A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Ferini, Gianluca; Pergolizzi, Stefano

doi:10.21873/invivo.12390

Cited by 20 publications

(19 citation statements)

References 100 publications

(72 reference statements)

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“…Some risk for adverse events is peculiar to the stereotactic technique, which is an approach effectively used also in other metastatic or primary sites [41] , [42] , [43] , [44] in order to prevent the characteristic side effects of less conformal types of external beam radiotherapy [45] , [46] ; this therapeutic option allows to use a high radiation dose in a single fraction or short fractionated radiotherapy schedule. Kano et al [47] conducted a retrospective study involving 755 patients who have been submitted to a median single radiosurgery dose of 20 Gy.…”

Section: Discussionmentioning

confidence: 99%

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Ferini¹,

Viola²,

Valenti³

et al. 2022

Clinical and Translational Radiation Oncology

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To evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). Methods: This multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). Discussion: Several studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement

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Section: Discussionmentioning

confidence: 99%

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Ferini¹,

Viola²,

Valenti³

et al. 2022

Clinical and Translational Radiation Oncology

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“…For example, higher prescription doses could be considered for squamous cell carcinomas, within normal tissue tolerances, where a lower BED translates to a worse outcome [54,55]. We also suppose that radiomics could help differentiate between post-radiotherapy benign changes and residual tumor tissues [56] or predict which patients are more prone to develop treatment-related adverse events [57]. Finally, radiomics could be a powerful tool in providing other biological and genomics tumor characterization, translating in a most accurate treatment [58].…”

Section: Tablementioning

confidence: 99%

Strategies to develop radiomics and machine learning models for lung cancer stage and histology prediction using small data samples

Ubaldi

Valenti²,

Borgese

et al. 2021

Physica Medica

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Predictive models based on radiomics and machine-learning (ML) need large and annotated datasets for training, often difficult to collect. We designed an operative pipeline for model training to exploit data already available to the scientific community. The aim of this work was to explore the capability of radiomic features in predicting tumor histology and stage in patients with non-small cell lung cancer (NSCLC).We analyzed the radiotherapy planning thoracic CT scans of a proprietary sample of 47 subjects (L-RT) and integrated this dataset with a publicly available set of 130 patients from the MAASTRO NSCLC collection (Lung1). We implemented intra-and inter-sample cross-validation strategies (CV) for evaluating the ML predictive model performances with not so large datasets.We carried out two classification tasks: histology classification (3 classes) and overall stage classification (two classes: stage I and II). In the first task, the best performance was obtained by a Random Forest classifier, once the analysis has been restricted to stage I and II tumors of the Lung1 and L-RT merged dataset (AUC = 0.72 ± 0.11). For the overall stage classification, the best results were obtained when training on Lung1 and testing of L-RT dataset (AUC = 0.72 ± 0.04 for Random Forest and AUC = 0.84 ± 0.03 for linear-kernel Support Vector Machine).According to the classification task to be accomplished and to the heterogeneity of the available dataset(s), different CV strategies have to be explored and compared to make a robust assessment of the potential of a predictive model based on radiomics and ML.

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“…For example, an upfront ablative boost delivered to MRI highly suspicious areas in localized prostate cancer through a lattice technique has proven to be effective and safe in a phase I trial, not adding any further toxicity than expected from a conventional fractionated approach [22]. Another trial by the same authors aims to learn about any difference in terms of cancer-specific outcomes and health-related quality of life between prostate cancer patients treated with upfront lattice boost followed by conventional EBRT or with daily moderately hypofractionated radiotherapy (NCT02307058), attempting to improve the therapeutic ratio of this treatment alternative to surgery [23]. Similarly, other authors explored the use of GammaPod-based Lattice RT for treating large bulky breast tumors and reported a dosimetric feasibility study where, against an extremely high dose concentrated at vertices, a very low mean dose to overlying skin (≈1-2 Gy) was obtained.…”

Section: Clinical Use Of Lattice Radiotherapymentioning

confidence: 99%

Lattice or Oxygen-Guided Radiotherapy: What If They Converge? Possible Future Directions in the Era of Immunotherapy

Ferini¹,

Valenti²,

Tripoli³

et al. 2021

Cancers

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Palliative radiotherapy has a great role in the treatment of large tumor masses. However, treating a bulky disease could be difficult, especially in critical anatomical areas. In daily clinical practice, short course hypofractionated radiotherapy is delivered in order to control the symptomatic disease. Radiation fields generally encompass the entire tumor mass, which is homogeneously irradiated. Recent technological advances enable delivering a higher radiation dose in small areas within a large mass. This goal, previously achieved thanks to the GRID approach, is now achievable using the newest concept of LATTICE radiotherapy (LT-RT). This kind of treatment allows exploiting various radiation effects, such as bystander and abscopal effects. These events may be enhanced by the concomitant use of immunotherapy, with the latter being ever more successfully delivered in cancer patients. Moreover, a critical issue in the treatment of large masses is the inhomogeneous intratumoral distribution of well-oxygenated and hypo-oxygenated areas. It is well known that hypoxic areas are more resistant to the killing effect of radiation, hence the need to target them with higher aggressive doses. This concept introduces the “oxygen-guided radiation therapy” (OGRT), which means looking for suitable hypoxic markers to implement in PET/CT and Magnetic Resonance Imaging. Future treatment strategies are likely to involve combinations of LT-RT, OGRT, and immunotherapy. In this paper, we review the radiobiological rationale behind a potential benefit of LT-RT and OGRT, and we summarize the results reported in the few clinical trials published so far regarding these issues. Lastly, we suggest what future perspectives may emerge by combining immunotherapy with LT-RT/OGRT.

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A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Cited by 20 publications

References 100 publications

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Strategies to develop radiomics and machine learning models for lung cancer stage and histology prediction using small data samples

Lattice or Oxygen-Guided Radiotherapy: What If They Converge? Possible Future Directions in the Era of Immunotherapy

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