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Purpose: In the last months, Italy faced a COVID-19 emergency and implemented preventive measures in order to protect patients and healthcare providers from a disease outbreak. The pandemic control strategies impacted patient experience directly. Questionnaires evaluating patients reported measures (PREMs) may assess critical issues and represent a helpful tool to measure the patient perception of healthcare service. Our aim was to prospectively assess patient satisfaction about doctor-patient interaction in a high-volume radiation therapy and oncology center during the COVID-19 pandemic., Methods: Cancer patients receiving either systemic and/or radiation treatment underwent a survey. Two validated questionnaires (EORTC QLQ-C30, FACIT-TS-G version 1) and 14 specific questions evaluating patients' perception of COVID-19 measures were administered., Results: One hundred twenty-five patients admitted to our department from 1-30 April 2020 completed the questionnaires. The majority (66.4%) of patients were women and the most common disease was breast cancer (40%). The average Global Health Status (GHS) of EORTC QLQ-C30 was 61.67. Emotional functioning, social, and cognitive domains obtained scores of 75.48, 80.13, and 84.67, respectively. FACIT-TS-G results revealed 120 patients rated the treatments effective and 108 patients thought the side effects were the same as expected or better. Most (89.6%) rated their treatment good, very good, or excellent. Concerning COVID-19-related questions, patients reported overall very good level of information., Conclusions: Despite the introduction of strict COVID-19 control measures, there was a high level of cancer outpatient satisfaction. The satisfaction levels may influence compliance, continuity of treatments, and patient-doctor communication, impacting the quality of clinical care in the next phases of the pandemic.

Background and Purpose: COVID-19 constitutes a worldwide threat, prompting Italian Government to implement specific measures on March 8, 2020, to protect patients and health workers from disease transmission. The impact of preventive measures on daily activity of a radiotherapy facility may hamper the ability to fulfill normal workload burden. Thus, we assessed the number of delivered treatments in a specific observation period after the adoption of preventive measures (since March 11 to April 24, 2020) and compared it with the corresponding period of the year 2019., Materials and Methods: Overall number of delivered fractions was related to actual time of platform daily activity and reported as a ratio between number of delivered fractions and activity hours (Fr/Hrs). Fr/Hrs were calculated and compared for two different periods of time, March 11-April 24, 2019 (Fr/Hrs1), and March 11-April 24, 2020 (Fr/Hrs2)., Results: Fr/Hrs1 and Fr/Hrs2 were 2.66 and 2.54 for year 2019 and 2020, respectively, for a Fr/Hrs ratio of 1.07 (95% CI 1.03-1.12, p = 0.0005). Fr/Hrs1 was significantly higher than Fr/Hrs2 for Sli R and Precise R , with Fr/Hrs ratio of 1.92 (95% CI 1.66-2.23, p < 0.0001) and 1.11 (95% CI 1.03-1.2, p = 0.003), respectively. No significant difference was reported for Synergy R and Cyberknife R with Fr/Hrs ratio of 0.99 (95% CI 0.91-1.08, p = 0.8) and 0.9 (95% CI 0.77-1.06, p = 0.2), respectively. Fr/Hrs1 was significantly lower than Fr/Hrs2 for Tomotherapy R , with Fr/Hrs ratio of 0.88 (95% CI 0.8-0.96, p = 0.007)., Conclusion: Preventive measures did not influence workload burden performed. Automation in treatment delivery seems to compensate effectively for health workers number reduction.

Early-stage follicular lymphoma (FL) can be cured with involved-field radiotherapy (IF-RT); however, many patients relapse in non-irradiated areas. A combined association with chemotherapy could increase treatment efficacy, but toxic effects could be unacceptable. In vitro synergistic effect between rituximab (R) and RT has been observed, but clinical data are limited. We retrospectively analyzed 41 early-stage FL patients receiving R and IF-RT as first-line treatment. We administered R 375mg/m 2 weekly for four courses, before or after IF-RT (median dose 24 Gy). Primary outcome was PFS, secondary endpoints were CR rate, OS and safety. All patients achieved CR, after a median follow-up of 46 months only three patients relapsed after 18, 26 and 42 months; estimated 5-year PFS was 90%. We suggest R in association with IF-RT could represent a feasible first-line treatment option for early-stage FL and could increase efficacy without additional toxicity compared to available data about RT alone.

