Papers by Francesca Arcadipane
Medical Oncology, Oct 4, 2018
To report initial experience of biochemical outcomes and the acute and late toxicity in 200 patie... more To report initial experience of biochemical outcomes and the acute and late toxicity in 200 patients with clinically localized prostate cancer treated with volumetric modulated arc therapy (VMAT). Materials/Methods: Between November 2007 and September 2011, 200 patients with clinically localized prostate cancer were treated with VMAT using daily cone-beam computed tomography acqusition. Treatment planning systems used were avoidance conformal-based in 77 patients and multileaf collimator-based in 123 patients. All plans were generated on an inverse-planning approach. A total of 182 patients (91%) were treated to 76 Gy, and 18 patients (9%) were treated to Z < 72 Gy. Acute and late toxicities were scored according to CTCAE grading scales. PSA relapse was defined according to Phoenix definition. The mean follow-up time was 50 months (range: 7-85 months). Results: Two patients (1%) developed acute Grade 2 or worse GI toxicity. Thirty-nine patients (19%) developed acute Grade 2 GU symptoms, and no one experienced Grade 3 GU toxicity. Six patients (3%) developed late Grade 2 rectal bleeding. Two patients (1%) experienced Grade 3 rectal toxicity requiring either one or more transfusions or a laser cauterization procedure. No Grade 4 rectal complications have been observed. The 5year actuarial likelihood of late Grade 2 or higher rectal bleeding was 3.4%. Twenty patients (10%) experienced late Grade 2 GU toxicity, and no one developed Grade 3 GU toxicity. The 5-year actuarial likelihood of late Grade 2 or higher GU toxicity was 11.6%. The 5-year actuarial PSA relapse-free survival rates for low-, intermediate-, and high-risk group patients stratified according to NCCN criteria, were 100%, 91,8%, and 85.3%, respectively. Conclusions: Our initial data demonstrate the feasibility of VMAT in patients with localized prostate cancer. Acute and late rectal toxicities seem to be dramatically reduced compared with what has been observed with conventional radiation therapy techniques. Short-term PSA control rates were excellent. Based on our promising initial experiences, VMAT is an established novel conformal radiation delivery method for localized prostate cancer at our institution. Further studies in a larger population are required to determine long-term results in VMAT.
Radiotherapy and Oncology, Apr 1, 2016
Conclusion: When using KV-CBCT for setup verification in stereotactic treatment a large inter-obs... more Conclusion: When using KV-CBCT for setup verification in stereotactic treatment a large inter-observer variability can be seen in a significant proportion of scans, particularly in extracranial treatment. Such a difference may have an impact on target coverage or organ at risk irradiation, thus requiring a proper margin. Further evaluation is needed, particularly focusing on methods to decrease such interobserver variability EP-2112 Intrafraction setup errors in single fraction stereotactic radiosurgery with Elekta Fraxion system
Radiologia Medica, Apr 3, 2014
Radiotherapy and Oncology, Apr 1, 2019
Purpose or Objective Craniospinal axis irradiation (CSI) is important in specific brain tumors li... more Purpose or Objective Craniospinal axis irradiation (CSI) is important in specific brain tumors like medulloblastoma. This is a challenging tumor site due to the large size of the fields and complicated patient positioning. Little is known about these patients' inter and intrafraction motion, while these are important components of the PTV margin. The purpose of this study is to determine the magnitude of the inter and intrafraction motion for the thoracic and lumbar spine, and to compare these to the currently used PTV margins. Additionally, we investigate whether 2D kV/DRR position verification yields the same results as 3D CBCT/CT, as the 2D method would lead to lower imaging dose for the patients. Material and Methods We retrospectively included 14 patients [median age 8.5y; range 5-14y] treated with CSI. The thoracic and lumbar CTVs were expanded with anisotropic margins of 0.8cm in LR direction, 1.0cm in caudal direction