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1. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Author

Luigi Marano, Federica Marmorino, Isacco Desideri, Ludovico Carbone, Alessandro Rizzo, Viola Salvestrini, Franco Roviello, Saverio Cinieri, Vittorio Donato, Raffaele De Luca, NutriOnc Research Group, Silvia Sofia, Marco Milone, Benedetto Ielpo, Maria Teresa Mita, Silvia Ministrini, Mario Giuffrida, Roberta Tutino, Caterina Baldi, Giampaolo Perri, Anna Stella Lippolis, Chiara Marafante, Giusy Giannandrea, Marco Vito Marino, Letizia Laface, Salomone Di Saverio, Luca Aldrighetti, Nicola de’Angelis, Nick Salimian, Marco Caricato, Gianluca Pellino, Sara Vertaldi, Federica Cipriani, Gabriella Teresa Capolupo, Antonio Costanzo, Letizia Santandrea, Gaetano Gallo, Andrea Belli, Laura Mastrangelo, Fausto Rosa, Nicolò Pecorelli, Graziella Marino, Alessio Giordano, Nicola Cillara, Maria Lemma, Francesco Pata, Federico Cammillini, Gianmario Edoardo Poto, Giulia Grassi, Donato Francesco Altomare, Arcangelo Picciariello, Lorenzo Petagna, Luca Ippolito, Elio Treppiedi, Daniele Delogu, Abdallah Moukachar, Stefano Granieri, Giuseppe Cuticone, Osvaldo Carpineto Samorani, Daniela Rega, Leonardo Solaini, Stefano de Pascale, Francesca Ascari, Michele Manigrasso, Simona Badalucco, Salvatore Paiella, Sara Coppola, Roberta Iadarola, Giovanna Di Meo, Isacco Montroni, Fabio Vistoli, Valentina Ferraro, Edoardo Saladino, Federico Fazio, Roberta Rota, Francesco Orlando, Simone Famularo, Cinzia Bizzoca, Giorgio Dalmonte, Marco Inama, Luigi Verre, Leandro Siragusa, Casoni Pattacini Gianmaria, Michele Benedetti, Nicolò Tamini, Cristian Conti, Giorgio Ammerata, Serena Mantova, Vito Leonardo Pinto, Arianna Corvasce, Giorgio Micheletti, Teresa Perra, Marco Pellicciaro, Marco Materazzo, Michele Zuolo, Emanuele Doria, Antonio Brillantino, Luca Del Prete, Andrea Muratore, Claudio Luciani, Giulia Turri, Fabio Casciani, Giuliani Giuseppe, Graziana Barile, Oldrà Gaia, Valeria Restaino, Simona Deidda, Michele Ammendola, Andrea Fares Bucci, Patrizia Marsanic, Dario Cassetti, Luca Resca, Daniele Fusario, Eleonora Andreucci, Anna Michelotti, Brunella Amoruso, Isabella Franco, Laura Noto, Andrea Spallanzani, Raimondo Calogero Scalia, Teresa Del Giudice, Valeria Merz, Gianmarco Motta, Alessandro Parisi, Mikol Modesti, Antonella Argentiero, Debora Basile, Gianmarco Vannini, Carlotta Ottanelli, Salvatore Corallo, Eufemia Stefania Lutrino, Daniele Rossini, Federica Morano, Luigia Stefania Stucci, Costanza Winchler, Martina Catalano, Andrea Marini, Giuseppe Brisinda, Enrico Sammarco, Martina Carullo, Giandomenico Roviello, Mirko Barone, Maria Grazia Rodriquenz, Giuseppe Tirino, Alessia Amoruso, Anna Russo, Veronica Conca, Laura Orgiano, Sveva Macrini, Giulia Nazzicone, Maria Bensi, Martina Montesano, Emanuela Dell’Aquila, Andrea Sbrana, Beatrice Borelli, Lorenzo Fornaro, Lucrezia Raimondi, Valeria Zurlo, Mattia Garutti, Elena Ongaro, Arianna Pellegrino, Andrea lanese, Laura Bernardini, Alessandra Boccaccino, Patrizia Farina, Federica Buzzacchino, Angelica Petrillo, Ada Taravella, Vittorio Studiale, Paolo Ciracì, Giovanna Lovino, Dora Di Cosmo, Sabrina Montrone, Fabiana Gregucci, Luca Dominici, Alba Fiorentino, Filippo Carannante, Giambattista Siepe, Giampaolo Montesi, Manuele Roghi, Michele Aquilano, Andrea Romei, Ilaria Bonaparte, Roberta Grassi, Emma D’Ippolito, Giulio Frosini, Giuseppina De Marco, Gennaro Giovine, Chiara Mattioli, Ilaria Morelli, Victoria Lorenzetti, Matteo Mariotti, Carolina Orsatti, Vincenzo Troncone, Lorenzo Livi, Antonio Angrisani, Marco Banini, Teresa Di Pietro, Giuseppe Carlo Iorio, Iacopo Cavallo, Cecilia Cerbai, Valerio Nardone, Francesca De Felice, Consuelo Rosa, Giulia Stocchi, Sara Lucidi, Michele Ganovelli, Damiano Dei, Chiara Cascone, Anna Peru, Luisa Caprara, Lucia Angelini, Luca Visani, Giulio Francolini, Beatrice Bettazzi, Francesco Belia, Virginia Boccardi, Simone Serafini, Vincenzo Bottino, Luca Ferrario, Giuseppe Frazzetta, Felice Pirozzi, Gennaro Martines, Francesco Antonio Ciarleglio, Daniele Indiani, Giuliano Barugola, Luca Mazza, and Chiara Guarini

Subjects
clinical nutrition, cancer, malnutrition, nutritional assessment, survey, Nutrition. Foods and food supply, TX341-641
Abstract

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.

Published
2023
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2. Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group

Author

Giuditta Chiloiro, Angela Romano, Silvia Mariani, Gabriella Macchia, Diana Giannarelli, Luciana Caravatta, Pierfrancesco Franco, Luca Boldrini, Alessandra Arcelli, Almalina Bacigalupo, Liliana Belgioia, Antonella Fontana, Elisa Meldolesi, Giampaolo Montesi, Rita Marina Niespolo, Elisa Palazzari, Cristina Piva, Vincenzo Valentini, and Maria Antonietta Gambacorta

Subjects
Rectal cancer, Neoadjuvant radiotherapy, Inflammatory markers, Prognostic factors, Predictive factors, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has been suggested that inflammation parameters may have a role in predicting tumor response to nCRT and survival outcomes and in rectal cancer, but no definitive conclusion can be drawn at present. The aim of the current study is to evaluate the role of baseline inflammatory markers as prognostic and predictive factors in a large multicentric Italian cohort of LARC pts. Methods: Patients diagnosed with LARC from January 2002 to December 2019 in 9 Italian centers were retrospectively collected. Patients underwent long-course RT with chemotherapy based on fluoropyrimidine ± oxaliplatin followed by surgery. Inflammatory markers were retrieved based on a pre-treatment blood sample including HEI (hemo-eosinophils inflammation index), SII (systemic index of inflammation), NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio). Outcomes of interest were pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS). Results: 808 pts were analyzed. pCR rate was 22 %, 5yOS and 5yDFS were 84.0% and 63.1% respectively. Multivariate analysis identified that a NLR cut-off value >1.2 and SII cut-off value >500 could predict pCR (p = 0.05 and 0.009 respectively). In addition to age, extramesorectal nodes and RT dose, MLR >0.18 (p = 0.03) and HEI = 3 (p = 0.05) were independent prognostic factors for DFS. Finally, age, RT dose, MLR with a cut-off >0.35 (p = 0.028) and HEI = 3 (p = 0.045) were independent predictors of OS. Conclusions: Higher values of baseline composite inflammatory markers can serve as predictors of lower pCR rates and worse survival outcomes in LARC patients undergoing nCRT. More reliable data from prospective studies could lead to the integration of these inexpensive and easy-to-derive tools into clinical practice.

Published
2023
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3. A predictive model of polymetastatic disease from a multicenter large retrospectIve database on colorectal lung metastases treated with stereotactic ablative radiotherapy: The RED LaIT-SABR study

Author

Luca Nicosia, Davide Franceschini, Francesca Perrone-Congedi, Alessandro Molinari, Marianna Alessandra Gerardi, Michele Rigo, Rosario Mazzola, Marco Perna, Vieri Scotti, Andrei Fodor, Aurelia Iurato, Francesco Pasqualetti, Giovanni Gadducci, Silvia Chiesa, Rita Marina Niespolo, Alessio Bruni, Anna Cappelli, Elisa D'Angelo, Paolo Borghetti, Alessandro Di Marzo, Andrea Ravasio, Berardino De Bari, Matteo Sepulcri, Dario Aiello, Gianluca Mortellaro, Claudia Sangalli, Marzia Franceschini, Giampaolo Montesi, Francesco Maria Aquilanti, Gianluigi Lunardi, Riccardo Valdagni, Ivan Fazio, Giovanni Scarzello, Vittorio Vavassori, Ernesto Maranzano, Stefano Maria Magrini, Stefano Arcangeli, Maria Antonietta Gambacorta, Vincenzo Valentini, Fabiola Paiar, Sara Ramella, Nadia Gisella Di Muzio, Mauro Loi, Barbara Alicja Jereczek-Fossa, Franco Casamassima, Mattia Falchetto Osti, Marta Scorsetti, and Filippo Alongi

Subjects
Stereotactic ablative radiotherapy, SABR, SBRT, Colorectal cancer, Oligometastatic disease, Predictive factors, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Aim: Stereotactic ablative radiotherapy (SABR) showed increasing survival in oligometastatic patients. Few studies actually depicted oligometastatic disease (OMD) evolution and which patient will remain disease-free and which will rapidly develop a polymetastatic disease (PMD) after SABR. Therefore, apart from the number of active metastases, there are no clues on which proven factor should be considered for prescribing local treatment in OMD. The study aims to identify predictive factors of polymetastatic evolution in lung oligometastatic colorectal cancer patients. Methods: This international Ethical Committee approved trial (Prot. Negrar 2019-ZT) involved 23 Centers and 450 lung oligometastatic patients. Primary end-point was time to the polymetastatic conversion (tPMC). Additionally, oligometastases number and cumulative gross tumor volume (cumGTV) were used as combined predictive factors of tPMC. Oligometastases number was stratified as 1, 2–3, and 4–5; cumGTV was dichotomized to the value of 10 cc. Results: The median tPMC in the overall population was 26 months. Population was classified in the following tPMC risk classes: low-risk (1–3 oligometastases and cumGTV ≤ 10 cc) with median tPMC of 35.1 months; intermediate-risk (1–3 oligometastases and cumGTV > 10 cc), with median tPMC of 13.9 months, and high-risk (4–5 oligometastases, any cumGTV) with median tPMC of 9.4 months (p = 0.000). Conclusion: The present study identified predictive factors of polymetastatic evolution after SABR in lung oligometastatic colorectal cancer. The results demonstrated that the sole metastases number is not sufficient to define the OMD since patients defined oligometastatic from a numerical point of view might rapidly progress to PMD when the cumulative tumor volume is high. A tailored approach in SABR prescription should be pursued considering the expected disease evolution after SABR, with the aim to avoid unnecessary treatment and toxicity in those at high risk of polymetastatic spread, and maximize local treatment in those with a favorable disease evolution.

