cavallin, F., Alaibac, M., Chiarion-Sileni, V., and Mocellin, S.
- Subjects
Cancer Research ,skin cancer ,Oncology ,Merkel treatment strategies ,Merkel carcinoma ,Merkel cell cancer ,non-melanoma skin cancer (NMSC) ,Original Research - Abstract
Background Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The incidence of the disease has undergone a significant increase in recent years, which is caused by an increase in the average age of the population and in the use of immunosuppressive therapies. MCC is an aggressive pathology, which metastasizes early to the lymph nodes. These characteristics impose an accurate diagnostic analysis of the regional lymph node district with radiography, clinical examination and sentinel node biopsy. In recent years, there has been a breakthrough in the treatment of the advanced pathology thanks to the introduction of monoclonal antibodies acting on the PD-1/PD-L1 axis. This study aimed to describe the clinico-pathological characteristics, treatment strategies and prognostic factors of MCC. Methods A retrospective cohort study was conducted involving 143 consecutive patients who were diagnosed and/or treated for MCC. These patients were referred to the Veneto Institute of Oncology IOV-IRCCS and to the University Hospital of Padua (a third-level center) in the period between December 1991 and January 2020. In the majority of cases, diagnosis took place at the IOV. However, some patients were diagnosed elsewhere and subsequently referred to the IOV for a review of the diagnosis or to begin specific therapeutic regimens. Results 143 patients, with an average age of 71 years, were affected mainly with autoimmune and neoplastic comorbidities. Our analysis has shown that age, autoimmune comorbidities and the use of therapy with immunomodulating drugs (which include corticosteroids, statins and beta-blockers) are associated with a negative prognosis. In this sense, male sex is also a negative prognostic factor. Conclusions Autoimmune and neoplastic comorbidities were frequent in the studied population. The use of drugs with immunomodulatory effects was also found to be a common feature of the population under examination. The use of this type of medication is considered a negative prognostic factor. The relevance of a multidisciplinary approach to the patient with MCC is confirmed, with the aim of assessing the risks and benefits related to the use of immunomodulating therapy in the individual patient.
- Published
- 2021
- Full Text
- View/download PDF
9. Current radiotherapy practice for children with metastases from solid tumors : SIOPE survey analysis
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Huijskens, S., Kroon, P., Abakay, C. Demiroz, Timmermann, B., Giralt, J., Gaze, M., Harrabi, S., Scarzello, G., Alexopoulou, A., Padovani, L., Escande, A., Gandola, L., Supiot, S., Chojnacka, M., Bokun, J., Napieralska, A., Rombi, B., Maduro, J. H., Bolle, S., Mussano, A., Mandeville, H., Claude, L., Seravalli, E., Janssens, G. O., and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
- Subjects
Medizin - Published
- 2020
10. Current Radiotherapy Practice With Curative Intent for Children With Metastases From Solid Tumors Across SIOPE Affiliated Countries : A Multicenter Survey Analysis
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Huijskens, Sophie C., de Kroon, Anton, Gondola, L., Bolle, Stéphanie, Gaze, Mark N., Supiot, Stéphane, Abakay, Candan Demiroz, Alexopoulou, Alexandra A., Bokun, Jelena, Chojnacka, Marzanna, Escande, Alexandre, Giralt, Jordi L., Harrabi, Semi Ben, Maduro, John H., Mandeville, Henry C., Mussano, Anna, Napieralska, Aleksandra, Padovani, Laëtitia, Scarzello, G., Timmermann, Beate, Claude, Line, Seravalli, Enrica, and Janssens, Geert O.R.J.
- Subjects
Medizin - Published
- 2020
11. OC-0454: Current radiotherapy practice for children with metastases from solid tumors: SIOPE survey analysis
- Author
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Huijskens, S., primary, Kroon, P., additional, Demiroz Abakay, C., additional, Timmermann, B., additional, Giralt, J., additional, Gaze, M., additional, Harrabi, S., additional, Scarzello, G., additional, Alexopoulou, A., additional, Padovani, L., additional, Escande, A., additional, Gandola, L., additional, Supiot, S., additional, Chojnacka, M., additional, Bokun, J., additional, Napieralska, A., additional, Rombi, B., additional, Maduro, J.H., additional, Bolle, S., additional, Mussano, A., additional, Mandeville, H., additional, Claude, L., additional, Seravalli, E., additional, and Janssens, G.O., additional
- Published
- 2020
- Full Text
- View/download PDF
12. Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group
- Author
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Hoeben, B.A.W., Carrie, C., Timmermann, B., Mandeville, H.C., Gandola, L., Dieckmann, K., Albiac, M. Ramos, Magelssen, H., Lassen-Ramshad, Y., Ondrova, B., Ajithkumar, T., Alapetite, C., Balgobind, B.V., Bolle, S., Cameron, A.L., Fajardo, R. Davila, Dietzsch, S., Lecomte, D. Dumont, Heuvel-Eibrink, M.M. van den, Kortmann, R.D., Laprie, A., Melchior, P., Padovani, L., Rombi, B., Scarzello, G., Schwarz, R., Seiersen, K., Seravalli, E., Thorp, N., Whitfield, G.A., Boterberg, T., Janssens, G.O., Hoeben, B.A.W., Carrie, C., Timmermann, B., Mandeville, H.C., Gandola, L., Dieckmann, K., Albiac, M. Ramos, Magelssen, H., Lassen-Ramshad, Y., Ondrova, B., Ajithkumar, T., Alapetite, C., Balgobind, B.V., Bolle, S., Cameron, A.L., Fajardo, R. Davila, Dietzsch, S., Lecomte, D. Dumont, Heuvel-Eibrink, M.M. van den, Kortmann, R.D., Laprie, A., Melchior, P., Padovani, L., Rombi, B., Scarzello, G., Schwarz, R., Seiersen, K., Seravalli, E., Thorp, N., Whitfield, G.A., Boterberg, T., and Janssens, G.O.
- Abstract
Item does not contain fulltext, Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy.
- Published
- 2019
13. Prognostic role of pleural effusion or ascites in localized rhabdomyosarcoma
- Author
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Di Carlo, D., Ferrari, A., Toffolutti, T., Milano, G. M., Manzitti, C., Ruggiero, Antonio, Dall'Igna, P., Melchionda, F., Zanetti, I., Scarzello, G., Bisogno, G., Ruggiero A. (ORCID:0000-0002-6052-3511), Di Carlo, D., Ferrari, A., Toffolutti, T., Milano, G. M., Manzitti, C., Ruggiero, Antonio, Dall'Igna, P., Melchionda, F., Zanetti, I., Scarzello, G., Bisogno, G., and Ruggiero A. (ORCID:0000-0002-6052-3511)
- Abstract
Purpose: The presence of pleural effusion or ascites at the time of diagnosis is generally considered a poor prognostic factor for children with rhabdomyosarcoma (RMS), and treatment is usually intensified despite the fact that there are no published studies to support this decision. We investigated the prognostic role of the presence of pleural effusion or ascites at diagnosis in patients with localized RMS consecutively enrolled in the Italian Soft Tissue Sarcoma Committee protocols over a 30-year period. Methods: We reviewed the radiological reports at diagnosis of 150 children with supradiaphragmatic and infradiaphragmatic RMS, noting any presence of effusion and its extent (minimal, moderate, or massive). All patients received intensive chemotherapy, surgery, and standard or hyperfractionated radiotherapy. Results: Effusion was identified in 32 children (21.3%), 14 with pleural effusion and 18 with ascites. As for its extent, 13 children presented with minimal, 12 with moderate, and 7 with massive effusion. The 5-year progression-free survival (PFS) rate was 49.8% (confidence interval [CI] 31.7–65.5) and 49.5% (CI 40–58.2) for patients with and without effusion, respectively (P =.5). When only patients with moderate or massive effusion were considered, however, their PFS was 36.8% (CI 16.5–57.5) versus 51.2% (CI 42.2–59.5) in patients with minimal or no effusion (P =.01). On the whole, patients with pleural effusion had a very poor outcome with a 5-year PFS of 35.7% (CI 13–59.4). Conclusions: The presence of moderate or massive effusion seems to be an unfavorable prognostic factor in children with RMS, and justifies their inclusion in experimental studies.
- Published
- 2019
14. Long-term results of the AIEOP MH’96 childhood Hodgkin’s lymphoma trial and focus on significance of response to chemotherapy and its implication in low risk patients to avoid radiotherapy
- Author
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Burnelli, R., Rinieri, S., Rondelli, R., Todesco, A., Bianchi, M., Garaventa, A., Zecca, M., Indolfi, P., Conter, V., Santoro, N., Arico, M., Cesaro, S., D'Amico, S., Farruggia, P., De Santis, R., Locatelli, Franco, Pileri, S. A., Scarzello, G., Mascarin, M., Vecchi, V., Locatelli F. (ORCID:0000-0002-7976-3654), Burnelli, R., Rinieri, S., Rondelli, R., Todesco, A., Bianchi, M., Garaventa, A., Zecca, M., Indolfi, P., Conter, V., Santoro, N., Arico, M., Cesaro, S., D'Amico, S., Farruggia, P., De Santis, R., Locatelli, Franco, Pileri, S. A., Scarzello, G., Mascarin, M., Vecchi, V., and Locatelli F. (ORCID:0000-0002-7976-3654)
- Abstract
Identify a subset of early-stage HL children (GR1) curable with limited chemotherapy+/-radiotherapy; improve outcome of intermediate (GR2) and high-risk (GR3) patients; establish impact of response to chemotherapy evaluated with conventional imaging (CI). One hundred and sixty GR1-patients received 3ABVD + involved-field (IF) low-dose (LD) (20 Gy) irradiation if mediastinal mass or partial response (PR) after chemotherapy. Eighty-five GR2- and 315 GR3-patients received 4 and 6 COPP/ABV + IFRT, respectively. The 63 GR1 patients spared from radiotherapy had 15-year survival and EFS of 100 and 84.5%, respectively. The GR2 and GR3 15-year FFP were 84.7 and 78.6%, respectively. No different prognosis for patients in CR or PR evaluated during and after chemotherapy was observed. In conclusion, low-risk patients in CR may be successfully treated with radiation-free, low-intensity chemotherapy. Good, but less satisfactory, results were registered in GR2 and GR3. Response evaluated with CI is not a prognostic factor, but permits identification of low-risk patients who can avoid radiotherapy.