in the lumbar field and 1.0cm in AP direction for the thoracic and lumbar CTV. All patients were treated in supine position on a thin matrass and knee support, immobilized with a 5 points mask. For clinical position verification, pre and post treatment CBCTs were acquired of the thoracic and lumbar CTV, using a hybrid offline/online protocol. Average time between the pre and post fractional CBCTs was 22min [range 17-33min]. In total 180 pre and 154 post fraction CBCTs were analyzed. Inter and intrafraction motion in LR, CC and AP directions were determined based on clinically used CBCT/CT automated matches of the bony anatomy. Distributions of systematic and random errors (standard deviations Σ and σ, respectively) were calculated. PTV margins were calculated using inter and intrafraction motion, without considering other sources of error. We simulated 2D kV/DRR position verification by extracting two orthogonal radiographs from the CBCT series under angles with optimal visibility of the target. These were matched manually to the bony anatomy on DRRs of corresponding angles from the planning CT. The corrections resulting from these matches were compared to the corrections from the 3D CBCT/CT matches and Pearson correlation coefficients were calculated. Results The systematic and random errors and resulting PTV margins for inter and intrafraction motion are shown in table 1 for the 3D CBCT/CT method. The clinically used PTV margins are sufficient for these uncertainties. In figure 1 the corrections from the 2D matches are plotted versus those from the 3D matches for all directions and linear regression lines are shown. A moderate to strong correlation was found as indicated by the Pearson correlation coefficients.
Tumori Journal, Sep 1, 2015
Short communication needing pelvic radiotherapy such as in the case of prostate cancer (2). Prost... more Short communication needing pelvic radiotherapy such as in the case of prostate cancer (2). Prostheses should be better taken into account at the time of treatment planning and geometrically avoided during radiation delivery (3). Several different approaches have been proposed to reduce metal artifacts impact during the planning process (4). Magnetic resonance imaging (MRI) might be a potential useful tool in this context, facilitating target definition and normal structure visualization through CT-MRI coregistration (5). However, several drawbacks remain, such as different patient positioning due to diverse couching systems, eventual image distortions, and heterogeneous dose calculation due to inaccurate electron density information because of metallic implants (5). Cone-beam CT (both kilovoltage CT and megavoltage CT) is generally available in modern linear accelerators as an on-board imaging system to perform image-guided radiotherapy (IGRT) (6). Images acquired at these energies are less prone to artifacts, as the primary modality of interaction is the Compton rather than the photoelectric effect (2). The Clarity platform (Clarity System, Elekta, Stockholm, Sweden) allows for the acquisition of 3D ultrasound scans (3D-US) of the pelvic region (Fig. 1), using a 2D transabdominal probe equipped with positional sensors that needs to be swept across the patient's sovrapubic region (7). The system uses an infrared camera to
Tumori Journal, Sep 1, 2012
Primary systemic therapy is not only used in patients with locally advanced inoperable non-metast... more Primary systemic therapy is not only used in patients with locally advanced inoperable non-metastatic breast cancer but also for operable stage II and III cancer aimed at breast conservation. The indications for local-regional radiotherapy for patients who receive primary systemic therapy are still evolving. The purpose of this article is to provide a comprehensive discussion of how primary systemic therapy in operable breast cancer patients could affect the indications of radiotherapy to optimize localregional treatment. An overview of available literature data regarding neoadjuvant treatment and radiotherapy is analyzed and discussed. Considering the variability of data on this issue, an appropriate approach could still be to tailor treatment decision to the individual clinical case.