Published
2023
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4. Pain REduction with bone metastases STereotactic radiotherapy (PREST): A phase III randomized multicentric trial

Author

Francesco Cellini, Stefania Manfrida, Francesco Deodato, Savino Cilla, Ernesto Maranzano, Stefano Pergolizzi, Fabio Arcidiacono, Rossella Di Franco, Francesco Pastore, Matteo Muto, Valentina Borzillo, Costanza Maria Donati, Giambattista Siepe, Salvatore Parisi, Antonia Salatino, Antonino D’Agostino, Giampaolo Montesi, Anna Santacaterina, Vincenzo Fusco, Mario Santarelli, Maria Antonietta Gambacorta, Renzo Corvò, Alessio Giuseppe Morganti, Valeria Masiello, Paolo Muto, and Vincenzo Valentini

Subjects
Bone metastases, Pain control, Simultaneous integrated boost, Randomised controlled trial, Medicine (General), R5-920
Abstract

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 (

Published
2019
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5. A Pattern of Care Report on the Management of Patients with Squamous Cell Carcinoma of the Anus—A Study by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Tumors Study Group

Author

Pierfrancesco Franco, Giuditta Chiloiro, Giampaolo Montesi, Sabrina Montrone, Alessandra Arcelli, Tiziana Comito, Francesca Arcadipane, Luciana Caravatta, Gabriella Macchia, Marco Lupattelli, Marina Rita Niespolo, Fernando Munoz, Elisa Palazzari, Marco Krengli, Francesca Valvo, Maria Antonietta Gambacorta, Domenico Genovesi, and Giovanna Mantello

Subjects
anal cancer, squamous cell carcinoma, anus, chemoradiation, radiotherapy, pattern of care, Medicine (General), R5-920
Abstract

Background and objectives: The diagnosis and therapy of squamous cell carcinoma of the anus may vary significantly in daily clinical practice, even if international guidelines are available. Materials and Methods: We conducted a pattern of care survey to assess the management of patients with anal cancer in Italy (38 questions). We analyzed 58 questionnaires. Results: Most of the respondents work in public and/or university hospitals (75.8%) in northern Italy (65.5%). The majority (88.0%) treat less than 20 patients/year. Common examinations for diagnosis and staging are anorectal endoscopy (84.5%), computed tomography scan (86.2%) and pelvic magnetic resonance imaging (MRI) (96.5%). The most frequently prescribed dose to primary tumor is 50–54 Gy (46.5–58.6%) for early stage disease and 54–59.4 Gy (62.1–32.8%) for locally advanced cases. Elective volumes are prescribed around 45 Gy (94.8%). Most participants use volumetric intensity modulated radiotherapy (89.7%) and a simultaneous integrated boost (84.5%). Concurrent radiotherapy, 5-fluorouracil and mitomycin is considered the standard of care (70.6%). Capecitabine is less frequently used (34.4%). Induction chemotherapy is an option for extensive localized disease (65.5%). Consolidation chemotherapy is rarely used (18.9%). A response evaluation is conducted at 26–30 weeks (63.9%) with a pelvic MRI (91.4%). Follow-up is generally run by the multidisciplinary tumor board (62.1%). Conclusions: Differences were observed for radiotherapy dose prescription, calling for a consensus to harmonize treatment strategies.

Published
2021
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6. Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients

Author

Gabriella Macchia, Maria Antonietta Gambacorta, Carlotta Masciocchi, Giuditta Chiloiro, Giovanna Mantello, Maika di Benedetto, Marco Lupattelli, Elisa Palazzari, Liliana Belgioia, Almalina Bacigalupo, Aldo Sainato, Sabrina Montrone, Lucia Turri, Angela Caroli, Antonino De Paoli, Fabio Matrone, Carlo Capirci, Giampaolo Montesi, Rita Marina Niespolo, Mattia Falchetto Osti, Luciana Caravatta, Alessandra Galardi, Domenico Genovesi, Maria Elena Rosetto, Caterina Boso, Piera Sciacero, Lucia Giaccherini, Salvatore Parisi, Antonella Fontana, Francesco Romeo Filippone, Vincenzo Picardi, Alessio Giuseppe Morganti, and Vincenzo Valentini

Subjects
Rectal cancer, Time interval, Surgery, TME, Chemoradiation, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background: To retrospectively evaluate the difference in terms of pathologic complete response (pCR) according to time elapsed between chemoradiation (CRT) and total mesorectal excision (TME) on a large unselected real-life dataset of locally advanced rectal cancer (LARC) patients. Methods: A multicentre retrospective cohort study of LARC patients from 21 Italian Radiotherapy Institutions was performed. Patients were stratified into 3 different time intervals from CRT. The 1st group included 300 patients who underwent TME within 6 weeks, the 2nd 1598 patients (TME within 7–12 weeks) and the 3rd 196 patients (TME within 13 or more weeks after CRT), respectively. Results: Data on 2094 LARC patients treated between 1997 and 2016 were considered suitable for analysis. Overall, 578 patients had stage II while 1516 had stage III histological proven invasive rectal adenocarcinoma. A CRT schedule of one agent (N = 1585) or 2-drugs (N = 509) was administered. Overall, pCR was 22.3% (N = 468 patients). The proportion of patients achieving pCR with respect to time interval was, as follows: 12.6% (1st group), 23% (2nd group) and 31.1% (3rd group) (p 5040 cGy (p = 0.002) and longer interval (p 13 weeks) from CRT to surgery improves the pathological response (pCR and pathologic partial response; pPR) in comparison to historic data. Furthermore, radiotherapy dose >5040 cGy and two drugs chemotherapy correlated with pPR rate.

Published
2017
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7. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Author

Marano, Luigi, Marmorino, Federica, Desideri, Isacco, Carbone, Ludovico, Rizzo, Alessandro, Salvestrini, Viola, Roviello, Franco, Cinieri, Saverio, Donato, Vittorio, De Luca, Raffaele, Silvia, Sofia, Marco, Milone, Benedetto, Ielpo, Maria Teresa Mita, Silvia, Ministrini, Mario, Giuffrida, Roberta, Tutino, Caterina, Baldi, Giampaolo, Perri, Anna Stella Lippolis, Chiara, Marafante, Giusy, Giannandrea, Marco Vito Marino, Letizia, Laface, Salomone Di Saverio, Luca, Aldrighetti, Nicola, De'Angelis, Nick, Salimian, Marco, Caricato, Gianluca, Pellino, Sara, Vertaldi, Federica, Cipriani, Gabriella Teresa Capolupo, Antonio, Costanzo, Letizia, Santandrea, Gallo, Gaetano, Andrea, Belli, Laura, Mastrangelo, Fausto, Rosa, Nicolò, Pecorelli, Graziella, Marino, Alessio, Giordano, Nicola, Cillara, Maria, Lemma, Francesco, Pata, Federico, Cammillini, Gianmario Edoardo Poto, Giulia, Grassi, Donato Francesco Altomare, Arcangelo, Picciariello, Lorenzo, Petagna, Luca, Ippolito, Elio, Treppiedi, Daniele, Delogu, Abdallah, Moukachar, Stefano, Granieri, Giuseppe, Cuticone, Osvaldo Carpineto Samorani, Daniela, Rega, Leonardo, Solaini, Stefano de Pascale, Francesca, Ascari, Michele, Manigrasso, Simona, Badalucco, Salvatore, Paiella, Sara, Coppola, Roberta, Iadarola, Giovanna Di Meo, Isacco, Montroni, Fabio, Vistoli, Valentina, Ferraro, Edoardo, Saladino, Federico, Fazio, Roberta, Rota, Francesco, Orlando, Simone, Famularo, Cinzia, Bizzoca, Giorgio, Dalmonte, Marco, Inama, Luigi, Verre, Leandro, Siragusa, Casoni Pattacini Gianmaria, Michele, Benedetti, Nicolò, Tamini, Cristian, Conti, Giorgio, Ammerata, Serena, Mantova, Vito Leonardo Pinto, Arianna, Corvasce, Giorgio, Micheletti, Teresa, Perra, Marco, Pellicciaro, Marco, Materazzo, Michele, Zuolo, Emanuele, Doria, Antonio, Brillantino, Luca Del Prete, Andrea, Muratore, Claudio, Luciani, Giulia, Turri, Fabio, Casciani, Giuliani, Giuseppe, Graziana, Barile, Oldrà, Gaia, Valeria, Restaino, Simona, Deidda, Michele, Ammendola, Andrea Fares Bucci, Patrizia, Marsanic, Dario, Cassetti, Luca, Resca, Daniele, Fusario, Eleonora, Andreucci, Anna, Michelotti, Brunella, Amoruso, Isabella, Franco, Laura, Noto, Andrea, Spallanzani, Raimondo Calogero Scalia, Teresa Del Giudice, Valeria, Merz, Gianmarco, Motta, Alessandro, Parisi, Mikol, Modesti, Antonella, Argentiero, Debora, Basile, Gianmarco, Vannini, Carlotta, Ottanelli, Salvatore, Corallo, Eufemia Stefania Lutrino, Daniele, Rossini, Federica, Morano, Luigia Stefania Stucci, Costanza, Winchler, Martina, Catalano, Andrea, Marini, Giuseppe, Brisinda, Enrico, Sammarco, Martina, Carullo, Giandomenico, Roviello, Mirko, Barone, Maria Grazia Rodriquenz, Giuseppe, Tirino, Alessia, Amoruso, Anna, Russo, Veronica, Conca, Laura, Orgiano, Sveva, Macrini, Giulia, Nazzicone, Maria, Bensi, Martina, Montesano, Emanuela, Dell'Aquila, Andrea, Sbrana, Beatrice, Borelli, Lorenzo, Fornaro, Lucrezia, Raimondi, Valeria, Zurlo, Mattia, Garutti, Elena, Ongaro, Arianna, Pellegrino, Andrea, Lanese, Laura, Bernardini, Alessandra, Boccaccino, Patrizia, Farina, Federica, Buzzacchino, Angelica, Petrillo, Ada, Taravella, Vittorio, Studiale, Paolo, Ciracì, Giovanna, Lovino, Dora Di Cosmo, Sabrina, Montrone, Fabiana, Gregucci, Luca, Dominici, Alba, Fiorentino, Filippo, Carannante, Giambattista, Siepe, Giampaolo, Montesi, Manuele, Roghi, Michele, Aquilano, Andrea, Romei, Ilaria, Bonaparte, Roberta, Grassi, Emma, D'Ippolito, Giulio, Frosini, Giuseppina De Marco, Gennaro, Giovine, Chiara, Mattioli, Ilaria, Morelli, Victoria, Lorenzetti, Matteo, Mariotti, Carolina, Orsatti, Vincenzo, Troncone, Lorenzo, Livi, Antonio, Angrisani, Marco, Banini, Teresa Di Pietro, Giuseppe Carlo Iorio, Iacopo, Cavallo, Cecilia, Cerbai, Valerio, Nardone, Francesca De Felice, Consuelo, Rosa, Giulia, Stocchi, Sara, Lucidi, Michele, Ganovelli, Damiano, Dei, Chiara, Cascone, Anna, Peru, Luisa, Caprara, Lucia, Angelini, Luca, Visani, Giulio, Francolini, Beatrice, Bettazzi, Francesco, Belia, Virginia, Boccardi, Simone, Serafini, Vincenzo, Bottino, Luca, Ferrario, Giuseppe, Frazzetta, Felice, Pirozzi, Gennaro, Martines, Francesco Antonio Ciarleglio, Daniele, Indiani, Giuliano, Barugola, Luca, Mazza, and Chiara, Guarini

