Search

Your search keyword '"Cellini, F."' showing total 23 results
Start Over Author "Cellini, F." Topic business.industry
23 results on '"Cellini, F."'

1. Multimodal treatment of resectable pancreatic ductal adenocarcinoma

Author

Silvestris N, Brunetti O, Vasile E, Cellini F, Cataldo I, Pusceddu V, Cattaneo M, Partelli S, Scartozzi M, Aprile G, Casadei Gardini A, Morganti AG, Valentini V, Scarpa A, Falconi M, Calabrese A, Lorusso V, Reni M, Cascinu S, CASADEI GARDINI, ANDREA, Silvestris, Nicola, Brunetti, Oronzo, Vasile, Enrico, Cellini, Francesco, Cataldo, Ivana, Pusceddu, Valeria, Cattaneo, Monica, Partelli, Stefano, Scartozzi, Mario, Aprile, Giuseppe, Casadei Gardini, Andrea, Morganti, Alessio Giuseppe, Valentini, Vincenzo, Scarpa, Aldo, Falconi, Massimo, Calabrese, Angela, Lorusso, Vito, Reni, Michele, Cascinu, Stefano, Silvestris, N, Brunetti, O, Vasile, E, Cellini, F, Cataldo, I, Pusceddu, V, Cattaneo, M, Partelli, S, Scartozzi, M, Aprile, G, Casadei Gardini, A, Morganti, Ag, Valentini, V, Scarpa, A, Falconi, M, Calabrese, A, Lorusso, V, Reni, M, Cascinu, S, and CASADEI GARDINI, Andrea

Subjects
Oncology, medicine.medical_specialty, Pancreatic ductal adenocarcinoma, medicine.medical_treatment, Adjuvant, Chemotherapy, Radiotherapy, Target therapy, Malignancy, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Multimodal treatment, Humans, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Randomized Controlled Trials as Topic, business.industry, Carcinoma, Pancreatic Ductal, Chemoradiotherapy, Chemotherapy, Adjuvant, Combined Modality Therapy, Immunotherapy, Neoadjuvant Therapy, Pancreatic Neoplasms, Hematology, Geriatrics and Gerontology, Carcinoma, Pancreatic Neoplasm, medicine.disease, Pancreatic Ductal, 030220 oncology & carcinogenesis, Adenocarcinoma, 030211 gastroenterology & hepatology, business, Human
Abstract

After a timing preoperative staging, treatment of resectable pancreatic adenocarcinoma (PDAC) includes surgery and adjuvant therapies, the former representing the initial therapeutic option and the latter aiming to reduce the incidence of both distant metastases (chemotherapy) and locoregional failures (chemoradiotherapy). Herein, we provide a critical overview on the role of multimodal treatment in PDAC and on new opportunities related to current more active poli-chemotherapy regimens, targeted therapies, and the more recent immunotherapy approaches. Moreover, an analysis of pathological markers and clinical features able to help clinicians in the selection of the best therapeutic strategy will be discussed. Lastly, the role of neoadjuvant treatment of initially resectable disease will be considered mostly in patients whose malignancy shows morphological but not clinical or biological criteria of resectability. Depending on the results of these investigational studies, today a multidisciplinary approach can offer the best address therapy for these patients.

Published
2016

2. Chemoradiation in Unresectable Biliary Tract Cancer: A Systematic Review

Author

Morganti Ag, Alessandra Arcelli, Gabriella Mattiucci, S. Bisello, G Macchia, Milly Buwenge, Cellini F, Savino Cilla, Alice Zamagni, Silvia Cammelli, and F. Deodato

Subjects
medicine.medical_specialty, Chemotherapy, business.industry, medicine.medical_treatment, Brachytherapy, Acute toxicity, Radiation therapy, Clinical trial, Biliary tract, Toxicity, medicine, Radiology, External beam radiotherapy, business
Abstract

Aim: To present a systematic review on efficacy and toxicity of modern concurrent chemoradiation (CCRT) in unresectable biliary tract cancers (BTC). Methods: A systematic review of literature published within the last ten years (1 January 2007-31 December 2017), based on PRISMA methodology and using PubMed electronic database was conducted. Only articles reporting patients’ outcome in terms of toxicity and/or overall survival (OS) or progression-free survival (PFS) after CCRT, with or without other treatments, were analyzed. Only studies of patients with diagnosis of unresectable BTC, including intrahepatic, extrahepatic, and gallbladder neoplasm were considered. Results: Six eligible studies were included reporting data on 195 patients. Median follow-up ranged between 9.4 and 27.7 months (median: 16 months). Four studies were prospective phase II trials and 2 had a retrospective design. Different external beam radiotherapy (EBRT) techniques and chemotherapy (CT) schedules were used while only in one study a brachytherapy boost was delivered. Grade ≥ 3 acute toxicity (hematological or gastrointestinal) ranged between 0.0 and 55.6% (median: 37.0%). One study reported 30.0% gastrointestinal grade ≥ 2 late toxicity. PFS ranged between 6.8 and 10.5 months (median: 7.5 months) in 5 studies. OS ranged between 9.6 and 13.5 months (median: 13 months) in 5 studies. Conclusion: CCRT remains a reasonable treatment option for locally advanced BTC, providing results comparable with the ones of standard CT, particularly in terms of OS. Considering the progressive advance of modern EBRT techniques, further improvement of these results can be expected. Therefore, clinical trials based on advanced radiotherapy techniques and new integrations of CCRT with systemic treatments are warranted.

