A.R. Alitto

Moddicom: a Complete and Easily Accessible Library for Prognostic Evaluations Relying on Image Features

Decision Support Systems (DSSs) are increasingly exploited in the area of prognostic evaluations. For predicting the effect of therapies on patients, the trend is now to use image features, i.e. information that can be automatically computed by considering images resulting by analysis. The DSSs application as predictive tools is particularly suitable for cancer treatment, given the peculiarities of the disease -which is highly localised and lead to significant social costs- and the large number of images that are available for each patient. At the state of the art, there exists tools that allow to handle image features for prognostic evaluations, but they are not designed for medical experts. They require either a strong engineering or computer science background since they do not integrate all the required functions, such as image retrieval and storage. In this paper we fill this gap by proposing Moddicom, a user-friendly complete library specifically designed to be exploited by physicians. A preliminary experimental analysis, performed by a medical expert that used the tool, demonstrates the efficiency and the effectiveness of Moddicom.

Intensified adjuvant treatment of prostate carcinoma: feasibility analysis of a phase I/II trial

Purpose. To perform a preliminary feasibility acute and late toxicity evaluation of an intensified and modulated adjuvant treatment in prostate cancer (PCa) patients after radical prostatectomy. Material and Methods. A phase I/II has been designed. Eligible patients were 79 years old or younger, with an ECOG of 0–2, previously untreated, histologically proven prostate adenocarcinoma with no distant metastases, pT2–4 N0-1, and with at least one of the following risk factors: capsular perforation, positive surgical margins, and seminal vesicle invasion. All patients received a minimum dose on tumor bed of 64.8 Gy, or higher dose (70.2 Gy; 85.4%), according to the pathological stage, pelvic lymph nodes irradiation (57.7%), and/or hormonal therapy (69.1%). Results. 123 patients were enrolled and completed the planned treatment, with good tolerance. Median follow-up was 50.6 months. Grade 3 acute toxicity was only 2.4% and 3.3% for genitourinary (GU) and gastrointestinal (GI) tract, respectively. No patient had late grade 3 GI toxicity, and the GU grade 3 toxicity incidence was 5.8% at 5 years. 5-year BDSF was 90.2%. Conclusions. A modulated and intensified adjuvant treatment in PCa was feasible in this trial. A further period of observation can provide a complete assessment of late toxicity and confirm the BDSF positive results.

RadioBio data: A Moddicom Module to Predict Tumor Control Probability and Normal Tissue Complication Probability in Radiotherapy

In this work a system for analysing radiotherapy treatment planning dose-volume data is proposed. The work starts from the definition of a framework inside a statistical scripting environment (R) used for creating a software package. The analysis of dose-volume data in radiotherapy of malignant tumours is mandatory for evaluating the prescribed treatment and for feedback analysis of outcome, both in the direction of tumour control and in detection of parameters for estimating and predicting toxicity outcome. The statistical analysis of large amount of clinical data can be slowed by the lack of practice in statistical tools needed, by clinicians, to perform such kind of analysis. This is the reason that lead our working group in the creation of such a tool. Finally an example of clinical application of our software is given for the analysis of the outcome of patients undergoing to radiotherapy for prostate cancer.

[Radiotherapy in men with prostate cancer: indications, evolutions and integrated approaches].

Prostate cancer is a heterogeneous, indolent or sometimes aggressive tumor. Treatment options are various and without proved superiority. Radiotherapy (RT) plays a key role in the disease history. Technological evolution with Intensity Modulate Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) allowed improvement, with significant results on local control and survival. Hypofractionation, Stereotactic Body RT (SBRT) and new brachytherapy approachs are still under investigation, with promising opportunities. Adjuvant vs salvage postoperative RT, hormone association, prophylactic pelvic irradiation are still under debate, but guidelines express overlapping indications.
Multidisciplinary managements will be the future for care optimization, providing the best tool for 
holistic and informed patients’ choice.1 Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy Cattedra di Radioterapia Oncologica, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Policlinico “A. Gemelli”, Roma Italy

