G. Di Paola

Lipids, Lipoproteins and Apolipoproteins AI AII, B, CII, CIII and E in Newborns

In this study lipid and apolipoprotein patterns were investigated at birth and compared with those of adults. In cord sera, cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol were 38.2, 46.2, 50.5, and 31.9%, respectively, of adult values. Apolipoprotein AII, B and CIII were 48.6, 30.6 and 44.5% of adult values, while apo AI, apo CII and apo E showed values approaching those of adults (63.4, 73.3 and 89.7%, respectively). Also cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios were lower in newborns. In cord sera, lipids were correlated with various apolipoproteins in a surprisingly different way from adult sera. HDL cholesterol was not inversely correlated with triglycerides, and showed a highly positive correlation with apo E, apo CII and apo CIII, which did not correlate with HDL cholesterol in adults. These data supported the presence of significant differences in plasma concentrations and composition of lipoproteins at birth. Therefore HDL, apo CII, and apo E seem to play a different and more important metabolic role in neonatal lipid metabolism.

Dose–volume-related dysphagia after constrictor muscles definition in head and neck cancer intensity-modulated radiation treatment

OBJECTIVE Dysphagia remains a side effect influencing the quality of life of patients with head and neck cancer (HNC) after radiotherapy. We evaluated the relationship between planned dose involvement and acute and late dysphagia in patients with HNC treated with intensity-modulated radiation therapy (IMRT), after a recontouring of constrictor muscles (PCs) and the cricopharyngeal muscle (CM). METHODS Between December 2011 and December 2013, 56 patients with histologically proven HNC were treated with IMRT or volumetric-modulated arc therapy. The PCs and CM were recontoured. Correlations between acute and late toxicity and dosimetric parameters were evaluated. End points were analysed using univariate logistic regression. RESULTS An increasing risk to develop acute dysphagia was observed when constraints to the middle PCs were not respected [mean dose (Dmean) ≥50 Gy, maximum dose (Dmax) >60 Gy, V50 >70% with a p = 0.05]. The superior PC was not correlated with acute toxicity but only with late dysphagia. The inferior PC was not correlated with dysphagia; for the CM only, Dmax >60 Gy was correlated with acute dysphagia ≥ grade 2. CONCLUSION According to our analysis, the superior PC has a major role, being correlated with dysphagia at 3 and 6 months after treatments; the middle PC maintains this correlation only at 3 months from the beginning of radiotherapy, but it does not have influence on late dysphagia. The inferior PC and CM have a minimum impact on swallowing symptoms. ADVANCES IN KNOWLEDGE We used recent guidelines to define dose constraints of the PCs and CM. Two results emerge in the present analysis: the superior PC influences late dysphagia, while the middle PC influences acute dysphagia.

Intensity modulated radiation therapy with simultaneous integrated boost in early breast cancer irradiation. Report of feasibility and preliminary toxicity.

PURPOSE To investigate the feasibility and tolerance in the use of adjuvant intensity modulated radiation therapy (IMRT) and simultaneous integrated boost in patients with a diagnosis of breast cancer after breast-conserving surgery. PATIENTS AND METHODS Between September 2011 to February 2013, 112 women with a diagnosis of early breast cancer (T1-2, N0-1, M0) were treated with IMRT and simultaneous integrated boost after breast-conserving surgery in our institution. A dose of 50Gy in 25 fractions was prescribed to the whole breast and an additional dose of radiation was prescribed on the tumour bed. A dose prescription of 60Gy in 25 fractions to the tumour bed was used in patients with negative margins after surgery, whereas if the margins were close (<1mm) or positive (without a new surgical resection) a dose of 64Gy was prescribed. All patients were followed with periodic clinical evaluation. Acute and late toxicity were scored using the EORTC/RTOG radiation morbidity score system. Both patient and physician recorded cosmetic outcome evaluation with a subjective judgment scale at the time of scheduled follow-up. RESULTS The median follow-up was 28 months (range 24-40 months). The acute skin grade toxicity during the treatment was grade 0 in 8 patients (7%), grade 1 in 80 (72%), grade 2 in 24 cases (21%). No grade 3 or higher acute skin toxicity was observed. At 12 months, skin toxicity was grade 0 in 78 patients (70%), grade 1 in 34 patients (30%). No toxicity grade 2 or higher was registered. At 24 months, skin toxicity was grade 0 in 79 patients (71%), grade 1 in 33 patients (29%). No case of grade 2 toxicity or higher was registered. The pretreatment variables correlated with skin grade 2 acute toxicity were adjuvant chemotherapy (P=0.01) and breast volume ≥700cm(3) (P=0.001). Patients with an acute skin toxicity grade 2 had a higher probability to develop late skin toxicity (P<0.0001). In the 98% of cases, patients were judged to have a good or excellent cosmetic outcome. The 2-year-overall survival and 2-year-local control were 100%. CONCLUSION These data support the feasibility and safety of IMRT with simultaneous integrated boost in patients with a diagnosis of early breast cancer following breast-conserving surgery with acceptable acute and late treatment-related toxicity. A longer follow-up is needed to define the efficacy on outcomes.

