Papers by Cynthia Aristei
Reports of Practical Oncology and Radiotherapy
this article is available in open access under creative common attribution-Non-commercial-No Deri... more this article is available in open access under creative common attribution-Non-commercial-No Derivatives 4.0 international (cc BY-Nc-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
Reports of Practical Oncology and Radiotherapy
this article is available in open access under creative common attribution-Non-commercial-No Deri... more this article is available in open access under creative common attribution-Non-commercial-No Derivatives 4.0 international (cc BY-Nc-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
Diagnostics
The aims of the present systematic review are to: (1) assess the diagnostic performance of somato... more The aims of the present systematic review are to: (1) assess the diagnostic performance of somatostatin receptor (SSR)targeted positron emission tomography (PET) with different tracers and devices in patients affected by meningiomas; and (2) to evaluate the theranostic applications of peptide receptor radionuclide therapy (PRRT) in meningiomas. A systematic literature search according to PRISMA criteria was made by using two main databases. Only studies published from 2011 up to March 2022 in the English language with ≥10 enrolled patients were selected. Following our research strategy, 17 studies were included for the assessment. Fourteen studies encompassed 534 patients, harboring 733 meningiomas, submitted to SSR-targeted PET/CT (n = 10) or PET/MRI (n = 4) for de novo diagnosis, recurrence detection, or radiation therapy (RT) planning (endpoint 1), while 3 studies included 69 patients with therapy-refractory meningiomas submitted to PRRT (endpoint 2). A relevant variation in meth...
Sensors
Indeterminate lung nodules detected on CT scans are common findings in clinical practice. Their c... more Indeterminate lung nodules detected on CT scans are common findings in clinical practice. Their correct assessment is critical, as early diagnosis of malignancy is crucial to maximise the treatment outcome. In this work, we evaluated the role of form factors as imaging biomarkers to differentiate benign vs. malignant lung lesions on CT scans. We tested a total of three conventional imaging features, six form factors, and two shape features for significant differences between benign and malignant lung lesions on CT scans. The study population consisted of 192 lung nodules from two independent datasets, containing 109 (38 benign, 71 malignant) and 83 (42 benign, 41 malignant) lung lesions, respectively. The standard of reference was either histological evaluation or stability on radiological followup. The statistical significance was determined via the Mann–Whitney U nonparametric test, and the ability of the form factors to discriminate a benign vs. a malignant lesion was assessed th...
Journal of Fungi
Oral mucositis is an acute side effect of radiation therapy that is especially common with head a... more Oral mucositis is an acute side effect of radiation therapy that is especially common with head and neck cancer treatment. In recent years, several studies have revealed the predisposing factors for mucositis, leading to the pre-treatment of patients to deter the development of opportunistic oral fungal infections. Although many clinical protocols already advise the use of probiotics to counteract inflammation and fungal colonization, preclinical studies are needed to better delineate the mechanisms by which a host may acquire benefits via co-evolution with oral microbiota, probiotics, and fungal commensals, such as Candida albicans, especially during acute inflammation. Here, we review the current understanding of radiation therapy-dependent oral mucositis in terms of pathology, prevention, treatment, and related opportunistic infections, with a final focus on the oral microbiome and how it may be important for future therapy.
Journal of Personalized Medicine, 2022
In localized prostate cancer clinicopathologic variables have been used to develop prognostic nom... more In localized prostate cancer clinicopathologic variables have been used to develop prognostic nomograms quantifying the probability of locally advanced disease, of pelvic lymph node and distant metastasis at diagnosis or the probability of recurrence after radical treatment of the primary tumor. These tools although essential in daily clinical practice for the management of such a heterogeneous disease, which can be cured with a wide spectrum of treatment strategies (i.e., active surveillance, RP and radiation therapy), do not allow the precise distinction of an indolent instead of an aggressive disease. In recent years, several prognostic biomarkers have been tested, combined with the currently available clinicopathologic prognostic tools, in order to improve the decision-making process. In the following article, we reviewed the literature of the last 10 years and gave an overview report on commercially available tissue-based biomarkers and more specifically on mRNA-based gene expr...