PRODIGE: PRediction models in prOstate cancer for personalized meDIcine challenGE

AIM Identifying the best care for a patient can be extremely challenging. To support the creation of multifactorial Decision Support Systems (DSSs), we propose an Umbrella Protocol, focusing on prostate cancer. MATERIALS & METHODS The PRODIGE project consisted of a workflow for standardizing data, and procedures, to create a consistent dataset useful to elaborate DSSs. Techniques from classical statistics and machine learning will be adopted. The general protocol accepted by our Ethical Committee can be downloaded from cancerdata.org . RESULTS A standardized knowledge sharing process has been implemented by using a semi-formal ontology for the representation of relevant clinical variables. CONCLUSION The development of DSSs, based on standardized knowledge, could be a tool to achieve a personalized decision-making.

EP-2117: Is Rotational shifts necessary in SBRT? A geometric analysis using a 6-degree of freedom(6-DoF)couch

Material and Methods: The study has been performed on 10 breast cancer patients positioned on All In One system, and 10 patients treated using dedicated breast board. Selected patients represent average breast cancer patients. Patients with special setup needed, were excluded. (eg. patients with reduced arm mobility, patients with large contra lateral breast etc.). On both fixation systems the same setup protocol was used. Imaging and setup correction were performed on fractions 1, 2, 3, 8, 13, and every 5th further fraction. All the correction data were written in specially prepared forms. All the data collected were entered in excel worksheet, and further analyzed.

EP-1798: Is there a true dosimetric improvement in lung SBRT using a 6-Degree of Freedom couch in IGRT era?

Material and Methods: The planning CT scans (CT0) and 7 per-treatment weekly CT scans of 20 patients having received IMRT for prostate cancer were used. The main pelvic vessels were manually delineated: common iliac (CI), external iliac (EI) and internal iliac (II) of both sides. The central lines of the vessels were first defined thanks to a 3D workstation (EndoSize®, Therenva) dedicated to the preoperative sizing before endovascular interventions. A pelvic bone registration was then performed. For a given vascular segment, the distance between its central line CL0 from CT0 and its central line CLi from the weekly CTs were calculated.The central line CL0 of each vascular segment was sampled every mm. The distance corresponded to the mean value of the distances between corresponding points of the two central lines (CL0 and CLi). The correspondance was established by considering the cross-section plane othogonal to CL0 at a given point and its intersection with CLi. For each patient, the mean and the standard deviation (SD) of the measurements of the 7 fractions were determined. The systematic error (∑) of the whole population was calculated as the SD of the mean values. The random error (σ) of the whole population was calculated as the root mean square of the standard deviation values. The margins were calculated both with M. Van Herk formula (IJROBP 2000) and by geometrically computing margins covering 99% of the vessels displacements.

Chemoradiotherapy: Radiation Total Dose and Fractionation

Glioblastoma Multiforme (GBM) is the most common brain tumor. The standard care is surgery followed by radiotherapy plus concurrent and adjuvant temozolomide. Despite technical advances in surgery and in radiotherapy, the prognosis remains dismal with a median overall survival of around 14 months. The standard radiation total dose is 60 Gy, while the optimal dose and fractionation in elderly patients remain to be defined. At diagnosis, several studies explored altered fractionation, dose escalation strategies using techniques such as intensity modulated radiotherapy, radiosurgery, or brachytherapy, but none demonstrated a survival advantage. The optimum management at recurrence has not been established. A variety of treatment, as well as supportive care, should be considered in multidisciplinary setting in order to perform an appropriate and personalized treatment. New research trends in genomics have significantly improved our knowledge of the molecular features of GBM, and this has translated into the identification of specific targets for potential treatments. Although the results are promising, the role of new strategies in the management of these patients remains to be defined by prospective randomized trials.