Subjects
nutritional assessment, clinical nutrition, cancer, malnutrition, survey
Published
2023

8. Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: long term results

Author

Gaya Spolverato, Daniela Rega, Paola Del Bianco, Mario Guerrieri, Claudio Belluco, Emilio Morpurgo, Claudio Coco, Angelo Restivo, Silvia De Franciscis, Carlo Aschele, Alessandro Perin, Michele Bonomo, Andrea Muratore, Antonino Spinelli, Salvatore Ramuscello, Francesca Bergamo, Giampaolo Montesi, Maria Antonietta Gambacorta, Paolo Delrio, and Salvatore Pucciarelli

Subjects
Oncology, Surgery, General Medicine
Published
2023

10. ASO Visual Abstract: Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial

Author

Francesco Marchegiani, Valeria Palatucci, Giulia Capelli, Mario Guerrieri, Claudio Belluco, Daniela Rega, Emilio Morpurgo, Claudio Coco, Angelo Restivo, Silvia De Franciscis, Carlo Aschele, Alessandro Perin, Michele Bonomo, Andrea Muratore, Antonino Spinelli, Salvatore Ramuscello, Francesca Bergamo, Giampaolo Montesi, Gaya Spolverato, Paola Del Bianco, Maria Antonietta Gambacorta, Paolo Delrio, and Salvatore Pucciarelli

Subjects
Oncology, Surgery
Published
2022

11. A Multicenter Large Retrospective Database on the Personalization of Stereotactic Ablative Radiotherapy for Lung Metastases From Colon-Rectal Cancer: The LaIT-SABR Study

Author

Davide Franceschini, Stefano Maria Magrini, Sara Ramella, Vieri Scotti, F. Casamassima, L. Frassinelli, Frank Lohr, Luigi Corti, N. Di Muzio, Claudia Sangalli, I. Fazio, F. Perrone, M. Perna, Stefano Arcangeli, R.M. Niespolo, D. Aiello, Lorenzo Livi, Francesco Pasqualetti, Marta Scorsetti, M. Franceschini, G. Mortellaro, M.F. Osti, B. De Bari, A. Ravasio, Riccardo Valdagni, M. Sepulcri, Silvia Chiesa, Ernesto Maranzano, V. Valentini, A. Di Marzo, F.M. Aquilanti, Fabiola Paiar, Alessio Bruni, Andrei Fodor, Paolo Borghetti, A. Iurato, Filippo Alongi, Michele Rigo, Marianna Alessandra Gerardi, Giampaolo Montesi, Luca Nicosia, L. Vavassori, Rosario Mazzola, Barbara Alicja Jereczek-Fossa, Nicosia, L, Franceschini, D, Perrone, F, Casamassima, F, Gerardi, M, Perna, M, Scotti, V, Fodor, A, Mazzola, R, Rigo, M, Iurato, A, Pasqualetti, F, Chiesa, S, Niespolo, R, Bruni, A, Frassinelli, L, Borghetti, P, Marzo, A, Ravasio, A, De Bari, B, Sepulcri, M, Aiello, D, Mortellaro, G, Sangalli, C, Franceschini, M, Montesi, G, Aquilanti, F, Valdagni, R, Fazio, I, Corti, L, Vavassori, L, Maranzano, E, Magrini, S, Lohr, F, Arcangeli, S, Valentini, V, Paiar, F, Ramella, S, Di Muzio, N, Livi, L, Jereczek-Fossa, B, Osti, M, Scorsetti, M, and Alongi, F

Subjects
Cancer Research, Univariate analysis, medicine.medical_specialty, Radiation, Predictive marker, Colorectal cancer, business.industry, medicine.medical_treatment, medicine.disease_cause, medicine.disease, SABR volatility model, Primary tumor, Radiation therapy, Lesion, colorectal metastase, Oncology, medicine, Radiology, Nuclear Medicine and imaging, KRAS, Radiology, oligometastase, medicine.symptom, business, SABR
Abstract

PURPOSE/OBJECTIVE(S): stereotactic ablative radiotherapy (SABR) has been shown to increase survival rates in oligometastatic disease (OMD), but local control of colorectal metastases still remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate how lung SBRT can impact on the progression to the polymetastatic disease (PMD). MATERIALS/METHODS: the study involved 22 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1023 lung metastases treated with SBRT in 622 patients were reported. The median BED was 105 Gy10. Lesion diameter GTV, PTV volume, dose, fractionations, and site of primary tumor were evaluated as potential predictive marker for SBRT response for the primary end-point local progression-free survival (LPFS). EGFR, KRAS, NRAS, BRAF, and MSI were also evaluated. Secondary end-point was the time to the polymetastatic conversion (ttPMC). RESULTS: the median follow-up was 26 months (range 3-117 months). The median lesion diameter was 13 mm (range 4-58 mm). The 2- and 3-year LPFS were 75.6% and 71%, respectively. At the univariate analysis, BED ≥125Gy10 was associated with improved LPFS (2-year: 94.1% versus 72.6%; P = < 0.0001), single fraction SBRT correlated with better LPFS in the overall population (2-year: 80.6% versus 73.7%; P = 0.03), but no significant difference was observed when considering the population treated with BED > 100 Gy10. Lesion diameter ≤19 mm correlated with improved LPFS (2-year 80% versus 60%; P = < 0.0001). The median ttPMC was 26 months, and the 2-year ttPMC was 54.5%. The median PFS was 11.3 months. After SABR, 36% patients had polymetastatic relapse, 39.5% patients had an oligometastatic relapse, and 24.5% patients had no further relapse. CONCLUSION: the present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Several biological and clinical predictive factors were identified to assure the highest local control, on the basis of which a decisional algorithm will be derived.

Published
2021

12. Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial

Author

Andrea Muratore, Carlo Aschele, Claudio Belluco, Giulia Capelli, Paolo Delrio, Francesca Bergamo, Angelo Restivo, Maria Antonietta Gambacorta, Daniela Rega, Michele Bonomo, Gaya Spolverato, Francesco Marchegiani, Paola Del Bianco, Silvia De Franciscis, Mario Guerrieri, Alessandro Perin, Giampaolo Montesi, Claudio Coco, Valeria Palatucci, Emilio Morpurgo, Antonino Spinelli, Salvatore Ramuscello, and Salvatore Pucciarelli

Subjects
medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Urology, Surgical oncology, medicine, Humans, In patient, Prospective Studies, Watchful Waiting, Neoadjuvant therapy, Chemotherapy, integumentary system, Rectal Neoplasms, business.industry, Incidence (epidemiology), Rectum, Chemoradiotherapy, medicine.disease, Total mesorectal excision, Neoadjuvant Therapy, Treatment Outcome, Oncology, Surgery, Neoplasm Recurrence, Local, business
Abstract

BACKGROUND Rectum-preservation for locally advanced rectal cancer has been proposed as an alternative to total mesorectal excision (TME) in patients with major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The purpose of this study was to report on the short-term outcomes of ReSARCh (Rectal Sparing Approach after preoperative Radio- and/or Chemotherapy) trial, which is a prospective, multicenter, observational trial that investigated the role of transanal local excision (LE) and watch-and-wait (WW) as integrated approaches after neoadjuvant therapy for rectal cancer. METHODS Patients with mid-low rectal cancer who achieved mCR or cCR after neoadjuvant therapy and were fit for major surgery were enrolled. Clinical response was evaluated at 8 and 12 weeks after completion of chemoradiotherapy. Treatment approach, incidence, and reasons for subsequent TME were recorded. RESULTS From 2016 to 2019, 160 patients were enrolled; mCR or cCR at 12 weeks was achieved in 64 and 96 of patients, respectively. Overall, 98 patients were managed with LE and 62 with WW. In the LE group, Clavien-Dindo 3+ complications occurred in three patients. The rate of cCR increased from 8- to 12-week restaging. Thirty-three (94.3%) of 35 patients with cCR had ypT0-1 tumor. At a median 24 months follow-up, a tumor regrowth was found in 15 (24.2%) patients undergoing WW. CONCLUSIONS LE for patients achieving cCR or mCR is safe. A 12-week interval from chemoradiotherapy completion to LE is correlated with an increased cCR rate. The risk of ypT > is reduced when LE is performed after cCR.

Published
2021

14. PH-0112 Multicenter large retrospectIve database on SBRT for colorectal lung metastases: the LaIT-SABR study

Author

Riccardo Valdagni, L. Vavassori, Michele Rigo, Marianna Alessandra Gerardi, B. De Bari, N. Di Muzio, Barbara Alicja Jereczek-Fossa, Vieri Scotti, Frank Lohr, M. Perna, Filippo Alongi, Luigi Corti, I. Fazio, R.M. Niespolo, G. Mortellaro, F.M. Aquilanti, Andrei Fodor, Paolo Borghetti, M.F. Osti, Luca Nicosia, A. Ravasio, Davide Franceschini, L. Frassinelli, A. Di Marzo, G. Gadducci, A. Iurato, Fabiola Paiar, D. Aiello, Alessio Bruni, F. Casamassima, Sara Ramella, Silvia Chiesa, Rosario Mazzola, F. Perrone Congedi, Stefano Arcangeli, Stefano Maria Magrini, M. Franceschini, Lorenzo Livi, M. Sepulcri, Francesco Pasqualetti, Claudia Sangalli, Marta Scorsetti, Ernesto Maranzano, Giampaolo Montesi, and V. Valentini

Subjects
medicine.medical_specialty, Lung, medicine.anatomical_structure, Oncology, business.industry, Medicine, Radiology, Nuclear Medicine and imaging, Hematology, Radiology, business, SABR volatility model, Retrospective database
Published
2021

15. Is It Time to Introduce PET/CT in Rectal Cancer Guidelines?

Author

Federica Matteucci, Domenico Rubello, Anna Margherita Maffione, Paola Caroli, Giampaolo Montesi, and Patrick M. Colletti

Subjects
medicine.medical_specialty, Colorectal cancer, Disease, Adenocarcinoma, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Carcinoembryonic antigen, Fluorodeoxyglucose F18, Positron Emission Tomography Computed Tomography, Biopsy, medicine, Humans, Radiology, Nuclear Medicine and imaging, Contraindication, PET-CT, biology, medicine.diagnostic_test, business.industry, Rectal Neoplasms, General Medicine, medicine.disease, Review article, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, biology.protein, Radiology, Radiopharmaceuticals, business
Abstract

At the moment, international guidelines for rectal cancer suggest to consider F-FDG PET/CT scan in a few conditions: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma with potentially curable M1 disease; (2) in the recurrence workup for serial carcinoembryonic antigen level elevation; (3) in the recurrence workup with metachronous metastases documented by CT, MRI, or biopsy; (4) in case of strong contraindication to IV contrast agent administration; and (5) to evaluate an equivocal finding on a contrast-enhanced CT or MRI. PET/CT is not indicated in the follow-up or surveillance of rectal cancer. On the other hand, an attentive evaluation of the literature shows that PET/CT may also be used in some circumstances with significant levels of diagnostic accuracy. This review article aims to emphasize differences between current international guidelines and scientific literature in the role of PET/CT in rectal cancer.