Published
2018
Full Text
View/download PDF

3. Adherence issues related to sublingual immunotherapy as perceived by allergists

Author

Scurati, S., Frati, F., Passalacqua, G., Puccinelli, P., Hilaire, C., Incorvaia, C., D Avino, G., Comi, R., Lo Schiavo, M., Pezzuto, F., Montera, C., Pio, A., Teresa Ielpo, M., Cellini, F., Vicentini, L., Pecorari, R., Aresu, T., Capra, L., Benedictis, E., Bombi, C., Zauli, D., Vanzi, A., Alberto Paltrinieri, C., Bondioli, A., Paletta, I., Ventura, D., Mei, F., Paolini, F., Colangelo, C., Cavallucci, E., Cucinelli, F., Tinari, R., Ermini, G., Beltrami, V., Novembre, E., Begliomini, C., Marchese, E., Solito, E., Ammannati, V., Molino, G., Galli, E., Baldassini, M., Di Michele, L., Calvani, M., Gidaro, M., Venuti, A., Li Bianchi, E., Benassi, F., Pocobelli, D., Zangari, P., Rocco, M. G., Lo Vecchio, A., Pingitore, G., Grimaldi, O., Schiavino, D., Perrone, N., Antonietta Frieri, M., Di Rienzo, V., Tripodi, S., Scarpa, A., Tomsic, M., Bonaguro, R., Enrico Senna, G., Sirena, A., Turatello, F., Crescioli, S., Favero, E., Billeri, L., Chieco Bianchi, F., Gemignani, C., Zanforlin, M., Angiola Crivellaro, M., Hendrick, B., Maltauro, A., Masieri, S., Elisabetta Conte, M., Fama, M., Pozzan, M., Bonadonna, P., Casanova, S., Vallerani, E., Schiappoli, M., Borghesan, F., Giro, G., Casotto, S., Berardino, L., Zanoni, G., Ariano, R., Aquilina, R., Pellegrino, R., Marsico, P., Del Giudice, A., Narzisi, G., Tomaselli, V., Fornaca, G., Favro, M., Loperfido, B., Gallo, C., Buffoni, S., Gani, F., Raviolo, P., Faggionato, S., Truffelli, T., Vivalda, L., Albano, M., Enzo Rossi, R., Lattuada, G., Bona, F., Quaglio, L., Chiesa, A., Trapani, M., Seminara, R., Cucchi, B., Oderda, S., Borio, G., Galeasso, G., Garbaccio, P., Marco, A., Marengo, F., Cadario, G., Manzoni, S., Vinay, C., Curcio, A., Silvestri, A., Peduto, A., Riario-Sforza, G. G., Maria Forgnone, A., Barocelli, P., Tartaglia, N., Feyles, G., Giacone, A., Ricca, V., Guida, G., Nebiolo, F., Bommarito, L., Heffler, E., Vietti, F., Galimberti, M., Savi, E., Pappacoda, A., Bottero, P., Porcu, S., Felice, G., Berra, D., Francesca Spina, M., Pravettoni, V., Calamari, A. M., Varin, E., Iemoli, E., Lietti, D., Ghiglioni, D., Alessandro Fiocchi, Tosi, A., Poppa, M., Caviglia, A., Restuccia, M., Russello, M., Alciato, P., Manzotti, G., Ranghino, E., Luraschi, G., Rapetti, A., Rivolta, F., Allegri, F., Terracciano, L., Agostinis, F., Paolo Piras, P., Ronchi, G., Gaspardini, G., Caria, V., Tolu, F., Fantasia, D., Carta, P., Moraschini, A., Quilleri, R., Santelli, A., Prandini, P., Del Giudice, G., Apollonio, A., Bonazza, L., Teresa Franzini, M., Branchi, S., Zanca, M., Rinaldi, S., Catelli, L., Zanoletti, T., Cosentino, C., Della Torre, F., Cremonte, L., Musazzi, D., Suli, C., Rivolta, L., Ottolenghi, A., Marino, G., Sterza, G., Sambugaro, R., Orlandini, A., Minale, P., Voltolini, S., Bignardi, D., Omodeo, P., Tiri, A., Milani, S., Ronchi, B., Licardi, G., Bruni, P., Scibilia, J., Schroeder, J., Crosti, F., Maltagliati, A., Alesina, M. R., Mosca, M., Leone, G., Napolitano, G., Di Gruttola, G., Scala, G., Mascio, S., Valente, A., Marchetiello, I., Catello, R., Gazulli, A., Del Prete, A., Varricchio, A. M., Carbone, A., Forestieri, A., Stillitano, M., Leonetti, L., Tirroni, E., Castellano, F., Abbagnara, F., Romano, F., Levanti, C., Cilia, M., Longo, R., Ferrari, A., Merenda, R., Di Ponti, A., Guercio, E., Surace, L., Ammendola, G., Tansella, F., Peccarisi, L., Stragapede, L., Minenna, M., Granato, M., Fuiano, N., Pannofino, A., Ciuffreda, S., Giannotta, A., Morero, G., D Oronzio, L., Taddeo, G., Nettis, E., Cinquepalmi, G., Lamanna, C., Mastrandrea, F., Minelli, M., Salamino, F., Muratore, L., Latorre, F., Quarta, C., Ventura, M., D Ippolito, G., Giannoccaro, F., Dambra, P., Pinto, L., Triggiani, M., Munno, G., Manfredi, G., Lonero, G., Damiano, V., Errico, G., Di Leo, E., Manzari, F., Spagna, V., Arsieni, A., Matarrese, A., Mazzarella, G., Scarcia, G., Scarano, R., Ferrannini, A., Pastore, A., Maionchi, P., Filannino, L., Tria, M., Giuliano, G., Damiani, E., Scichilone, N., Marchese, M., Lucania, A., Marino, M., Strazzeri, L., Tumminello, S., Vitale, G. I., Gulotta, S., Gragotto, G., Zambito, M., Greco, D., Valenti, G., Licitra, G., Cannata, E., Filpi, R., Contraffatto, M., Sichili, S., Randazzo, S., Scarantino, G., Lo Porto, B., Pavone, F., Di Bartolo, C., Paternò, A., Rapisarda, F., Laudani, E., Leonardi, S., Padua, V., Cabibbo, G., Marino Guzzardi, G., Deluca, F., Agozzino, C., Pettinato, R., Ghini, M., Scurati S., Frati F., Passalacqua G., Puccinelli P., Hilaire C., Incorvaia C., D'Avino G., Comi R., Lo Schiavo M., Pezzuto F., Montera C., Pio A., Teresa Ielpo M., Cellini F., Vicentini L., Pecorari R., Aresu T., Capra L., De Benedictis E., Bombi C., Zauli D., Vanzi A., Alberto Paltrinieri C., Bondioli A., Paletta I., Ventura D., Mei F., Paolini F., Colangelo C., Cavallucci E., Cucinelli F., Tinari R., Ermini G., Beltrami V., Novembre E., Begliomini C., Marchese E., Solito E., Ammannati V., Molino G., Galli E., Baldassini M., Di Michele L., Calvani M., Gidaro M., Venuti A., Li Bianchi E., Benassi F., Pocobelli D., Zangari P., De Rocco M.G., Lo Vecchio A., Pingitore G., Grimaldi O., Schiavino D., Perrone N., Antonietta Frieri M., Di Rienzo V., Tripodi S., Scarpa A., Tomsic M., Bonaguro R., Enrico Senna G., Sirena A., Turatello F., Crescioli S., Favero E., Billeri L., Chieco Bianchi F., Gemignani C., Zanforlin M., Angiola Crivellaro M., Hendrick B., Maltauro A., Masieri S., Elisabetta Conte M., Fama M., Pozzan M., Bonadonna P., Casanova S., Vallerani E., Schiappoli M., Borghesan F., Giro G., Casotto S., Berardino L., Zanoni G., Ariano R., Aquilina R., Pellegrino R., Marsico P., Del Giudice A., Narzisi G., Tomaselli V., Fornaca G., Favro M., Loperfido B., Gallo C., Buffoni S., Gani F., Raviolo P., Faggionato S., Truffelli T., Vivalda L., Albano M., Enzo Rossi R., Lattuada G., Bona F., Quaglio L., Chiesa A., Trapani M., Seminara R., Cucchi B., Oderda S., Borio G., Galeasso G., Garbaccio P., De Marco A., Marengo F., Cadario G., Manzoni S., Vinay C., Curcio A., Silvestri A., Peduto A., Riario-Sforza G.G., Maria Forgnone A., Barocelli P., Tartaglia N., Feyles G., Giacone A., Ricca V., Guida G., Nebiolo F., Bommarito L., Heffler E., Vietti F., Galimberti M., Savi E., Pappacoda A., Bottero P., Porcu S., Felice G., Berra D., Francesca Spina M., Pravettoni V., Calamari A.M., Varin E., Iemoli E., Lietti D., Ghiglioni D., Fiocchi A., Tosi A., Poppa M., Caviglia A., Restuccia M., Russello M., Alciato P., Manzotti G., Ranghino E., Luraschi G., Rapetti A., Rivolta F., Allegri F., Terracciano L., Agostinis F., Paolo Piras P., Ronchi G., Gaspardini G., Caria V., Tolu F., Fantasia D., Carta P., Moraschini A., Quilleri R., Santelli A., Prandini P., Del Giudice G., Apollonio A., Bonazza L., Teresa Franzini M., Branchi S., Zanca M., Rinaldi S., Catelli L., Zanoletti T., Cosentino C., Della Torre F., Cremonte L., Musazzi D., Suli C., Rivolta L., Ottolenghi A., Marino G., Sterza G., Sambugaro R., Orlandini A., Minale P., Voltolini S., Bignardi D., Omodeo P., Tiri A., Milani S., Ronchi B., Licardi G., Bruni P., Scibilia J., Schroeder J., Crosti F., Maltagliati A., Alesina M.R., Mosca M., Leone G., Napolitano G., Di Gruttola G., Scala G., Mascio S., Valente A., Marchetiello I., Catello R., Gazulli A., Del Prete A., Varricchio A.M., Carbone A., Forestieri A., Stillitano M., Leonetti L., Tirroni E., Castellano F., Abbagnara F., Romano F., Levanti C., Cilia M., Longo R., Ferrari A., Merenda R., Di Ponti A., Guercio E., Surace L., Ammendola G., Tansella F., Peccarisi L., Stragapede L., Minenna M., Granato M., Fuiano N., Pannofino A., Ciuffreda S., Giannotta A., Morero G., D'Oronzio L., Taddeo G., Nettis E., Cinquepalmi G., Lamanna C., Mastrandrea F., Minelli M., Salamino F., Muratore L., Latorre F., Quarta C., Ventura M., D'Ippolito G., Giannoccaro F., Dambra P., Pinto L., Triggiani M., Munno G., Manfredi G., Lonero G., Damiano V., Errico G., Di Leo E., Manzari F., Spagna V., Arsieni A., Matarrese A., Mazzarella G., Scarcia G., Scarano R., Ferrannini A., Pastore A., Maionchi P., Filannino L., Tria M., Giuliano G., Damiani E., Scichilone N., Marchese M., Lucania A., Marino M., Strazzeri L., Tumminello S., Vitale G.I., Gulotta S., Gragotto G., Zambito M., Greco D., Valenti G., Licitra G., Cannata E., Filpi R., Contraffatto M., Sichili S., Randazzo S., Scarantino G., Lo Porto B., Pavone F., Di Bartolo C., Paterno A., Rapisarda F., Laudani E., Leonardi S., Padua V., Cabibbo G., Marino Guzzardi G., Deluca F., Agozzino C., Pettinato R., Ghini M., Scurati S, Frati F, Passalacqua G, Puccinelli P, Hilaire C, Incorvaia I, D'Avino G, Comi R, Lo Schiavio M, Pezzuto F, Montera C, Pio A, Ielpo MT, Cellini F, Vicentini L, Pecorari R, Aresu T, Capra L, De Benedictis E, Bombi C, Zauli D, and et al

Subjects
medicine.medical_specialty, Pathology, genetic structures, efficacy, Alternative medicine, Medicine (miscellaneous), Adherence, Cost, Efficacy, Side effects, Sublingual immunotherapy, Settore MED/10 - Malattie Dell'Apparato Respiratorio, sublingual immunotherapy, ALLERGEN, cost, medicine, Subcutaneous immunotherapy, Sublingual immunotherapy, adherence, Clinical efficacy, Intensive care medicine, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), sublingual immunoterapy, Original Research, Asthma, AEROALLERGENS, side effects, business.industry, Health Policy, medicine.disease, Slit, eye diseases, Clinical trial, Patient Preference and Adherence, immunotherapy, sense organs, Allergists, ADHERENCE TO TREATMENT, business, Social Sciences (miscellaneous)
Abstract

Silvia Scurati1, Franco Frati1, Gianni Passalacqua2, Paola Puccinelli1, Cecile Hilaire1, Cristoforo Incorvaia3, Italian Study Group on SLIT Compliance 1Scientific and Medical Department, Stallergenes, Milan, Italy; 2Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa; 3Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, ItalyObjectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence.Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10.Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists.Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers.Keywords: adherence, sublingual immunotherapy, efficacy, cost, side effects

Published
2010

4. Radiochemotherapy in the Management of Gastroesophageal Junction Tumours: Basic Evidences in the Neoadjuvant Setting

Author

Cellini F, Fiore M, and Mattiucci G

Subjects
medicine.medical_specialty, Anatomical location, business.industry, Incidence (epidemiology), medicine.medical_treatment, Cancer, medicine.disease, Gastroesophageal Junction, Omics, Surgery, Radiation therapy, Concurrent chemotherapy, Medicine, Radiology, business
Abstract

In recent years the incidence of gastroesophageal junction (GEJ) tumors has been rapidly increasing. Many trials have investigated the role of preoperative radiochemotherapy for this specific subgroup. In past, GEJ tumors were sometimes considered either esophageal or gastric cancer, due to their anatomical location. Purpose of this paper is to elucidate the benefit of radiotherapy in combination with concurrent chemotherapy in neoadjuvant setting, reviewing the literature by the point of view of the recent classification provided for GEJ tumors.

