V. Valentini

Locally Recurrent Rectal Cancer: Prognostic Factors and Long-Term Outcomes of Multimodal Therapy

BackgroundPelvic recurrent rectal cancer is still a challenging clinical problem, and patients generally have a dismal prognosis and a poor quality of life. Surgical resection represents the only potentially curative treatment; neoadjuvant treatments are presently being taken into consideration to increase the resectability rate and to improve long-term survival.MethodsAmong 157 patients observed with recurrent rectal cancer, a series of 58 patients who underwent surgical exploration with curative intent for isolated local recurrence at a single referral institution was retrospectively analyzed. Demographic, pathologic, and therapeutic factors were evaluated to assess long-term prognosis and local control.ResultsForty-four (75.9%) of 58 patients underwent surgical resection. The overall 5-year survival rate for patients who underwent surgical resection was 54.2%, whereas none of the unresected patients lived 5xa0years (Pxa0<xa00.001). Patients with R0 resection showed a statistically higher 5-year overall survival and local control rate (72.4 and 70.2%, respectively) compared to R1 patients (37.5 and 31.2%, respectively). At multivariate survival analysis, feasibility of a surgical resection and radicality of excision proved to be independent positive prognostic factors. In contrast, increased presalvage carcinoembryonic antigen serum levels, back pain at diagnosis, and an increasing degree of fixation of recurrent disease to the pelvic wall at preoperative computed tomographic scan were statistically significantly linked to decreased overall survival. Preoperative chemoradiation and radicality of the surgical excision independently influenced the local control among surgically resected patients.ConclusionsSurgical resection still remains the most important therapeutic and prognostic factor for patients with locally recurrent rectal cancer. Multimodal treatments can be safely performed by an experienced team in referral tertiary centers and can result in a safer outcome, better local disease control, and even long-term survival in carefully selected patients.

Treatment of Merkel cell carcinoma with radiotherapy and imiquimod (Aldara): a case report.

Aims and background Merkel cell carcinoma (MCC) is a rare skin tumor occurring mostly in older people. Postoperative radiotherapy is strongly recommended to improve local control. A case of a MCC treated by radiotherapy associated with imiquimod (Aldara) is presented. A possible physiopathological rationale for this concomitant treatment is also given. Materials and methods We treated a diabetic 82-year-old man presenting with a MCC of the right zygomatic area. Despite surgery, postoperative ultrasonography showed a firm, painless residual mass of about 11 × 10 cm, fixed to the deep tissues. Parotid and zygomatic areas were treated along with the ipsilateral laterocervical lymph nodes. The total dose to the planning target volume was 50.4 Gy (1.8 Gy/day). Imiquimod was applied once a day to the zygomatic area with macroscopic infiltration and to the surrounding erythema. Results During the combination treatment, the patient showed acute G3 skin toxicity (RTOG) and a scab that resolved after a 3-week interruption of the radiotherapy and imiquimod treatment. When the scab was removed, the underlying skin appeared completely re-epithelialized. Imiquimod was suspended and treatment was continued only with irradiation. During this second phase of the treatment, the patient developed G2 dermatitis and G2 stomatitis. Clinical and instrumental re-evaluation showed a complete response 7 months after the end of radiotherapy, with very good local tropism. Conclusion This case report suggests the possible effective use of immunomodulators, in this case imiquimod, combined with radiation therapy for cutaneous malignancies such as MCC. Skin tolerance should be an important issue to consider.

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

Medulloblastoma (MB) occurs infrequently in adult patients and standard treatment is still controversial. We report our long-term, single-institution experience of adult MB and a review of the literature. We analysed adult patients with histologically proved MB treated by postoperative radiotherapy. Primary endpoints were local control (LC), disease-free survival (DFS), and overall survival (OS). Acute toxicity was reported according to CTC-NCI score vers. 3.0 and specific neuropsychological assessment analysis was performed to define late brain toxicity. From 1990–2008, 13 patients were treated by craniospinal (CSI, 12/13) or cranial irradiation (1/13, because of bad clinical conditions). Median follow up was 101xa0months (64–218). Complete radiological response was observed in 12/13 patients and a partial response in 1/13. Ten-year LC, OS, and DFS were 91, 76, and 84%, respectively. Two patients died because of local and spinal progression after 13 and 62xa0months. Acute G3 haematological toxicity (RTOG score) was observed for one patient only. The neuropsychological analysis did not reveal late toxicity related to brain radiotherapy. This experience confirms the efficacy and safety of radiotherapy in adult MB patients, resulting in very interesting 10-year LC and OS.

Rectal cancer multidisciplinary treatment: evidences, consensus and perspectives.