Published
2020

16. Radiotherapy during COVID-19 pandemic. How to create a No fly zone: a Northern Italy experience

Author

Giovanni Pavanato, Sara Chierchini, Giampaolo Montesi, Saide Di Biase, Mandoliti G, Edgardo Contato, and Graziella Elia Virdis

Subjects
Short Communication, medicine.medical_treatment, Pneumonia, Viral, Radiation oncology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Pandemic, medicine, Humans, Radiology, Nuclear Medicine and imaging, Pandemics, Protocol (science), Clinical governance, Cross Infection, Infection Control, Radiology Department, Hospital, Radiotherapy, medicine.diagnostic_test, SARS-CoV-2, business.industry, COVID-19, Interventional radiology, General Medicine, medicine.disease, Triage, Discontinuation, EXPOSE, Coronavirus, Radiation therapy, Italy, Radiology Nuclear Medicine and imaging, 030220 oncology & carcinogenesis, Medical emergency, Coronavirus Infections, business
Abstract

Background SARS-CoV-2 pandemic represents a troubling health emergency but also a main challenge for the clinical governance of the system. Discontinuation of radiation treatments is not desirable and potentially life-threatening. On the other hand, accesses to hospital expose cancer patients to an increased risk of COVID-19 infection. We report our extended protocol, draft to manage clinical activities in our radiotherapy department, by minimizing contagion risks. Methods We used telephonic screening to assess the need for patient admission. A telephonic triage was performed to identify the presence of COVID-19 infection risk factors or symptoms. New treatments were stratified according to priority codes. A reserved entrance to radiotherapy department was assured for patients and staff. Surgical disposable mask was required for patients and caregivers. The activities were distributed during the whole workday, avoiding overlap to reduce aggregation. Results From 1st February 2020 to 31 March 2020, we reported an increase in the number of first medical examinations and treatments, compared to the same period of the previous year. Outpatients first medical examinations have been spread over the 12 working hours. No COVID-19 cases were detected. Conclusion During COVID-19 pandemic, we introduced procedures that allowed us to ensure the continuity in oncological cares, with limited risks of infection for patients and staff.

Published
2020
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17. Fractionated Stereotactic Sequential Boost in a Selected Cohort of Glioblastoma Patients: A Mono-institutional Analysis

Author

Cynthia Aristei, Isabella Palumbo, Marco Lupattelli, Giampaolo Montesi, Vittorio Bini, Stefano Saccia, Nunzia Cenci, Alessandro Marchionni, Pietro Chiarini, and C. Zucchetti

Subjects
Oncology, Adult, Male, Cancer Research, medicine.medical_specialty, Multivariate analysis, Survival, Kaplan-Meier Estimate, Radiosurgery, Boost, Fractionated stereotactic radiotherapy, Glioblastoma, Toxicity, Stereotactic radiotherapy, Cohort Studies, Internal medicine, medicine, Overall survival, Humans, Survival analysis, Aged, Proportional Hazards Models, business.industry, Brain Neoplasms, Radiotherapy Planning, Computer-Assisted, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Treatment Outcome, Cohort, Female, Dose Fractionation, Radiation, business, Tomography, X-Ray Computed, Radiotherapy, Image-Guided
Abstract

Aim To retrospectively assess toxicity and survival in 15 selected Glioblastoma patients treated with a sequential fractionated stereotactic radiotherapy (FSRT) boost after chemo-radiotherapy (CHT-RT) and compare their survival outcomes with a control group. Patients and methods Toxicity was assessed with the CTCAE 3.0 scale. The Kaplan-Meier method was used to design survival curves, log-rank test for bivariate analysis and Cox proportional hazard regression model for multivariate analysis. Results The median follow-up was 16 months (range=5-60). One case of headache and one of radionecrosis (RN) occurred. Median overall survival (OS) was 25 months in the boost group vs. 14 in the no-boost group (p=0.004). Median progression-free survival (PFS) was 15 months in the boost group versus 8 in the no-boost group (p=0.046). At multivariate analysis FSRT boost resulted significantly associated with OS and PFS. Conclusion In our series a sequential FSRT boost resulted in safe outcomes and significantly associated with survival.

Published
2020

18. Radiation therapy during the coronavirus disease 2019 (covid-19) pandemic in Italy: a view of the nation's young oncologists

Author

Matteo Lambertini, Luca Boldrini, Icro Meattini, Angela Botticella, Pierfrancesco Franco, Giampaolo Montesi, Maria De Santis, Luca Triggiani, Giulia Marvaso, Liliana Belgioia, Lorenzo Livi, and Silvana Parisi

Subjects
medicine.medical_specialty, Cancer Research, medicine.medical_treatment, Pneumonia, Viral, Telehealth, Systemic therapy, radiation therapy, Patient safety, Betacoronavirus, Breast cancer, COVID-19, clinical oncology, recommendations, young oncologists, medicine, Infection control, Humans, Viral, Intensive care medicine, Pandemics, Radiation oncologist, Coronavirus Infections, Italy, Coronavirus, Oncologists, Science & Technology, business.industry, SARS-CoV-2, Pneumonia, Precision medicine, medicine.disease, CANCER, Radiation therapy, Editorial, Oncology, business, Life Sciences & Biomedicine, RADIOTHERAPY
Abstract

The SARS-CoV-2 pandemic and covid-19 diffusion are an international public health emergency.1 Cancer patients are particularly exposed to infections and their potential complications.2 In this context, the usual clinical decision-making process in radiation therapy is being consistently revised.3 There is an urgent need to share expertise and offer emergency guidance. It is crucial to minimise contacts and to reduce the complexity of radiation treatments where possible to optimise the workforce, keeping intact the effectiveness of the interventions.4 Radiation and systemic therapy modifications should be implemented depending on local circumstances.5 A general guiding principle should include approaches where clinical equivalence supported by trials testing de-escalation strategies is present even without level 1–2 evidence (box 1, bullet points 1).3 Patients with cancer have an intrinsic degree of frailty and therefore are prone to covid-19 complications. Age and comorbidities have been reported as independent risk factors for poor outcome during covid-19 infection and, of note, more than half of cancer patients are elderly and have significant comorbidities (box 1, bullet points 2).6 Hence, an appropriate evaluation of the risk-benefit of radiation therapy treatments is cogent. Urgent cases and non-deferrable treatments (ie, active tumours, spinal cord compression, life threatening bleeding) should be initiated or continued, provided there is full compliance with the safety regulations of local authorities for both patients and staff members. In non-urgent cases, irradiation can be postponed to an extent, depending on the clinical setting and the possibility to offer patients bridging systemic therapies. Whenever radiation therapy is indicated, dose prescription, fractionation and delivery techniques should be adapted, reduced in duration, and optimised (box 1, bullet points 3 and 4). A timely example of precision medicine application is non-metastatic breast cancer radiation …

