Alessia Carnevale

Clinical Outcomes of Single Dose Stereotactic Radiotherapy for Lung Metastases

INTRODUCTION Stereotactic body radiation therapy is an emerging noninvasive technique for the treatment of oligometastatic cancer. The use of small numbers of large doses achieve a high percentage of local control. The aim of this study was to evaluate the efficacy and tolerability of SBRT for the treatment of lung metastases in a cohort of patients treated between 2008 and 2012 at our institution. PATIENTS AND METHODS A total of 66 patients with oligometastatic lung tumors (single pulmonary nodules in 40 patients; 61%) were included in the study. SBRT was performed with a stereotactic body frame and a 3-D conformal technique. Forty-nine central tumors received 23 Gy in a single fraction and 54 peripheral tumors received a dose of 30 Gy in a single fraction. The primary end point was local control; secondary end points were survival and toxicity. RESULTS Median follow-up was 15 months (range, 3-45 months). Local control rates at 1 and 2 years were 89.1% and 82.1%, overall survival rates were 76.4% and 31.2%, cancer-specific survival rates were 78.5% and 35.4%, and progression-free survival rates were 53.9% and 22%, respectively. Median survival time was 12 months, and median progression-free survival time was 10 months. Toxicity profiles were good, with 2 cases of Grade 3 toxicity (pneumonitis). CONCLUSION SBRT is an effective and safe local treatment option for patients with lung metastases, although it remains investigational; longer follow-up to confirm results is required.

Radiation therapy after breast reconstruction: outcomes, complications, and patient satisfaction

PurposeThe aim of this study was to evaluate treatmentrelated complications, outcomes, and patient satisfaction in women with locally advanced breast cancer who received post-mastectomy radiation therapy (PMRT) after breast reconstruction (BR).Materials and methodsBetween October 2007 and November 2010, 46 patients with locally advanced breast cancer who underwent mastectomy followed by BR received PMRT at our Department. Radiotherapy was delivered to the chest wall with a dose of 50 Gy in 25 fractions over 5 weeks.ResultsThe median follow-up was 19 months. Skin erythema grade 1 and 2 was seen in 44 (96%) and two (4%) patients, respectively. Major complications, requiring additional corrective surgical procedure, occurred in three (7%) patients (one patient with prosthesis, one patient with tissue expander and one patient with deep inferior epigastric perforator flap). At univariate analysis, smoking, chemotherapy, hormone therapy with tamoxifen and reconstruction with implant were associated with overall complications (capsular contracture and reconstruction failure). Forty (86%) patients were very satisfied or satisfied with the cosmetic outcome of reconstruction.ConclusionsRadiotherapy can be safely delivered after BR, with a low complication rate and good patient satisfaction. Further randomised studies are needed to better define the optimal timing of breast reconstruction and post-mastectomy radiation therapy.RiassuntoObiettivoScopo del nostro lavoro è stato valutare le complicanze del trattamento e il livello di soddisfazione del risultato in pazienti con tumore della mammella localmente avanzato sottoposte a trattamento radioterapico post-mastectomia e ricostruzione mammaria.Materiali e metodiTra ottobre 2007 e novembre 2010, presso il nostro Dipartimento, 46 pazienti affette da neoplasia della mammella sono state sottoposte a trattamento radioterapico dopo intervento di mastectomia radicale e ricostruzione mammaria. La dose totale somministrata sulla parete toracica è stata di 50 Gy in 25 frazioni.RisultatiA un follow-up mediano di 19 mesi, si è osservata la comparsa di eritema cutaneo di grado 1 e 2 rispettivamente in 44 (96%) e in 2 (4%) pazienti. Complicanze maggiori, che hanno richiesto un ulteriore intervento chirurgico correttivo, sono state osservate in 3 pazienti (7%). All’analisi univariata il fumo, la chemioterapia, il tamoxifene e la ricostruzione con protesi risultano associate a un maggior rischio di complicanze generali (contrattura capsulare e fallimento della ricostruzione). Quaranta pazienti (86%) si sono mostrate soddisfatte o molto soddisfatte dei risultati estetici.ConclusioniLa radioterapia dopo ricostruzione mammaria è un trattamento sicuro associato a una bassa incidenza di complicanze e a un buon livello di soddisfazione da parte delle pazienti. Sono necessari ulteriori studi per definire meglio la sequenza ottimale di trattamento tra ricostruzione mammaria e radioterapia.

