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Background: Radiomics represents an emerging field of precision‐medicine. Its application in head and neck is still at the beginning. Methods: Retrospective study about magnetic resonance imaging (MRI) based radiomics in oral tongue squamous cell carcinoma (OTSCC) surgically treated (2010–2019; 79 patients). All preoperative MRIs include different sequences (T1, T2, DWI, ADC). Tumor volume was manually segmented and exported to radiomic‐software, to perform feature extraction. Statistically significant variables were included in multivariable analysis and related to survival endpoints. Predictive models were elaborated (clinical, radiomic, clinical‐radiomic models) and compared using C‐index. Results: In almost all clinical‐radiomic models radiomic‐score maintained statistical significance. In all cases C‐index was higher in clinical‐radiomic models than in clinical ones. ADC provided the best fit to the models (C‐index 0.98, 0.86, 0.84 in loco‐regional recurrence, cause‐specific mortality, overall survival, respectively). Conclusion: MRI‐based radiomics in OTSCC represents a promising noninvasive method of precision medicine, improving prognosis prediction before surgery. [ABSTRACT FROM AUTHOR]

Objective: The space comprised between tumor and neck lymph nodes (T‐N tract) is one of the main routes of tumor spread in oral cavity tumors. Aim of the study was to investigate the impact of T‐N tract involvement on the postoperative radiotherapy (PORT) outcomes. Materials and Methods: Patients (pts) treated between 2000 and 2016 with indication to PORT were retrospectively retrieved. Inclusion criteria were: (a) locally advanced tumors of the oral cavity, (b) who received with indication to PORT (c) with a minimum follow‐up of six months. Results: One hundred and fifty‐seven pts met the inclusion criteria (136 pts treated with PORT and 21 pts not treated with PORT). In the PORT cohort, the T‐N tract involvement had no impact on both OS (p =.09) and LRFS (p =.2). Among the non‐PORT cohort, both OS (p =.007) and LRFS (p =.017) were worse for pts with positive T‐N tract compared to those with negative T‐N tract. PORT improved both OS (p =.008) and LRFS (p =.003) in pts with positive T‐N tract but not in those with negative T‐N tract (p =.36 and p =.37, respectively). Conclusions: Our results suggest that involvement of T‐N tract should be considered as prognostic factors informing the indication to PORT. [ABSTRACT FROM AUTHOR]

Objectives: The main aim was to assess the performance and cutoff value for the detection of liver steatosis (grade S > 0) with the Attenuation Imaging–Penetration (ATI‐Pen) algorithm available on the Aplio i‐series ultrasound systems (Canon Medical Systems, Otawara, Japan). The magnetic resonance imaging–derived proton density fat fraction (MRI‐PDFF) was used as the reference standard. Secondary aims were to compare the results to those obtained with the previous ATI algorithm (Attenuation Imaging–General [ATI‐Gen]) and with the controlled attenuation parameter (CAP) and to generate a regression equation between ATI‐Pen and ATI‐Gen values. Methods: Consecutive adult patients potentially at risk of liver steatosis were prospectively enrolled. Each patient underwent ultrasound quantification of liver steatosis with ATI‐Pen and ATI‐Gen and a CAP assessment with the FibroScan system (Echosens, Paris, France). The MRI‐PDFF evaluation was performed within a week. The correlations between ATI‐Pen, ATI‐Gen, the CAP, and the MRI‐PDFF were analyzed with the Pearson rank correlation coefficient. The diagnostic performance of ATI‐Pen, ATI‐Gen, and the CAP was assessed with receiver operating characteristic curves and an area under the receiver operating characteristic curve (AUROC) analysis. Results: Seventy‐two individuals (31 male and 41 female) were enrolled. Correlation coefficients of ATI‐Pen, ATI‐Gen, and the CAP with the MRI‐PDFF were 0.78, 0.83, and 0.58, respectively. The AUROCs of ATI‐Pen, ATI‐Gen, and the CAP for detecting steatosis (S > 0) were 0.90 (95% confidence interval, 0.81–0.96), 0.92 (0.82–0.98), and 0.85 (0.74–0.92), and the cutoffs were greater than 0.69 dB/cm/MHz, greater than 0.62 dB/cm/MHz, and greater than 273 dB/m. The regression equation between ATI‐Pen and ATI‐Gen was ATI‐Pen = 0.88 ATI‐Gen + 0.13. Conclusions: Attenuation Imaging is a reliable tool for detecting liver steatosis, showing an excellent correlation with the MRI‐PDFF and high performance with AUROCs of 0.90 or higher. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Purpose: Proton therapy could benefit from noninvasively gaining tumor microstructure information, at both planning and monitoring stages. The anatomical location of brain tumors, such as meningiomas, often hinders the recovery of such information from histopathology, and conventional noninvasive imaging biomarkers, like the apparent diffusion coefficient (ADC) from diffusion‐weighted MRI (DW‐MRI), are nonspecific. The aim of this study was to retrieve discriminative microstructural markers from conventional ADC for meningiomas treated with proton therapy. These markers were employed for tumor grading and tumor response assessment. Methods: DW‐MRIs from patients affected by meningioma and enrolled in proton therapy were collected before (n = 35) and 3 months after (n = 25) treatment. For the latter group, the risk of an adverse outcome was inferred by their clinical history. Using Monte Carlo methods, DW‐MRI signals were simulated from packings of synthetic cells built with well‐defined geometrical and diffusion properties. Patients' ADC was modeled as a weighted sum of selected simulated signals. The weights that best described a patient's ADC were determined through an optimization procedure and used to estimate a set of markers of tumor microstructure: diffusion coefficient (D), volume fraction (vf), and radius (R). Apparent cellularity (ρapp) was estimated from vf and R for an easier clinical interpretability. Differences between meningothelial and atypical subtypes, and low‐ and high‐grade meningiomas were assessed with nonparametric statistical tests, whereas sensitivity and specificity with ROC analyses. Similar analyses were performed for patients showing low or high risk of an adverse outcome to preliminary evaluate response to treatment. Results: Significant (P < 0.05) differences in median ADC, D, vf, R, and ρapp values were found when comparing meningiomas' subtypes and grades. ROC analyses showed that estimated microstructural parameters reached higher specificity than ADC for subtyping (0.93 for D and vf vs 0.80 for ADC) and grading (0.75 for R vs 0.67 for ADC). High‐ and low‐risk patients showed significant differences in ADC and microstructural parameters. The skewness of ρapp was the parameter with highest AUC (0.90) and sensitivity (0.75). Conclusions: Matching measured with simulated ADC yielded a set of potential imaging markers for meningiomas grading and response monitoring in proton therapy, showing higher specificity than conventional ADC. These markers can provide discriminative information about spatial patterns of tumor microstructure implying important advantages for patient‐specific proton therapy workflows. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a method for generating virtual four‐dimensional computed tomography (4DCT) from four‐dimensional magnetic resonance imaging (4DMRI) data in carbon ion radiotherapy with pencil beam scanning for abdominal tumors. Methods: Deformable image registration is used to: (a) register each respiratory phase of the 4DMRI to the end‐exhale MRI; (b) register the reference end‐exhale CT to the end‐exhale MRI volume; (c) generate the virtual 4DCT by warping the registered CT according to the obtained deformation fields. A respiratory‐gated carbon ion treatment plan is optimized on the planning 4DCT and the corresponding dose distribution is recalculated on the virtual 4DCT. The method was validated on a digital anthropomorphic phantom and tested on eight patients (18 acquisitions). For the phantom, a ground truth dataset was available to assess the method performances from the geometrical and dosimetric standpoints. For the patients, the virtual 4DCT was compared with the planning 4DCT. Results: In the phantom, the method exhibits a geometrical accuracy within the voxel size and Dose Volume Histograms deviations up to 3.3% for target V95% (mean dose difference ≤ 0.2% of the prescription dose, gamma pass rate > 98%). For patients, the virtual and the planning 4DCTs show good agreement at end‐exhale (3% median D95% difference), whereas other respiratory phases exhibit moderate motion variability with consequent dose discrepancies, confirming the need for motion mitigation strategies during treatment. Conclusions: The virtual 4DCT approach is feasible to evaluate treatment plan robustness against intra‐ and interfraction motion in carbon ion therapy delivered at the abdominal site. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to identify the factors influencing oncologic outcomes for patients with early-intermediate glottic cancer treated by transoral laser microsurgery (TLM). Methods This was a retrospective mono-institutional study. A total of 590 patients with cTis-cT3 glottic cancer underwent TLM with curative intent. Results TLM alone was performed in 538 patients (91.2%) and TLM followed by adjuvant radiotherapy (RT) was done in 52 (8.8%). Five-year recurrence-free survival (RFS) and 10-year overall survival (OS) were 85.3% and 74.7%, respectively. The larynx-preservation ratio was 95.9%. In particular, from our data, we found that occult metastases were rare (1.2%); preventive tracheotomy was not necessary; the local recurrence rate of Tis was similar to that in the T2 and T3 group; and no major or lethal complications were observed. Conclusion Age (>60 vs ≤60), type of cordectomy (≥IV vs ≤III), status of margins, fixed arytenoid, and pathologic T classification, were the variables associated with RFS, OS, and organ-preservation rate. © 2016 Wiley Periodicals, Head Neck 39: 71-81, 2017 [ABSTRACT FROM AUTHOR]

Rituximab, a chimeric monoclonal antibody directed against the CD20 antigen, has been shown to be active in newly diagnosed and relapsed patients with follicular lymphoma (FL), both as monotherapy and in combination with chemotherapy. Many studies suggest that the prognosis of patients with FL may improve when it is used in combination with chemotherapy. Despite these advances, the disease remains essentially incurable with standard therapy, and novel approaches to treatment are needed because optimal therapy is not defined. The combination of chlorambucil-rituximab is one of several standard treatment options for FL. Here, we considered data arising from 75 patients with newly diagnosed FL at the European Institute of Oncology treated with the combination of rituximab plus chlorambucil. The aim of this study was to evaluate the efficacy and safety of chlorambucil and rituximab, delivered 6 mg/m(2) /day orally for 6 weeks and 375 mg/m(2) in a standard 4-weekly schedule, respectively. Patients responding to the induction therapy received a prolonged therapy with four additional cycles of chlorambucil plus rituximab. Seventy-one patients (94.6%) completed the treatment; four patients discontinued treatment because of grade 3-4 hematological toxicity. The overall response rate was 97.3% including 74.7% of complete responses. Only two patients had a stable disease at revaluation after treatment. With a median follow-up of 57 months, 72 patients (96%) are alive. Median event-free survival (EFS) and median overall survival (OS) were not reached; 5-year OS rate was 98.4%. The 5-year EFS was 71.3%. By univariate and multivariate analyses, elevated beta-2 microglobulin levels and partial responses to therapy were correlated with worse EFS. These results suggest that the combination of chlorambucil and rituximab is an active and safe regimen in patients with newly diagnosed FL, principally in those with low tumour burden and favourable prognostic factors. [ABSTRACT FROM AUTHOR]

Background: Patients with bulky laryngopharyngeal masses and a relative or absolute contraindication to general anesthesia present diagnostic difficulties. In the current study, the authors assessed the utility of transcutaneous ultrasound-guided Tru-Cut biopsy (USGTCB) under local anesthesia in such individuals. Methods: The current report was a prospective, nonrandomized study. Patients meeting the inclusion criteria underwent USGTCB as outpatients. Results: Ten patients were recruited, 4 of whom had an untreated mass obstructing the laryngeal lumen and 6 of whom were previously treated for laryngeal cancer. All tolerated the procedure well. The only adverse event noted was spontaneously resolving near-syncope in 1 patient. In 9 patients the biopsy was diagnostic: invasive squamous cell carcinoma in 7 patients and chondronecrosis in 2 patients. In the remaining patient, radiologically suspected cricoid chondrosarcoma was confirmed based on the surgical specimen. Conclusions: The results of this pilot study are encouraging. USGTCB of laryngopharyngeal masses was found to produce no local morbidity, was diagnostic in each of the 5 patients with suspected disease recurrence after radiotherapy, was feasible in the outpatient setting, and had high sensitivity and specificity. The procedure is particularly useful for patients contraindicated for general anesthesia or those with a risk of tracheotomy due to intubation difficulties. [ABSTRACT FROM AUTHOR]