Reports of Practical Oncology and Radiotherapy, 2021
This article is available in open access under creative common attribution-Non-commercial-No Deri... more This article is available in open access under creative common attribution-Non-commercial-No Derivatives 4.0 International (cc BY-Nc-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
The British Journal of Radiology, 2021
Objectives: To determine interobserver variability in axillary nodal contouring in breast cancer ... more Objectives: To determine interobserver variability in axillary nodal contouring in breast cancer (BC) radiotherapy (RT) by comparing the clinical target volume of participating single centres (SC-CTV) with a gold-standard CTV (GS-CTV). Methods: The GS-CTV of three patients (P1, P2, P3) with increasing complexity was created in DICOM format from the median contour of axillary CTVs drawn by BC experts, validated using the simultaneous truth and performance-level estimation and peer-reviewed. GS-CTVs were compared with the correspondent SC-CTVs drawn by radiation oncologists, using validated metrics and a total score (TS) integrating all of them. Results: Eighteen RT centres participated in the study. Comparative analyses revealed that, on average, the SC-CTVs were smaller than GS-CTV for P1 and P2 (by −29.25% and −27.83%, respectively) and larger for P3 (by +12.53%). The mean Jaccard index was greater for P1 and P2 compared to P3, but the overlap extent value was around 0.50 or less. ...
Journal of Personalized Medicine, 2021
Background: During the 2016 Assisi Think Tank Meeting (ATTM) on breast cancer, the panel of exper... more Background: During the 2016 Assisi Think Tank Meeting (ATTM) on breast cancer, the panel of experts proposed developing a validated system, based on rapid learning health care (RLHC) principles, to standardize inter-center data collection and promote personalized treatments for breast cancer. Material and Methods: The seven-step Breast LArge DatabasE (BLADE) project included data collection, analysis, application, and evaluation on a data-sharing platform. The multidisciplinary team developed a consensus-based ontology of validated variables with over 80% agreement. This English-language ontology constituted a breast cancer library with seven knowledge domains: baseline, primary systemic therapy, surgery, adjuvant systemic therapies, radiation therapy, follow-up, and toxicity. The library was uploaded to the BLADE domain. The safety of data encryption and preservation was tested according to General Data Protection Regulation (GDPR) guidelines on data from 15 clinical charts. The sy...
AntiCancer Research, 2020
Aim: To retrospectively assess toxicity and survival in 15 selected Glioblastoma patients treated... more 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 ...
Total Marrow Irradiation, 2020
This chapter briefly outlines Perugia University’s experience with haploidentical hematopoietic s... more This chapter briefly outlines Perugia University’s experience with haploidentical hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). It describes modifications to the conditioning regimens over time, focusing on the contribution from radiation oncology and the changes to the haploidentical graft. It reports outcomes in a subset of elderly or unfit young patients with AML who received an immunosuppressive, myeloablative, low-toxic total marrow/lymphoid irradiation (TMLI)-based conditioning regimen and a CD34+ inoculum with Treg/Tcon adoptive immunotherapy. Finally, perspectives and future directions of TMLI are illustrated.
Frontiers in Oncology, 2021
Breast cancer, the most frequent malignancy in women worldwide, is a heterogeneous group of disea... more Breast cancer, the most frequent malignancy in women worldwide, is a heterogeneous group of diseases, characterized by distinct molecular aberrations. In precision medicine, radiation oncology for breast cancer aims at tailoring treatment according to tumor biology and each patient’s clinical features and genetics. Although systemic therapies are personalized according to molecular sub-type [i.e. endocrine therapy for receptor-positive disease and anti-human epidermal growth factor receptor 2 (HER2) therapy for HER2-positive disease] and multi-gene assays, personalized radiation therapy has yet to be adopted in the clinical setting. Currently, attempts are being made to identify prognostic and/or predictive factors, biomarkers, signatures that could lead to personalized treatment in order to select appropriate patients who might, or might not, benefit from radiation therapy or whose radiation therapy might be escalated or de-escalated in dosages and volumes. This overview focuses on...