Aim: The present phase II study aimed to evaluate the tolerance and safety of Dixentil, a nutritional supplement based on zinc with the addition of prebiotics (galacto-oligosaccharides), tyndalized probiotics (Lactobacillus acidophilus and L. casei) and vitamins B1, B2 and B6, and nicotinamide), given as prophylaxis to patients undergoing pelvic radiotherapy and its efficacy in the prevention and reduction of radiation-related gastrointestinal disorders., Patients and Methods: Forty consecutive patients who were candidates for pelvic radiotherapy received Dixentil before starting and during radiotherapy. The primary end-point was to evaluate the safety and tolerance of Dixentil. Secondary end-points were incidence and severity of radiation-induced diarrhea and number of patients who discontinued radiotherapy because of diarrhea., Results: Radiation-induced enteritis occurred in 17 patients, grade I and grade II diarrhea was documented in 14 and 3 patients respectively; no grade III or IV diarrhea was observed. Radiotherapy was discontinued due to treatment-induced enteritis only in two patients for 6 days., Conclusion: Use of Dixentil is an easy, safe, and feasible approach to protect patients against the risk of radiation-induced diarrhea., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Purpose: Primary bone lymphoma is a rare disease. Little is reported about surgical procedures in these patients. We evaluated a single-centre consecutive series of 21 patients for results, prognostic factors and surgical treatment., Methods: Patient ages ranged from 19 to 82 years. The most frequently affected site was the spine (six cases), followed by the ileum, femur and mandible (three cases each). Four patients were treated with chemotherapy and 17 with chemotherapy and radiation therapy. Six patients were affected by a pathological fracture. Surgery was performed in four patients (19%), in two cases before chemotherapy, in one case during chemotherapy and in one case after chemotherapy and radiotherapy. Five patients died within the range of three to 36 months after diagnosis. Average follow-up of the remaining patients was 62.8 (19-145) months., Results: Overall survival was 74.2% at five years. The only positive prognostic factor was complete remission after chemotherapy. A trend for better survival was present for International Prognostic Index (IPI) score (P = 0.051), under 40 years of age (P = 0.10) and abnormal lactate dehydrogenase (LDH) values (P = 0.10), but it did not reach statistical significance., Conclusions: Surgical treatment should be aimed at restoring function and eliminating pain while minimising delays in the chemotherapy schedule. When feasible, postponing surgery until after chemotherapy is advisable.

1 English Translation of COVID-19 focused questionnaire Graph: Fig. Correction to: Impact of COVID-19 on patient-doctor interaction in a complex radiation therapy facility 2 Average scores for specific subdomains of EORTC QLQ-C30 questionnaires Note that the errors made during the assembly of this figure did not affect the major conclusions reported in the paper. [Extracted from the article]

Abstract: Purpose: To evaluate if in low-risk breast cancer patients (pT1a–pT1b, pN0) tamoxifen can reduce local recurrence and improve survival. Methods: Retrospectively 700 patients were analyzed. All patients were treated from 1980 to 2003 with conservative surgery plus radiotherapy at the University of Florence. No patients were treated with adjuvant chemotherapy. Tamoxifen was prescribed in 359 patients (51.3%). The crude probability of survival (or local recurrence) was estimated by using Kaplan–Meier method, and survival (or local recurrence) comparisons were carried out using Cox proportional hazard regression models. Results: The univariate analysis for specific survival showed that only histological type and local recurrence were significant prognostic factors (log rank test: p =0.02 and p <0.0001, respectively). The Cox regression model by stepwise selection confirmed lobular histological type (p =0.008; HR: 3.83, 95% CI: 1.31–11.21) and local recurrence (p <0.001; HR: 9.05, 95% CI: 3.05–26.82) as independent prognostic factors for disease specific survival. For local disease free survival, multivariate analysis did not show any significant parameters. Conclusion: In our series tamoxifen did not seem to improve disease specific survival and local disease specific survival. The number of events in terms of death for cancer or in terms of local recurrence is too small in this group of patients. However, according to our results we suggest not to prescribe tamoxifen in patients affected by pT1a–pT1b, pN0 breast cancer. [Copyright &y& Elsevier]

Abstract: Aim: The aim of the current study is to identify a subgroup of patients with breast cancer who have a low risk of local recurrence after conservative surgery in order to avoid radiotherapy treatment. Methods: A group of 472 patients underwent conservative surgery without radiotherapy, and it was compared to a second group of 755 patients with similar characteristics, but who had received radiotherapy treatment (RT) after conservative surgery. Results: Breast relapse''s univariate analysis demonstrated statistical significance for the following factors: radiotherapy treatment, clinical stage, pathological stage, positive axillary nodes and tumour grading. Different results were obtained studying breast relapse. In the no-RT group breast relapse was 10.6% while in the irradiated group it was 3.4%. The breast relapse incidence decreases as the age of the patients increases especially over 75 years of age. Conclusions: In conclusion, there is clinical evidence of avoiding adjuvant radiotherapy for patients over 75 years with T1–T2 cancer treated with quadrantectomy with a clear excision margin. [Copyright &y& Elsevier]