Published
2013
Full Text
View/download PDF

5. Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival

Author

Gian Carlo Mattiucci, Alessio G. Morganti, Lorenzo Fuccio, Michele Reni, Alessia Re, Felipe A. Calvo, Alessandra Arcelli, Francesco Cellini, Sergio Alfieri, Robert C. Miller, William F. Regine, Massimo Falconi, Vincenzo Valentini, Giancarmine Di Gioia, F. Bertini, Chiara Valentini, Joseph M. Herman, Riccardo Casadei, Milly Buwenge, Francesco Minni, Paolo Passoni, Mariacristina Di Marco, Savino Cilla, Francesco Deodato, Bert W. Maidment, Gabriella Macchia, Alessandra Guido, Morganti A.G., Cellini F., Buwenge M., Arcelli A., Alfieri S., Calvo F.A., Casadei R., Cilla S., Deodato F., Di Gioia G., Di Marco M., Fuccio L., Bertini F., Guido A., Herman J.M., Macchia G., Maidment B.W., Miller R.C., Minni F., Passoni P., Valentini C., Re A., Regine W.F., Reni M., Falconi M., Valentini V., Mattiucci G.C., Morganti, A. G., Cellini, F., Buwenge, M., Arcelli, A., Alfieri, S., Calvo, F. A., Casadei, R., Cilla, S., Deodato, F., Di Gioia, G., Di Marco, M., Fuccio, L., Bertini, F., Guido, A., Herman, J. M., Macchia, G., Maidment, B. W., Miller, R. C., Minni, F., Passoni, P., Valentini, C., Re, A., Regine, W. F., Reni, M., Falconi, M., Valentini, V., and Mattiucci, G. C.

Subjects
Male, 0301 basic medicine, Cancer Research, medicine.medical_treatment, Kaplan-Meier Estimate, Gastroenterology, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Surgical oncology, 80 and over, Stage (cooking), Pancreatic neoplasm, Adjuvant, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, 80 and over, Univariate analysis, Radiation, Radiotherapy Dosage, Chemoradiotherapy, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Tumor Burden, Treatment Outcome, Oncology, Pancreatic Ductal, 030220 oncology & carcinogenesis, Female, Dose effect, Research Article, Carcinoma, Pancreatic Ductal, Adult, medicine.medical_specialty, CA-19-9 Antigen, lcsh:RC254-282, Dose-Response Relationship, 03 medical and health sciences, Radiotherapy, Aged, Chemoradiotherapy, Adjuvant, Dose-Response Relationship, Radiation, Follow-Up Studies, Humans, Lymph Nodes, Multivariate Analysis, Neoplasm Grading, Pancreatic Neoplasms, Retrospective Studies, Pancreatic cancer, Internal medicine, Genetics, medicine, business.industry, Carcinoma, Retrospective cohort study, medicine.disease, Radiation therapy, 030104 developmental biology, business
Abstract

Background: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). Methods: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. Results: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. Conclusions: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.

Published
2019
Full Text
View/download PDF

6. Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis

Author

Stefano Partelli, Vincenzo Valentini, Alessandra Guido, Francesco Cellini, William F. Regine, Andrea Farioli, Gian Carlo Mattiucci, Alessio G. Morganti, Alessandra Arcelli, Silvia Cammelli, Milly Buwenge, L. Giaccherini, F. Bertini, Riccardo Casadei, Joseph M. Herman, Felipe A. Calvo, Francesco Minni, Robert C. Miller, Michele Reni, Sergio Alfieri, Bert W. Maidment, Lorenzo Fuccio, Gabriella Macchia, Massimo Falconi, Mattiucci, G. C., Morganti, A. G., Cellini, F., Buwenge, M., Casadei, R., Farioli, A., Alfieri, S., Arcelli, A., Bertini, F., Calvo, F. A., Cammelli, S., Fuccio, L., Giaccherini, L., Guido, A., Herman, J. M., Macchia, G., Maidment, B. W., Miller, R. C., Minni, F., Regine, W. F., Reni, M., Partelli, S., Falconi, M., Valentini, V., and Mattiucci GC, Morganti AG, Cellini F, Buwenge M, Casadei R, Farioli A, Alfieri S, Arcelli A, Bertini F, Calvo FA, Cammelli S, Fuccio L, Giaccherini L, Guido A, Herman JM, Macchia G, Maidment BW 3rd, Miller RC, Minni F, Regine WF, Reni M, Partelli S, Falconi M, Valentini V.

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, Multivariate analysis, endocrine system diseases, Settore MED/18 - CHIRURGIA GENERALE, Gastroenterology, lcsh:RC254-282, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Overall survival, Medicine, Ca 19.9, radiotherapy, pancreatic adenocarcinoma, Univariate analysis, business.industry, food and beverages, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Weibull regression, digestive system diseases, 030104 developmental biology, Pooled analysis, Oncology, 030220 oncology & carcinogenesis, Adenocarcinoma, CA19-9, business, Carbohydrate antigen
Abstract

BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter 353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and 30 mm (P50.0 Gy showed improved OS (P

Published
2019

7. Clinical Studies on Ultrafractionated Chemoradiation: A Systematic Review

Author

Erica Scirocco, Francesco Cellini, Alice Zamagni, Gabriella Macchia, Francesco Deodato, Savino Cilla, Lidia Strigari, Milly Buwenge, Stefania Rizzo, Silvia Cammelli, Alessio Giuseppe Morganti, Scirocco E., Cellini F., Zamagni A., Macchia G., Deodato F., Cilla S., Strigari L., Buwenge M., Rizzo S., Cammelli S., and Morganti A.G.

Subjects
Oncology, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Tumor response, law.invention, Randomized controlled trial, Open label study, systematic review, law, Internal medicine, medicine, Adverse effect, RC254-282, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Chemotherapy, clinical trials, Temozolomide, business.industry, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, clinical trial, chemo-sensitization, Clinical trial, combined modality treatment, Toxicity, low-dose radiotherapy, business, medicine.drug
Abstract

AimThe efficacy of low-dose fractionated radiotherapy (LDFRT) and chemotherapy (CHT) combination has large preclinical but little clinical evidence. Therefore, the aim of this review was to collect and analyze the clinical results of LDRT plus concurrent CHT in patients with advanced cancers.MethodsA systematic literature search was conducted on PubMed using the PRISMA methodology. Only studies based on the combination of LDFRT (< 1 Gy/fraction) and CHT were included. Endpoints of the analysis were tumor response, toxicity, and overall survival, with particular focus on any differences between LDFRT-CHT and CHT alone.ResultsTwelve studies (307 patients) fulfilled the selection criteria and were included in this review. Two studies were retrospective, one was a prospective pilot trial, six were phase II studies, two were phase I trials, and one was a phase I/II open label study. No randomized controlled trials were found. Seven out of eight studies comparing clinical response showed higher rates after LDFRT-CHT compared to CHT alone. Three out of four studies comparing survival reported improved results after combined treatment. Three studies compared toxicity of CHT and LDFRT plus CHT, and all of them reported similar adverse events rates. In most cases, toxicity was manageable with only three likely LDFRT-unrelated fatal events (1%), all recorded in the same series on LDFRT plus temozolomide in glioblastoma multiforme patients.ConclusionNone of the analyzed studies provided level I evidence on the clinical impact of LDFRT plus CHT. However, it should be noted that, apart from two small series of breast cancers, all studies reported improved therapeutic outcomes and similar tolerability compared to CHT alone. Systematic Review Registrationwww.crd.york.ac.uk/prospero/, identifier CRD42020206639.

Published
2021
Full Text
View/download PDF

8. Definition of Local Recurrence Site in Resected Pancreatic Adenocarcinoma: A Multicenter Study (DOLORES-1)

Author

Alessandra Guido, Domenico Genovesi, Lidia Strigari, Rita Golfieri, Emiliano Loi, Silvia Bisello, Francesco Deodato, Pietro Gabriele, Aldo Sainato, Alessandra Arcelli, Salvatore Parisi, Francesco Cellini, Savino Cilla, F. Bertini, Milly Buwenge, Alessio G. Morganti, Matteo Renzulli, Gabriella Macchia, Michele Fiore, Silvia Cammelli, S. Strolin, Arcelli A., Bertini F., Strolin S., Macchia G., Deodato F., Cilla S., Parisi S., Sainato A., Fiore M., Gabriele P., Genovesi D., Cellini F., Guido A., Cammelli S., Buwenge M., Loi E., Bisello S., Renzulli M., Golfieri R., Morganti A.G., and Strigari L.

Subjects
0301 basic medicine, Cancer Research, Postoperative radiotherapy, Planning target volume, Article, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Pancreatic cancer, medicine, Superior mesenteric artery, Pancreatic neoplasm, RC254-282, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Patterns of failure, Kernel density estimation, business.industry, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, pancreatic neoplasms, pattern of failure, medicine.disease, SMA, 030104 developmental biology, Oncology, Multicenter study, 030220 oncology & carcinogenesis, Adenocarcinoma, adjuvant chemoradiation, business, Nuclear medicine
Abstract

Simple Summary Pancreatic cancer remains a disease with a dismal outlook for patients, with high relapse rates after surgery and adjuvant treatments. Thanks to the high conformality achievable with advanced radiotherapy techniques, a more robust definition of clinical target volume (CTV) margins is mandatory. Moreover, a precise CTV definition may affect local control, minimizing radiation-related toxicity and allowing dose escalation. Contrary to two recent studies, RTOG contouring guidelines are not based on a pattern of failure analysis. We provided a local failure risk map in resected pancreatic cancer, validating the results of previous studies. Moreover, according to a new probabilistic approach, we provided new CTV contouring guidelines for the postoperative radiotherapy of pancreatic cancer, modeling targets’ margins on a combination of our validated local failure map (30% of local failures) and RTOG guidelines (70% of local failures). Abstract The study aimed to generate a local failure (LF) risk map in resected pancreatic cancer (PC) and validate the results of previous studies, proposing new guidelines for PC postoperative radiotherapy clinical target volume (CTV) delineation. Follow-up computer tomography (CT) of resected PC was retrospectively reviewed by two radiologists identifying LFs and plotting them on a representative patient CT scan. The percentages of LF points randomly extracted based on CTV following the RTOG guidelines and based on the LF database were 70% and 30%, respectively. According to the Kernel density estimation, an LF 3D distribution map was generated and compared with the results of previous studies using a Dice index. Among the 64 resected patients, 59.4% underwent adjuvant treatment. LFs closer to the root of the celiac axis (CA) or the superior mesenteric artery (SMA) were reported in 32.8% and 67.2% cases, respectively. The mean (± standard deviation) distances of LF points to CA and SMA were 21.5 ± 17.9 mm and 21.6 ± 12.1 mm, respectively. The Dice values comparing our iso-level risk maps corresponding to 80% and 90% of the LF probabilistic density and the CTVs-80 and CTVs-90 of previous publications were 0.45–0.53 and 0.58–0.60, respectively. According to the Kernel density approach, a validated LF map was proposed, modeling a new adjuvant CTV based on a PC pattern of failure.