Published
2020

19. Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: The Pros-IT CNR study

Author

Angelo, Porreca, Marianna, Noale, Walter, Artibani, Pier Francesco Bassi, Filippo, Bertoni, Sergio, Bracarda, Giario Natale Conti, Renzo, Corvò, Mauro, Gacci, Pierpaolo, Graziotti, Magrini, STEFANO MARIA, Vincenzo, Mirone, Rodolfo, Montironi, Giovanni, Muto, Stefano, Pecoraro, Umberto, Ricardi, Elvio, Russi, Andrea, Tubaro, Vittorina, Zagonel, Gaetano, Crepaldi, Stefania, Maggi, Pierfrancesco, Bassi, Stefano Maria Magrini, Anna Rita Alitto, Enrica, Ambrosi, Alessandro, Antonelli, Cynthia, Aristei, Michele, Barbieri, Franco, Bardari, Lilia, Bardoscia, Salvina, Barra, Sara, Bartoncini, Umberto, Basso, Carlotta, Becherini, Rita, Bellavita, Franco, Bergamaschi, Stefania, Berlingheri, Berruti, Alfredo, Marco, Borghesi, Roberto, Bortolus, Valentina, Borzillo, Davide, Bosetti, Giuseppe, Bove, Pierluigi, Bove, Maurizio, Brausi, Alessio, Bruni, Giorgio, Bruno, Eugenio, Brunocilla, Alberto, Buffoli, BUGLIONE DI MONALE E BASTIA, Michela, Consuelo, Buttigliero, Giovanni, Cacciamani, Michela, Caldiroli, Giuseppe, Cardo, Giorgio, Carmignani, Giuseppe, Carrieri, Emanuele, Castelli, Elisabetta, Castrezzati, Gianpiero, Catalano, Susanna, Cattarino, Francesco, Catucci, Francolini Dario Cavallini, Ofelia, Ceccarini, Antonio, Celia, Francesco, Chiancone, Tommaso, Chini, Claudia, Cianci, Antonio, Cisternino, Devis, Collura, Franco, Corbella, Matteo, Corinti, Paolo, Corsi, Fiorenza, Cortese, Luigi, Corti, Cosimo de Nunzio, Olga, Cristiano, Rolando, M D'Angelillo, Luigi Da Pozzo, Daniele, D'Agostino, Carolina, D'Elia, Matteo, Dandrea, Michele De Angelis, Paolo De Angelis, Ottavio De Cobelli, Bernardino De Concilio, Antonello De Lisa, Stefano De Luca, Agostina De Stefani, Chiara Lucrezia Deantoni, Esposti Claudio Degli, Anna, Destito, Beatrice, Detti, Nadia Di Muzio, Andrea Di Stasio, Calogero Di Stefano, Danilo Di Trapani, Giuseppe, Difino, Sara, Falivene, Giuseppe, Farullo, Paolo, Fedelini, Ilaria, Ferrari, Francesco, Ferrau, Matteo, Ferro, Andrei, Fodor, Francesco, Fontanta, Francesco, Francesca, Giulio, Francolini, Paolo, Frata, Giovanni, Frezza, Pietro, Gabriele, Maria, Galeandro, Elisabetta, Garibaldi, Pietro Giovanni Gennari, Alessandro, Gentilucci, Alessandro, Giacobbe, Laura, Giussani, Giuseppe, Giusti, Paolo, Gontero, Alessia, Guarneri, Cesare, Guida, Alberto, Gurioli, Dorijan, Huqi, Ciro, Imbimbo, Gianluca, Ingrosso, Cinzia, Iotti, Corrado, Italia, Pierdaniele La Mattina, Enza, Lamanna, Luciana, Lastrucci, Grazia, Lazzari, Fabiola, Liberale, Giovanni, Liguori, Roberto, Lisi, Frank, Lohr, Riccardo, Lombardo, Jon A, J Lovisolo, Giuseppe Mario Ludovico, Nicola, Macchione, Francesca, Maggio, Michele, Malizia, Gianluca, Manasse, Giovanni, Mandoliti, Giovanna, Mantini, Luigi, Marafioti, Luisa, Marciello, Alberto Mario Marconi, Antonietta, Martilotta, Salvino, Marzano, Stefano, Masciullo, Gloria, Maso, Adele, Massenzo, Ercole, Mazzeo, Luigi, Mearini, Serena, Medoro, Rosa, Molè, Giorgio, Monesi, Emanuele, Montanari, Franco, Montefiore, Giampaolo, Montesi, Giuseppe, Morgia, Gregorio, Moro, Giorgio, Muscas, Daniela, Musio, Paolo, Muto, Giovanni, Muzzonigro, Giorgio, Napodano, Carlo Luigi Augusto Negro, Mattia, Nidini, Maria, Ntreta, Marco, Orsatti, Carmela, Palazzolo, Isabella, Palumbo, Alessandro, Parisi, Paolo, Parma, Nicola, Pavan, Martina, Pericolini, Francesco, Pinto, Antonio, Pistone, Valerio, Pizzuti, Angelo, Platania, Caterina, Polli, Giorgio, Pomara, Elisabetta, Ponti, Antonio Benito Porcaro, Francesco, Porpiglia, Dario, Pugliese, Armin, Pycha, Giuseppe, Raguso, Andrea, Rampini, Donato Franco Randone, Valentina, Roboldi, Marco, Roscigno, Maria Paola Ruggieri, Giuseppe, Ruoppo, Roberto, Sanseverino, Anna, Santacaterina, Michele, Santarsieri, Riccardo, Santoni, Sarah, Scagliarini, Giorgio Vittorio Scagliotti, Mauro, Scanzi, Marcello, Scarcia, Riccardo, Schiavina, Alessandro, Sciarra, Carmine, Sciorio, Tindaro, Scolaro, Salvatore, Scuzzarella, Oscar, Selvaggio, Armando, Serao, Sergio, Serni, Marco Andrea Signor, Mauro, Silvani, Giovanni, Silvano, Franco, Silvestris, Simeone, Claudio, Valeria, Simone, Girolamo, Spagnoletti, Matteo Giulio Spinelli, Luigi, Squillace, Vincenzo, Tombolini, Mariastella, Toninelli, Triggiani, Luca, Alberto, Trinchieri, Luca Eolo Trodella, Lucio, Trodella, Carlo, Trombetta, Lidia, Tronnolone, Marcello, Tucci, Daniele, Urzì, Riccardo, Valdagni, Maurizio, Valeriani, Maurizio, Vanoli, Elisabetta, Vitali, Alessandro, Volpe, Stefano, Zaramella, Guglielmo, Zeccolini, Giampaolo, Zini, Porreca, Angelo, Noale, Marianna, Artibani, Walter, Bassi, Pier Francesco, Bertoni, Filippo, Bracarda, Sergio, Conti, Giario Natale, Corvò, Renzo, Gacci, Mauro, Graziotti, Pierpaolo, Magrini, Stefano Maria, Mirone, Vincenzo, Montironi, Rodolfo, Muto, Giovanni, Pecoraro, Stefano, Ricardi, Umberto, Russi, Elvio, Tubaro, Andrea, Zagonel, Vittorina, Crepaldi, Gaetano, Maggi, Stefania, Gaetano, Crepaldi, Umberto, Basso, Luigi, Corti, D'Agostino, Daniele, Matteo, Dandrea, Davide, Bosetti, Gianpiero, Catalano, Ottavio, De Cobelli, Lucrezia, Deantoni Chiara, Nadia, Di Muzio, Ferro, Matteo, Andrei, Fodor, Pierdaniele, La Mattina, Emanuele, Montanari, Barbieri, Michele, Valentina, Borzillo, Chiancone, Francesco, Sara, Falivene, Paolo, Fedelini, Imbimbo, Ciro, Paolo, Muto, Sarah, Scagliarini, Giovanni, Muzzonigro, Enrica, Ambrosi, Alessandro, Antonelli, Lilia, Bardoscia, Stefania, Berlingheri, Alfredo, Berruti, Alberto, Buffoli, Michela, Buglione, Mauro, Scanzi, Elisabetta, Castrezzati, Paolo, Frata, Giulio, Francolini, Beatrice, Detti, Tommaso, Chini, Carlotta, Becherini, Olga, Cristiano, Cesare, Guida, Sara, Bartoncini, Consuelo, Buttigliero, Emanuele, Castelli, Devis, Collura, Stefano, De Luca, Pietro, Gabriele, Elisabetta, Garibaldi, Alessandro, Giacobbe, Paolo, Gontero, Alessia, Guarneri, Alberto, Gurioli, Francesco, Porpiglia, Franco, Randone Donato, Vittorio, Scagliotti Giorgio, Cynthia, Aristei, Rita, Bellavita, Isabella, Palumbo, Franco, Bardari, Augusto, Negro Carlo Luigi, Franco, Bergamaschi, Maria, Galeandro, Cinzia, Iotti, Giuseppe, Raguso, Paola, Ruggieri Maria, Giuseppe, Ruoppo, Marco, Borghesi, Eugenio, Brunocilla, Claudio, Degli Esposti, Giovanni, Frezza, Michele, Malizia, Maria, Ntreta, Alessandro, Parisi, Riccardo, Schiavina, Roberto, Bortolu, Giuseppe, Bove, Antonio, Cisternino, Carrieri, Giuseppe, Giuseppe, Difino, Oscar, Selvaggio, Maurizio, Brausi, Alessio, Bruni, Frank, Lohr, Ercole, Mazzeo, Enza, Lamanna, Calogero, Di Stefano, Giorgio, Bruno, Michela, Caldiroli, Ilaria, Ferrari, Laura, Giussani, Lovisolo Jon, A. J., Mario, Marconi Alberto, Giuseppe, Cardo, Mario, Ludovico Giuseppe, Marcello, Scarcia, Giorgio, Carmignani, Salvina, Barra, Dario, Cavallini Francolini, Franco, Corbella, Ofelia, Ceccarini, Luigi, Da Pozzo, Agostina, De Stefani, Corrado, Italia, Stefano, Masciullo, Valentina, Roboldi, Marco, Roscigno, Antonio, Celia, Bernardino, De Concilio, Claudia, Cianci, Francesco, Francesca, Giorgio, Pomara, Michele, Santarsieri, Fiorenza, Cortese, Andrea, Di Stasio, Franco, Montefiore, Armando, Serao, D'Elia, Carolina, Armin, Pycha, Dorijan, Huqi, Paolo, De Angeli, Nicola, Macchione, Francesco, Fontanta, Giorgio, Monesi, Antonello, De Lisa, Giuseppe, Giusti, Giorgio, Musca, Anna, Destito, Rosa, Molè, Danilo, Di Trapani, Francesco, Ferrau, Carmela, Palazzolo, Angelo, Platania, Anna, Santacaterina, Grazia, Lazzari, Fabiola, Liberale, Gregorio, Moro, Giovanni, Liguori, Nicola, Pavan, Francesca, Maggio, Marco, Orsatti, Giovanni, Mandoliti, Giampaolo, Montesi, Luigi, Marafioti, Antonietta, Martilotta, Adele, Massenzo, Luisa, Marciello, Salvino, Marzano, Caterina, Polli, Gloria, Maso, Serena, Medoro, Giuseppe, Morgia, Napodano, Giorgio, Pistone, Antonio, Roberto, Sanseverino, Mattia, Nidini, Paolo, Parma, Valerio, Pizzuti, Sciorio, Carmine, Scuzzarella, Salvatore, Tindaro, Scolaro, Porreca A, Noale M, Artibani W, Bassi PF, Bertoni F, Bracarda S, Conti GN, Corvò R, Gacci M, Graziotti P, Magrini SM, Mirone V, Montironi R, Muto G, Pecoraro S, Ricardi U, Russi E, Tubaro A, Zagonel V, Crepaldi G, Maggi S, Crepaldi G, Maggi S, Noale M, Porreca A, Artibani W, Bassi P, Bracarda S, Conti GN, Corvò R, Graziotti P, Russi E, Mirone V, Montironi R, Bertoni F, Gacci M, Magrini SM, Muto G, Pecoraro S, Ricardi U, Tubaro A, Zagonel V, Alitto AR, Ambrosi E, Antonelli A, Aristei C, Barbieri M, Bardari F, Bardoscia L, Barra S, Bartoncini S, Basso U, Becherini C, Bellavita R, Bergamaschi F, Berlingheri S, Berruti A, Borghesi M, Bortolus R, Borzillo V, Bosetti D, Bove G, Bove P, Brausi M, Bruni A, Bruno G, Brunocilla E, Buffoli A, Buglione M, Buttigliero C, Cacciamani G, Caldiroli M, Cardo G, Carmignani G, Carrieri G, Castelli E, Castrezzati E, Catalano G, Cattarino S, Catucci F, Cavallini FD, Ceccarini O, Celia A, Chiancone F, Chini T, Cianci C, Cisternino A, Collura D, Corbella F, Corinti M, Corsi P, Cortese F, Corti L, de Nunzio C, Cristiano O, D'Angelillo RM, Da Pozzo L, D'agostino D, D'Elia C, Dandrea M, De Angelis M, De Angelis P, De Cobelli O, De Concilio B, De Lisa A, De Luca S, De Stefani A, Deantoni CL, Degli EC, Destito A, Detti B, Di Muzio N, Di Stasio A, Di Stefano C, Di Trapani D, Difino G, Falivene S, Farullo G, Fedelini P, Ferrari I, Ferrau F, Ferro M, Fodor A, Fontanta F, Francesca F, Francolini G, Frata P, Frezza G, Gabriele P, Galeandro M, Garibaldi E, Gennari PG, Gentilucci A, Giacobbe A, Giussani L, Giusti G, Gontero P, Guarneri A, Guida C, Gurioli A, Huqi D, Imbimbo C, Ingrosso G, Iotti C, Italia C, La Mattina P, Lamanna E, Lastrucci L, Lazzari G, Liberale F, Liguori G, Lisi R, Lohr F, Lombardo R, Lovisolo JAJ, Ludovico GM, Macchione N, Maggio F, Malizia M, Manasse G, Mandoliti G, Mantini G, Marafioti L, Marciello L, Marconi AM, Martilotta A, Marzano S, Masciullo S, Maso G, Massenzo A, Mazzeo E, Mearini L, Medoro S, Molè R, Monesi G, Montanari E, Montefiore F, Montesi G, Morgia G, Moro G, Muscas G, Musio D, Muto P, Muzzonigro G, Napodano G, Negro CLA, Nidini M, Ntreta M, Orsatti M, Palazzolo C, Palumbo I, Parisi A, Parma P, Pavan N, Pericolini M, Pinto F, Pistone A, Pizzuti V, Platania A, Polli C, Pomara G, Ponti E, Porcaro AB, Porpiglia F, Pugliese D, Pycha A, Raguso G, Rampini A, Randone DF, Roboldi V, Roscigno M, Ruggieri MP, Ruoppo G, Sanseverino R, Santacaterina A, Santarsieri M, Santoni R, Scagliarini S, Scagliotti GV, Scanzi M, Scarcia M, Schiavina R, Sciarra A, Sciorio C, Scolaro T, Scuzzarella S, Selvaggio O, Serao A, Serni S, Signor MA, Silvani M, Silvano G, Silvestris F, Simeone C, Simone V, Spagnoletti G, Spinelli MG, Squillace L, Tombolini V, Toninelli M, Triggiani L, Trinchieri A, Trodella LE, Trodella L, Trombetta C, Tronnolone L, Tucci M, Urzì D, Valdagni R, Valeriani M, Vanoli M, Vitali E, Volpe A, Zaramella S, Zeccolini G, Zini G, Porreca, A., Noale, M., Artibani, W., Bassi, P. F., Bertoni, F., Bracarda, S., Conti, G. N., Corvo, R., Gacci, M., Graziotti, P., Magrini, S. M., Mirone, V., Montironi, R., Muto, G., Pecoraro, S., Ricardi, U., Russi, E., Tubaro, A., Zagonel, V., Crepaldi, G., Maggi, S., Alitto, A. R., Ambrosi, E., Antonelli, A., Aristei, C., Barbieri, M., Bardari, F., Bardoscia, L., Barra, S., Bartoncini, S., Basso, U., Becherini, C., Bellavita, R., Bergamaschi, F., Berlingheri, S., Berruti, A., Borghesi, M., Bortolus, R., Borzillo, V., Bosetti, D., Bove, G., Bove, P., Maurizio, B., Alessio, B., Giorgio, B., Eugenio, B., Alberto, B., Michela, B., Consuelo, B., Giovanni, C., Michela, C., Giuseppe, C., Giorgio, C., Emanuele, C., Elisabetta, C., Gianpiero, C., Susanna, C., Catucci, F., Dario, C. F., Ofelia, C., Antonio, C., Francesco, C., Tommaso, C., Claudia, C., Devis, C., Franco, C., Matteo, C., Paolo, C., Fiorenza, C., Luigi, C., Cosimo, N., Cristiano, O., D'Angelillo, R. M., Da Pozzo, L., D'Agostino, D., D'Elia, C., Dandrea, M., De Angelis, M., De Angelis, P., De Cobelli, O., De Concilio, B., De Lisa, A., De Luca, S., De Stefani, A., Deantoni, C. L., Degli, E. C., Destito, A., Detti, B., Di Muzio, N., Di Stasio, A., Di Stefano, C., Di Trapani, D., Difino, G., Falivene, S., Farullo, G., Fedelini, P., Ferrari, I., Ferrau, F., Ferro, M., Fodor, A., Fontanta, F., Francesca, F., Francolini, G., Frata, P., Frezza, G., Gabriele, P., Galeandro, M., Garibaldi, E., Gennari, P. G., Gentilucci, A., Giacobbe, A., Giussani, L., Giusti, G., Gontero, P., Guarneri, A., Guida, C., Gurioli, A., Huqi, D., Imbimbo, C., Ingrosso, G., Iotti, C., Italia, C., La Mattina, P., Lamanna, E., Lastrucci, L., Lazzari, G., Liberale, F., Liguori, G., Lisi, R., Lohr, F., Lombardo, R., Lovisolo, J. A. J., Ludovico, G. M., Macchione, N., Maggio, F., Malizia, M., Manasse, G., Mandoliti, G., Mantini, G., Marafioti, L., Marciello, L., Marconi, A. M., Martilotta, A., Marzano, S., Masciullo, S., Maso, G., Massenzo, A., Mazzeo, E., Mearini, L., Medoro, S., Mole, R., Monesi, G., Montanari, E., Montefiore, F., Montesi, G., Morgia, G., Moro, G., Muscas, G., Musio, D., Muto, P., Muzzonigro, G., Napodano, G., Negro, C. L. A., Nidini, M., Ntreta, M., Orsatti, M., Palazzolo, C., Palumbo, I., Parisi, A., Parma, P., Pavan, N., Pericolini, M., Pinto, F., Pistone, A., Pizzuti, V., Platania, A., Polli, C., Pomara, G., Ponti, E., Porcaro, A. B., Porpiglia, F., Pugliese, D., Pycha, A., Raguso, G., Rampini, A., Randone, D. F., Roboldi, V., Roscigno, M., Ruggieri, M. P., Ruoppo, G., Sanseverino, R., Santacaterina, A., Santarsieri, M., Santoni, R., Scagliarini, S., Scagliotti, G. V., Scanzi, M., Scarcia, M., Schiavina, R., Sciarra, A., Sciorio, C., Scolaro, T., Scuzzarella, S., Selvaggio, O., Serao, A., Serni, S., Signor, M. A., Silvani, M., Silvano, G., Silvestris, F., Simeone, C., Simone, V., Spagnoletti, G., Spinelli, M. G., Squillace, L., Tombolini, V., Toninelli, M., Triggiani, L., Trinchieri, A., Trodella, L. E., Trodella, L., Trombetta, C., Tronnolone, L., Tucci, M., Urzi, D., Valdagni, R., Valeriani, M., Vanoli, M., Vitali, E., Volpe, A., Zaramella, S., Zeccolini, G., Zini, G., Porreca, A, Noale, M, Artibani, W, Bassi, P, Bertoni, F, Bracarda, S, Conti, G, Corvò, R, Gacci, M, Graziotti, P, Magrini, S, Mirone, V, Montironi, R, Muto, G, Pecoraro, S, Ricardi, U, Russi, E, Tubaro, A, Zagonel, V, Crepaldi, G, Maggi, S, and Da Pozzo, L