Clinical & Translational Oncology, Apr 1, 2016
This study aimed at investigating whether the irradiated volume of pelvic bone marrow (PBM) and s... more This study aimed at investigating whether the irradiated volume of pelvic bone marrow (PBM) and specific subsites may predict the occurrence of acute hematologic toxicity (HT) in anal cancer patients undergoing concurrent chemo-radiation. 50 patients, submitted to IMRT and concurrent chemotherapy, were analyzed. Several bony structures were defined on planning-CT: PBM and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. On dose-volume histograms, dosimetric parameters were taken. Endpoints included white blood-cell-count (WBC), absolute-neutrophil-count (ANC), hemoglobin (Hb) and platelet nadirs and acute hematologic toxicity (HT) according to RTOG scoring scale. Generalized linear modeling was used to find correlations between dosimetric variables and blood cell nadirs, while logistic regression analysis was used to test correlation with ≥G3 HT. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the optimal cut-off points for predictive dosimetric variables with the Youden method. Maximum detected acute HT comprised 38 % of ≥G3 leukopenia and 32 % of ≥G3 neutropenia. Grade 2 anemia was observed in 4 % of patients and ≥G3 thrombocytopenia in 10 %. On multivariate analysis a higher PBM-V 20 was associated with lower WBC nadir. Increased LSBM-V 40 was correlated with a higher likelihood to develop ≥G3 HT. A cut-off point at 41 % for LSBM-V 40 was found. Patients with LSBM-V 40 ≥41 % were more likely to develop ≥G3 HT (55.3 vs. 32.4 %; p &amp;amp;amp;amp;amp;amp;lt; 0.01). Increased low-dose to pelvic bony structures significantly predicted for WBC decrease. Medium-high dose to specific osseous subsites was associated with a higher probability of HT. LSBM-V 40 was a strong predictor of ≥G3 HT. A threshold at 41 % for LSBM-V 40 could be used to limit HT.
2018 IEEE Life Sciences Conference (LSC)
The radiation dose received by the pelvic Bone Marrow (BM) is a predictive factor for Hematologic... more The radiation dose received by the pelvic Bone Marrow (BM) is a predictive factor for Hematologic Toxicity (HT) occurrence in the treatment of anal cancer. For this reason it is important to avoid BM during radiotherapy. In particular, the standard strategy in these cases consists in the identification of hematopoietically active BM (actBM), i.e. the part of BM in charge of blood cells generation, on 18FDG-PET, FLT-PET or MRI, but no approached have been developed for identifying actBM from CT images. This exploratory study aims to use radiomics for detecting actBM on CT sequences. Our approach is based on the extraction of 36 first-order and texture (second-order) features for each CT slice. These features are used as input of a Decision Tree (DT) classifier able to discriminate between active and inactive BM regions on the images. This method was applied to five patients affected by carcinoma of the anal canal and the obtained actBM segmentation was compared with the standard actBM identification from 18FDG-PET (reference standard, RS). Our results show that actBM identification in lumbosacral and iliac structures using radiomics overlaps the RS for more than 75% in 4 out of 5 patients.
2020 IEEE International Symposium on Medical Measurements and Applications (MeMeA)
One of the main problems during in the treatment of anal cancer with chemotherapy and radiation i... more One of the main problems during in the treatment of anal cancer with chemotherapy and radiation is the occurrence of Hematologic Toxicity (HT). In particular, during radiotherapy it is crucial to spare Bone Marrow (BM), since the radiation dose received by BM in pelvic bones predicts the onset of HT. In this direction, the most popular strategies are based on the identification of the hematopoietically active BM (actBM), that is the part of BM in charge of blood cells generation, using MRI, SPECT or PET, but no approached have been proposed based on CT. In this study we compare four different classifiers in recognizing actBM from CT images using 36 radiomic features. We used Genetic Algorithms (GAs) to simultaneously optimize the feature subsets and the classifier parameters, separately for three pelvic subregions: iliac bone marrow (IBM), lower pelvis bone marrow (LPBM), and lumbosacral bone marrow (LSBM). The obtained classifiers were applied to CT sequences of a cohort of 25 patients affected by carcinoma of the anal canal. Classifiers results were compared with the actBM identified from 18FDG-PET (reference standard, RS). It emerged that the performances of the 4 classifiers are similar and they are satisfactory for IBM and LSBM subregions (Dice > 0.7) whereas they are poor for LPBM (Dice < 0.5).