Published
2021

9. Palliative radiotherapy indications during the COVID-19 pandemic and in future complex logistic settings: the NORMALITY model

Author

Anna Merlotti, Giambattista Siepe, Francesco Cellini, Vincenzo Fusco, Marta Scorsetti, Elvio G. Russi, Umberto Ricardi, Vittorio Donato, Vincenzo Valentini, Stefano Pergolizzi, Barbara Alicja Jereczek-Fossa, R. Rossi, Francesco Deodato, Renzo Corvò, Ernesto Maranzano, Maria Antonietta Gambacorta, Rossella Di Franco, Angelo Tozzi, V. Borzillo, Fabio Arcidiacono, Alessio G. Morganti, Paolo Muto, M. Santarelli, Alberto Cacciola, Stefania Manfrida, Sara Reina, Cellini F., Di Franco R., Manfrida S., Borzillo V., Maranzano E., Pergolizzi S., Morganti A.G., Fusco V., Deodato F., Santarelli M., Arcidiacono F., Rossi R., Reina S., Merlotti A., Jereczek-Fossa B.A., Tozzi A., Siepe G., Cacciola A., Russi E., Gambacorta M.A., Scorsetti M., Ricardi U., Corvo R., Donato V., Muto P., and Valentini V.

Subjects
QoL, Palliative care, Consensus, media_common.quotation_subject, Consensu, Guideline, Guidelines, Presentation, Quality of life (healthcare), Palliative radiotherapy, Medical, Neoplasms, Pandemic, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Pandemics, Normality, Societies, Medical, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, media_common, Palliative Radiotherapy, Radiotherapy, business.industry, Clinical Care Model, Palliative Care, Clinical Indication, food and beverages, COVID-19, Palliation, Italy, Practice Guidelines as Topic, Radiation Oncology, General Medicine, medicine.disease, Triage, Neoplasm, Medical emergency, business, Societies, Human
Abstract

Introduction The COVID-19 pandemic has challenged healthcare systems worldwide over the last few months, and it continues to do so. Although some restrictions are being removed, it is not certain when the pandemic is going to be definitively over. Pandemics can be seen as a highly complex logistic scenario. From this perspective, some of the indications provided for palliative radiotherapy (PRT) during the COVID-19 pandemic could be maintained in the future in settings that limit the possibility of patients achieving symptom relief by radiotherapy. This paper has two aims: (1) to provide a summary of the indications for PRT during the COVID-19 pandemic; since some indications can differ slightly, and to avoid any possible contradictions, an expert panel composed of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and the Palliative Care and Supportive Therapies Working Group (AIRO-palliative) voted by consensus on the summary; (2) to introduce a clinical care model for PRT [endorsed by AIRO and by a spontaneous Italian collaborative network for PRT named “La Rete del Sollievo” (“The Net of Relief”)]. The proposed model, denoted “No cOmpRoMise on quality of life by pALliative radiotherapy” (NORMALITY), is based on an AIRO-palliative consensus-based list of clinical indications for PRT and on practical suggestions regarding the management of patients potentially suitable for PRT but dealing with highly complex logistics scenarios (similar to the ongoing logistics limits due to COVID-19). Material and Methods First, a summary of the available literature guidelines for PRT published during the COVID-19 pandemic was prepared. A systematic literature search based on the PRISMA approach was performed to retrieve the available literature reporting guideline indications fully or partially focused on PRT. Tables reporting each addressed clinical presentation and respective literature indications were prepared and distributed into two main groups: palliative emergencies and palliative non-emergencies. These summaries were voted in by consensus by selected members of the AIRO and AIRO-palliative panels. Second, based on the summary for palliative indications during the COVID-19 pandemic, a clinical care model to facilitate recruitment and delivery of PRT to patients in complex logistic scenarios was proposed. The summary tables were critically integrated and shuffled according to clinical presentations and then voted on in a second consensus round. Along with the adapted guideline indications, some methods of performing the first triage of patients and facilitating a teleconsultation preliminary to the first in-person visit were developed. Results After the revision of 161 documents, 13 papers were selected for analysis. From the papers, 19 clinical presentation items were collected; in total, 61 question items were extracted and voted on (i.e., for each presentation, more than one indication was provided from the literature). Two tables summarizing the PRT indications during the COVID-19 pandemic available from the literature (PRT COVID-19 summary tables) were developed: palliative emergencies and palliative non-emergencies. The consensus of the vote by the AIRO panel for the PRT COVID-19 summary was reached. The PRT COVID-19 summary tables for palliative emergencies and palliative non-emergencies were adapted for clinical presentations possibly associated with patients in complex clinical scenarios other than the COVID-19 pandemic. The two new indication tables (i.e., “Normality model of PRT indications”) for both palliative emergencies and palliative non-emergencies were voted on in a second consensus round. The consensus rate was reached and strong. Written forms facilitating two levels of teleconsultation (triage and remote visits) were also developed, both in English and in Italian, to evaluate the patients for possible indications for PRT before scheduling clinical visits. Conclusion We provide a comprehensive summary of the literature guideline indications for PRT during COVID-19 pandemic. We also propose a clinical care model including clinical indications and written forms facilitating two levels of teleconsultation (triage and remote visits) to evaluate the patients for indications of PRT before scheduling clinical visits. The normality model could facilitate the provision of PRT to patients in future complex logistic scenarios.

Published
2021

10. An Intensive Educational Intervention Significantly Improves the Adoption of Single Fractionation Radiotherapy in Uncomplicated Bone Metastases

Author

Elena Nardi, C.M. Donati, Francesco Cellini, Alice Zamagni, Lidia Strigari, M. Buwenge, Alessio G. Morganti, Silvia Cammelli, Maria L. Alfieri, Francesco Deodato, Erika Galietta, Gabriella Macchia, Savino Cilla, Giambattista Siepe, Donati C.M., Nardi E., Galietta E., Alfieri M.L., Siepe G., Zamagni A., Buwenge M., Macchia G., Deodato F., Cilla S., Strigari L., Cammelli S., Cellini F., and Morganti A.G.

Subjects
medicine.medical_specialty, Palliative Radiation Therapy, business.industry, Bone metastases, Dose fractionation, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Fractionation Radiotherapy, compliance, 030218 nuclear medicine & medical imaging, Surgery, 03 medical and health sciences, Bone metastase, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, Intervention (counseling), palliative radiation therapy, Medicine, dose fractionation, Original Research Article, Bone metastasis — from pathogenesis to treatments, single-fraction irradiation, business, RC254-282, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA
Abstract

Introduction: An education strategy was employed in our department to increase the rate of patients with uncomplicated painful bone metastases undergoing single fractionation radiotherapy (SFRT). The purpose of this report is to analyze the results of this strategy over a 5 year period. Materials and Methods: In January 2015, two meetings were organized in our department. In the first, data from an audit on the current SFRT rate were shown. In the second, evidence of SFRT efficacy in the relief of pain from uncomplicated bone metastases was presented. In addition, during the weekly discussion of clinical cases, the opportunity to use the SFRT was systematically recalled. Using our institutional database, all patients treated with radiotherapy for uncomplicated painful bone metastases in the period between 2014 (year considered as a reference) and 2019 were retrieved. Data regarding treatment date (year), radiotherapy fractionation, and tumor, patients, and radiation oncologists characteristics were collected. Results: A total of 627 patients were included in the analysis. The rate of patients undergoing SFRT increased from 4.0% in 2014 to 63.5% in 2019 ( p 80 years), lung cancer as the primary tumor, treatment prescribed by a radiation oncologist dedicated to palliative treatments, and treatment date (2014 vs 2015–2019). Conclusions: This retrospective single-center analysis showed that a simple but intensive and prolonged departmental education strategy can increase the rate of patients treated with SFRT by nearly 16 times.

Published
2021

11. Hypofractionated sequential radiotherapy boost: a promising strategy in inoperable locally advanced pancreatic cancer patients

Author

Luca Boldrini, Alessio G. Morganti, Gabriella Macchia, Vincenzo Frascino, Francesco Deodato, Gian Carlo Mattiucci, Nicola Dinapoli, A. Nardangeli, Francesco Cellini, Milly Buwenge, Andrea D'Aviero, Vincenzo Valentini, Mattiucci G.C., Boldrini L., Nardangeli A., D'Aviero A., Buwenge M., Cellini F., Deodato F., Dinapoli N., Frascino V., Macchia G., Morganti A.G., and Valentini V.