Subjects
Male, 030232 urology & nephrology, Severity of Illness Index, Prostate cancer, 0302 clinical medicine, Quality of life, Activities of Daily Living, Diagnosis, Medicine, Age Factor, Prospective Studies, Prospective cohort study, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Age Factors, Pros-IT CNR study, General Medicine, Health Survey, Middle Aged, Neoadjuvant Therapy, 3. Good health, Italy, 030220 oncology & carcinogenesis, lcsh:R858-859.7, Regression Analysis, Public Health, Human, Diagnosi, prostate cancer, survival, quality of life, medicine.medical_specialty, lcsh:Computer applications to medicine. Medical informatics, Regression Analysi, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, Severity of illness, Humans, Aged, Cancer staging, business.industry, Research, Environmental and Occupational Health, Public Health, Environmental and Occupational Health, Prostatic Neoplasms, Cancer, medicine.disease, Health Surveys, Comorbidity, Quality of Life, Prospective Studie, Settore MED/24, Prostatic Neoplasm, business, Sexual function
Abstract

Background The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care.

Published
2018

20. PO-0846: Preliminary outcome results of a PET-CT based direct planning protocol in head and neck radiotherapy

Author

S. Di Biase, L. Rampin, A. Ferretti, E. Bellan, G. Virdis, Giampaolo Montesi, M. Maffione, Giovanni Pavanato, F. Perrotti, and Giovanni Mandoliti

Subjects
Protocol (science), medicine.medical_specialty, PET-CT, Oncology, Head and neck radiotherapy, business.industry, medicine, Radiology, Nuclear Medicine and imaging, Hematology, Radiology, business, Outcome (game theory)
Published
2020

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

Author

M. Santarelli, Giampaolo Montesi, Masiello, Francesco Cellini, Alessio G. Morganti, Salvatore Parisi, Savino Cilla, Stefano Pergolizzi, Antonino D'Agostino, Giambattista Siepe, C.M. Donati, Francesco Pastore, Francesco Deodato, Ernesto Maranzano, Rossella Di Franco, Paolo Muto, Salatino A, Stefania Manfrida, Valentini, Anna Santacaterina, Fabio Arcidiacono, and Fusco

Subjects
Stereotactic radiotherapy, medicine.medical_specialty, Text mining, Pain reduction, business.industry, medicine, Radiology, 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. Still is lacking evidence from randomized, direct comparison of RT and SBRT. Methods/Design The PREST trial was designed as an interventional study without medicinal, randomized 1:1, open-label, multicentric, phase 3. Inclusion criteria: painful spinal bone metastases presenting pain level >4 (or >1 if assuming analgesic) at numeric rating scale (NRS); expected intermediate/high prognosis (superior to 6 months) according to the Mizumoto prognostic score; low spine instability neoplastic score (SINS) sores (

Published
2019

22. 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

23. Radiotherapy for Early-Stage Prostate Cancer in Men under 70 Years of Age

Author

Giampaolo Montesi, Melissa Scricciolo, Cynthia Aristei, Isabella Palumbo, Marco Lupattelli, Valentina Lancellotta, Fabio Arcidiacono, Rita Bellavita, Vittorio Bini, and C. Zucchetti

Subjects
Male, Oncology, Cancer Research, medicine.medical_treatment, 030232 urology & nephrology, Kaplan-Meier Estimate, Gastroenterology, Prostate cancer, 0302 clinical medicine, Risk Factors, Medicine, Neoadjuvant therapy, Radical radiotherapy, Age Factors, Radiotherapy Dosage, General Medicine, Middle Aged, Prognosis, Neoadjuvant Therapy, Prostate-specific antigen, Treatment Outcome, Dose, 030220 oncology & carcinogenesis, Toxicity, Adenocarcinoma, medicine.medical_specialty, Antineoplastic Agents, Hormonal, Urogenital System, Disease-Free Survival, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Biomarkers, Tumor, Humans, Aged, Neoplasm Staging, Retrospective Studies, business.industry, Prostatic Neoplasms, Retrospective cohort study, Prostate-Specific Antigen, medicine.disease, Acute toxicity, Gastrointestinal Tract, Radiation therapy, Neoplasm Grading, Radiotherapy, Conformal, business, Follow-Up Studies
Abstract

Aims To demonstrate that radiotherapy (RT) is a valid alternative to surgery in men ≤70 years old with localized prostate cancer. Methods From 1988 to 2009, 214 patients with T1-2 N0 M0 prostate cancer were treated with RT. The effects of patient- and treatment-related risk factors on toxicity were investigated. Results Median follow-up was 105 months (range 14.2-180). The 5-, 10-, and 15-year biochemical relapse-free survival for all 214 patients was 80%, 61.9%, and 57.5%, respectively. In bivariate analysis, age (≤65 vs 65-70 years) was not a significant factor for biochemical relapse, while radiation dose was (p = 0.05) in multivariate analysis. Cancer-specific survival rates at 5, 10, and 15 years were 98.4%, 93.2%, and 69.7%, respectively. Median overall survival (OS) was 167 months (95% confidence interval 147.3-186.7). The OS rates at 5, 10, and 15 years were 91.8%, 75.8%, and 42.5%, respectively. Acute genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 105 (49%) and 98 patients (45.8%), respectively, with only 2 cases of grade III GI toxicity. Late GU and GI toxicities occurred in 17 (7.9%) and 20 (9.3%) patients, respectively, with 1 grade III GI toxicity and 2 grade III GU toxicities. Risk factors for late toxicity were age and RT dose and technique, which were unrelated to acute toxicity. Conclusions Age ≤70 years does not consistently confer a negative prognosis for localized prostate cancer. Radiotherapy appears to be a viable alternative to surgery, offering excellent long-term cancer control.