- Published
- 2018
15. Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up
- Author
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Massimino, M, Barretta, F, Modena, P, Giangaspero, F, Chiapparini, L, Erbetta, A, Boschetti, L, Antonelli, M, Ferroli, P, Bertin, D, Pecori, E, Biassoni, V, Garrè, M, Schiavello, E, Sardi, I, Viscardi, E, Scarzello, G, Mascarin, M, Quaglietta, L, Cinalli, G, Genitori, L, Peretta, P, Mussano, A, Barra, S, Mastronuzzi, A, Giussani, C, Marras, C, Balter, R, Bertolini, P, Tornesello, A, La Spina, M, Buttarelli, F, Ruggiero, A, Caldarelli, M, Poggi, G, Gandola, L, Garrè, ML, Marras, CE, Buttarelli, FR, Massimino, M, Barretta, F, Modena, P, Giangaspero, F, Chiapparini, L, Erbetta, A, Boschetti, L, Antonelli, M, Ferroli, P, Bertin, D, Pecori, E, Biassoni, V, Garrè, M, Schiavello, E, Sardi, I, Viscardi, E, Scarzello, G, Mascarin, M, Quaglietta, L, Cinalli, G, Genitori, L, Peretta, P, Mussano, A, Barra, S, Mastronuzzi, A, Giussani, C, Marras, C, Balter, R, Bertolini, P, Tornesello, A, La Spina, M, Buttarelli, F, Ruggiero, A, Caldarelli, M, Poggi, G, Gandola, L, Garrè, ML, Marras, CE, and Buttarelli, FR
- Abstract
Purpose: The aims of patients’ radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear. Methods: We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months. Results: No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5–104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients. Conclusions: Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI
- Published
- 2018
16. Central nervous system involvement in children and adolescents with rhabdomyosarcoma. A report from the AIEOP soft tissue sarcoma committee
- Author
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Pierobon, M., Ferrari, A., Scarzello, G., Tamburini, A., Quaglietta, L., Ruggiero, Antonio, Milano, G. M., Zin, A., Bisogno, G., Ruggiero A. (ORCID:0000-0002-6052-3511), Pierobon, M., Ferrari, A., Scarzello, G., Tamburini, A., Quaglietta, L., Ruggiero, Antonio, Milano, G. M., Zin, A., Bisogno, G., and Ruggiero A. (ORCID:0000-0002-6052-3511)
- Abstract
Background. Rhabdomyosarcoma (RMS) is a highly malignant tumor typically affecting children and adolescents. Central nervous system (CNS) dissemination is rare in RMS patients, but seems to have a particularly negative impact.The aim of this study was to analyze treatment and outcome of patients with RMS and evidence of CNS disease who were registered in the protocols coordinated by the Italian SoftTissue Sarcoma Committee from March 1979 to December 2016. Methods. We analyzed 39 patients with CNS disease. Depending on when their CNS disease was identified, we grouped patients as: Group A, at diagnosis; Group B, progression during treatment; Group C, at first relapse. Results. Six patients were in Group A (2.7% of metastatic RMS patients at diagnosis); 24 were in Group B and 9 in Group C (6.5% of patients with tumor progression/relapse included in the protocols). Only 5 patients (4 in Group A, 1 in Group B) survived the event and are alive in complete remission with a median follow-up of 17.5 years.These 5 patients received systemic chemotherapy and craniospinal radiotherapy, and 2 of them also received intrathecal therapy with topotecan. Conclusions. CNS involvement at diagnosis is a rare and prognostically negative event in RMS patients, but not always fatal when it is found at diagnosis. It is more frequent during or shortly after treatment, and the more dismal prognosis in these cases underscores the need to improve our ability to identify patients at risk of CNS dissemination in order to attempt more effective treatments that can sterilize the meninges.
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- 2018
17. Trasposizione dell’intestino con rete riassorbibile per il trattamento radioterapico di un rabdomiosarcoma pelvico
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Calogero Virgone, Ganarin, A., Scarzello, G., Patrizia Dall'Igna, Gianni Bisogno, and Giovanni Cecchetto
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- 2016
18. Il linfoma di Hodgkin in età pediatrica: risultati a lungo termine del protocollo AIEOP-MH’89
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Robazza, M., Mascarin, M., Elia, C., Barra, S., Bianchi, M., Buffardi, S., Bunkheila, F., Caniglia, M., Casini, T., Cellini, M., Cesaro, Simone, Consarino, C., D’Amico, S., De Santis, R., Farruggia, P., Guerrini, G., Garaventa, A., Indolfi, P., Locatelli, F., Moleti, M. L., Nardi, M., Pession, A., Pierani, P., Porta, F., Provenzi, M., Riccardi, U., Rondelli, R., Sala, A., Santoro, N., Sau, A., Scarzello, G., Todesco, A., Zanazzo, G. A., Zecca, M., and Brunelli, R.
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chemioterapia ,protocollo MH 89 ,Linfoma di Hodgkin ,Linfoma di Hodgkin, protocollo MH 89, chemioterapia - Published
- 2016
19. Isolated limb perfusion for the management limb threatening soft tissue sarcomas: The role of histological type on clinical outcomes
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Rastrelli, M., primary, Mocellin, S., additional, Stramare, R., additional, Brunello, A., additional, Maruzzo, M., additional, Basso, U., additional, Scarzello, G., additional, Buzzaccarini, M.S., additional, Pilati, P., additional, Saadeh, L.M., additional, Del Fiore, S.P., additional, Tosi, A., additional, Montesco, C., additional, Campana, L.G., additional, Tropea, S., additional, and Rossi, C.R., additional
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- 2017
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20. Final results of the second prospective AIEOP protocol for pediatric intracranial ependymoma
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Massimino, M, Miceli, R, Giangaspero, F, Boschetti, L, Modena, P, Antonelli, M, Ferroli, P, Bertin, D, Pecori, E, Valentini, L, Biassoni, V, Garrè, M, Schiavello, E, Sardi, I, Cama, A, Viscardi, E, Scarzello, G, Scoccianti, S, Mascarin, M, Quaglietta, L, Cinalli, G, Diletto, B, Genitori, L, Peretta, P, Mussano, A, Buccoliero, A, Calareso, G, Barra, S, Mastronuzzi, A, Giussani, C, Marras, C, Balter, R, Bertolini, P, Giombelli, E, La Spina, M, Buttarelli, F, Pollo, B, Gandola, L, GIUSSANI, CARLO GIORGIO, Gandola, L., Massimino, M, Miceli, R, Giangaspero, F, Boschetti, L, Modena, P, Antonelli, M, Ferroli, P, Bertin, D, Pecori, E, Valentini, L, Biassoni, V, Garrè, M, Schiavello, E, Sardi, I, Cama, A, Viscardi, E, Scarzello, G, Scoccianti, S, Mascarin, M, Quaglietta, L, Cinalli, G, Diletto, B, Genitori, L, Peretta, P, Mussano, A, Buccoliero, A, Calareso, G, Barra, S, Mastronuzzi, A, Giussani, C, Marras, C, Balter, R, Bertolini, P, Giombelli, E, La Spina, M, Buttarelli, F, Pollo, B, Gandola, L, GIUSSANI, CARLO GIORGIO, and Gandola, L.
- Abstract
Background This prospective study stratified patients by surgical resection (complete = NED vs incomplete = ED) and centrally reviewed histology (World Health Organization [WHO] grade II vs III). Methods WHO grade II/NED patients received focal radiotherapy (RT) up to 59.4 Gy with 1.8 Gy/day. Grade III/NED received 4 courses of VEC (vincristine, etoposide, cyclophosphamide) after RT. ED patients received 1-4 VEC courses, second-look surgery, and 59.4 Gy followed by an 8-Gy boost in 2 fractions on still measurable residue. NED children aged 1-3 years with grade II tumors could receive 6 VEC courses alone. Results From January 2002 to December 2014, one hundred sixty consecutive children entered the protocol (median age, 4.9 y; males, 100). Follow-up was a median of 67 months. An infratentorial origin was identified in 110 cases. After surgery, 110 patients were NED, and 84 had grade III disease. Multiple resections were performed in 46/160 children (28.8%). A boost was given to 24/40 ED patients achieving progression-free survival (PFS) and overall survival (OS) rates of 58.1% and 68.7%, respectively, in this poor prognosis subgroup. For the whole series, 5-year PFS and OS rates were 65.4% and 81.1%, with no toxic deaths. On multivariable analysis, NED status and grade II were favorable for OS, and for PFS grade II remained favorable. Conclusions In a multicenter collaboration, this trial accrued the highest number of patients published so far, and results are comparable to the best single-institution series. The RT boost, when feasible, seemed effective in improving prognosis. Even after multiple procedures, complete resection confirmed its prognostic strength, along with tumor grade. Biological parameters emerging in this series will be the object of future correlatives and reports.