Subjects
0301 basic medicine, Male, Cancer Research, medicine.medical_specialty, Abdominal pain, medicine.medical_treatment, Leucovorin, Irinotecan, Deoxycytidine, Disease-Free Survival, Late toxicity, 03 medical and health sciences, Gastrointestinal complications, 0302 clinical medicine, Pain assessment, Antineoplastic Combined Chemotherapy Protocols, medicine, 80 and over, Humans, Radiotherapy boost, Capecitabine, Aged, Retrospective Studies, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, 80 and over, Chemotherapy, business.industry, General Medicine, Chemoradiotherapy, Middle Aged, Primary lesion, Gemcitabine, Locally advanced pancreatic cancer, Radiation therapy, Oxaliplatin, Pancreatic Neoplasms, Survival Rate, 030104 developmental biology, Locally advanced pancreatic adenocarcinoma, Oncology, 030220 oncology & carcinogenesis, Hypofractionation, Female, Radiation Dose Hypofractionation, Radiology, Fluorouracil, medicine.symptom, business
Abstract

Purpose: To investigate the potential benefits of a hypofractionated radiotherapy boost (HRB) after chemotherapy (CT) and concomitant chemoradiotherapy (CRT) in locally advanced pancreatic cancer (LAPC) patients. Primary endpoints were early and late toxicity, local control (LC) and pain-free progression (PFP) assessment. Two-years overall survival (OS), metastasis-free survival (MFS) and disease-free survival (DFS) were secondary endpoints. Materials and methods: Patients (pts) affected by unresectable non-metastatic LAPC, previously treated with CT and CRT in upfront or sandwich setting, were selected for sequential HRB. Total prescribed dose was 30Gy in 5 fractions (fr) to pancreatic primary lesion. Dose de-escalation was allowed in case of failure in respecting organs at risk constraints. Early and late toxicity were assessed according to CTCAE v.4.0 classification. The Kersh-Hazra scale was used for pain assessment. Local Control, PFP, MFS and DFS were calculated from the date of HRB to the date of relapse or the date of the last follow-up. Results: Thirty-one pts affected by unresectable, non-metastatic LAPC were consecutively enrolled from November 2004 to October 2019. All pts completed the planned HRB. Total delivered dose varied according to duodenal dose constraint: 20Gy in 5 fr (N: 6; 19.4%), 20Gy in 4 fr (N: 5; 16.2%), 25Gy in 5 fr (N: 18; 58.0%) and 30Gy in 6 fr (N: 2; 6.4%). Early and late toxicity were assessed in all pts: no Grade 3 or 4 acute gastrointestinal toxicity and no late gastrointestinal complications occurred. Median LC was 19months (range 1–156) and 1- and 2-year PFP were 85% and 62.7%, respectively (median 28months; range 2–139). According to the Kersh-Hazra scale, four pts had a Grade 3 and four pts had a Grade 1 abdominal pain before HRB. At the last follow-up only 3/31 pts had residual Grade 1 abdominal pain.Median MFS was 18months (range 1–139). The 2-year OS after HRB was 57.4%, while 2-year OS from diagnosis was 77.3%. Conclusion: Treatment intensification with hypofractionated radiotherapy boost is well tolerated in pts affected by unresectable LAPC previously treated with CT/CRT. Its rates of local and pain control are encouraging, supporting its introduction in clinical practice. Timing, schedule and dose of HRB need to be further investigated to personalize therapy and optimize clinical advantages.

Published
2021

12. ESTRO ACROP guidelines for the delineation of lymph nodal areas in upper gastrointestinal malignancies

Author

William H. Allum, Alessio G. Morganti, Eleni Gkika, Vincenzo Valentini, Angela Riddell, Francesco Cellini, Marcel Verheij, Francesco Ardito, Riccardo Manfredi, Thomas Brunner, Karin Haustermans, Claudio Fiorillo, Falk Roeder, Sergio Alfieri, Stefano Margaritora, Claus Belka, Felice Giuliante, Berardino De Bari, Venanzio Porziella, Oscar Matzinger, Valentini V., Cellini F., Riddell A., Brunner T.B., Roeder F., Giuliante F., Alfieri S., Manfredi R., Ardito F., Fiorillo C., Porziella V., Morganti A.G., Haustermans K., Margaritora S., De Bari B., Matzinger O., Gkika E., Belka C., Allum W., and Verheij M.

Subjects
Target, Target volumes, Advisory committee, medicine.medical_treatment, Radiotherapy Planning, Planning target volume, Computed tomography, RECOMMENDATIONS, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Computer-Assisted, Tomography, TARGET VOLUME DELINEATION, Gastrointestinal Neoplasms, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, medicine.diagnostic_test, Upper gastrointestinal malignancies, Radiology, Nuclear Medicine & Medical Imaging, Lymph Node, Hematology, Target volume, ATLAS, CANCER, X-Ray Computed, VARIABILITY, Oncology, Radiological weapon, Gastrointestinal Neoplasm, Contouring, Life Sciences & Biomedicine, Human, medicine.medical_specialty, Upper gastrointestinal malignancies, lymph-nodes, lymph-nodes, All institutes and research themes of the Radboud University Medical Center, RADIATION-THERAPY, Radiation oncology, medicine, Upper gastrointestinal, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, HEAD, Science & Technology, ESOPHAGEAL, Radiotherapy, business.industry, Radiotherapy Planning, Computer-Assisted, Upper gastrointestinal malignancies, lymph-node, Delineation, Radiation therapy, DEFINITION, Radiation Oncology, Lymph Nodes, business, Tomography, X-Ray Computed
Abstract

The European SocieTy for Radiation and Oncology -Advisory Committee on Radiation Oncology Practice (ESTRO-ACROP) endorsed a project to provide guidelines (GL) for the identification and delineation of clinically negative lymph-nodal stations (LNs) involved in upper gastrointestinal clinical scenarios. The presented GL is focused on preoperative (or definitive) setting. The project aim is to improve the consistency of clinical target volume (CTV) delineation by providing: a description of the anatomical boundaries of the LNs; a radiological computed tomography-based atlas depicting the LNs areas; a free, web-based, interactive example case for independent training of radiation oncologists on LNs delineation according to the presented GL, by both qualitative and quantitative analysis (through the FALCON EduCase platform). This project was carried out with the intention to facilitate and improve uniformity of future upper gastrointestinal guidelines on nodal CTV delineation. We report methodology and results from the collaboration of a working group panel selected by the ESTRO-ACROP. ispartof: RADIOTHERAPY AND ONCOLOGY vol:164 pages:92-97 ispartof: location:Ireland status: published

Published
2021

13. Short-course regimen of palliative radiotherapy in complicated bone metastases: a phase i–ii study (SHARON Project)

Author

E. Farina, Milly Buwenge, Nam P. Nguyen, Domenico Genovesi, Francesco Cellini, Tigeneh Wondemagegnhu, J. Capuccini, Alessio G. Morganti, Luciana Caravatta, Vincenzo Valentini, A. F. M. Kamal Uddin, Francesco Deodato, Gabriella Macchia, M.A. Sumon, Savino Cilla, Silvia Cammelli, and Capuccini J, Macchia G, Farina E, Buwenge M, Genovesi D, Caravatta L, Nguyen NP, Cammelli S, Cilla S, Wondemagegnhu T, Uddin AFMK, Aziz Sumon M, Cellini F, Valentini V Deodato F, Morganti AG.

Subjects
Adult, Male, Quality of life, Cancer Research, medicine.medical_specialty, Palliative care, medicine.medical_treatment, Complicated bone metastases, Pain, Bone Neoplasms, 030218 nuclear medicine & medical imaging, Dose-Response Relationship, 03 medical and health sciences, 0302 clinical medicine, Surgical oncology, Spinal cord compression, Internal medicine, 80 and over, medicine, Humans, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, Aged, 80 and over, Radiation, Hematology, Radiotherapy, business.industry, Complicated bone metastase, Soft tissue, Dose-Response Relationship, Radiation, Cancer Pain, General Medicine, Middle Aged, medicine.disease, Radiation therapy, Regimen, Oncology, Feasibility Studies, Female, Palliative Care, 030220 oncology & carcinogenesis, Radiology, business
Abstract

Metastases with soft tissues invasion, impending fractures or spinal cord compression (complicated bone metastases) represent a common clinical problem in advanced cancers and frequently lead to deterioration of patients' quality of life (QoL). A phase I-II study was planned to define the maximum tolerated dose (MTD) of a short-course radiotherapy (RT) and its efficacy in palliation of complicated bone metastases. A phase I trial was designed with three dose-escalation steps: 16, 18, and 20Gy. Total dose at each level was delivered in 2 days, twice daily. Eligibility criteria were painful complicated bone metastases and ECOG performance status ≤ 3. The presence of acute toxicity ≥ Grade 3 (RTOG scale) was considered the dose limiting toxicity. The MTD was used to plan a phase II trial with pain response as the primary outcome. Pain was recorded using a Visual Analogic Scale (VAS), and QoL using CLAS scales. Forty-five patients were enrolled in this trial. In phase I no Grade ≥ 2 acute toxicities were recorded. Thus 20Gy was established as MTD. In phase II, with a median follow-up of 4 months, rates of complete symptom remission, partial response, no symptomatic change, and symptoms progression were 32.0%, 52.0%, 8.0%, and 8.0%, respectively. This RT protocol tested in our study is effective and tolerable with comparable results to traditional RT treatments delivered in 5-10 daily fractions.

Published
2018
Full Text
View/download PDF

14. Basics and frontiers on pancreatic cancer for radiation oncology: Target delineation, SBRT, SIB technique, MRgRT, particle therapy, immunotherapy and clinical guidelines

Author

Renzo Mazzarotto, Francesco Cellini, Alessandra Arcelli, Domenico Genovesi, Francesco Deodato, Alessio G. Morganti, Gian Carlo Mattiucci, Nicola Silvestris, Oronzo Brunetti, Luciana Caravatta, N. Simoni, Vincenzo Valentini, Milly Buwenge, Angela Calabrese, Cellini F., Arcelli A., Simoni N., Caravatta L., Buwenge M., Calabrese A., Brunetti O., Genovesi D., Mazzarotto R., Deodato F., Mattiucci G.C., Silvestris N., Valentini V., and Morganti A.G.