Published
2015

24. Epstein-Barr Virus-Positive Mucocutaneous Ulcer Mimicking Rectal Carcinoma at 18F-FDG PET/CT

Author

Giampaolo Montesi, Giovanni Pavanato, Domenico Rubello, Patrick M. Colletti, Laura Camilla Lisato, Maria Ballotta, Lucia Rampin, Rossella Paolini, Elisabetta Rodella, and Anna Margherita Maffione

Subjects
0301 basic medicine, Male, Pathology, medicine.medical_specialty, Herpesvirus 4, Human, Chronic lymphocytic leukemia, Mucocutaneous zone, Gastroenterology, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Fluorodeoxyglucose F18, hemic and lymphatic diseases, Internal medicine, Positron Emission Tomography Computed Tomography, Rectal carcinoma, medicine, Rectal Adenocarcinoma, Humans, Radiology, Nuclear Medicine and imaging, Ulcer, Epstein-Barr Virus-Positive Mucocutaneous Ulcer, Aged, 80 and over, business.industry, Rectal Neoplasms, Histology, General Medicine, medicine.disease, 030104 developmental biology, 030220 oncology & carcinogenesis, Fdg pet ct, Differential diagnosis, business
Abstract

We report focally intense F-FDG PET/CT rectal activity (SUVmax = 25) with a horseshoe distribution in an 81-year-old man with B-cell chronic lymphocytic leukemia and suspected Richter transformation. While imaging findings were typical for rectal adenocarcinoma, histology revealed Epstein-Barr virus-positive mucocutaneous ulcer.

Published
2017

25. Statins Protect Against Acute RT-related Rectal Toxicity in Patients with Prostate Cancer: An Observational Prospective Study

Author

Alessandro Frattegiani, C. Mariucci, Isabella Palumbo, E. Arena, Lorenzo Falcinelli, Giampaolo Montesi, Rita Bellavita, Fabio Matrone, Cynthia Aristei, Marco Lupattelli, Vittorio Bini, and Simonetta Saldi

Subjects
Male, Oncology, Cancer Research, medicine.medical_specialty, Intensity-modulated radiotherapy, Urology, Rectum, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Risk Factors, Prostate, Internal medicine, Acute rectal toxicity, medicine, Humans, Prospective Studies, Radiation Injuries, Radiometry, Prospective cohort study, Aged, Aged, 80 and over, Univariate analysis, business.industry, Statins, Prostatic Neoplasms, Common Terminology Criteria for Adverse Events, General Medicine, Middle Aged, Prostate-Specific Antigen, medicine.disease, Prostate-specific antigen, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Hormonal therapy, Hypofractionation, Dose Fractionation, Radiation, Radiotherapy, Intensity-Modulated, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

AIM To analyze risk factors for acute rectal toxicity during hypofractionated intensity-modulated radiotherapy (IMRT) for prostate cancer. PATIENTS AND METHODS A total of 195 patients received 74.25 Gy in 33 fractions to the prostate and, if involved, to the seminal vescicles (SV). When the risk of SV involvement was >15% according to the Roach's formula, they received 62 Gy in 33 fractions. Overall, 107/195 patients (54.87%) received hormonal therapy (luteinizing hormone-releasing hormone analogue, anti-androgen, or both). Common Terminology Criteria for Adverse Events version 3.0 was used to classify rectal toxicity. RESULTS Acute rectal toxicity occurred in 79 (40.51%) patients (grade 1 in 44). In univariate analysis, use of calcium channel blockers significantly reduced the acute rectal toxicity rate and 3-hydroxy-methylglutaryl CoA reductase inhibitors (statins) significantly reduced the rectal toxicity rate and grade. In multivariate analysis, only statin use was an independent protective factor. CONCLUSION In patients with prostate cancer treated with a moderate hypofractionated IMRT schedule, use of statins lowered the incidence and grade of acute rectal toxicity.

Published
2017

26. Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients

Author

Fabio Matrone, Maika di Benedetto, Giampaolo Montesi, Gabriella Macchia, Giuditta Chiloiro, Liliana Belgioia, E. Palazzari, R.M. Niespolo, Francesco Romeo Filippone, L. Giaccherini, M.E. Rosetto, Aldo Sainato, Salvatore Parisi, Luciana Caravatta, Antonino De Paoli, Mattia Falchetto Osti, Piera Sciacero, A. Fontana, Vincenzo Valentini, A. Caroli, Carlo Capirci, Caterina Boso, Lucia Turri, Alessio G. Morganti, Maria Antonietta Gambacorta, S. Montrone, Almalina Bacigalupo, Domenico Genovesi, Vincenzo Picardi, Alessandra Galardi, Carlotta Masciocchi, Marco Lupattelli, Giovanna Mantello, Macchia, Gabriella, Gambacorta, Maria Antonietta, Masciocchi, Carlotta, Chiloiro, Giuditta, Mantello, Giovanna, di Benedetto, Maika, Lupattelli, Marco, Palazzari, Elisa, Belgioia, Liliana, Bacigalupo, Almalina, Sainato, Aldo, Montrone, Sabrina, Turri, Lucia, Caroli, Angela, De Paoli, Antonino, Matrone, Fabio, Capirci, Carlo, Montesi, Giampaolo, Niespolo, Rita Marina, Osti, Mattia Falchetto, Caravatta, Luciana, Galardi, Alessandra, Genovesi, Domenico, Rosetto, Maria Elena, Boso, Caterina, Sciacero, Piera, Giaccherini, Lucia, Parisi, Salvatore, Fontana, Antonella, Filippone, Francesco Romeo, Picardi, Vincenzo, Morganti, Alessio Giuseppe, and Valentini, Vincenzo

Subjects
medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Urology, R895-920, 030230 surgery, Article, 03 medical and health sciences, Medical physics. Medical radiology. Nuclear medicine, 0302 clinical medicine, Chemoradiation, Rectal cancer, Surgery, TME, Time interval, Rectal Adenocarcinoma, Medicine, Radiology, Nuclear Medicine and imaging, Stage (cooking), RC254-282, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Chemotherapy, business.industry, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Retrospective cohort study, medicine.disease, Total mesorectal excision, Radiation therapy, Oncology, 030220 oncology & carcinogenesis, Population study, business
Abstract

Highlights • A large population based analysis to evaluate pathologic response according to time of surgery. • LARC patients were treated with modern techniques of radiotherapy and surgery. • The rate of pCR increased according to time interval from 12.6% to 31.1%. • The pCR increasing was 1.5% (about 0.2%/die) per each week of waiting. • Lengthening the interval (>13 weeks) significantly improved the pathological response., Background To retrospectively evaluate the difference in terms of pathologic complete response (pCR) according to time elapsed between chemoradiation (CRT) and total mesorectal excision (TME) on a large unselected real-life dataset of locally advanced rectal cancer (LARC) patients. Methods A multicentre retrospective cohort study of LARC patients from 21 Italian Radiotherapy Institutions was performed. Patients were stratified into 3 different time intervals from CRT. The 1st group included 300 patients who underwent TME within 6 weeks, the 2nd 1598 patients (TME within 7–12 weeks) and the 3rd 196 patients (TME within 13 or more weeks after CRT), respectively. Results Data on 2094 LARC patients treated between 1997 and 2016 were considered suitable for analysis. Overall, 578 patients had stage II while 1516 had stage III histological proven invasive rectal adenocarcinoma. A CRT schedule of one agent (N = 1585) or 2-drugs (N = 509) was administered. Overall, pCR was 22.3% (N = 468 patients). The proportion of patients achieving pCR with respect to time interval was, as follows: 12.6% (1st group), 23% (2nd group) and 31.1% (3rd group) (p 5040 cGy (p = 0.002) and longer interval (p 13 weeks) from CRT to surgery improves the pathological response (pCR and pathologic partial response; pPR) in comparison to historic data. Furthermore, radiotherapy dose >5040 cGy and two drugs chemotherapy correlated with pPR rate.

Published
2017

27. EP-1527: Pelvic Intensity-Modulated Radiotherapy in prone and supine position in gynaecological cancer

Author

M. Marcantonini, A. Didona, Valentina Lancellotta, Giampaolo Montesi, A. Cavalli, S. Saccia, Elisabetta Perrucci, Cynthia Aristei, C. Mariucci, Vittorio Bini, and M. Mendichi

Subjects
medicine.medical_specialty, Supine position, business.industry, Hematology, Gynaecological cancer, Surgery, 03 medical and health sciences, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, medicine, Radiology, Nuclear Medicine and imaging, Radiology, Intensity modulated radiotherapy, business
Published
2017

28. Prostate cancer: contouring target and organs at risk by kilovoltage and megavoltage CT and MRI in patients with and without hip prostheses

Author

Cynthia Aristei, Valentina Lancellotta, Fabio Arcidiacono, Isabella Palumbo, Vittorio Bini, Fabio Matrone, Marta Marcantonini, Valentina Radicchia, Lorenzo Falcinelli, C. Zucchetti, and Giampaolo Montesi

Subjects
Male, Organs at Risk, medicine.medical_specialty, Megavoltage ct, Short Communication, Radiotherapy Planning, Urinary Bladder, Rectum, Prostate cancer, Computer-Assisted, Artifacts, Observer Variation, Prostate, Prostatic Neoplasms, Radiotherapy Planning, Computer-Assisted, Hip Prosthesis, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Contouring, Urinary bladder, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Radiology, business, Tomography, X-Ray Computed
Abstract

In radiotherapy treatment, planning target volume and organs at risk are contoured on kilovoltage CT (kVCT) images. Unlike MR images, kVCT does not provide precise information on target volume extension. Since neither kVCT nor MRI may be suitable for contouring in patients with ferrous hip prostheses, this study evaluated whether megavoltage CT (MVCT) reduced interobserver variability.Two patients without hip prostheses and one patient (Patient 3) with hip prostheses were enrolled. Six radiation oncologists contoured prostate, rectum and bladder on kVCT (Patients 1 and 3), MRI (Patient 2) and MVCT images (Patient 3). MVCT was acquired with fine, normal and coarse modalities. Interobserver variability for each organ was analysed using conformity index (CI) and coefficient of variation (CV).In patients without hip prostheses, CIs were higher in prostate contouring with MRI than with kVCT, indicating lower interobserver variability with MRI. Very slight variations were seen in rectum and bladder contouring. In the patient with hip prostheses (Patient 3), contouring on kVCT lowered CI and increased CV in the prostate, bladder and rectum. The differences were more marked in the prostate. Only fine modality MVCT reduced interobserver variability and only for the prostate.Even though greater noise and less soft-tissue contrast increase contouring variability with MVCT than with kVCT, lack of artefacts on MVCT could provide better image definition by this modality in hip prosthesis patients in whom MRI is precluded.We recommend the fine modality MVCT for contouring hip prostheses patients.