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- 2016
21. OC-0541: Long-term results of the AIEOP MH-89 protocol for pediatric Hodgkin lymphoma
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Robazza, M., primary, Mascarin, M., additional, Elia, C., additional, Todesco, A., additional, Scarzello, G., additional, Pession, A., additional, Garaventa, A., additional, Barra, S., additional, Zecca, M., additional, Santoro, N., additional, Bianchi, M., additional, Riccardi, U., additional, Locatelli, F., additional, De Santis, R., additional, Indolfi, P., additional, Nardi, M., additional, Porta, F., additional, Casini, T., additional, Consarino, C., additional, D’Amico, S., additional, Provenzi, M., additional, Zanazzo, G.A., additional, Farruggia, P., additional, Guerrini, G., additional, and Burnelli, R., additional
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- 2016
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22. OC-0310: Hypofractionated radiotherapy (RT) boost for children with Ependymoma and a measurable residue after surgery
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Gandola, L., primary, Pecori, E., additional, Scarzello, G., additional, Barra, S., additional, Mascarin, M., additional, Scoccianti, S., additional, Diletto, B., additional, Mussano, A., additional, Garré, M.L., additional, Sardi, I., additional, Meroni, S., additional, Biassoni, V., additional, Pignoli, E., additional, Giangaspero, F., additional, and Massimino, M., additional
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- 2015
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23. A multicenter LArge retrospectIve daTabase on the personalization of stereotactic ABlative radiotherapy use in lung metastases from colon-rectal cancer: The LaIT-SABR study
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L. Nicosia, D. Franceschini, F. Perrone-Congedi, F. Casamassima, M.A. Gerardi, M. Rigo, R. Mazzola, M. Perna, V. Scotti, A. Fodor, A. Iurato, F. Pasqualetti, G. Gadducci, S. Chiesa, R.M. Niespolo, A. Bruni, G. Alicino, L. Frassinelli, P. Borghetti, A. Di Marzo, A. Ravasio, B. De Bari, M. Sepulcri, D. Aiello, G. Mortellaro, C. Sangalli, M. Franceschini, G. Montesi, F.M. Aquilanti, G. Lunardi, R. Valdagni, I. Fazio, Giovanni Scarzello, L. Corti, V. Vavassori, E. Maranzano, S.M. Magrini, S. Arcangeli, Maria Antonietta Gambacorta, V. Valentini, F. Paiar, S. Ramella, N.G. Di Muzio, L. Livi, B.A. Jereczek-Fossa, M.F. Osti, M. Scorsetti, F. Alongi, Nicosia, L, Franceschini, D, Perrone-Congedi, F, Casamassima, F, Gerardi, M, Rigo, M, Mazzola, R, Perna, M, Scotti, V, Fodor, A, Iurato, A, Pasqualetti, F, Gadducci, G, Chiesa, S, Niespolo, R, Bruni, A, Alicino, G, Frassinelli, L, Borghetti, P, Di Marzo, A, Ravasio, A, De Bari, B, Sepulcri, M, Aiello, D, Mortellaro, G, Sangalli, C, Franceschini, M, Montesi, G, Aquilanti, F, Lunardi, G, Valdagni, R, Fazio, I, Scarzello, G, Corti, L, Vavassori, V, Maranzano, E, Magrini, S, Arcangeli, S, Gambacorta, M, Valentini, V, Paiar, F, Ramella, S, Di Muzio, N, Livi, L, Jereczek-Fossa, B, Osti, M, Scorsetti, M, and Alongi, F
- Subjects
medicine.medical_specialty ,Multivariate analysis ,Colorectal cancer ,medicine.medical_treatment ,SABR volatility model ,Oligometastatic disease ,Predictive factors ,SABR ,SBRT ,Stereotactic ablative radiotherapy ,Retrospective database ,Ablative case ,medicine ,Radiology, Nuclear Medicine and imaging ,Lung ,business.industry ,Hematology ,medicine.disease ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Radiology ,Predictive factor ,business - Abstract
Introduction: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD). Material and methods: The study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for freedom from local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC). Results: Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED < 00 Gy, 100–124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p = 0.000). Two-year FLP for lesion measuring ≤10 mm, 10–20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p = 0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11–0.51; p = 0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2–3 or 4–5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p = 0.035). Conclusion: The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.
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- 2022
24. Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group
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Geert O. Janssens, Beate Timmermann, Lorenza Gandola, Yasmin Lassen-Ramshad, Henriette Magelssen, Enrica Seravalli, Brian V. Balgobind, Raquel Davila Fajardo, Anne Laprie, Gillian A Whitfield, Patrick Melchior, Rudolf Schwarz, Laetitia Padovani, Barbora Ondrová, Klaus Seiersen, Monica Ramos Albiac, Stefan Dietzsch, Thankamma Ajithkumar, Rolf D. Kortmann, Karin Dieckmann, Tom Boterberg, Delphine Dumont Lecomte, Christian Carrie, Nicola Thorp, Henry Mandeville, Giovanni Scarzello, Claire Alapetite, Stéphanie Bolle, Bianca A.W. Hoeben, Alison Cameron, Marry M. van den Heuvel-Eibrink, Barbara Rombi, Hoeben B.A., Carrie C., Timmermann B., Mandeville H.C., Gandola L., Dieckmann K., Ramos Albiac M., Magelssen H., Lassen-Ramshad Y., Ondrova B., Ajithkumar T., Alapetite C., Balgobind B.V., Bolle S., Cameron A.L., Davila Fajardo R., Dietzsch S., Dumont Lecomte D., van den Heuvel-Eibrink M.M., Kortmann R.D., Laprie A., Melchior P., Padovani L., Rombi B., Scarzello G., Schwarz R., Seiersen K., Seravalli E., Thorp N., Whitfield G.A., Boterberg T., and Janssens G.O.
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Male ,medicine.medical_specialty ,Lordosis ,medicine.medical_treatment ,Medizin ,Kyphosis ,Review ,Scoliosis ,Pediatrics ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Journal Article ,medicine ,Humans ,Radiotherapy dose ,Child ,conformal radiotherapy, primary ossification vertebral body ,Ossification ,business.industry ,Cancer ,Radiotherapy Dosage ,medicine.disease ,Hypoplasia ,Radiation therapy ,Oncology ,Child, Preschool ,030220 oncology & carcinogenesis ,Radiation Oncology ,Female ,Radiology ,Radiotherapy, Conformal ,medicine.symptom ,business ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Item does not contain fulltext Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (
- Published
- 2019
25. Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up
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Manila Antonelli, Luisa Chiapparini, Carlo Giussani, Felice Giangaspero, Lucia Quaglietta, Lorenzo Genitori, Lorenza Gandola, Geraldina Poggi, Francesco Barretta, Paolo Ferroli, Maurizio Mascarin, Giuseppe Cinalli, Angela Mastronuzzi, P Bertolini, Antonio Ruggiero, Paola Peretta, Alessandra Erbetta, Daniele Bertin, Iacopo Sardi, Rita Balter, Veronica Biassoni, Maura Massimino, Elisabetta Schiavello, Emilia Pecori, Giovanni Scarzello, Francesca R. Buttarelli, Anna Mussano, Assunta Tornesello, Milena La Spina, Luna Boschetti, Massimo Caldarelli, Elisabetta Viscardi, Carlo Efisio Marras, Salvina Barra, Maria Luisa Garrè, Piergiorgio Modena, Massimino, M, Barretta, F, Modena, P, Giangaspero, F, Chiapparini, L, Erbetta, A, Boschetti, L, Antonelli, M, Ferroli, P, Bertin, D, Pecori, E, Biassoni, V, Garrè, M, Schiavello, E, Sardi, I, Viscardi, E, Scarzello, G, Mascarin, M, Quaglietta, L, Cinalli, G, Genitori, L, Peretta, P, Mussano, A, Barra, S, Mastronuzzi, A, Giussani, C, Marras, C, Balter, R, Bertolini, P, Tornesello, A, La Spina, M, Buttarelli, F, Ruggiero, A, Caldarelli, M, Poggi, G, and Gandola, L
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Ependymoma ,Male ,Cancer Research ,Pediatrics ,medicine.medical_specialty ,Adolescent ,re-irradiation ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,childhood ependymoma ,follow-up ,relapse ,surveillance ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Child ,Preschool ,Survival rate ,business.industry ,Brain Neoplasms ,Childhood ependymoma ,Follow-up ,Re-irradiation ,Relapse ,Surveillance ,Child, Preschool ,Female ,Follow-Up Studies ,Magnetic Resonance Imaging ,Neoplasm Recurrence, Local ,Prognosis ,Retrospective cohort study ,medicine.disease ,Minimal residual disease ,Clinical trial ,Neoplasm Recurrence ,Neurology ,Oncology ,Local ,Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA ,030220 oncology & carcinogenesis ,Concomitant ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Purpose: The aims of patients’ radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear. Methods: We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months. Results: No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5–104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients. Conclusions: Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI
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- 2018
26. Final results of the second prospective AIEOP protocol for pediatric intracranial ependymoma
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Carlo Giussani, Paola Peretta, Daniele Bertin, Piergiorgio Modena, E. Schiavello, Maura Massimino, Ermanno Giombelli, Laura Valentini, Rosalba Miceli, Maria Luisa Garrè, Luna Boschetti, P Bertolini, Giuseppina Calareso, Lorenza Gandola, Salvina Barra, Paolo Ferroli, Barbara Diletto, Giuseppe Cinalli, Veronica Biassoni, Annamaria Buccoliero, Felice Giangaspero, Lucia Quaglietta, Maurizio Mascarin, Angela Mastronuzzi, Milena La Spina, Elisabetta Viscardi, Carlo Efisio Marras, Anna Mussano, Giovanni Scarzello, Armando Cama, Emilia Pecori, Bianca Pollo, Iacopo Sardi, Rita Balter, Francesca R. Buttarelli, Manila Antonelli, Silvia Scoccianti, Lorenzo Genitori, Massimino, M, Miceli, R, Giangaspero, F, Boschetti, L, Modena, P, Antonelli, M, Ferroli, P, Bertin, D, Pecori, E, Valentini, L, Biassoni, V, Garrè, M, Schiavello, E, Sardi, I, Cama, A, Viscardi, E, Scarzello, G, Scoccianti, S, Mascarin, M, Quaglietta, L, Cinalli, G, Diletto, B, Genitori, L, Peretta, P, Mussano, A, Buccoliero, A, Calareso, G, Barra, S, Mastronuzzi, A, Giussani, C, Marras, C, Balter, R, Bertolini, P, Giombelli, E, La Spina, M, Buttarelli, F, Pollo, B, and Gandola, L