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Planning target volume, Review, Guideline, Guidelines, lcsh:RC254-282, 03 medical and health sciences, 0302 clinical medicine, Pancreatic cancer, Radiation oncology, medicine, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Particle therapy, SBRT, medicine.diagnostic_test, Radiotherapy, business.industry, CTV, Guidelines, Immunotherapy, MR guided RT, Pancreatic cancer, Protons, Radiotherapy, Review, SBRT, SIB, SIB, Magnetic resonance imaging, Immunotherapy, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Radiation therapy, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, CTV, Radiology, Proton, MR guided RT, Protons, business, Stereotactic body radiotherapy
Abstract

Pancreatic cancer represents a modern oncological urgency. Its management is aimed to both distal and local disease control. Resectability is the cornerstone of treatment aim. It influences the clinical presentation’s definitions as up-front resectable, borderline resectable and locally advanced (unresectable). The main treatment categories are neoadjuvant (preoperative), definitive and adjuvant (postoperative). This review will focus on (i) the current indications by the available national and international guidelines; (ii) the current standard indications for target volume delineation in radiotherapy (RT); (iii) the emerging modern technologies (including particle therapy and Magnetic Resonance [MR]-guided-RT); (iv) stereotactic body radiotherapy (SBRT), as the most promising technical delivery application of RT in this framework; (v) a particularly promising dose delivery technique called simultaneous integrated boost (SIB); and (vi) a multimodal integration opportunity: the combination of RT with immunotherapy.

Published
2020

15. Accelerated Middle Half Body Radiotherapy in Bone Metastases from Prostate Cancer: A Phase I Study (SHARON Project)

Author

Alessandra Arcelli, Alice Zamagni, Francesco Cellini, Francesco Deodato, Gabriella Macchia, Savino Cilla, Alessio G. Morganti, E. Farina, Giambattista Siepe, Milly Buwenge, Silvia Cammelli, Zamagni A., Buwenge M., Macchia G., Siepe G., Cilla S., Cellini F., Arcelli A., Farina E., Deodato F., Cammelli S., and Morganti A.G.

Subjects
Male, Cancer Research, Maximum Tolerated Dose, medicine.medical_treatment, Prostate neoplasm, Bone Neoplasms, Bone Neoplasm, Follow-Up Studie, Prostate cancer, Phase I, medicine, Clinical endpoint, Humans, Palliative therapy, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, Radiotherapy, business.industry, Bone metastases, Prostatic Neoplasms, Radiotherapy Dosage, General Medicine, Middle Aged, medicine.disease, Combined Modality Therapy, Phase i study, Radiation therapy, Bone metastase, Treatment Outcome, Oncology, Maximum tolerated dose, Cohort, Toxicity, Prostatic Neoplasm, Quality of Life, Nuclear medicine, business, Human, Follow-Up Studies
Abstract

Background/aim The primary endpoint of this phase I study was the maximum tolerated dose (MTD) of middle half body (MHB) accelerated radiotherapy (RT) in multiple bone metastatic (BM) prostate cancer (PCa) patients. Patients and methods Three step dose escalation [13 Gy (3.25 Gy/fraction), 14 Gy (3.5 Gy/fraction), and 15 Gy (3.75 Gy/fraction)] in three consecutive patient cohorts were planned. RT was delivered in two consecutive days and two daily fractions. Six patients were enrolled in the first two cohorts and 12 in the third cohort. Grade ≥3 toxicity was considered as a dose-limiting toxicity (DLT). Results Twenty-five patients (median age=71 years, median follow-up=7.4 months) were enrolled. Defined MTD dose was 15 Gy. Overall pain response rate was 76%: 9 patients (36%) showed complete and 10 patients (40%) reported partial response of pain. Conclusion MHB accelerated RT (total dose: 15 Gy) delivered in two consecutive days and two daily fractions is well tolerated.

Published
2019

16. Palliative short-course radiotherapy in advanced pelvic cancer: A phase II study (SHARON project)

Author

E. Farina, Alice Zamagni, Flora Anna Mauro, Savino Cilla, Francesco Cellini, M.A. Sumon, Luciana Caravatta, Kamal A.F.M. Uddin, Erica Scirocco, Domenico Genovesi, Giambattista Siepe, Biniyam Tefera Deressa, Silvia Cammelli, Milly Buwenge, Francesco Deodato, Wondemagegnehu Tigeneh, Gabriella Macchia, Alessio G. Morganti, Farina E., Macchia G., Siepe G., Zamagni A., Buwenge M., Scirocco E., Cellini F., Deressa B.T., Tigeneh W., Uddin K.A.F.M., Sumon M.A., Caravatta L., Genovesi D., Mauro F.A., Cammelli S., Cilla S., Morganti A.G., and Deodato F.

Subjects
Quality of life, Adult, Male, Cancer Research, medicine.medical_specialty, Pelvic Neoplasm, Palliative care, Maximum Tolerated Dose, Pelvi, medicine.medical_treatment, Phases of clinical research, Pain, Pelvis, 03 medical and health sciences, 0302 clinical medicine, 80 and over, medicine, Humans, Pelvic Neoplasms, Radiation Injuries, Radiation Injurie, Dose Fractionation, Pelvic cancer, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, Neoplasm Staging, Aged, 80 and over, Radiation, Radiotherapy, business.industry, Palliative Care, Cancer, Radiotherapy Dosage, General Medicine, Middle Aged, medicine.disease, Phase II, Surgery, Radiation therapy, Regimen, Oncology, 030220 oncology & carcinogenesis, Female, Dose Fractionation, Radiation, Accelerated Radiation Therapy, business, Human
Abstract

Aim To define safety and efficacy of a palliative, short-course accelerated radiation therapy for symptomatic locally advanced primary pelvic cancer. Materials and methods A phase II trial was planned based on the minimax Simon's two-stage design. A total of 18 Gy in 4.5 Gy/fraction administered twice a day was delivered (SHARON). Pain and quality of life were recorded according to the Visual Analogue self-assessment and the cancer linear analog scales (CLAS), respectively. Results Twenty-five patients were enrolled in the study. The most frequent baseline symptoms were pain (48%), bleeding (40%), bleeding/pain (8%), and intestinal sub-occlusion (4%). The overall palliative response rate was 96.0%, with a median palliative duration of 6 months. An improvement of quality-of-life indices (well-being, fatigue, and ability to perform daily activities) was noted in 64.0%, 36.0%, and 48.0% of patients, respectively. Conclusion The SHARON regimen was well tolerated and effective in the palliative treatment of patients with locally advanced pelvic cancer. Based on these results, a multicentric prospective phase III trial is ongoing to compare this regimen with traditional 2-week radiotherapy treatment.

Published
2019

17. The INTERACT Trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)–cT3 rectal cancer

Author

Francesco Cellini, Sara Lonardi, Brunella Barbaro, Giuseppe La Torre, Angela Buonadonna, F. Navarria, Antonino De Paoli, Fabio Maria Vecchio, M.C. Barba, Giovanna Mantello, Domenico D'Ugo, Roberto Persiani, Alessio G. Morganti, Francesco Deodato, Claudio Belluco, Ernesto Maranzano, Domenico Genovesi, Sergio Alfieri, Maria Antonietta Gambacorta, Giovanni Battista Doglietto, Cynthia Aristei, Antonio Crucitti, Marco Lupattelli, Vincenzo Valentini, Luciana Caravatta, Claudio Coco, Caterina Boso, Salvatore Pucciarelli, Valentini V., Gambacorta M.A., Cellini F., Aristei C., Coco C., Barbaro B., Alfieri S., D'Ugo D., Persiani R., Deodato F., Crucitti A., Lupattelli M., Mantello G., Navarria F., Belluco C., Buonadonna A., Boso C., Lonardi S., Caravatta L., Barba M.C., Vecchio F.M., Maranzano E., Genovesi D., Doglietto G.B., Morganti A.G., La Torre G., Pucciarelli S., and De Paoli A.

Subjects
Male, Oxaloacetates, Colorectal cancer, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Nuclear Medicine and Imaging, Antineoplastic Combined Chemotherapy Protocols, Pathologic complete response, Prospective Studies, Rectal cancer, Boost, Chemoradiation, Oxaliplatin, Preoperative radiochemotherapy, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, 80 and over, Chemoradiotherapy, Hematology, Middle Aged, Oncology, 030220 oncology & carcinogenesis, Toxicity, Female, Radiology, Nuclear Medicine and Imaging, Radiology, medicine.drug, Adult, medicine.medical_specialty, Capecitabine, 03 medical and health sciences, medicine, Humans, Radiology, Nuclear Medicine and imaging, Aged, Chemotherapy, Rectal Neoplasms, business.industry, medicine.disease, Surgery, Radiation therapy, Concomitant, business
Abstract

Background and purpose: Capecitabine-based radiochemotherapy (cbRCT) is standard for preoperative long-course radiochemotherapy of locally advanced rectal cancer. This prospective, parallel-group, randomised controlled trial investigated two intensification regimens. cT4 lesions were excluded. Primary objective: pathological outcome (TRG 1-2) among arms.Materials and methods: Low-located cT2N0-2M0, cT3N0-2M0 (up to 12 cm from anal verge) presentations were treated with cbRCT randomly intensified by either radiotherapy boost (Xelac arm) or multidrug concomitant chemotherapy (Xelox arm). Xelac: concomitant boost to bulky site (45 Gy/1.8 Gy/die, 5 sessions/week to the pelvis, + 10 Gy at 1 Gy twice/week to the bulky) plus concurrent capecitabine (1650 mg/mq/die). Xelox: 45 Gy to the pelvis + 5.4 Gy/1.8 Gy/die, 5 sessions/week to the bulky site + concurrent capecitabine (1300 mg/mq/die) and oxaliplatin (130 mg/mq on days 1,19,38). Surgery was planned 7-9 weeks after radiochemotherapy.Results: From June 2005 to September 2013, 534 patients were analysed: 280 in Xelac, 254 in Xelox arm. Xelox arm presented higher G >= 3 haematologic (p = 0.01) and neurologic toxicity (p < 0.001). Overall, 98.5% patients received curative surgery. The tumour regression grade distribution did not differ between arms (p = 0.102). TRG 1+2 rate significantly differed: Xelac arm 61.7% vs. Xelox 52.3% (p = 0.039). Pathological complete response (ypT0N0) rates were 24.4 and 23.8%, respectively (p non-significant). Median follow-up: 5.62 years. Five-year disease-free survival rate were 74.7% (Xelac) and 73.8% (Xelox), respectively (p = 0.444). Five-year overall survival rate were 80.4% (Xelac) and 85.5% (Xelox), respectively (p = 0.155).Conclusion: Xelac arm significantly obtained higher TRG1-2 rates. No differences were found about clinical outcome. Because of efficacy on TRG, inferior toxicity and good compliance, Xelac schedules or similar radiotherapy dose intensification schemes could be considered as reference treatments for cT3 lesions. (C) 2018 Published by Elsevier B.V.