Radiotherapy and Oncology
Journal of Gastrointestinal Cancer
Background and Aim Anal squamous cell carcinoma (SCC) and oropharyngeal cancer (OPC) are rare tum... more Background and Aim Anal squamous cell carcinoma (SCC) and oropharyngeal cancer (OPC) are rare tumors associated with HPV infection. Bioumoral predictors of response to chemoradiation (CT-RT) are lacking in these settings. With the aim to find new biomarkers, we investigated the role of eosinophils in both HPV-positive anal SCC and HPV-related oropharyngeal cancer (OPC). Methods We retrieved clinical and laboratory data of patients with HPV-positive anal SCC treated with CT-RT in 5 institutions, and patients with locally advanced OPC SCC treated with CT-RT in 2 institutions. We examined the association between baseline eosinophil count (the best cutoff has been evaluated by ROC curve analysis: 100 × 10^9/L) and disease-free survival (DFS). Unadjusted and adjusted hazard ratios by baseline characteristics were calculated using the Cox proportional hazards model. Results Three hundred four patients with HPV-positive anal SCCs and 168 patients with OPCs (122 HPV-positive, 46 HPV-negativ...
Radiotherapy and Oncology, 2020
Radiotherapy and Oncology, 2020
Radiotherapy and Oncology, 2021
Radiotherapy and Oncology, 2018
Radiotherapy and Oncology, 2018
Radiotherapy and Oncology, 2018
Purpose or Objective The mainstay of rectal cancer treatment is surgery according to the total me... more Purpose or Objective The mainstay of rectal cancer treatment is surgery according to the total mesorectal excision (TME) principle. Unfortunately, TME surgery may result in significant long-term morbidity. In locally advanced tumors TME surgery is generally preceded by neoadjuvant radiotherapy or chemoradiotherapy as this has been shown to improve locoregional control. For 15-20% of patients, a clinical complete response (cCR) is seen after chemoradiotherapy. These patients can potentially be spared mutilating surgery through a watch and wait policy. Recent studies have shown that dose escalation by a radiation boost increases the complete response rate compared to the standard uniform dose. The boost dose to the tumor can be administered through external beam radiotherapy (EBRT) or through internal radiotherapy, the latter using different techniques like contact X-ray therapy (CXT), low-dose-rate (LDR) brachytherapy (BT) or high-dose-rate (HDR) BT. CXT is often mentioned as causing very little toxicity. However, very limited information is available concerning the treatment-related toxicity of these techniques. With this systematic review, we aim to summarize and compare the data that has been published concerning acute and late toxicity after CXT and/or BT for rectal cancer. Material and Methods The search on Pubmed was performed by two of the authors. All studies reporting toxicity after endorectal radiation techniques for rectal cancer were included and analyzed according to the PRISMA Checklist of items to include when reporting a systematic review and metaanalysis 2009. Results 35 studies were included, resulting in 2591 patients for analysis. Direct comparison of the occurrence of toxicity by the different radiation techniques was hampered by various combinations of endorectal techniques, a lack of clear reporting of toxicity scores, dose prescription, technique used, and treated volumes. ≥ Grade 3 rectal toxicity was reported in 9 out of 480 patients having received only CXT. 12 out of 330 patients who clearly received only BT had ≥ Grade 3 rectal toxicity, and BT also caused Grade 3 urinary toxicity in one patient. Conclusion All techniques reported some ≥ Grade 3 toxicity. Notably, toxicity after CXT was confined to only the rectum. Unfortunately, few specific conclusions could be drawn regarding the dose related risk of toxicity for the various endorectal techniques due to missing information. Hence, recommendations were given for standard dose reporting for endorectal techniques to enable comparison of techniques in the future. EP-1461 Immune inflammation indicators in anal cancer patients treated with concurrent chemoradiation
Radiotherapy and Oncology, 2019
The linear model, adjusted by the number of arcs, resulted to have a R 2 of 0.9. All three input ... more The linear model, adjusted by the number of arcs, resulted to have a R 2 of 0.9. All three input parameters were significant (P<0.05). A representation of the linear fit is reported in figure 2 Conclusion These data could be used as predictive model to assist in risk evaluation and decision for appropriate technique, such as breath hold or other suitable techniques EP-1917 Variable versus conventional inter-fraction intervals in SBRT
Radiotherapy and Oncology, 2019
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Papers by Francesca Arcadipane