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Male ,Ependymoma ,Cancer Research ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Neurosurgical Procedures ,surgery ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,Child ,Prospective cohort study ,Adjuvant ,Etoposide ,grade ,Brain Neoplasms ,boost ,ependymoma ,prognosis ,Chemoradiotherapy ,Chemotherapy regimen ,Treatment Outcome ,Oncology ,Vincristine ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,prognosi ,medicine.drug ,medicine.medical_specialty ,Adolescent ,Cyclophosphamide ,Disease-Free Survival ,03 medical and health sciences ,medicine ,Humans ,Clinical Investigation ,Progression-free survival ,Preschool ,Radiotherapy ,business.industry ,Infant ,Chemoradiotherapy, Adjuvant ,medicine.disease ,Surgery ,Radiation therapy ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background This prospective study stratified patients by surgical resection (complete = NED vs incomplete = ED) and centrally reviewed histology (World Health Organization [WHO] grade II vs III). Methods WHO grade II/NED patients received focal radiotherapy (RT) up to 59.4 Gy with 1.8 Gy/day. Grade III/NED received 4 courses of VEC (vincristine, etoposide, cyclophosphamide) after RT. ED patients received 1-4 VEC courses, second-look surgery, and 59.4 Gy followed by an 8-Gy boost in 2 fractions on still measurable residue. NED children aged 1-3 years with grade II tumors could receive 6 VEC courses alone. Results From January 2002 to December 2014, one hundred sixty consecutive children entered the protocol (median age, 4.9 y; males, 100). Follow-up was a median of 67 months. An infratentorial origin was identified in 110 cases. After surgery, 110 patients were NED, and 84 had grade III disease. Multiple resections were performed in 46/160 children (28.8%). A boost was given to 24/40 ED patients achieving progression-free survival (PFS) and overall survival (OS) rates of 58.1% and 68.7%, respectively, in this poor prognosis subgroup. For the whole series, 5-year PFS and OS rates were 65.4% and 81.1%, with no toxic deaths. On multivariable analysis, NED status and grade II were favorable for OS, and for PFS grade II remained favorable. Conclusions In a multicenter collaboration, this trial accrued the highest number of patients published so far, and results are comparable to the best single-institution series. The RT boost, when feasible, seemed effective in improving prognosis. Even after multiple procedures, complete resection confirmed its prognostic strength, along with tumor grade. Biological parameters emerging in this series will be the object of future correlatives and reports.
- Published
- 2016
27. Reappraisal of prognostic factors used in the European Pediatric Soft Tissue Sarcoma Study Group RMS 2005 study for localized rhabdomyosarcoma to optimize risk stratification and generate a prognostic nomogram.
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De Salvo GL, Del Bianco P, Minard-Colin V, Chisholm J, Jenney M, Guillen G, Devalck C, Van Rijn R, Shipley J, Orbach D, Kelsey A, Rogers T, Guerin F, Scarzello G, Ferrari A, Cesen Mazic M, Merks JHM, and Bisogno G
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- Humans, Male, Female, Child, Preschool, Child, Prognosis, Infant, Risk Assessment, Adolescent, Europe epidemiology, Forkhead Box Protein O1 genetics, Forkhead Box Protein O1 metabolism, Oncogene Proteins, Fusion genetics, Rhabdomyosarcoma mortality, Rhabdomyosarcoma pathology, Rhabdomyosarcoma therapy, Nomograms
- Abstract
Background: The objective of this study was to investigate the role of clinical factors together with FOXO1 fusion status in patients with nonmetastatic rhabdomyosarcoma (RMS) to develop a predictive model for event-free survival and provide a rationale for risk stratification in future trials., Methods: The authors used data from patients enrolled in the European Pediatric Soft Tissue Sarcoma Study Group (EpSSG) RMS 2005 study (EpSSG RMS 2005; EudraCT number 2005-000217-35). The following baseline variables were considered for the multivariable model: age at diagnosis, sex, histology, primary tumor site, Intergroup Rhabdomyosarcoma Studies group, tumor size, nodal status, and FOXO1 fusion status. Main effects and significant second-order interactions of candidate predictors were included in a multiple Cox proportional hazards regression model. A nomogram was generated for predicting 5-year event-free survival (EFS) probabilities., Results: The EFS and overall survival rates at 5 years were 70.9% (95% confidence interval, 68.6%-73.1%) and 81.0% (95% confidence interval, 78.9%-82.8%), respectively. The multivariable model retained five prognostic factors, including age at diagnosis interacting with tumor size, tumor primary site, Intergroup Rhabdomyosarcoma Studies clinical group, and FOXO1 fusion status. Based on each patient's total score in the nomogram, patients were stratified into four groups. The 5-year EFS rates were 94.1%, 78.4%, 65.2%, and 52.1% in the low-risk, intermediate-risk, high-risk, and very-high-risk groups, respectively, and the corresponding 5-year overall survival rates were 97.2%, 91.5%, 74.3%, and 60.8%, respectively., Conclusions: The results presented here provide the rationale to modify the EpSSG stratification, with the most significant change represented by the replacement of histology with fusion status. This classification was adopted in the new international trial launched by the EpSSG., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)
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- 2024
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28. Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines.
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Dávila Fajardo R, Scarzello G, Gaze MN, Boterberg T, Cameron A, Fuchs J, Guérin F, Hoskin P, Krasin MJ, Kroon P, Magelssen H, Mercke C, Merks JHM, Paulsen F, Pommier P, Ramos M, Rees H, Rogers T, Schmid M, Seitz G, Slater O, Smeulders N, Stenman J, Terwisscha S, Chargari C, and Mandeville HC
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- Humans, Child, Surveys and Questionnaires, Radiotherapy Dosage, Rhabdomyosarcoma radiotherapy, Brachytherapy methods, Brachytherapy standards, Practice Guidelines as Topic
- Abstract
Background and Purpose: The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines., Materials and Methods: An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented., Results: The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined., Conclusions: Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Conflicts of interest Dr. Mark N. Gaze is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre and by the Radiation Research Unit at the Cancer Research UK City of London Centre Award [C7893/A28990]. Prof. Dr. Peter Hoskin is supported by the NIHR Manchester Biomedical Centre. Dr. Henry C. Mandeville is supported by the National Institute for Health Research Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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29. Primary vascular tumors of bone: A comprehensive literature review on classification, diagnosis and treatment.
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Tortorelli I, Bellan E, Chiusole B, Murtas F, Ruggieri P, Pala E, Cerchiaro M, Buzzaccarini MS, Scarzello G, Krengli M, Bisinella G, Battisti S, Di Maggio A, Zagonel V, Tos APD, Sbaraglia M, and Brunello A
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- Humans, Prognosis, Vascular Neoplasms pathology, Hemangiosarcoma pathology, Hemangioendothelioma, Epithelioid pathology, Bone Neoplasms diagnosis, Bone Neoplasms genetics, Bone Neoplasms therapy
- Abstract
Primary vascular tumors of bone are a heterogeneous group of neoplasms, ranging from benign hemangiomas to frankly malignant epithelioid hemangioendotheliomas and angiosarcomas. Over the years, their classification has been a matter of discussion, due to morphologic similarities and uncertainty regarding biologic behavior. Over the past decade, with the development of next-generation sequencing, there has been a significant improvement in the molecular characterization of these lesions. The integration of their morphologic, immunohistochemical and molecular features has led to a better stratification, with important prognostic and therapeutic implications. Nevertheless, primary vascular bone tumors still represent a challenge for medical oncologists. Given their rarity and heterogeneity, in the last few years, there has been no significant progress in medical treatment options, so further research is needed. Here we present a review of the current knowledge regarding primary vascular tumors of the bone, correlating clinicopathologic features with tumor behavior and therapeutic approaches., Competing Interests: Declaration of Competing Interest PR reports personal fees as Consultant for Exactech and Stryker. AB reports serving on advisory boards for Eli Lilly, Roche, GSK, Eisai, Pharmamar, Boehringer Ingelheim, Deciphera; personal fees or honoraria for educational events by GSK and Pharmamar; travel grants by Gentili and Pharmamar. All the authors, including PR and AB, declare no competing interests with respect to this research., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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30. Management of the vertebrae as an organ at risk in paediatric radiotherapy clinical trials: Initial QUARTET experience.
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Turcas A, Kelly SM, Bernier-Chastagner V, Bolle S, Cameron A, Corning C, Clementel E, Dieckmann K, Davila Fajardo R, Gaze MN, Laprie A, Magelssen H, Meroni S, Pignoli E, Safwat A, Scarzello G, Talbot J, Timmermann B, Boterberg T, and Mandeville HC
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- Child, Humans, Forecasting, Clinical Trials as Topic, Radiation Oncology, Spine
- Abstract
Irradiation of the vertebrae in prepubertal patients, if non-homogenous, can result in future growth deformities including kyphoscoliosis. Vertebral delineation and dosimetry were assessed for 101 paediatric cases reviewed within QUARTET-affiliated trials. Despite the availability of published consensus guidelines, a high variability in vertebral delineation was observed, with impact on dosimetry., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2023
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31. A predictive model of polymetastatic disease from a multicenter large retrospectIve database on colorectal lung metastases treated with stereotactic ablative radiotherapy: The RED LaIT-SABR study.