EP-1307: Chemoradiation in anal cancer with using VMAT: toxicity and early outcome.

Purpose or Objective: Intensity modulated radiotherapy (IMRT), including helical Tomotherapy (HT), has been only recently introduced in the treatment of locally advanced rectal cancer (LARC) patients. We retrospectively assessed acute toxicity and efficacy of concomitant chemoradiotherapy (CRT) delivered with HT and daily image-guided RT (IGRT) for non metastatic LARC patients in 2 Swiss institutions.

EP-1137: Volumetric Modulated Arc Therapy (VMAT) and simultaneus boost for brain metastases patients

ESTRO 35 2016 _____________________________________________________________________________________________________ with median follow up of 18 months (6-40 months). Six patients had prior surgical resection of tumor, 12 received treatment as first line. The majority (60 %) of lesions were close to the optic pathway with median values for GTV volume was 9,4 cm3 (0,38-55,66 cm3). The control rates at tow years were favorable with stable disease in 100 % patients, vision was preserved and improved symptoms in 65% patients. We observed no grade 3 or 4 toxicity. The most frequent being grade 1 retro-orbital pain (20%). No late toxicity was reported and no death during the follow – up period.

PO-0632: Dose-volume related dysphagia in head and neck cancer Intensity Modulated Radiation Treatment

Purpose/Objective: Dysphagia remains a side effect influencing quality of life for head and neck cancer (HNC) patients after radiotherapy. We evaluated relationship between planned dose involvement and acute and late dysphagia in HNC patients treated with Intensity Modulated Radiation treatments, after a re-contouring of constrictors muscles (PCs) and cricopharyngeal muscle (CM). Materials and Methods: Between December 2011 and December 2013, 56 patients, with histologically proven HNC, were treated with IMRT or VMAT. The PCs and CM were recontoured. We used recent guidelines to define doseconstraints of constrictors muscles (PCs) and cricopharyngeal muscle (CM). Correlations between acute and late toxicity and dosimetric parameters were evaluated. Endpoints were analyzed using univariate logistic regression. Results: Median follow up was 24 months (range 10-36 months). An increasing risk to develop acute dysphagia was observed when constraints to middle PC are not respected (Dmean ≥ 50Gy, Dmax >60Gy, V50 >70% with a p=0.05). Superior PC was not correlated with acute toxicity, but only with early-late dysphagia (until to 6 months after radiotherapy). The inferior PC is not correlated with dysphagia; for cricopharyngeal muscle only Dmax > 60Gy is correlated with acute dysphagia ≥ G2. No correlations were found at 12 months of follow up. Univariate logistic regression analysis for clinical parameters showed a significant correlation with oropharynx primary site (p-value < 0.05) and acute/late disphagia. Late xerostomia ≥ G2 is statistically related with late disphagia ≥ G2 (p-value < 0.05). Conclusions: Superior PC has a major role, being correlated with dysphagia at 3 and 6 months after the treatments; the middle PC mantains this correlation only at 3 months from beginning of radiotherapy but it does not have influence on late dysphagia. Inferior PC and CM have a minimum impact on the swallowing symptoms.