Hypofractionated intensity-modulated simultaneous integrated boost and image-guided radiotherapy in the treatment of high-risk prostate cancer patients: a preliminary report on acute toxicity

AIMS AND BACKGROUND To evaluate acute toxicity of hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in the treatment of high-risk prostate cancer patients. METHODS Between November 2009 and March 2012, 59 patients with high-risk prostate cancer were enrolled. The eclipse inverse planning system (Varian) was used to calculate an IMRT plan with simultaneous integrated boost, delivering 68.75 Gy (2.75 Gy per fraction) to the prostate, 55 Gy (2.2 Gy per fraction) to the seminal vesicles and positive nodes, and 45 Gy (1.8 Gy per fraction) to the pelvis, 4 fractions per week, 25 fractions. Prior to each treatment, patients underwent a kilo-voltage cone-beam CT performing an image-guided radiation therapy (IGRT). All patients were submitted to neoadjuvant, concomitant and adjuvant hormone therapy. RESULTS The median follow-up for all patients was 13 months (range, 3-28). At the last follow-up, no grade 3 or 4 side effect was observed. Toxicity occurred as follows during the treatment: grade 1 and 2 gastrointestinal toxicity 5.2% and 6.9%, respectively; grade 1 and 2 genitourinary toxicity 24.1% and 1.7%, respectively. Only 1.7% of the patients developed grade 3 genitourinary toxicity. No grade 3 gastrointestinal toxicity was observed. CONCLUSIONS The present study demonstrated that 4/w hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in patients with high-risk prostate cancer is feasible and safe. Low acute toxicity rates were verified. Longer follow-up is needed to evaluate the outcomes in terms of late toxicity and survival.

Multifraction radiotherapy for palliation of painful bone metastases: 20 Gy versus 30 Gy

Aims and Background To compare 2 multifraction radiotherapy schedules in the palliation of painful bone metastases. Methods and Study Design We retrospectively analyzed clinical data of 105 patients with a total of 140 painful bone metastases who were treated with 20 Gy in 5 fractions or 30 Gy in 10 fractions. The primary tumors were breast (30%), lung (28%), and prostate (14%). The main sites of irradiation were spine (n = 79) and sacrum or pelvis (n = 39). Pain was graded by patients according to the pain numeric rating scale just before and 1 month after radiotherapy. Pain progression was defined as an increase ≥2 on pain scale after an initial response. Results The overall response rate at 1 month was 88.6%. Overall response rate was 89.6% in the 20-Gy arm and 87.3% in the 30-Gy arm (p = 0.669). The rate of complete response was statistically better in patients treated with 30 Gy (p = 0.019). The mean reduction in pain was 3.2 in the 20-Gy group and 3.6 in the 30-Gy group. Pain progression was 6.5% and 1.6%, respectively. The incidence of acute toxicity was statistically significantly higher in the 30-Gy arm (23.8%) than in the 20-Gy arm (2.6%) (p = 0.001). One pathologic fracture of the irradiated bone was observed in the 30-Gy arm. Two lesions, one in each group, were re-irradiated for pain recurrence. Pain progression was found in 6.5% of the irradiated lesions in the 20-Gy arm and in 1.6% in the 30-Gy arm. Conclusions In our series, both regimens achieved high rate of pain relief, although the group treated with higher total dose reported better complete response rate. The 30-Gy arm had a significantly higher rate of acute toxicity.

Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT) in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT). Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60 Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 11.9% and 40.7%, respectively. Grade 1 GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ≥2 late toxicities were recorded. Acute grade 2-3 GU toxicity resulted significantly lower (P = 0.04) in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2 GU toxicity was significantly higher (P < 0.001) for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT.

Effects of ionizing radiation on bio-active plant extracts useful for preventing oxidative damages

Abstract Humans are exposed to ionizing radiations in medical radiodiagnosis and radiotherapy that cause oxidative damages and degenerative diseases. Airplane pilots, and even more astronauts, are exposed to a variety of potentially harmful factors, including cosmic radiations. Among the phytochemicals, phenols are particularly efficient in countering the oxidative stress. In the present study, different extracts obtained from plant food, plant by-products and dietary supplements, have been compared for their antioxidant properties before and after irradiation of 140 cGy, a dose absorbed during a hypothetical stay of three years in the space. All the dry extracts, characterized in terms of vitamin C and phenolic content, remained chemically unaltered and maintained their antioxidant capability after irradiation. Our results suggest the potential use of these extracts as nutraceuticals to protect humans from oxidative damages, even when these extracts must be stored in an environment exposed to cosmic radiations as in a space station.

Radiation therapy after breast reconstruction: outcomes, complications, and patient satisfaction@@@Terapia radiante dopo ricostruzione mammaria: esiti, complicazioni e soddisfazione delle pazienti