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Nicosia L, Franceschini D, Perrone-Congedi F, Molinari A, Gerardi MA, Rigo M, Mazzola R, Perna M, Scotti V, Fodor A, Iurato A, Pasqualetti F, Gadducci G, Chiesa S, Niespolo RM, Bruni A, Cappelli A, D'Angelo E, Borghetti P, Di Marzo A, Ravasio A, De Bari B, Sepulcri M, Aiello D, Mortellaro G, Sangalli C, Franceschini M, Montesi G, Aquilanti FM, Lunardi G, Valdagni R, Fazio I, Scarzello G, Vavassori V, Maranzano E, Maria Magrini S, Arcangeli S, Gambacorta MA, Valentini V, Paiar F, Ramella S, Di Muzio NG, Loi M, Jereczek-Fossa BA, Casamassima F, Osti MF, Scorsetti M, and Alongi F
- Abstract
Aim: Stereotactic ablative radiotherapy (SABR) showed increasing survival in oligometastatic patients. Few studies actually depicted oligometastatic disease (OMD) evolution and which patient will remain disease-free and which will rapidly develop a polymetastatic disease (PMD) after SABR. Therefore, apart from the number of active metastases, there are no clues on which proven factor should be considered for prescribing local treatment in OMD. The study aims to identify predictive factors of polymetastatic evolution in lung oligometastatic colorectal cancer patients., Methods: This international Ethical Committee approved trial (Prot. Negrar 2019-ZT) involved 23 Centers and 450 lung oligometastatic patients. Primary end-point was time to the polymetastatic conversion (tPMC). Additionally, oligometastases number and cumulative gross tumor volume (cumGTV) were used as combined predictive factors of tPMC. Oligometastases number was stratified as 1, 2-3, and 4-5; cumGTV was dichotomized to the value of 10 cc., Results: The median tPMC in the overall population was 26 months. Population was classified in the following tPMC risk classes: low-risk (1-3 oligometastases and cumGTV ≤ 10 cc) with median tPMC of 35.1 months; intermediate-risk (1-3 oligometastases and cumGTV > 10 cc), with median tPMC of 13.9 months, and high-risk (4-5 oligometastases, any cumGTV) with median tPMC of 9.4 months (p = 0.000)., Conclusion: The present study identified predictive factors of polymetastatic evolution after SABR in lung oligometastatic colorectal cancer. The results demonstrated that the sole metastases number is not sufficient to define the OMD since patients defined oligometastatic from a numerical point of view might rapidly progress to PMD when the cumulative tumor volume is high. A tailored approach in SABR prescription should be pursued considering the expected disease evolution after SABR, with the aim to avoid unnecessary treatment and toxicity in those at high risk of polymetastatic spread, and maximize local treatment in those with a favorable disease evolution., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)
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- 2022
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32. Role of SAMITAL in the Prevention and Treatment of Chemo-Radiotherapy-Induced Oral Mucositis in Head and Neck Carcinoma: A Phase 2, Randomized, Double-Blind, Placebo-Controlled Clinical Trial (ROSAM).
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Fasanaro E, Del Bianco P, Groff E, Riva A, Petrangolini G, Busato F, Stritoni P, Scarzello G, Loreggian L, and De Salvo GL
- Abstract
Background: In patients affected by head and neck squamous cell carcinoma, the onset of severe oral mucositis is a decisive factor in completing concurrent chemo-radiotherapy, and few interventions have demonstrated a modest benefit. The primary aim of this clinical study was to evaluate the role of SAMITAL in reducing the incidence of severe mucositis induced by concurrent chemo-radiotherapy; the secondary aims were the tolerability and patient-reported quality of life measures., Methods: Patients were randomized to receive SAMITAL granules for oral suspension of 20 mL, four-time daily or matching placebo in a 1:1 fashion using a stratified-block randomization scheme by disease site and type of chemotherapy. The SAMITAL/placebo was dispensed at the baseline visit and at each weekly visit following radiotherapy initiation. Patients were subjected to weekly endoscopic evaluations to assess the presence of mucositis. In addition, patient-reported outcomes were measured., Results: Among the 116 patients treated with a median total dose of 66 Gy, 59 were randomized to SAMITAL and 57 to placebo. Overall, the incidence of severe mucositis was 51.7%, with 45.8% in the SAMITAL and 57.9% in the placebo arm (OR = 0.6; 95% CI: 0.3-1.3). After chemo-radiotherapy, patients randomized to SAMITAL reported significantly lower xerostomia, coughing and swallowing scores and a better quality of life., Conclusion: SAMITAL did not significantly reduce the incidence of severe mucositis in all studied populations. However, the lower rate of mucositis, together with a significantly better quality of life, suggested that a clinical benefit existed. This trial is registered with the EU Clinical Trials Register database, number 2012-002046-20, and with ClinicalTrials.gov, NCT01941992.
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- 2022
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33. Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress.
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Cerea S, Sansoni M, Scarzello G, Groff E, and Ghisi M
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- Humans, Female, Male, Body Image psychology, Cross-Sectional Studies, Adaptation, Psychological, Surveys and Questionnaires, Pain, Stress, Psychological epidemiology, Stress, Psychological etiology, Stress, Psychological psychology, Quality of Life psychology, Head and Neck Neoplasms
- Abstract
Objective: The aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC., Methods: Fifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson's correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences., Results: Physical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males., Conclusion: Body image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind., (© 2022. The Author(s).)
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- 2022
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34. Therapy and prognostic significance of regional lymph node involvement in embryonal rhabdomyosarcoma: a report from the European paediatric Soft tissue sarcoma Study Group.
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Ben-Arush M, Minard-Colin V, Scarzello G, Fajardo RD, Terwisscha Van Scheltinga S, Bernier V, Jenney M, Gallego S, Zanetti I, Cesen M, Merks JHM, and Bisogno G
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Child, Disease-Free Survival, Humans, Infant, Lymph Nodes pathology, Prognosis, Rhabdomyosarcoma drug therapy, Rhabdomyosarcoma, Alveolar drug therapy, Rhabdomyosarcoma, Embryonal therapy
- Abstract
Purpose: Regional lymph node disease (N1) is a component of the risk-based treatment stratification in rhabdomyosarcoma (RMS). The purpose of this study was to determine the contribution of nodal disease to the prognosis of patients with non-metastatic embryonal RMS (ERMS) and analyse their outcome by treatment received., Patients and Methods: Between 2005 and 2016, 1294 children with ERMS were enrolled in the European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 protocol, 143 patients with N1. Treatment comprised 9 cycles of ifosfamide, vincristine and dactinomycin. Some patients also received doxorubicin and/or maintenance if enrolled in the randomised studies. Local treatment was planned after 4 cycles of chemotherapy and included surgery to remove macroscopic residual tumour and/or radiotherapy (primary tumour and involved nodes)., Results: N1 patients were older and presented with tumours of unfavourable size, invasiveness, site and resectability. Unlike alveolar RMS, nodal involvement was more frequent in the head and neck area and rare in extremity sites. The 5-year event-free and overall survival were 75.5% and 86.3% for patients with N0, and 65.2% and 70.7% for patients with N1, respectively. The nodal involvement and the result of surgery at diagnosis (Intergroup Rhabdomyosarcoma Study group) were independent prognostic factors on multivariate analysis. Considering only patients with N1 ERMS, we were not able to identify any treatment variables which correlated with the outcome., Conclusion: In the case of nodal involvement, patients with ERMS present different characteristics and a better outcome than alveolar RMS. Regional nodal involvement is an independent prognostic factor in ERMS, therefore it is appropriate to include this population in the high-risk category., Competing Interests: Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2022
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35. Long-term results from the multicentric European randomized phase 3 trial CWS/RMS-96 for localized high-risk soft tissue sarcoma in children, adolescents, and young adults.
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Sparber-Sauer M, Ferrari A, Kosztyla D, Ladenstein R, Cecchetto G, Kazanowska B, Scarzello G, Ljungman G, Milano GM, Niggli F, Alaggio R, Vokuhl C, Casanova M, Klingebiel T, Zin A, Koscielniak E, and Bisogno G
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- Adolescent, Antineoplastic Combined Chemotherapy Protocols adverse effects, Child, Dactinomycin, Doxorubicin, Humans, Ifosfamide, Vincristine, Young Adult, Rhabdomyosarcoma surgery, Rhabdomyosarcoma, Embryonal drug therapy, Sarcoma, Ewing drug therapy, Soft Tissue Neoplasms pathology
- Abstract
Background: CWS/RMS-96 was an international multicenter trial with randomization between two therapy arms of the standard four-drug therapy (vincristine, ifosfamide, adriamycin, dactinomycin [VAIA]) versus an intensified six-drug regimen (carboplatin, epirubicin, vincristine, dactinomycin, ifosfamide, and etoposide [CEVAIE]) for high-risk rhabdomyosarcoma (RMS), extraskeletal Ewing sarcoma (EES), and undifferentiated sarcoma (UDS) in children, adolescents, and young adults aiming to improve their survival. Intensified chemotherapy with CEVAIE did not improve outcome., Methods: Patients younger than 21 years with a previously untreated localized HR-RMS, EES, and UDS were enrolled from Cooperative Weichteilsarkom Studiengruppe (CWS) centers in Germany, Austria, Poland, Switzerland, and from Italian Soft Tissue Sarcoma Committee (STSC) centers. Randomization (1:1) to receive either 9 × 21 days cycles of VAIA or CEVAIE was performed separately in CWS and STSC. Hyperfractionated accelerated radiotherapy (32-44.8 Gy) was added at week 9-12 according to histology and response to chemotherapy. A secondary microscopically complete nonmutilating resection was performed if possible. Primary endpoints were response to chemotherapy, event-free (EFS) and overall survival (OS)., Results: Five hundred fifty-seven patients (HR-RMS: n = 416, EES and UDS: n = 141) underwent randomization: VAIA (n = 273) or CEVAIE (n = 284). Radiotherapy was given to 70% of patients in both groups. A secondary resection was performed in 47% and 48% patients, respectively. The 5-year EFS and OS for the VAIA and CEVAIE treatment arms were 59.8% and 60.8% (p = .89), and 74.2% and 68.3% (p = .16), respectively. No differences in response, toxicity, or second malignancies emerged in the two groups., Conclusion: The use of an intensified regimen failed to show a significant improvement in tumor response and outcome of patients with localized HR-RMS, EES, and UDS., (© 2022 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)
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- 2022
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36. QUARTET: A SIOP Europe project for quality and excellence in radiotherapy and imaging for children and adolescents with cancer.
