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Introduction The aim of the study is to evaluate whether placental location at term is associated with delivery outcome. Methods A prospective study including 2354 patients with singleton pregnancy at term admitted for vaginal delivery was conducted. Placental position was determined before delivery by ultrasonographic examination performed transabdominally with women in the supine position. Maternal characteristics and delivery outcome such as premature rupture of membranes, induction of labor, mode and gestational age at delivery, indication for cesarean section, duration of the third stage, postpartum hemorrhage (PPH) and manual removal of placenta were correlated with anterior, posterior or fundal placental locations. Results Among women enrolled: i) 1164 had an anterior placenta, ii) 1087 a posterior placenta, iii) 103 a fundal placenta. Women with anterior placenta showed: i) a higher incidence of induction of labor (p = 0.0001), especially for postdate pregnancies and prolonged prelabor rupture of membranes (p < 0.0001), ii) a higher rate of cesarean section rate for failure to progress in labor (p = 0.02), iii) a prolonged third stage (p = 0.01), iv) a higher incidence of manual removal of placenta (p = 0.003) and a higher rate of PPH in vaginal deliveries (p = 0.02). Discussion The present study showed the influence of anterior placental location on the course of labor, with a later onset of labor, a higher rate of induction and cesarean section and postpartum complications. The reason for this influence on labor and delivery complications remains to be elucidated. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in locally advanced rectal cancer (LARC) 8 weeks after neoadjuvant chemoradiotherapy (CRT). Methods and materials: A total of 28 patients with LARC underwent magnetic resonance imaging (MRI) prior to and 8 weeks after CRT. Tumor volume (TV) was calculated on T2-weighted MRI scans as well as the apparent diffusion coefficient (ADC) was calculated using Echo-planar DWI-sequences. All data were correlated to surgical results and histopathologic tumor regression grade (TRG), according to Mandard's classification. Post-treatment difference ADC (%ΔADC) and TV (%ΔTV) changes at 8 weeks were compared complete response (CR; TRG1) and non-complete response tumors (non-CR; TRG2–5). Results: The mean % ADC increase of CR group was significantly higher compared to non-CR group (77.2 ± 54.63% vs. 36.0 ± 29.44%; p = 0.05). Conversely, the mean % TV reduction did not significantly differ in CR group from non-CR group (73.7% vs. 63.77%; p = 0.21). Accordingly, the diagnostic accuracy of the mean % ADC increase to discriminate CR from non-CR group was significantly higher than that of the mean % TV reduction (0.913 vs. 0.658; p = 0.022). No correlation was found between mean % TV reduction and TRG (rho = 0.22; p = 0.3037), whereas a negative correlation between mean % ADC increase and TRG was recorded (r = −0.69; p = 0.006). Conclusion: The mean % ADC increase appears to be a reliable tool to differentiate CR from non-CR after CRT in patients with LARC. [ABSTRACT FROM AUTHOR]

Purpose To present In-Vivo Dosimetry (IVD) results obtained elaborating EPID images by a commercial software. Methods 8474 IVD tests for 386 cancer patients treated with 3DCRT, IMRT and VMAT techniques, were performed using the SOFTDISO software. SOFTDISO uses EPID-images to calculate for each beam (i) the R index, i.e. the ratio between daily reconstructed dose and the planned one at isocenter point and (ii) a γ -like analysis between the reference EPID image and that obtained in a daily fraction. γ -like analysis supplies two indexes: the percentage of points with γ < 1 (γ %) and the mean γ value, ( γ mean). For each test, the pass criteria for the signals (S) agreement Δ S% and distance to agreement Δ d, were: 0.95 ⩽ R ⩽ 1.05, γ % ⩾ 90% and γ mean ⩽ 0.5. Results The results of R ratios, the γ -like analysis and the visual inspection of out of tolerance tests, together with the patient anatomical images, permitted to individuate 2 classes of errors: class-1, due to inadequate standard quality controls and class-2, due to patient morphological changes. Depending on the technique and anatomical site, a maximum of 18% of tests had at least one index out of tolerance level (OTL). Once removed the causes of class-1 errors, all patients (except four lung and two breast cancer patients treated with 3DCRT) presented mean indexes values ( R ¯ , γ ¯ % and γ ¯ mean ) within tolerance at the end of treatment course. Class-2 errors were found in some patients. As an example, the Table reports the results of 1810 tests for prostate and H&N tumours treated with VMAT technique with 163 OTL tests (9%). As regards the workload, it took 20 min for 10 patients per day. Conclusions The IVD procedure with SOFTDISO resulted easily implementable and able to individuate errors with a limited workload. [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus (CMV) infection is the leading infectious cause of neurological impairment for which, currently, there are no approved antenatal treatment options. The aim of this article was to summarize the available evidence on the use of valacyclovir during pregnancy to prevent and treat congenital CMV infection and disease. Two databases (PubMed and ClinicalTrial.gov) were reviewed. Six relevant documents were identified, namely one observational study, three clinical trials, two case reports. Most relevant findings were those from two clinical trials. A phase 2/3 placebo-controlled study showed a decrease of 71% (5 of 45 vs 14 of 47) in rate of CMV vertical transmission in women treated with 8 g/day valacyclovir following primary CMV infection in pregnancy. A phase 2, single-arm clinical trial, showed that 8 g/day valacyclovir administered to mothers of symptomatic infected foetuses increased the portion of asymptomatic neonates to 82% (34 of 41), compared with 43% (20 of 47) in untreated pregnancies from a historical cohort. Studies in favour of using valacyclovir during pregnancy for prevention and treatment of congenital CMV infection are emerging but are still few. Randomized clinical trials on large cohorts of patients investigating the efficacy on prevention and treatment of congenital CMV are required. Unfortunately, this will be probably not be feasible at least in the short period. In the meantime, data on the 'off label' use of valacyclovir for CMV in pregnancy could be collected within a multicentre observational study. [ABSTRACT FROM AUTHOR]