PurposeThe aim of this study was to evaluate treatmentrelated complications, outcomes, and patient satisfaction in women with locally advanced breast cancer who received post-mastectomy radiation therapy (PMRT) after breast reconstruction (BR).Materials and methodsBetween October 2007 and November 2010, 46 patients with locally advanced breast cancer who underwent mastectomy followed by BR received PMRT at our Department. Radiotherapy was delivered to the chest wall with a dose of 50 Gy in 25 fractions over 5 weeks.ResultsThe median follow-up was 19 months. Skin erythema grade 1 and 2 was seen in 44 (96%) and two (4%) patients, respectively. Major complications, requiring additional corrective surgical procedure, occurred in three (7%) patients (one patient with prosthesis, one patient with tissue expander and one patient with deep inferior epigastric perforator flap). At univariate analysis, smoking, chemotherapy, hormone therapy with tamoxifen and reconstruction with implant were associated with overall complications (capsular contracture and reconstruction failure). Forty (86%) patients were very satisfied or satisfied with the cosmetic outcome of reconstruction.ConclusionsRadiotherapy can be safely delivered after BR, with a low complication rate and good patient satisfaction. Further randomised studies are needed to better define the optimal timing of breast reconstruction and post-mastectomy radiation therapy.RiassuntoObiettivoScopo del nostro lavoro è stato valutare le complicanze del trattamento e il livello di soddisfazione del risultato in pazienti con tumore della mammella localmente avanzato sottoposte a trattamento radioterapico post-mastectomia e ricostruzione mammaria.Materiali e metodiTra ottobre 2007 e novembre 2010, presso il nostro Dipartimento, 46 pazienti affette da neoplasia della mammella sono state sottoposte a trattamento radioterapico dopo intervento di mastectomia radicale e ricostruzione mammaria. La dose totale somministrata sulla parete toracica è stata di 50 Gy in 25 frazioni.RisultatiA un follow-up mediano di 19 mesi, si è osservata la comparsa di eritema cutaneo di grado 1 e 2 rispettivamente in 44 (96%) e in 2 (4%) pazienti. Complicanze maggiori, che hanno richiesto un ulteriore intervento chirurgico correttivo, sono state osservate in 3 pazienti (7%). All’analisi univariata il fumo, la chemioterapia, il tamoxifene e la ricostruzione con protesi risultano associate a un maggior rischio di complicanze generali (contrattura capsulare e fallimento della ricostruzione). Quaranta pazienti (86%) si sono mostrate soddisfatte o molto soddisfatte dei risultati estetici.ConclusioniLa radioterapia dopo ricostruzione mammaria è un trattamento sicuro associato a una bassa incidenza di complicanze e a un buon livello di soddisfazione da parte delle pazienti. Sono necessari ulteriori studi per definire meglio la sequenza ottimale di trattamento tra ricostruzione mammaria e radioterapia.

Terapia radiante dopo ricostruzione mammaria: esiti, complicazioni e soddisfazione delle pazienti

PurposeThe aim of this study was to evaluate treatmentrelated complications, outcomes, and patient satisfaction in women with locally advanced breast cancer who received post-mastectomy radiation therapy (PMRT) after breast reconstruction (BR).Materials and methodsBetween October 2007 and November 2010, 46 patients with locally advanced breast cancer who underwent mastectomy followed by BR received PMRT at our Department. Radiotherapy was delivered to the chest wall with a dose of 50 Gy in 25 fractions over 5 weeks.ResultsThe median follow-up was 19 months. Skin erythema grade 1 and 2 was seen in 44 (96%) and two (4%) patients, respectively. Major complications, requiring additional corrective surgical procedure, occurred in three (7%) patients (one patient with prosthesis, one patient with tissue expander and one patient with deep inferior epigastric perforator flap). At univariate analysis, smoking, chemotherapy, hormone therapy with tamoxifen and reconstruction with implant were associated with overall complications (capsular contracture and reconstruction failure). Forty (86%) patients were very satisfied or satisfied with the cosmetic outcome of reconstruction.ConclusionsRadiotherapy can be safely delivered after BR, with a low complication rate and good patient satisfaction. Further randomised studies are needed to better define the optimal timing of breast reconstruction and post-mastectomy radiation therapy.RiassuntoObiettivoScopo del nostro lavoro è stato valutare le complicanze del trattamento e il livello di soddisfazione del risultato in pazienti con tumore della mammella localmente avanzato sottoposte a trattamento radioterapico post-mastectomia e ricostruzione mammaria.Materiali e metodiTra ottobre 2007 e novembre 2010, presso il nostro Dipartimento, 46 pazienti affette da neoplasia della mammella sono state sottoposte a trattamento radioterapico dopo intervento di mastectomia radicale e ricostruzione mammaria. La dose totale somministrata sulla parete toracica è stata di 50 Gy in 25 frazioni.RisultatiA un follow-up mediano di 19 mesi, si è osservata la comparsa di eritema cutaneo di grado 1 e 2 rispettivamente in 44 (96%) e in 2 (4%) pazienti. Complicanze maggiori, che hanno richiesto un ulteriore intervento chirurgico correttivo, sono state osservate in 3 pazienti (7%). All’analisi univariata il fumo, la chemioterapia, il tamoxifene e la ricostruzione con protesi risultano associate a un maggior rischio di complicanze generali (contrattura capsulare e fallimento della ricostruzione). Quaranta pazienti (86%) si sono mostrate soddisfatte o molto soddisfatte dei risultati estetici.ConclusioniLa radioterapia dopo ricostruzione mammaria è un trattamento sicuro associato a una bassa incidenza di complicanze e a un buon livello di soddisfazione da parte delle pazienti. Sono necessari ulteriori studi per definire meglio la sequenza ottimale di trattamento tra ricostruzione mammaria e radioterapia.