Published
2019

18. Pain REduction with bone metastases STereotactic radiotherapy (PREST): A phase III randomized multicentric trial

Author

Maria Antonietta Gambacorta, Vincenzo Valentini, Francesco Cellini, Alessio G. Morganti, Giambattista Siepe, C.M. Donati, Antonia Salatino, Vincenzo Fusco, V. Borzillo, Anna Santacaterina, Rossella Di Franco, Matteo Muto, Antonino D'Agostino, Francesco Pastore, Paolo Muto, Salvatore Parisi, Savino Cilla, Stefano Pergolizzi, Renzo Corvò, Stefania Manfrida, Giampaolo Montesi, Fabio Arcidiacono, Valeria Masiello, Francesco Deodato, Ernesto Maranzano, Mario Santarelli, Cellini F., Manfrida S., Deodato F., Cilla S., Maranzano E., Pergolizzi S., Arcidiacono F., Di Franco R., Pastore F., Muto M., Borzillo V., Donati C.M., Siepe G., Parisi S., Salatino A., D'Agostino A., Montesi G., Santacaterina A., Fusco V., Santarelli M., Gambacorta M.A., Corvo R., Morganti A.G., Masiello V., Muto P., and Valentini V.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Analgesic, Medicine (miscellaneous), Radiosurgery, 030218 nuclear medicine & medical imaging, law.invention, Lesion, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Quality of life, Randomized controlled trial, law, Outcome Assessment, Health Care, medicine, Clinical endpoint, Humans, Simultaneous integrated boost, Pharmacology (medical), Progression-free survival, Pain control, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Randomised controlled trial, lcsh:R5-920, Spinal Neoplasms, medicine.diagnostic_test, business.industry, Bone metastases, Magnetic resonance imaging, Cancer Pain, Magnetic Resonance Imaging, Radiation therapy, Bone metastase, 030220 oncology & carcinogenesis, Radiology, Radiotherapy, Intensity-Modulated, medicine.symptom, lcsh:Medicine (General), business
Abstract

Background Palliative antalgic treatments represent an issue for clinical management and a challenge for scientific research. Radiotherapy (RT) plays a central role. Techniques such as stereotactic body radiotherapy (SBRT) were largely investigated in several phase 2 studies with good symptom response, becoming widely adopted. However, evidence from randomized, direct comparison of RT and SBRT is still lacking. Methods/design The PREST trial was designed as an interventional study without medicinal treatment. It is a phase 3, open-label, multicentric trial randomized 1:1. Inclusion criteria include painful spinal bone metastases presenting with a pain level > 4 (or > 1 if being treated with an analgesic) on the Numeric Rating Scale (NRS); expected intermediate/high prognosis (greater than 6 months) according to the Mizumoto prognostic score; low spine instability neoplastic score (SINS) sores ( Discussion The primary endpoint is overall pain reduction, defined in terms of variation between baseline and 3-month evaluation; pain will be measured using the NRS. Secondary endpoints include pain control duration; retreatment rates (after a minimum interval of 1 month); local control assessed with RECIST criteria; symptom progression free survival; progression-free survival; overall survival; and quality of life (at 0, 30, and 90 days). Accrual of 330 lesions is planned. The experimental arm is expected to have an improvement in overall pain response rates of 15% with respect to the standard arm (60% according to Chow et al. (Int J Radiat Oncol Biol Phys. 82(5):1730–7, 2012)). Trial registration ClinicalTrials.gov, NCT03597984. Registered on July 2018.

Published
2019

19. Phase I-II Study of Short-course Accelerated Radiotherapy (SHARON) for Palliation in Head and Neck Cancer

Author

Gabriella Macchia, Andrea Farioli, M.A. Sumon, Luciana Caravatta, Domenico Genovesi, A. F. M. Kamal Uddin, E. Farina, Francesco Deodato, Francesco Cellini, Silvia Cammelli, Savino Cilla, Alessio G. Morganti, Nam P. Nguyen, Tigeneh Wondemagegnhu, J. Capuccini, Milly Buwenge, Giuseppe Zanirato Rambaldi, Vincenzo Valentini, and Farina E, Capuccini J, Macchia G, Caravatta L, Nguyen NP, Cammelli S, Farioli A, Zanirato Rambaldi G, Cilla S, Wondemagegnhu T, Uddin AFMK, Sumon MA, Genovesi D, Buwenge M, Cellini F, Valentini V, Deodato F, Morganti AG

Subjects
Male, 0301 basic medicine, Cancer Research, Time Factors, Palliative care, medicine.medical_treatment, Head, Neck cancer, Pain, Quality of life, Radiotherapy, Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell, Dose Fractionation, Radiation, Female, Head and Neck Neoplasms, Humans, Maximum Tolerated Dose, Middle Aged, Palliative Care, Quality of Life, Radiotherapy Dosage, 0302 clinical medicine, 80 and over, pain, Head and neck cancer, Dose Fractionation, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Radiation, palliative care, Head and Neck Neoplasm, General Medicine, Oncology, 030220 oncology & carcinogenesis, Toxicity, Radiology, Human, medicine.medical_specialty, 03 medical and health sciences, medicine, radiotherapy, business.industry, Carcinoma, Dose fractionation, medicine.disease, Radiation therapy, 030104 developmental biology, Squamous Cell, quality of life, Maximum tolerated dose, Accelerated radiotherapy, business
Abstract

Aim To determine the maximum tolerated dose (MTD) of a short-course accelerated radiotherapy and its feasibility for symptomatic palliation of advanced head and neck cancer or head and neck metastases from any primary site. Patients and methods A phase I trial in four dose-escalation steps was planned: total dose ranged between 14 and 20 Gy in a total of four fractions administered twice a day. The dose-limiting toxicity (DLT) was determined as grade 3 or more toxicity occurring during treatment. The MTD obtained was used to plan a phase II trial. Results A total of 48 patients were treated. In the phase I trial, the 20 Gy dose level was determined to be the MTD. In the phase II trial, the palliative response rate was 82.7%, with a median duration of palliation of 3 months. Conclusion Short-course accelerated radiotherapy was well tolerated and effective for palliation. These findings may help design future prospective randomized studies.

Published
2018
Full Text
View/download PDF

20. Short course accelerated radiation therapy (SHARON) in palliative treatment of advanced solid cancer in older patients: A pooled analysis

Author

Domenico Genovesi, Vincenzo Valentini, E. Farina, Luciana Caravatta, A. F. M. Kamal Uddin, Gabriella Macchia, Tigeneh Wondemagegnhu, J. Capuccini, Francesco Deodato, Francesco Cellini, Savino Cilla, M.A. Sumon, Milly Buwenge, Silvia Cammelli, Nam P. Nguyen, Alessio G. Morganti, Giuseppe Zanirato Rambaldi, and Farina E, Capuccini J, Macchia G, Caravatta L, Nguyen NP, Cammelli S, Zanirato Rambaldi G, Cilla S, Wondemagegnhu T, Uddin AFMK, Sumon MA, Genovesi D, Buwenge M, Cellini F, Valentini V, Deodato F, Morganti AG

Subjects
Male, Quality of life, medicine.medical_specialty, Palliative care, medicine.medical_treatment, Pain, Bone Neoplasms, 030218 nuclear medicine & medical imaging, Older patient, 03 medical and health sciences, 0302 clinical medicine, medicine, Clinical endpoint, Older patients, Radiotherapy, Humans, Pain Management, Short course, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, 80 and over, Response rate (survey), business.industry, Cancer, Thoracic Neoplasms, medicine.disease, Radiation therapy, Treatment Outcome, Oncology, Head and Neck Neoplasms, 030220 oncology & carcinogenesis, Female, Dose Fractionation, Radiation, Radiology, Geriatrics and Gerontology, Accelerated Radiation Therapy, Tomography, X-Ray Computed, business
Abstract

Objectives To evaluate the efficacy and safety of a conformal Short Course Accelerated Radiation therapy (SHARON) for symptomatic palliation of locally advanced or metastatic cancers in older patients. Materials and Methods This is a pooled analysis on patients aged ≥ 80 years selected between subjects enrolled in 3 phase I-II studies on a short course palliative treatment of advanced or metastatic cancer. The primary endpoint was to evaluate the symptoms response rate produced by accelerated radiotherapy delivered in 4 total fractions in twice a day. Total dose ranged between 14 Gy and 20 Gy while dose/fraction between 3.5 and 5 Gy. Results A total of 48 patients were included in this analysis. Twenty-six patients (54.2%) had advanced primary or metastatic head and neck tumors, 11 (22.9%) locally advanced or metastatic thoracic cancers, 11 (22.9%) complicated bone metastases. The majority of patients presented pain (60.4%). With a median follow-up time of 5.5 months, no G4 acute and late toxicities were recorded. The overall palliative response rate was 91.7% with a median duration of palliation of 4 months. Conclusion Short course accelerated radiotherapy in locally advanced or metastatic cancers is effective in terms of symptom relief and well tolerated even in older patients.