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Kelly SM, Effeney R, Gaze MN, Bernier-Chastagner V, Blondeel A, Clementel E, Corning C, Dieckmann K, Essiaf S, Gandola L, Janssens GO, Kearns PR, Lacombe D, Lassen-Ramshad Y, Merks H, Miles E, Padovani L, Scarzello G, Schwarz R, Timmermann B, van Rijn RR, Vassal G, Boterberg T, and Mandeville HC
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- Adolescent, Child, Europe, Humans, Prospective Studies, Retrospective Studies, Kidney Neoplasms drug therapy, Radiation Oncology, Wilms Tumor drug therapy
- Abstract
The European Society for Paediatric Oncology (SIOPE) Radiation Oncology Working Group presents the QUARTET Project: a centralised quality assurance programme designed to standardise care and improve the quality of radiotherapy and imaging for international clinical trials recruiting children and adolescents with cancer throughout Europe. QUARTET combines the paediatric radiation oncology expertise of SIOPE with the infrastructure and experience of the European Organisation for Research and Treatment of Cancer to deliver radiotherapy quality assurance programmes for large, prospective, international clinical trials. QUARTET-affiliated trials include children and adolescents with brain tumours, neuroblastoma, sarcomas including rhabdomyosarcoma, and renal tumours including Wilms' tumour. With nine prospective clinical trials and two retrospective studies within the active portfolio in March 2022, QUARTET will collect one of the largest repositories of paediatric radiotherapy and imaging data, support the clinical assessment of radiotherapy, and evaluate the role and benefit of radiotherapy quality assurance for this cohort of patients within the context of clinical trials., Competing Interests: Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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37. ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children.
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Hoeben BAW, Pazos M, Seravalli E, Bosman ME, Losert C, Albert MH, Boterberg T, Ospovat I, Mico Milla S, Demiroz Abakay C, Engellau J, Jóhannesson V, Kos G, Supiot S, Llagostera C, Bierings M, Scarzello G, Seiersen K, Smith E, Ocanto A, Ferrer C, Bentzen SM, Kobyzeva DA, Loginova AA, and Janssens GO
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- Bone Marrow, Child, Child, Preschool, Humans, Retrospective Studies, Transplantation Conditioning methods, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Whole-Body Irradiation adverse effects, Whole-Body Irradiation methods
- Abstract
Background and Purpose: Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children., Material and Methods: The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established., Results: Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies., Conclusions: These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2022
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38. Treatment and outcome of intracranial ependymoma after first relapse in the 2nd AIEOP protocol.
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Massimino M, Barretta F, Modena P, Johann P, Ferroli P, Antonelli M, Gandola L, Garrè ML, Bertin D, Mastronuzzi A, Mascarin M, Quaglietta L, Viscardi E, Sardi I, Ruggiero A, Boschetti L, Giagnacovo M, Biassoni V, Schiavello E, Chiapparini L, Erbetta A, Mussano A, Giussani C, Mura RM, Barra S, Scarzello G, Scimone G, Carai A, Giangaspero F, and Buttarelli FR
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- Child, Preschool, Female, Humans, Neoplasm Recurrence, Local therapy, Prognosis, Treatment Outcome, Brain Neoplasms pathology, Ependymoma pathology
- Abstract
Background: More than 40% of patients with intracranial ependymoma need a salvage treatment within 5 years after diagnosis, and no standard treatment is available as yet. We report the outcome after first relapse of 64 patients treated within the 2nd AIEOP protocol., Methods: We considered relapse sites and treatments, that is, various combinations of complete/incomplete surgery, if followed by standard or hypofractionated radiotherapy (RT) ± chemotherapy (CT). Molecular analyses were available for 38/64 samples obtained at first diagnosis. Of the 64 cases, 55 were suitable for subsequent analyses., Results: The median follow-up was 147 months after diagnosis, 84 months after first relapse, 5-year EFS/OS were 26.2%/30.8% (median EFS/OS 13/32 months) after relapse. For patients with a local relapse (LR), the 5-year cumulative incidence of second LRs was 51.6%, with a 5-year event-specific probability of being LR-free of 40.0%. Tumor site/grade, need for shunting, age above/below 3 years, molecular subgroup at diagnosis, had no influence on outcomes. Due to variation in the RT dose/fractionation used and the subgroup sizes, it was not possible to assess the impact of the different RT modalities. Multivariable analyses identified completion of surgery, the absence of symptoms at relapse, and female sex as prognostically favorable. Tumors with a 1q gain carried a higher cumulative incidence of dissemination after first relapse., Conclusions: Survival after recurrence was significantly influenced by symptoms and completeness of surgery. Only a homogeneous protocol with well-posed, randomized questions could clarify the numerous issues, orient salvage treatment, and ameliorate prognosis for this group of patients., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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39. A multicenter LArge retrospectIve daTabase on the personalization of stereotactic ABlative radiotherapy use in lung metastases from colon-rectal cancer: The LaIT-SABR study.
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Nicosia L, Franceschini D, Perrone-Congedi F, Casamassima F, Gerardi MA, Rigo M, Mazzola R, Perna M, Scotti V, Fodor A, Iurato A, Pasqualetti F, Gadducci G, Chiesa S, Niespolo RM, Bruni A, Alicino G, Frassinelli L, Borghetti P, Di Marzo A, Ravasio A, De Bari B, Sepulcri M, Aiello D, Mortellaro G, Sangalli C, Franceschini M, Montesi G, Aquilanti FM, Lunardi G, Valdagni R, Fazio I, Scarzello G, Corti L, Vavassori V, Maranzano E, Magrini SM, Arcangeli S, Gambacorta MA, Valentini V, Paiar F, Ramella S, Di Muzio NG, Livi L, Jereczek-Fossa BA, Osti MF, Scorsetti M, and Alongi F
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- Humans, Retrospective Studies, Colorectal Neoplasms pathology, Lung Neoplasms, Radiosurgery methods, Rectal Neoplasms etiology
- Abstract
Introduction: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD)., Material and Methods: The study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for freedom from local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC)., Results: Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED < 00 Gy, 100-124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p = 0.000). Two-year FLP for lesion measuring ≤10 mm, 10-20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p = 0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11-0.51; p = 0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2-3 or 4-5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p = 0.035)., Conclusion: The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization., Competing Interests: Conflicts of interest None declared., (Copyright © 2021 Elsevier B.V. All rights reserved.)
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- 2022
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40. The Role of Electrochemotherapy in the Cutaneous and Subcutaneous Metastases From Breast Cancer: Analysis of Predictive Factors to Treatment From an Italian Cohort of Patients.
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Russano F, Del Fiore P, Di Prata C, Pasqual A, Marconato R, Campana LG, Spina R, Gianesini CM, Collodetto A, Tropea S, Dall'Olmo L, Carraro S, Parisi A, Galuppo S, Scarzello G, De Terlizzi F, Rastrelli M, and Mocellin S
- Abstract
The treatment of cutaneous and subcutaneous localizations from breast cancer (BC) is still a therapeutic challenge. Electrochemotherapy (ECT) is one of the available options, and it is characterized by the association between the administration of a chemotherapic agent (Bleomycin) with the temporary raise of permeability of the cellular membrane induced by the local administration of electrical impulses (electroporation). ECT represents an effective therapy for loco-regional control of this disease. This study aimed to investigate the predictive factors of response in cutaneous and subcutaneous localizations from breast cancer treated with ECT. We decided to evaluate the response to this treatment in 55 patients who underwent ECT between January 2013 and March 2020 at our Institute. We performed a monocentric retrospective cohort study. ECT was administered following the ESOPE (European Standard Operative Procedure of Electrochemotherapy) guidelines, a set of criteria updated in 2018 by a panel of European experts on ECT who defined the indications for selecting the patients who can benefit from the ECT treatment and the ones for technically performing the procedure. The responses were evaluated with the RECIST criteria (Response Evaluation Criteria in Solid Tumor). We found after 12 weeks of treatment a complete response (CR) in 64% of our patients. From the analysis divided for subgroups of covariates is emerged that lower BMI, reduced body surface, and absence of previous radiation treatment could be predictive for a better complete response. This study suggests that the efficacy of the ECT treatment is related to the concurrent systemic therapies while administering ECT. The association between ECT and immunotherapy has offered better results than the association between ECT and chemotherapy (p-value = 0.0463). So, ECT is a valuable tool in the treatment of cutaneous and subcutaneous metastases from breast cancer and its efficacy in local control of these lesions improves when it is well planned in a therapeutic scenario., Competing Interests: Author FT was employed by company IGEA S.p.A. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Russano, Del Fiore, Di Prata, Pasqual, Marconato, Campana, Spina, Gianesini, Collodetto, Tropea, Dall’Olmo, Carraro, Parisi, Galuppo, Scarzello, De Terlizzi, Rastrelli and Mocellin.)