Management of locally advanced Soft Tissue Sarcoma (STS) is based on surgery and external beam radiation therapy (EBRT). Theoretical benefits of neoadjuvant EBRT include reduced volume and dose requirements and possible tumor shrinkage, particularly in association with concurrent chemotherapy (CT), that may facilitate clear margin resection, although at the price of increased wound complications rate in up to 35% of patients. The aim of this study is to evaluate outcome and toxicity results of neoadjuvant radiotherapy in STS patients candidate to surgical excision and to assess prognostic-related features to guide treatment personalization. Clinical and treatment related data were retrospectively retrieved from a consecutive cohort of non-metastatic STS patients treated at our Institution with neoadjuvant RT followed by surgery from 1991 to 2023. CT consisted of an Epirubicin-Ifosfamide regimen for 3 cycles during EBRT delivery in selected candidates. Overall survival (OS), Distant-metastasis free survival (DMFS), Local control (LC) data were extrapolated using Kaplan-Meier method. Chi-square, log-rank test and Cox model were performed to identify factors related with outcome and toxicity. 156 patients were included in our study. Median age was 55 years. Tumors were mostly located in the limbs (94%). Disease stage was T≥3 in 71% of cases. Most represented histologic subtypes were liposarcoma (LPS) (34%), undifferentiated pleomorphic sarcoma (UPS) (24%) and synovial sarcoma (5%). Neoadjuvant EBRT was administered to a dose of 50 Gy in 25 daily fractions concurrently with CT in 82 % patients. IMRT was used in 34% of case. R0 and R1 resection were obtained in 93% and 7% of patients respectively. Wound complications were observed in 16% of patients. Grade (G) 3 disease was found in 70% patients. After a median follow-up of 32 months, 5-year OS, DMFS and LC rates were 72%, 57% and 82%, respectively. At multivariate analysis only R1 resection was significantly associated to worse LC rates (p = 0.0214), while G3 disease was correlated with impaired DMFS (p = 0.0029). UPS (p = 0.0028), G3 (p = 0.004) and R1 (p = 0.05) correlated with poorer OS rates. None of the examined variables, particularly use of IMRT and CT, were associated with higher occurrence of wound complications. In this large STS cohort, neoadjuvant RT resulted in excellent RO rate and favorable outcomes. Wound complications rate was inferior to historical data from landmark trials. R1 resection and G3 disease correlated respectively with impaired LC and DMFS. Both factors were associated with poorer OS, as well as UPS subtype, suggesting an unmet need for treatment intensification in selected patients. Use of IMRT and concurrent CT were not correlated with wound complications occurrence. [ABSTRACT FROM AUTHOR]