Published
2018

21. Clinical Target Volume in Biliary Carcinoma: A Systematic Review of Pathological Studies

Author

Alessandra Arcelli, Vincenzo Tombolini, Ilaria Marinelli, Giovanni Brandi, Vincenzo Valentini, Milly Buwenge, V. Panni, Andrea Farioli, L. Giaccherini, Andrea Galuppi, Francesco Deodato, Alessio G. Morganti, G.C. Mattiucci, Savino Cilla, Lorenzo Fuccio, R. Frakulli, Rita Golfieri, Francesco Cellini, Alessandra Guido, Giorgio Ercolani, Gabriella Macchia, Matteo Renzulli, Silvia Cammelli, Marinelli, I, Guido, A, Fuccio, Lorenzo, Farioli, Andrea, Panni, V, Giaccherini, L, Arcelli, Alessandra, Ercolani, Giorgio, Brandi, Giovanni, Cammelli, Silvia, Galuppi, A, Macchia, G, Frakulli, R, Mattiucci, Gc, Cellini, F, Buwenge, Milly, Renzulli, M, Deodato, F, Cilla, S, Valentini, V, Tombolini, V, Golfieri, Rita, and Morganti, ALESSIO GIUSEPPE

Subjects
Cancer Research, medicine.medical_specialty, Lymph node metastasis, biliary tract cancer, clinical target volume, review, Biliary Tract Neoplasms, Carcinoma, Evidence-Based Medicine, Hepatic Artery, Humans, Lymph Nodes, Lymphatic Metastasis, Neoadjuvant Therapy, Neoplasm Metastasis, Radiotherapy Planning, Computer-Assisted, Research Design, Treatment Outcome, radiotherapy planning, Gastroenterology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Lymph node metastasi, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Gallbladder cancer, Lymph node, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Common hepatic artery, lymph node metastasis, business.industry, biliary tract neoplasms, carcinoma, evidence-based medicine, hepatic artery, humans, lymph nodes, lymphatic metastasis, neoadjuvant therapy, neoplasm metastasis, radiotherapy planning,computer-assisted, research design, treatment outcome, Cancer, Hepatoduodenal ligament, General Medicine, medicine.disease, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, computer-assisted, Cystic duct, Lymph, business
Abstract

Background/Aim: Radiotherapy is a treatment option for both adjuvant and neo-adjuvant settings for biliary tract cancer. Guidelines on the delineation of the target volume of lymph nodes are lacking; only generic indications are available, without specific recommendations for different primary tumour locations (e.g. intrahepatic, extrahepatic biliary tract or gallbladder cancer). The aim of this study was to systematically review available literature to provide recommendations on lymph node target volume delineation in patients with unresectable biliary tumour. Materials and Methods: A systematic search of electronic databases was performed up to July 2016. The primary outcome measure was the rate of lymph node involvement according to the location of primary biliary tumour. Sites with ≥5% of nodal metastases were considered in the clinical target volume for radiotherapy planning. Results: Twelve studies (1075 patients) were included. The most frequent site of lymph node metastasis in intrahepatic biliary tree carcinoma was retroportal (61.1%, 95% confidence interval (CI)=50.7-70-6%). Other frequently involved lymph nodes were along the hepatoduodenal ligament [frequency=38.7%, 95% CI=31.0-47.0%], those along the common hepatic artery (17.0%, 95% CI=8.2-31.9%) and the hilar nodes (16.9%, 95% CI=13.2-21.4%). In extrahepatic biliary tree cancer, the most frequently involved lymph nodes were the pericholedochal (42.7%, 95% CI=33.8-52.1%) and those along the hepatoduodenal ligament (40.3%, 95% CI=32.4-48.8%). Other commonly involved nodal regions included retroportal lymph nodes (30.9%, 95% CI=23.0-40.1%), pancreaticoduodenal anterior and posterior nodes (30.1%, 95% CI=12.2-57.1%), those along the common hepatic artery (19.7%, 95% CI=11.8-31.0%) and para_aortic nodes (15.2%, 95% CI=8.0-27.0%). The most common site of metastases in gallbladder cancer were the pericholedochal nodes (25.2%, 95% CI=18.6-33.2%), those along the cystic duct (23%, 95% CI=16.6-30.8%), and retroportal nodes (17.1%, 95% CI=11.6-24.5%). Conclusion: Biliary tract cancer has a high propensity for regional lymphatic metastases. An evidence-based nodal target definition of biliary tract cancer based on primary tumour location was proposed.

Published
2016

22. Neoadjuvant multimodal treatment of pancreatic ductal adenocarcinoma

Author

Francesco Cellini, Daniele Santini, Nicola Silvestris, Ivana Cataldo, Vito Longo, Alessandro Bittoni, Oronzo Brunetti, Michele Reni, Aldo Scarpa, Massimo Falconi, Stefano Cascinu, Vincenzo Valentini, Alessio G. Morganti, Stefano Partelli, Vito Lorusso, Silvestris, N, Longo, V, Cellini, F, Reni, M, Bittoni, A, Cataldo, I, Partelli, S, Falconi, M, Scarpa, A, Brunetti, O, Lorusso, V, Santini, D, Morganti, A, Valentini, V, and Cascinu, Stefano

Subjects
Oncology, medicine.medical_specialty, medicine.medical_treatment, Disease, Adenocarcinoma, Target therapy, Borderline, Chemotherapy, Locally advanced, Neoadjuvant, Pancreatic ductal adenocarcinoma, Radiotherapy, Hematology, Geriatrics and Gerontology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Carcinoma, Humans, Molecular Targeted Therapy, Neoadjuvant therapy, Clinical Trials as Topic, business.industry, Chemoradiotherapy, medicine.disease, Neoadjuvant Therapy, Surgery, Radiation therapy, Clinical trial, Pancreatic Neoplasms, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Carcinoma, Pancreatic Ductal
Abstract

Treatment of pancreatic ductal adenocarcinoma (PDAC) is increasingly multidisciplinary, with neoadjuvant strategies (chemotherapy, radiation, and surgery) administered in patients with resectable, borderline resectable, or locally advanced disease. The rational supporting this management is the achievement of both higher margin-negative resections and conversion rates into potentially resectable disease and in vivo assessment of novel therapeutics. International guidelines suggest an initial staging of the disease followed by a multidisciplinary approach, even considering the lack of a treatment approach to be considered as standard in this setting. This review will focus on both literature data supporting these guidelines and on new opportunities related to current more active chemotherapy regimens. An analysis of the pathological assessment of response to therapy and the potential role of target therapies and translational biomarkers and ongoing clinical trials of significance will be discussed.

Published
2016

23. Planning comparison between standard and conformal 3D techniques in post-operative radiotherapy of gastric cancer: a systematic review

Author

Gabriella Macchia, Vincenzo Picardi, Milena Ferro, Luciana Caravatta, Vincenzo Valentini, Cinzia Digesù, Francesco Deodato, Francesco Cellini, M. Buwenge, Mariangela Massaccesi, Alessio G. Morganti, A. Di Castelnuovo, P. Forte, Savino Cilla, Morganti, A.G, Di Castelnuovo, A., Massaccesi, M., Cellini, F., Cilla, S., Macchia, G., Forte, P., Buwenge, M., Digesu, C., Ferro, M., Picardi, V., Caravatta, L., Valentini, V., and Deodato, F.

Subjects
medicine.medical_specialty, Radiography, medicine.medical_treatment, Radiotherapy Planning, MEDLINE, Patient characteristics, Review Article, Adenocarcinoma, Imaging, Computer-Assisted, Imaging, Three-Dimensional, Stomach Neoplasms, medicine, Humans, Radiology, Nuclear Medicine and imaging, Review process, Medical physics, Postoperative Period, Left kidney, Adjuvant, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, Radiotherapy, Conformal, business.industry, Radiotherapy Planning, Computer-Assisted, Cancer, Radiotherapy Dosage, General Medicine, medicine.disease, Post operative radiotherapy, Radiation therapy, Liver, Three-Dimensional, Female, Radiotherapy, Adjuvant, Radiotherapy, Conformal, business, Human
Abstract

The objective of this study was to establish the impact of three-dimensional conformal radiotherapy (3D-CRT) technique in post-operative radiotherapy of gastric cancer. A bibliographical research was performed using the PubMed. On the database, Search was carried out using Medical Subject Heading (MeSH) database; the algorithm for search was ‘‘Radiotherapy” (MeSH) AND ‘‘Stomach Neoplasms” (MeSH). Only planning comparative studies on conformal techniques vs standard techniques in post-operative radiotherapy of gastric cancer were included in the review process. We identified 185 papers, five of them fulfilling the inclusion criteria. A great inhomogeneity was observed regarding the analysed dosimetric end points. Three of the five studies reported a benefit in favour of 3D-CRT for target irradiation despite a minimal advantage in most cases. The liver was better spared from irradiation by the traditional technique in all studies. No univocal result was obtained for the right kidney: the traditional technique performed better in two studies, 3D-CRT yielded better results in two others, whereas in the fifth study, each technique was either better or worse according to the different considered end point. 3D-CRT, however, allowed for better sparing of the left kidney in four studies. There is no absolute reason to prefer 3D-CRT with multiple beams in every patient. It may be preferable to choose the technique based on individual patient characteristics. Because there is no proof of superiority for 3D-CRT, there is no absolute reason to exclude patients who are treated in centres equipped with only the two-dimensional technique from the potential benefit of post-operative chemoradiation.

Published
2013

Catalog

Books, media, physical & digital resources
See catalog results