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- 2021
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41. Role of centers with different patient volumes in the management of rhabdomyosarcoma. An analysis by the Italian Pediatric Soft Tissue Sarcoma Committee.
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Bisogno G, Congiu G, Affinita MC, Milano GM, Zanetti I, Coppadoro B, Manzitti C, Basso E, Tamburini A, Melchionda F, Cellini M, Pericoli R, D'Angelo P, Cataldo AD, De Leonardis F, Rabusin M, De Corti F, Zin A, Alaggio R, Scarzello G, and Ferrari A
- Subjects
- Child, Humans, Italy, Rhabdomyosarcoma surgery, Rhabdomyosarcoma, Embryonal, Soft Tissue Neoplasms therapy
- Abstract
Procedure: The survival of children with rhabdomyosarcoma (RMS) has gradually improved as a result of the adoption of multidisciplinary treatments. Dedicated skills and facilities are indispensable and more readily available at reference centers. In this study, we examined the role of centers' experience (based on the number of patients treated) in their management of patients with RMS., Methods: We analyzed 342 patients with localized RMS enrolled in the European RMS 2005 protocol from October 2005 to December 2016 at 31 Italian centers that are part of the Soft Tissue Sarcoma Committee (STSC). We grouped the centers by the number of patients each one enrolled (Group 1: >40; Group 2: <40 and >10; and Group 3: <10), and compared a number of indicators to assess the appropriateness of patients' diagnostic workup and treatment and their survival., Results: Overall, 74.6% of patients were treated at 10 centers, and only three of them classifiable as high-volume centers. Only minor differences emerged between the three patient groups in terms of diagnostic investigations and treatment modalities. Survival was similar in the three groups. Approximately, one in four children treated at the centers in Groups 2 and 3 traveled to another center for surgery or radiotherapy., Conclusion: Patients treated at STSC centers with different amounts of experience had similar results in terms of survival. This is attributable to all centers in the network adhering to protocol recommendations and receiving the STSC's support on diagnostics and multidisciplinary treatments for RMS., (© 2021 Wiley Periodicals LLC.)
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- 2021
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42. Role of 18 F-FDG-PET/CT in the staging of metastatic rhabdomyosarcoma: a report from the European paediatric Soft tissue sarcoma Study Group.
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Mercolini F, Zucchetta P, Jehanno N, Corradini N, Van Rijn RR, Rogers T, Cameron A, Scarzello G, Coppadoro B, Minard-Colin V, Gallego S, Chisholm J, Merks JH, and Bisogno G
- Subjects
- Child, Child, Preschool, Female, Humans, Male, Neoplasm Metastasis, Neoplasm Staging, Retrospective Studies, Rhabdomyosarcoma pathology, Sarcoma pathology, Fluorodeoxyglucose F18 therapeutic use, Positron Emission Tomography Computed Tomography methods, Rhabdomyosarcoma diagnostic imaging, Sarcoma diagnostic imaging
- Abstract
Background: Initial staging of rhabdomyosarcoma is crucial for prognosis and to tailor the treatment. The standard radiology workup (SRW) includes magnetic resonance imaging, chest computed tomography (CT) and bone scintigraphy, but 18 Fluorine-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (
18 F-FDG-PET/CT (PET-CT)) use is increasing. The aim of this study was to evaluate the impact of PET-CT in the initial staging of patients with metastatic rhabdomyosarcoma enrolled in the European protocol MTS2008., Methods: Two authors retrospectively reviewed the SRW and PET-CT reports comparing the number and sites of metastases detected. For bone marrow involvement, PET-CT and bone marrow aspirates/biopsies were compared., Results: Among 263 metastatic patients enrolled from October 2008 to December 2016, 121 had PET-CT performed at diagnosis, and for 118 of 121 patients, both PET-CT and radiological reports were available for review. PET-CT showed higher sensitivity than SRW in the ability to detect locoregional (96.2% versus 78.5%, P value = 0.0013) and distant lymph node involvement (94.8% versus 79.3%, P value = 0.0242), but sensitivity was lower for intrathoracic sites (lung 79.6% versus 100%, P value = 0.0025). For bone metastasis, PET-CT was more sensitive than bone scintigraphy (96.4% versus 67.9%, P value = 0.0116). The PET-CT sensitivity and specificity to detect marrow involvement were 91.8% and 93.8%, respectively. The mean number of metastatic sites was 1.94 (range 0-5) with PET-CT and 1.72 (range 0-5) with SRW. In four patients (3.4%), PET-CT changed the staging from localised to metastatic disease., Conclusion: PET can identify metastatic disease not evident on SRW in a small number of patients. This is because of its higher ability to recognise lymph node and bone involvement. Chest CT remains essential to detect lesions in intrathoracic sites, which can be performed in a one stop-shot routine examination or on a dedicated chest CT scan. PET-CT could replace bone scintigraphy to study bone involvement., (Copyright © 2021 Elsevier Ltd. All rights reserved.)- Published
- 2021
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43. Integrating irinotecan in standard chemotherapy: A novel dose-density combination for high-risk pediatric sarcomas.
- Author
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Bisogno G, Ferrari A, Tagarelli A, Sorbara S, Chiaravalli S, Poli E, Scarzello G, De Corti F, Casanova M, and Affinita MC
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols, Cyclophosphamide therapeutic use, Dactinomycin therapeutic use, Doxorubicin therapeutic use, Etoposide therapeutic use, Humans, Ifosfamide therapeutic use, Vincristine adverse effects, Irinotecan therapeutic use, Sarcoma drug therapy
- Abstract
Background: Irinotecan is a drug active against pediatric sarcomas with a toxicity profile that theoretically allows for its association with more myelotoxic drugs. We examined the feasibility of a dose-density strategy integrating irinotecan in standard chemotherapy regimens for patients with high-risk sarcomas., Methods: Between November 2013 and January 2020, 23 patients ≤25 years old were included in the study. Eleven patients newly diagnosed with metastatic disease received nine cycles of IrIVA (irinotecan-ifosfamide-vincristine-actinomycin D; ifosfamide 3 g/m
2 on days 1 and 2, vincristine 1.5 mg/m2 on day 1, actinomycin D 1.5 mg/m2 on day 1, irinotecan 20 mg/m2 for 5 consecutive days starting on day 8) as first-line therapy. Two relapsed patients received IrIVA and 10 IrVAC (irinotecan-vincristine-actinomycin D-cyclophosphamide; cyclophosphamide 1.5 g/m2 on day 1 instead of ifosfamide). Feasibility was assessed in terms of toxicity and time to complete the treatment., Results: Seventeen rhabdomyosarcomas, four Ewing sarcomas, two desmoplastic small round cell tumors received a total of 181 cycles (range 2-10). Grade 4 neutropenia occurred in 62.4% of the cycles. Thirteen patients had febrile neutropenia. Diarrhea occurred in 14 cycles. The median time to complete the treatment was 195 days (range 170-231), 83.4% of cycles were administered on time or with a delay <1 week. With a median follow-up of 2.6 years (range 0.2-5.0), 12 patients are alive, nine complete remissions, three with the disease., Conclusions: A dose-density strategy combining irinotecan with standard chemotherapy is feasible. This approach will be investigated in the next trial coordinated by the European pediatric Soft tissue sarcoma Study Group., (© 2021 Wiley Periodicals LLC.)- Published
- 2021
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44. Rhabdomyosarcoma.
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Yechieli RL, Mandeville HC, Hiniker SM, Bernier-Chastagner V, McGovern S, Scarzello G, Wolden S, Cameron A, Breneman J, Fajardo RD, and Donaldson SS
- Subjects
- Child, Combined Modality Therapy, Humans, Prognosis, Rhabdomyosarcoma pathology, Survival Rate, Rhabdomyosarcoma therapy
- Abstract
Rhabdomyosarcoma is a heterogeneous disease both in presentation and histology. Improvements in a multimodality therapy resulted in the improved overall survival for patients with a low-risk and intermediate-risk disease but not for patients with a metastatic disease. We reviewed and contrasted the North American and European practice patterns, though ultimately the principles of staging, surgery, radiation therapy, and chemotherapy are similar in both Children's Oncology Group and International Society of Paediatric Oncology treatment approaches. Efforts are underway to investigate improved local control rates in higher risk patients using radiation dose escalation strategies, and delayed primary excision in select cases. The prognostic significance of imaging-based chemotherapy response, proton therapy, novel biomarkers, and targeted drugs will be determined in upcoming clinical trials., (© 2021 Wiley Periodicals LLC.)
- Published
- 2021
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45. Radical radiotherapy for paediatric solid tumour metastases: An overview of current European protocols and outcomes of a SIOPE multicenter survey.