Clinical research has been very fruitful in the past 20 years in diagnostic procedures and in the treatment of rectal cancer patients. Such progress was guided first by im provements in morphologic imaging (ultrasound, computed tomography and nu clear magnetic resonance), in preoperative staging, by new surgical technique (total mesorectal excision), and by accurate application of histopathological assessment of the resected tumor. In radiotherapy treatment, investigators have also tested an important role of ad juvant radiotherapy. Seven European phase III studies have been evaluated and demonstrated the efficacy of both short-course preoperative radiotherapy and con current preoperative chemoradiotherapy 1-7 . In Europe and in other countries, there are different opinions about the best sequence of clinical and therapeutic proce

Identification of the most significant magnetic resonance imaging (MRI) radiomic features in oncological patients with vertebral bone marrow metastatic disease: a feasibility study

ObjectivesRecently, radiomic analysis has gained attention as a valuable instrument for the management of oncological patients. The aim of the study is to isolate which features of magnetic resonance imaging (MRI)-based radiomic analysis have to be considered the most significant predictors of metastasis in oncological patients with spinal bone marrow metastatic disease.Materials and methodsEight oncological patients (3 lung cancer; 1 prostatic cancer; 1 esophageal cancer; 1 nasopharyngeal cancer; 1 hepatocarcinoma; 1 breast cancer) with pre-radiotherapy MR imaging for a total of 58 dorsal vertebral bodies, 29 metastatic and 29 non-metastatic were included. Each vertebral body was contoured in T1 and T2 weighted images at a radiotherapy delineation console. The obtained data were transferred to an automated data extraction system for morphological, statistical and textural analysis. Eighty-nine features for each lesion in both T1 and T2 images were computed as the median of by-slice values. A Wilcoxon test was applied to the 89 features and the most statistically significant of them underwent to a stepwise feature selection, to find the best performing predictors of metastasis in a logistic regression model. An internal cross-validation via bootstrap was conducted for estimating the model performance in terms of the area under the curve (AUC) of the receiver operating characteristic.ResultsOf the 89 textural features tested, 16 were found to differ with statistical significance in the metastatic vs non-metastatic group. The best performing model was constituted by two predictors for T1 and T2 images, namely one morphological feature (center of mass shift) (p valueu2009<u20090.01) for both datasets and one histogram feature minimum grey level (p valueu2009<u20090.01) for T1 images and one textural feature (grey-level co-occurrence matrix joint variance (p valueu2009<u20090.01) for T2 images. The internal cross-validation showed an AUC of 0.8141 (95% CI 0.6854–0.9427) in T1 images and 0.9116 (95% CI 0.8294–0.9937) in T2 images.ConclusionsThe results suggest that MRI-based radiomic analysis on oncological patients with bone marrow metastatic disease is able to differentiate between metastatic and non-metastatic vertebral bodies. The most significant predictors of metastasis were found to be based on T2 sequence and were one morphological and one textural feature.

How Can Radiomics Improve Clinical Choices

Over the past decade, we have witnessed a great expansion of the use and the role of medical imaging technologies in clinical oncology from a primarily diagnostic, qualitative tool to include a central role in the context of individualized medicine, with a dominant quantitative value [1].

PO-0952: Blended teaching reduces interobserver contouring variability: first results of the FALCON project

S463 ________________________________________________________________________________ system towards or away from the isocentre position, which is defined by the isocentre of the MRI scanner. The rail system enables the linatron to be placed at 8 different positions from the linatron ranging from a SSD of 190-336cm. To verify alignment of the radiation beam for the different linac rail positions, radiation profiles were acquired in air at different distances from the target. From the profiles the central axis position (CAX) was used to establish the alignment of the radiation beam. To verify MLC alignment to the CAX without the ability to rotate the collimator, a series of half blocked fields were used, with abutting fields and picket fence tests used to verify positional accuracy. Standard scanning water tank systems can not be used within the MRI scanner due to both ferromagnetic components and lack of physical space. To enable a comparison of baseline data once the magnet is installed, water dosimetry measurements were compared with measurements within an adjustable solid water phantom.

EP-1181: Prostheses irradiation in breast cancer: clinical and aesthetic outcomes in retrospective series

Purpose or Objective: Post-mastectomy radiation therapy (RT) is a prophylactic adjuvant treatment for high risk patients with breast cancer. Mammary prostheses or expanders often do not tolerate RT causing a reduction of aesthetic profile and, even more, an exposure to clinical risks or new surgery. In this retrospective study clinical and aesthetic results were quantified in patients who did or did not undergo adjuvant RT after reconstruction for breast cancer