International Journal of Gynecologic Cancer, 2021
This review analyzes the experience and trends in external beam radiotherapy for delivering a boo... more This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy ...
European Journal of Cancer, 2020
Background: Uterine sarcomas are very rare tumours with different histotypes, molecular features ... more Background: Uterine sarcomas are very rare tumours with different histotypes, molecular features and clinical outcomes; therefore, it is difficult to carry out prospective clinical trials, and this often results in heterogeneous management of patients in the clinical practice. Aim: We planned to set up an Italian consensus conference on these diseases in order to provide recommendations on treatments and quality of care in our country. Results: Early-stage uterine sarcomas are managed by hysterectomy þ bilateral salpingooophorectomy according to menopausal status and histology; lymphadenectomy is not indicated in patients without bulky nodes, and morcellation must be avoided. The postoperative management is represented by observation, even though chemotherapy can be considered in some high-risk patients. In early-stage low-grade endometrial stromal sarcoma and adenosarcomas without sarcomatous overgrowth, hormonal adjuvant treatment can be offered based o n h o r m o n e r e c e p t o r e x p r e s s i o n. I n s e l e c t e d c a s e s , e x t e r n a l b e a m radiotherapy AE brachytherapy can be considered to increase local control only. Patients with advanced disease involving the abdomen can be offered primary chemotherapy (or hormonal therapy in the case of low-grade endometrial stromal sarcoma and adenosarcoma without sarcomatous overgrowth), even if potentially resectable in the absence of residual disease in order to test the chemosensitivity (or hormonosensitivity); debulking surgery can be considered in patients with clinical and radiological response. Chemotherapy is based on anthracyclines AE ifosfamide or dacarbazine. Palliative radiotherapy can be offered for symptom control, and stereotactic radiotherapy can be used for up to five isolated metastatic lesions. Conclusions: Treatment of uterine sarcoma should be centralised at referral centres and managed in a multidisciplinary setting.
Asia-Pacific Journal of Clinical Oncology, 2020
Aim: Despite the advances in surgery and radio-chemotherapy, the prognosis of glioblastoma (GBM) ... more Aim: Despite the advances in surgery and radio-chemotherapy, the prognosis of glioblastoma (GBM) remains poor with about 13% of patients alive at 24 months. Methods: A total of 75 long-term survivors (LTS), defined as alive at least 24 months from diagnosis, were retrospectively analyzed. Overall survival (OS) and recurrencefree-survival (RFS) were calculated and related to patient characteristics and treatment received. Results: Median age and Karnofsky performance status (KPS) were 56 years and 100%, respectively. After surgery (gross tumor resection-GTR in 62, 83% patients), all LTS received concomitant temozolomide (TMZ) with radiotherapy and 70 (93%) adjuvant TMZ. Of these, 10 (13%) discontinued TMZ prior the completion of 6 cycles, 37 (49%) received 6 cycles and 23 (31%) >6 cycles. Sixty-nine (92%) patients experienced a first tumor recurrence at a median time of 21 months. Of these, 32 (46%) were submitted to a second surgery, 34 (49%) to other no-surgical treatments and 3 (5%) only supportive care. At multivariate analysis, OS was significantly improved by second surgery after first recurrence (P = 0.0032) and by cycles of adjuvant TMZ > 6 versus ≤6 (P = 0.05). More than six cycles of TMZ significantly conditioned also first RFS (P = 0.011) and second RFS (P = 0.033). Conclusion: The large majority of LTS had <65 years, had a high KPS and received GTR. OS and RFS resulted significantly related to an extended administration of adjuvant TMZ (>6 cycles) and a second surgery in case of recurrence.