Published
2015

29. Recurrences and toxicity after adjuvant vaginal brachytherapy in Stage I-II endometrial cancer: A monoinstitutional experience

Author

Isabella Palumbo, Elisabetta Perrucci, Valentina Lancellotta, C. Zucchetti, C. Mariucci, Stefano Saccia, Giampaolo Montesi, Vittorio Bini, and Cynthia Aristei

Subjects
Adult, medicine.medical_specialty, Brachytherapy, Endometrial cancer, Relapse, Vaginal Neoplasms, medicine.medical_treatment, Urology, Disease-Free Survival, 030218 nuclear medicine & medical imaging, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Radiation Injuries, Chronic toxicity, Aged, Neoplasm Staging, Aged, 80 and over, business.industry, Hazard ratio, Middle Aged, medicine.disease, Confidence interval, Surgery, Endometrial Neoplasms, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Toxicity, Vagina, Lymphadenectomy, Female, Radiotherapy, Adjuvant, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

Purpose To evaluate the incidences of vaginal recurrence and toxicity after vaginal brachytherapy in Stage I–II endometrial cancer. Methods and Materials Between 2003 and 2012, 150 high-intermediate-risk Stage I and 7 Stage II patients, median age 64 years, underwent surgery, with or without lymphadenectomy, and 3D brachytherapy: 7 Gy, at 5 mm depth from applicator surface, for 3-week fractions. The effects of age, grading, number of excised lymph nodes and pathologic stage on loco-regional relapse (LRR), metastases, and tumor-related death were investigated. Vaginal toxicity was evaluated during followup visits. Results At 83 months of median followup, 144 patients were disease free, 2 in relapse, 7 deceased from disease, and 4 from other causes. One vaginal (0.6%), five nodal (3.2%), three pelvic over the vaginal cuff (1.9%), and one distant recurrences were seen (0.6%). The 5-year probability of LRR-free, distant metastasis-free and cause-specific survivals for all patients were 93.6% (95% confidence interval [CI]: 88.1–96.7), 97.8% (95% CI: 93.2–99.3), and 96.5% (95% CI: 93.5–99.5) and for Stage I 95.7% (95% CI: 92.2–9.1), 99.3% (95% CI: 98.0–100), and 97.7% (95% CI: 95.2–100), respectively. At multivariate analysis, Stage II disease and more than 12 lymph nodes sampled were associated with LRR (hazard ratio [HR]: 3.88; 95% CI: 1.390–10.878; p = 0.010 and HR: 6.952; 95% CI: 1.591–30.385; p = 0.010) and Stage II with metastasis and tumor-related death (HR: 23.057; 95% CI: 2.296–231.485; p = 0.008 and HR: 4.324; 95% CI: 1.223–15.290; p = 0.023). Vaginal acute and chronic toxicity was 16% and 55.4%, respectively, all only Grades 1–2. Conclusions For high-to-intermediate-risk Stage I endometrial cancer, 3D vaginal brachytherapy achieved good local control and low toxicity. In Stage II, patients brachytherapy could be administered after complete surgical staging.

Published
2015

30. Metachronous cardiac and cerebral sarcomas: case report with focus on molecular findings and review of the literature

Author

Angelo Sidoni, Angela Guerriero, Giampaolo Montesi, Roberta La Starza, Stefano Pasquino, Paolo Giovenali, Cristina Mecucci, Tiziana Pierini, and Temistocle Ragni

Subjects
Male, Pathology, medicine.medical_specialty, Monosomy, Gliosarcoma, 12E7 Antigen, medicine.disease_cause, Asbestos, Pathology and Forensic Medicine, Synovial sarcoma, Heart Neoplasms, Fatal Outcome, Multiple primary tumors, Antigens, CD, Neoplasms, Asbestos exposure, Cardiac sarcoma, Brain Neoplasms, Cell Adhesion Molecules, Combined Modality Therapy, Humans, Immunohistochemistry, Middle Aged, Neoplasm Grading, Neoplasms, Second Primary, Sarcoma, Vimentin, medicine, Mesothelioma, Family history, Antigens, business.industry, Cancer, medicine.disease, CD, Second Primary, business
Abstract

Although multiple primary malignancies are relatively rare, they have increased in frequency over the last decades, partly because of advances in diagnosis and therapy. This report describes for the first time the case of a patient with past occupational exposure to asbestos and no family history of cancer who developed 2 rare primary malignancies: a cardiac sarcoma and a gliosarcoma 11 months later. Molecular-cytogenetic studies did not identify common lesions to these 2 rare metachronous sarcomas. The gliosarcoma was associated with monosomy 10 and underlying PTEN monoallelic loss, which has been recurrently observed. In the cardiac sarcoma, MDM2 amplification and CDKN2AB/9p21 biallelic deletion suggested intimal sarcoma. No causal relationship was found between cardiac sarcoma and asbestos exposure, although MDM2 abnormalities were linked to malignant mesothelioma.

Published
2015

31. PV-0326: Time to surgery and pCR after neoadjuvant CRT in rectal cancer: a population study on 2113 patients

Author

L. Giaccherini, Gabriella Macchia, M.A. Gambacorta, Alessandra Galardi, A. De Paoli, Luciana Caravatta, Caterina Boso, Giampaolo Montesi, Mattia Falchetto Osti, Carlotta Masciocchi, Marco Lupattelli, Liliana Belgioia, M.E. Rosetto, F. Perrotti, Salvatore Parisi, Lucia Turri, R.M. Niespolo, Francesco Romeo Filippone, Giovanna Mantello, Piera Sciacero, V. Valentini, Giuditta Chiloiro, Alessio G. Morganti, Aldo Sainato, and A. Fontana

Subjects
medicine.medical_specialty, Oncology, Colorectal cancer, business.industry, Time to surgery, medicine, Population study, Radiology, Nuclear Medicine and imaging, Hematology, medicine.disease, business, Surgery
Published
2017

32. Short-course radiotherapy with delayed surgery in unfit locally advanced rectal cancer patients

Author

Cynthia Aristei, Marco Lupattelli, Danilo Castellani, Valentina Lancellotta, Isabella Palumbo, Vittorio Bini, Lorenzo Falcinelli, and Giampaolo Montesi

Subjects
rectal cancer, radiotherapy, medicine.medical_specialty, Rectal Neoplasms, business.industry, Colorectal cancer, General surgery, Gastroenterology, Locally advanced, 030230 surgery, Hepatology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, Delayed surgery, Humans, Neoplasm Recurrence, Local, rectal cancer, business, radiotherapy, Aged, Neoplasm Staging, Short course radiotherapy
Published
2015

33. EP-1260: Risk factors for acute toxicity in prostate cancer patients receiving hypofractionated IMRT

Author

Giampaolo Montesi, S. Cusco, Rita Bellavita, Simonetta Saldi, C. Zucchetti, Cynthia Aristei, Alessandro Frattegiani, Marco Lupattelli, Vittorio Bini, and Fabio Matrone

Subjects
Oncology, medicine.medical_specialty, Prostate cancer, business.industry, Radiology Nuclear Medicine and imaging, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, Hematology, medicine.disease, business, Acute toxicity
Published
2015
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35. Does ultrasound provide any added value in breast contouring for radiotherapy after conserving surgery for cancer?

Author

C. Zucchetti, G. Gobbi, Barbara Palumbo, Cynthia Aristei, Valentina Lancellotta, Giampaolo Montesi, Isabella Palumbo, Vittorio Bini, Rossana Crisci, Laura Cardinali, and Lorenzo Falcinelli

Subjects
Adult, medicine.medical_specialty, Breast contouring, medicine.medical_treatment, Breast Neoplasms, Mastectomy, Segmental, Palpation, Breast conserving surgery, Intra-modality variability, Palpation vs ultrasound vs CT, Radiotherapy, Breast cancer, Whole Breast Irradiation, medicine, Breast-conserving surgery, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, skin and connective tissue diseases, Aged, Ultrasonography, Contouring, medicine.diagnostic_test, business.industry, Research, Radiotherapy Planning, Computer-Assisted, Ultrasound, Reproducibility of Results, Middle Aged, medicine.disease, Surgery, Radiation therapy, Oncology, Radiology Nuclear Medicine and imaging, Female, Tomography, Radiology, Tomography, X-Ray Computed, business
Abstract

Background Whole breast irradiation after conserving surgery for breast cancer requires precise definition of the target volume. The standard approach uses computed tomography (CT) images. However, since fatty breast and non-breast tissues have similar electronic densities, difficulties in differentiating between them hamper breast volume delineation. To overcome this limitation the breast contour is defined by palpation and then radio-opaque wire is put around it before the CT scan. To optimize assessment of breast margins in the cranial, caudal, medial, lateral and posterior directions, the present study evaluated palpation and CT and determined whether ultrasound (US) provided any added value. Methods Twenty consecutive patients were enrolled after they had provided informed consent to participating in this prospective study which was approved by the Regional Public Health Ethics Committee. Palpation and US defined breast margins and each contour was marked and outlined with a fine plastic wire. Breasts were then contoured on axial CT images using the breast window width (WW) and window level (WL) (401 and 750 Hounsfield Units –HU- respectively), at which setting the plastic wires were invisible. Then, the lung window function (WW 1601 HU; WL −300 HU) was inserted to visualize the plastic wires which were used as guidelines to contour the palpable and US breast volumes. As each wire had a different diameter, both volumes were easily defined on CT slices. Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability). Results Volumes: US gave the largest and palpation the smallest. Agreement was best between palpation and CT. Reliability was almost perfect in all correlations. Extensions: Cranial and posterior were highest with US and smallest with palpation. Agreement was best between palpation and CT in all extensions except the cranial. Since strong to almost perfect agreement emerged for all comparisons, reliability was high. Conclusions US may be useful in defining the cranial and posterior extensions, mainly when tumours are localized there. This study demonstrates that the now standard radio-opaque wires around the palpable breast may not be needed in breast contouring.

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36. EP-1182: FDG-PET does not predict outcome for early stage nonsmall- cell lung cancer after sterotactic body radiotherapy

Author

Giampaolo Montesi, Vittorio Bini, E. Arena, Cynthia Aristei, Fabio Arcidiacono, Lorenzo Falcinelli, Simonetta Saldi, M. Porcari, Rita Bellavita, N. Baffa, and F. Paglione

Subjects
Oncology, medicine.medical_specialty, business.industry, medicine.medical_treatment, Hematology, Radiation therapy, Radiology Nuclear Medicine and imaging, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, Non small cell, Stage (cooking), business
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