To retrospectively evaluate the inter-observer agreement between a radiologist and a radiation oncologist and volume differences, in T2 and diffusion-weighted (DWI) MRI of gross tumor volume (GTV) delineation, in rectal cancer patients. Two observers, a radiologist and a radiation oncologist, delineated GTVs of 50 patients on T2-weighted MRI (T2 GTV) and echo planar DWI (DWI GTV). Observers agreement was assessed using DICE index, Bland-Altman analysis and intra-class correlation coefficient (ICC). Student's t -test was used for GTV comparison. Median T2 GTV and DWI GTV were 17.09 ± 14.12 cm3 (1.92–62.03) and 12.79 ± 12.31 cm3 (1.23–62.25) for radiologist, and 16.82 ± 13.66 cm3 (1.78–65.9) and 13.72 ± 12.77 cm3 (1.29–69.75) for radiation oncologist. T2 GTV were significantly larger compared to DWI GTV (P < 0.001 and P < 0.001, for both observers). Mean DICE index for T2 GTV and DWI GTV were 0.80 ± 0.07 and 0.77 ± 0.06. The mean difference between the two observers were 0.26 cm3 (95% CI: −5.36 to 5.88) and −1.13 cm3 (95% CI: −5.70 to 3.44) for T2 and DWI volumes. The ICC for T2 volumes was 0.989 (95% CI: 0.981–0.994) (P < 0.001) and 0.992 (95% CI: 0.986–0.996) (P < 0.001) for DWI volumes. DWI resulted in smaller volumes delineation compared to T2-weighted MRI. Substantial and almost perfect agreements were reported for DWI GTV and T2 GTV between radiologist and radiation oncologist. Due to the fact that DWI could be considered a simple technique for volume delineation for radiation oncologist, DWI could be used to improve quality in radiation planning for an accurate boost volume delineation when a dose escalation is investigated. [ABSTRACT FROM AUTHOR]

Purpose The aim of our study was to evaluate hippocampal irradiation in patients treated with fractionated stereotactic brain radiotherapy. Patients and methods Retrospective hippocampal dosimetric analysis performed on 22 patients with one to four brain metastases treated with fractionated stereotactic radiotherapy using volumetric intensity-modulated arc therapy. Original plans did not include hippocampus as avoidance structure in optimization criteria; hippocampus was retrospectively delineated on magnetic resonance coregistered with planning CT and using as reference the RTOG 0933 atlas. Hippocampus was defined both as a single and as pair organ. Constraints analysed were: Dmax < 16 Gy, D40% < 7.3 Gy, D100% = Dmin < 9 Gy. Assuming a α/β ratio of 2 Gy, biologically equivalent dose in 2 Gy fractions was calculated. Hippocampal-sparing plans were developed in cases where hippocampal constraints were not respected in the original plan. Results Among constraints analysed Dmax and D40% have been exceeded in ten out of 22 cases. The constraints were not respected in patients with more than one metastatic lesion and in three patients with only one lesion. Considering all exceeded constraints values in non-hippocampal sparing plans, the 50% of them was respected after replanning. No significant differences were found among conformity and homogeneity index between non-hippocampal sparing and hippocampal sparing plans. Conclusion Volumetric intensity-modulated arc therapy hippocampal sparing plans significantly decreases dose to hippocampus assuring an equal target coverage and organs at risk avoiding. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The present observational study reports the results of a multi-institutional dummy-run designed to estimate the consistency of interobserver variability in clinical target volume delineation in two different cases of soft-tissue sarcomas in which postoperative and preoperative radiotherapy were prescribed, respectively. The purpose of this work was to quantify interobserver variability in routine clinical practice. Patients and methods: Two different cases of soft-tissues sarcomas were chosen: a case of postoperative and a case of preoperative radiation therapy. Participating centres were requested to delineate clinical target volumes according to their experience in both cases. Descriptive statistic was calculated for each variable (volume, diameters) separately for two cases. Box-whiskers plots were used for presentation of clinical target volume. A Shapiro-Wilk's test was performed to evaluate the departures from normality distribution for each variable. The comparison between relative variations of diameters was evaluated using the Student's t test. Results: Several variations affecting both volumes and diameters were observed. Main variations were observed in the craniocaudal and laterolateral diameters. Each case showed similar dispersion, indicating a lack of reproducibility in volumes definition. Conclusions: This observational study highlighted that, in the absence of specific instructions or guidelines, the interobserver variability can be significant both in postoperative and preoperative radiotherapy of soft-tissue sarcomas. [Copyright &y& Elsevier]

Poster discussion: CL: Gynaecology PD-0656: A contouring atlas on MRI of emerging pelvic female organs at risk for daily practice radiotherapy A. Allajbej, F. Patani, L. Gasparini, F.C. Di Guglielmo, C. Bonfiglio, D. Fasciolo, C. Rosa, M. Trignani, A. Vinciguerra, L. Caravatta, M. Di Tommaso, R. Cianci, R. Basilico, A. Augurio, D. Genovesi. [Extracted from the article]