Reports of Practical Oncology & Radiotherapy, 2018
Background: Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (... more Background: Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Methods and materials: Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle 3 TPS (v 9.8) using 6 MV photon energy. Three PTVs were defined to receive respectively prescribed doses of
Radiotherapy and Oncology, 2018
The Oncologist, 1999
We review the rationale for, and the results of, clinical trials on chemoradiotherapy-based pretr... more We review the rationale for, and the results of, clinical trials on chemoradiotherapy-based pretransplant regimens for non-Hodgkin's lymphomas, Hodgkin's disease and multiple myeloma. What clearly emerges from this review is the lack of any conclusive evidence that total-body irradiation (TBI)-containing regimens are better than chemotherapy alone in diseases which are considered to be radiosensitive. Due to the variety of pretransplant regimens adopted, the relatively low number of patients enrolled in each trial, and the lack of randomized studies, no one conditioning scheme, with or without TBI, could be identified as superior to another. Only randomized clinical studies will indicate whether TBI-containing regimens are superior to chemotherapy-only regimens and whether TBI and/or involved field radiation therapy have a place in autologous stem cell transplantation programs for lymphoproliferative disorders. And finally, the best TBI dose, schedule, and technique should b...
Tumori Journal, 2004
Aim and background: The aim of this study was to investigate the efficacy of postoperative locore... more Aim and background: The aim of this study was to investigate the efficacy of postoperative locoregional radiotherapy in patients with T1-T2 breast cancer and four or more positive axillary lymph nodes submitted to mastectomy or breast-conserving surgery followed by standard-dose or high-dose adjuvant chemotherapy. The incidence of locoregional relapses and the survival correlated with the number of positive nodes were recorded for each treatment arm. Patients and methods: From August 1992 to August 1999 86 breast cancer patients (median age, 54 years, T1-T2, N+ ~4) submitted to surgery were treated. Sixty-three patients received standard-dose chemotherapy while 23 patients with 10 or more positive nodes received high-dose chemotherapy. After four courses of standard-dose anthracycline-based chemotherapy peripheral blood stem cells were mobilized with cyclophosphamide (7 g/m 2) and G-CSF (10-16 µg/kg/day/sc). Hiph-dose chemotherapy consisted of etoposide 1000 mg/m , thiotepa 500 mg/m 2 and carboplatin 800 mg/m 2 • Hormone receptor-positive patients underwent hormone therapy. Following chemotherapy all 86 patients were given conventional radiotherapy to the breast or the chest wall and the supraclavicular fossa. The high-dose subgroup received radiotherapy to the internal mammary nodes ± axilla. Results: The median follow-up from the start of radiotherapy was 36.5 months. Locoregional relapses occurred in nine patients (10.4%); in four of them they were isolated (4.6%). Local relapses were four (4.6%) and regional relapses six (6.9%). Twenty-five patients (29%) had distant metastases. The five-year and eight-year overall actuarial survival rates were 82.6% ± 4.8 and 60.1% ± 8.8, respectively. No statistical differences were found when the number of positive nodes or the type of treatment of N+ 10 patients was included in the analysis. Conclusions: Breast cancer patients with four or more positive axillary lymph nodes are at high risk of developing locoregional and distant relapses. The results reported here demonstrate the efficacy of radiotherapy in the reduction of locoregional failure; no differences in survival and locoregional control in relation to treatment arm and number of positive nodes were found.
Tumori Journal, 2001
Aims and background: To investigate the safety and efficacy of a high-dose chemotherapy regimen w... more Aims and background: To investigate the safety and efficacy of a high-dose chemotherapy regimen with etoposide, carboplatin and thiotepa in high-risk stage II-iliA breast cancer and in responsive metastatic patients. Study design: From April 1992 to December 1998, 24 patients with high-risk stage II-iliA breast cancer (~9 positive nodes) and 9 responsive metastatic patients were enrolled in the trial. After induction chemotherapy with an anthracycline-based regimen, peripheral blood stem cells were mobilized with cyclophosphamide (7 g/m 2) and G-CSF (5-16 jJg/kg/sc/day). The high-dose chemotherapy regimen consisted of etoposide (1000 mg/m 2) , carboplatin (800 mg/m 2) and thiotepa (500 mg/m 2). At the end of the high-dose chemotherapy, all stage 11-iliA patients received radiotherapy to the breast or chest wall and draining nodes; stage IV patients were irradiated to sites
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Papers by Cynthia Aristei