Neoadjuvant radiotherapy to 50 Gy in 25 fractions is delivered in operable Soft Tissue Sarcoma (STS) patients to downstage the tumor and improve resectability, although at the expense of increased risk of wound dehiscence. Nonetheless, clear margin resection (R0) may not be achieved in tumors located in proximity of critical structures such as the neurovascular bundle (NVB), resulting in impaired local control. The aim of this study is to increase R0 rate through addition of an IMRT boost to the potential sites of suboptimal resection in STS patients receiving neoadjuvant RT. We report hereby the dosimetric results and safety results from the first 5 patients enrolled in this trial. We designed a prospective monocentric interventional single-arm Phase II study enrolling locally advanced STS eligible for surgery. RT is administered in 25 daily fractions to include the MRI-based Gross Tumor Volume (GTV) and peritumoral tissue at risk of microscopic spread (CTV1) to a dose of 50 Gy (2Gy/fraction), with SIB (Simultaneous Integrated Boost) intensification to the tumor/dissection plane interface (CTV2) to a dose of 60 Gy (2.4 Gy/fraction). CTV2 delineation is approved by both a Radiation Oncologist and Surgeon. A margin of 0.5 cm is applied to both CTV to obtain PTV1 and PTV2. Concurrent anthracyclines-based chemotherapy (ChT) is allowed up to 3 cycles. Primary endpoint is R0 resection rate. Secondary endpoints include pathologic complete response rate, objective response rate, overall survival, local and distant progression-free survival, acute and chronic toxicity rate. To assess an increase in R0 rate from 81% to 97% assuming β = 80% e α = 0.05, 33 patients will be included. Dose constraints are summarized in Table1. At least 95% of the PTV1 and PTV2 should be covered by 95% the prescription dose up to a maximum allowed dose of 107%. Five patients were included. Tumor was located in the limbs and in the trunk in respectively 4 and 1 patient. Mean age was 47 years (range: 19-67). Concurrent chemotherapy was performed in 2 patients. Mean GTV size was 228.6 cm3 (range: 59.8-314.5). Mean PTV coverage by the 95% of the dose prescription was 98% (95-100) and 97% (95-100) in PTV1 and PTV2, respectively. Mean PTV1 and PTV2 Dmax were 61.6 Gy (range: 59-63) and 64.1 Gy (range:63-66), in both cases below the 107% threshold. Mean Bone Dmax was 55 Gy (56.6-61.8 Gy). Dmax to the skin corridor exceeded 20 Gy in 1 patient (range 12.5-58.1). While the NVB was overlapping the PTV2 in all cases, Dmax was below 66 Gy. At the time of this report, no Grade ≥3 acute skin toxicity was observed. Two patients underwent surgery with a radiological partial response (RECIST) and pathological complete response. No major wound complication was reported. Planning goals of the first 5 enrolled patients are achieved in most cases. Preliminary results show a benign safety profile and promising tumor response rate. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the incidence of locoregional recurrence (LRR) and the cosmetic results in a group of patients with breast cancer treated with a hypofractionated schedule of adjuvant radiotherapy after conservative surgery. Materials and methods: In total, 539 patients with pTis–pT1–pT2 breast cancer underwent radiotherapy treatment after conservative surgery at the University of Florence and at the Pistoia Hospital. The dose delivered was 44Gy (2.75Gy daily fraction). The tumour bed boost (10Gy) was given by electrons. Results: At the time of the analysis, 1.8% of patients (10/539) had breast relapse. No patients developed nodal recurrence (supraclavicular, axillary and internal mammary nodes). The 3- and 5-year actuarial rates for LRR were 1.2% (±0.5% standard error) and 2.1% (±0.6% standard error), respectively. Considering the late toxicity, we found that 412 (76.4%) patients had grade 0 or grade 1 late toxicity, 113 patients (20.9%) had grade 2 late toxicity and 14 patients (2.5%) had grade 3 late toxicity. No patients developed grade 4 toxicity. Conclusion: This type of approach resulted in an effective treatment in terms of local control in patients with negative or one to three positive axillary nodes and negative surgical margins. Patients treated with a hypofractionated schedule showed very good cosmesis. [Copyright &y& Elsevier]

Poster: Clinical track: Haematology PO-0932: Preoperative radiotherapy for early breast cancer: quality assessment of the ROCK trial - NCT03520894 G. Francolini, V. Di Cataldo, S. Cipressi, E. Scoccimarro, V. Maragna, L. Masi, R. Doro, G. Simontacchi, I. Desideri, I. Meattini, L. Livi. [Extracted from the article]

: PurposeA correlation of treatment for uterine sarcoma with outcome, prognostic importance of pathology, and clinical parameters.: Patients and methodsOne hundred forty-one patients (median age: 56 years, range: 19–85 years) with a histologically verified uterine sarcoma were identified from a database compiled at the Royal Marsden Hospital and the University of Florence between 1974 and 2001. Seventy-two patients had leiomyosarcoma, 42 had mixed mu¨llerian tumors, 22 had endometrial stromal sarcoma, 1 hemangiopericytoma, 1 rhabdomyosarcoma, and 3 patients had unspecified sarcoma. According to FIGO classification, Stage I, II, III, and IV tumors were identified in 71, 13, 31, and 26 patients, respectively.: ResultsAt the time of analysis, 73.7% of patients were dead, and 26.3% were alive with a median survival of 2 years from initial diagnosis. Univariate analysis for cause-specific survival demonstrated statistical significance for histology (p = 0.02), grade (p = 0.003), stage (p = 0.007), and age (p = 0.02). Multivariate analysis demonstrated significant prognostic values for stage (p = 0.02) and histology (p = 0.05) only. Postoperative radiotherapy with a total dose higher than 50 Gy seems to be significant (p = 0.001) in reducing local recurrence.: ConclusionsOur data favor treatment for Stages I, II, and III of uterine sarcoma with radical surgery plus radical dose irradiation comprising both external beam radiotherapy and brachytherapy. [Copyright &y& Elsevier]

Poster: RTT track: Image guided radiotherapy and verification protocols PO-1905: IGRT protocols analysis in brain radiotherapy treatment A. Lastrucci, Y. Wandael, E. Serventi, L. Marciello, L. Fedeli, M. Betti, G. Simontacchi, L. Livi. [Extracted from the article]