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Huijskens SC, Kroon PS, Gaze MN, Gandola L, Bolle S, Supiot S, Abakay CD, Alexopoulou A, Bokun J, Chojnacka M, Escande A, Giralt J, Harrabi S, Maduro JH, Mandeville H, Mussano A, Napieralska A, Padovani L, Scarzello G, Timmermann B, Claude L, Seravalli E, and Janssens GO
- Subjects
- Age Factors, Dose Fractionation, Radiation, Europe, Health Care Surveys, Humans, Neoplasm Metastasis, Neoplasms diagnostic imaging, Neoplasms pathology, Practice Guidelines as Topic, Treatment Outcome, Healthcare Disparities trends, Neoplasms radiotherapy, Practice Patterns, Physicians' trends, Radiosurgery trends
- Abstract
Purpose/objective: About 20% of children with solid tumours (ST) present with distant metastases (DM). Evidence regarding the use of radical radiotherapy of these DM is sparse and open for personal interpretation. The aim of this survey was to review European protocols and to map current practice regarding the irradiation of DM across SIOPE-affiliated countries., Materials/methods: Radiotherapy guidelines for metastatic sites (bone, brain, distant lymph nodes, lung and liver) in eight European protocols for rhabdomyosarcoma, non-rhabdomyosarcoma soft-tissue sarcoma, Ewing sarcoma, neuroblastoma and renal tumours were reviewed. SIOPE centres irradiating ≥50 children annually were invited to participate in an online survey., Results: Radiotherapy to at least one metastatic site was recommended in all protocols, except for high-risk neuroblastoma. Per protocol, dose prescription varied per site, and information on delineation and treatment planning/delivery was generally missing. Between July and September 2019, 20/27 centres completed the survey. Around 14% of patients were deemed to have DM from ST at diagnosis, of which half were treated with curative intent. A clear cut-off for a maximum number of DM was not used in half of the centres. Regardless of the tumour type and site, conventional radiotherapy regimens were most commonly used to treat DM. When stereotactic radiotherapy was used, a wide range of fractionation regimens were applied., Conclusion: Current radiotherapy guidelines for DM do not allow a consistent approach in a multicentre setting. Prospective (randomised) trials are needed to define the role of radical irradiation of DM from paediatric ST., Competing Interests: Conflict of interest statement None declared., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
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46. Histiocytic sarcoma arising in a child affected by Burkitt lymphoma, with t(8;14)(q24;q32) positivity in both tumors.
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d'Amore ESG, Mainardi C, Mussolin L, Carraro E, Alaggio R, Lazzari E, Fusetti S, Ghirotto C, Marzollo A, Biddeci G, Toffolutti T, Massano D, Scarzello G, Zuliani M, Putti MC, Biffi A, and Pillon M
- Subjects
- Burkitt Lymphoma pathology, Child, Preschool, Female, Histiocytic Sarcoma pathology, Humans, Burkitt Lymphoma diagnosis, Histiocytic Sarcoma etiology
- Published
- 2021
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47. Defining the impact of prognostic factors at the time of relapse for nonmetastatic rhabdomyosarcoma.
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Affinita MC, Ferrari A, Chiaravalli S, Melchionda F, Quaglietta L, Casanova M, Zanetti I, Scarzello G, Di Pasquale L, Di Cataldo A, and Bisogno G
- Subjects
- Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Prognosis, Retrospective Studies, Rhabdomyosarcoma pathology, Rhabdomyosarcoma surgery, Survival Rate, Neoplasm Recurrence, Local mortality, Rhabdomyosarcoma mortality
- Abstract
Background: The prognosis for patients with relapsed rhabdomyosarcoma (RMS) depends on a number of variables, including tumor characteristics, type of relapse, and treatment received. All published studies have considered tumor characteristics at initial diagnosis, but not at the time of recurrence. In this study, we compared tumor characteristics at diagnosis and at the moment of local relapse to better define the chance of cure in this group of patients., Methods: We first analyzed 92 children with localized RMS treated according to the RMS96 and RMS2005 protocols who developed relapse after achieving complete remission at the end of treatment. Then we restricted our analysis to 51 patients with local recurrence to compare their initial tumor characteristics with those at relapse. All characteristics were studied using univariate and multivariate analyses., Results: The 10-year progression-free survival (PFS) and overall survival (OS) rates for the whole group were 23.5% (15.4-32.6) and 34.4% (24.8-44.1), respectively. On multivariate analysis, only primary tumor site appeared to have a strong impact on prognosis (P = .0010). The 10-year PFS and OS rates of patients with locoregional recurrences were 22.7% (12.3-35.0) and 34.9% (22.1-47.9), respectively. Multivariate analysis showed that tumors at unfavorable sites (P = .0044), and tumor size > 5 cm at recurrence (P = .0088) were associated with the poorest prognosis., Conclusion: Our study demonstrates that to estimate the chance of cure in patients with relapsed RMS, we should also consider tumor characteristics at the time of relapse, and tumor size in particular., (© 2020 Wiley Periodicals LLC.)
- Published
- 2020
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48. Prognostic role of pleural effusion or ascites in localized rhabdomyosarcoma.
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Di Carlo D, Ferrari A, Toffolutti T, Milano GM, Manzitti C, Ruggiero A, Dall'Igna P, Melchionda F, Zanetti I, Scarzello G, and Bisogno G
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Child, Child, Preschool, Clinical Trials as Topic statistics & numerical data, Combined Modality Therapy, Disease Management, Female, Humans, Infant, Italy epidemiology, Kaplan-Meier Estimate, Male, Multicenter Studies as Topic statistics & numerical data, Organ Specificity, Prognosis, Progression-Free Survival, Retrospective Studies, Rhabdomyosarcoma complications, Rhabdomyosarcoma therapy, Treatment Outcome, Ascites etiology, Pleural Effusion, Malignant etiology, Rhabdomyosarcoma mortality
- Abstract
Purpose: The presence of pleural effusion or ascites at the time of diagnosis is generally considered a poor prognostic factor for children with rhabdomyosarcoma (RMS), and treatment is usually intensified despite the fact that there are no published studies to support this decision. We investigated the prognostic role of the presence of pleural effusion or ascites at diagnosis in patients with localized RMS consecutively enrolled in the Italian Soft Tissue Sarcoma Committee protocols over a 30-year period., Methods: We reviewed the radiological reports at diagnosis of 150 children with supradiaphragmatic and infradiaphragmatic RMS, noting any presence of effusion and its extent (minimal, moderate, or massive). All patients received intensive chemotherapy, surgery, and standard or hyperfractionated radiotherapy., Results: Effusion was identified in 32 children (21.3%), 14 with pleural effusion and 18 with ascites. As for its extent, 13 children presented with minimal, 12 with moderate, and 7 with massive effusion. The 5-year progression-free survival (PFS) rate was 49.8% (confidence interval [CI] 31.7-65.5) and 49.5% (CI 40-58.2) for patients with and without effusion, respectively (P = .5). When only patients with moderate or massive effusion were considered, however, their PFS was 36.8% (CI 16.5-57.5) versus 51.2% (CI 42.2-59.5) in patients with minimal or no effusion (P = .01). On the whole, patients with pleural effusion had a very poor outcome with a 5-year PFS of 35.7% (CI 13-59.4)., Conclusions: The presence of moderate or massive effusion seems to be an unfavorable prognostic factor in children with RMS, and justifies their inclusion in experimental studies., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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49. A dedicated cloud system for real-time upfront quality assurance in pediatric radiation therapy.
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Meroni S, Cavatorta C, Barra S, Cavagnetto F, Scarzello G, Scaggion A, Pecori E, Diletto B, Alessandro O, Massimino M, Gianolini S, Pignoli E, and Gandola L
- Subjects
- Child, Humans, Organs at Risk radiation effects, Radiometry, Radiotherapy Planning, Computer-Assisted methods, Software Design, Workflow, Cerebellar Neoplasms radiotherapy, Cloud Computing, Medulloblastoma radiotherapy, Neuroectodermal Tumors, Primitive radiotherapy, Quality Assurance, Health Care organization & administration, Specialization
- Abstract
Purpose: Pediatric radiotherapy (RT) is a highly specialized field, requiring great experience to delineate correctly tumor targets and organs at risk. To reduce treatment failures related to planning inaccuracies and to obtain robust clinical results despite the limited numbers of enrolled pediatric patients, the SIOP PNET5MB clinical trial on medulloblastoma requires a real-time, pre-radiation review of the RT treatment (craniospinal irradiation and boost plan) under the direct responsibility of the national coordinator center. Here we describe the centralized radiotherapy quality assurance (QA) program developed in Italy for this purpose., Methods: Using the software package VODCA (MSS, Hagendorn, Switzerland, www.vodca.ch ), we developed a cloud platform able to handle computed tomography (CT) images and RT objects and to support the complete workflow required by the review process in the context of the SIOP PNET5 trial., Results: All Italian centers participating in the PNET5 trial adopted the proposed QA system. 24 patients were successfully enrolled and reviewed. For 15 patients (62.5%), one or more plan revisions were requested for the craniospinal irradiation plan and for 11 patients (45.8%) plan revisions were requested for the boost. RT was delivered after the plan was centrally approved for all enrolled patients. So far, in Italy, no patients have been excluded from PNET5 due to dosimetric incompliance to the protocol or for exceeding the RT starting time limit., Conclusion: The cloud platform successfully supported the trial workflow, producing official review documents. This efficient QA was crucial to guarantee optimized treatments and protocol compliance for all pediatric patients enrolled in the SIOP protocol.
- Published
- 2019
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50. Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group.
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Hoeben BA, Carrie C, Timmermann B, Mandeville HC, Gandola L, Dieckmann K, Ramos Albiac M, Magelssen H, Lassen-Ramshad Y, Ondrová B, Ajithkumar T, Alapetite C, Balgobind BV, Bolle S, Cameron AL, Davila Fajardo R, Dietzsch S, Dumont Lecomte D, van den Heuvel-Eibrink MM, Kortmann RD, Laprie A, Melchior P, Padovani L, Rombi B, Scarzello G, Schwarz R, Seiersen K, Seravalli E, Thorp N, Whitfield GA, Boterberg T, and Janssens GO
- Subjects
- Child, Child, Preschool, Female, Humans, Male, Neoplasms pathology, Radiation Oncology standards, Neoplasms radiotherapy, Pediatrics standards, Radiotherapy Dosage standards, Radiotherapy, Conformal standards
- Abstract
Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2019
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