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A meticulous study has led to description and identification of a novel member of the aphelinid genus Eretmocerus as a species associated with nymphs of the orange spiny whitefly, Aleurocanthus spiniferus (Quaintance) (Hemiptera Aleyrodidae). The detailed morphological analysis of the parasitoid has revealed distinctive characteristics that differentiate it from known species within the genus. Molecular analysis has been conducted to provide additional evidence to the morphological analyses. Molecular data obtained from DNA sequencing of the mitochondrial COI and 28S ribosomal genes has been compared with sequences from existing databases, revealing a genetic divergence from other available Eretmocerus species and genetically defining the studied entity. The integrated methodology employed in this study enabled the delineation of a new species within the Eretmocerus serius Silvestri group, Eretmocerus iulii Laudonia et Melone sp. n. (Hymenoptera Aphelinidae). [ABSTRACT FROM AUTHOR]

The invasive spread of the Bactrocera dorsalis (Hendel), (Diptera, Tephritidae) (the oriental fruit fly), is intensifying globally. After sporadic interceptions in Europe, the first field findings occurred in Italy in 2018-2019. Despite a record-free period from 2020 to 2021, catches in Campania surged from June 2022 onwards. In response, a series of research activities began in Campania, aiming to delineate the infested zone, evaluate dispersion, assess population dynamics, identify the epicenter, and determine prevalent host fruits. Over 250 traps of various types, baited with diverse attractants, along with fruit samplings, led to the capture of the first B. dorsalis females and the identification of the first active infestation in Europe during the summer of 2022. Results reveal a rapid increase in captures from June 2022 to January 2023, with over 3,000 adults captured, reaching the peak in October. The expansion of the infested zone reached 48.24 km2, indicating a localized hotspot. Active infestations primarily occurred in specific locations, with Citrus spp. being the most frequently infested fruits. The sex ratio of captured specimens indicates a bias towards males, particularly due to the lure used. The study identifies a narrow 14.04 km2 area, concentrating 97.4% of catches, as the probable epicenter. Specific anthropized localities play a crucial role in sustaining the population. Bactrocera dorsalis specimens exhibited a potential movement range of about 7 km, but the movement of infested fruits can greatly expand this range. The high number of recorded catches suggests the existence of a substantial nucleus of individuals, possibly facilitating the acclimatization of the species in Italy. [ABSTRACT FROM AUTHOR]

Objectives: To discriminate between post-treatment changes and tumor recurrence in patients affected by glioma undergoing surgery and chemoradiation with a new enhancing lesion is challenging. We aimed to evaluate the role of ASL, DSC, DCE perfusion MRI, and 18F-DOPA PET/CT in distinguishing tumor recurrence from post-treatment changes in patients with glioma. Materials and methods: We prospectively enrolled patients with treated glioma (surgery plus chemoradiation) and a new enhancing lesion doubtful for recurrence or post-treatment changes. Each patient underwent a 1.5T MRI examination, including ASL, DSC, and DCE PWI, and an 18F-DOPA PET/CT examination. For each lesion, we measured ASL-derived CBF and normalized CBF, DSC-derived rCBV, DCE-derived Ktrans, Vp, Ve, Kep, and PET/CT-derived SUV maximum. Clinical and radiological follow-up determined the diagnosis of tumor recurrence or post-treatment changes. Results: We evaluated 29 lesions (5 low-grade gliomas and 24 high-grade gliomas); 14 were malignancies, and 15 were post-treatment changes. CBF ASL, nCBF ASL, rCBV DSC, and PET SUVmax were associated with tumor recurrence from post-treatment changes in patients with glioma through an univariable logistic regression. Whereas the multivariable logistic regression results showed only nCBF ASL (p = 0.008) was associated with tumor recurrence from post-treatment changes in patients with glioma with OR = 22.85, CI95%: (2.28–228.77). Conclusion: In our study, ASL was the best technique, among the other two MRI PWI and the 18F-DOPA PET/CT PET, in distinguishing disease recurrence from post-treatment changes in treated glioma. [ABSTRACT FROM AUTHOR]

This study focuses on the first detection in Europe of a parasitoid Eretmocerus sp. gr. serius (Hymenoptera: Aphelinidae) on the Orange Spiny Whitefly, Aleurocanthus spiniferus (Quaintance) (Hemiptera: Aleyrodidae). Through extensive field surveys, this study investigates the occurrence of the aphelinid in several regions across central and southern Italy. Different sites were monitored to investigate the Eretmocerus sp. gr. serius parasitization rate on A. spiniferus, shedding light on its potential as a biological control agent against the invasive whitefly pest. The research results offer a hopeful prospect for progressing sustainable and eco-friendly methods in handling A. spiniferus infestations in citrus crops, highlighting the importance of natural enemies in integrated pest management programs. The research emphasizes the importance of the recently discovered parasitoid for European agriculture, paving the way for inventive approaches in pest control and cultivation practices. [ABSTRACT FROM AUTHOR]

Background: The ocular involvement of neuroendocrine neoplasms (NENs) is uncommon and mainly represented by metastases from gastrointestinal and lung neuroendocrine tumors. Primary orbital NENs are even less common and their diagnostic and therapeutic management is a challenge. Methods: A systematic review of the literature was conducted from 1966 to September 2023 on PubMed to identify articles on orbital NENs and to summarize their clinical–pathological features, diagnosis and therapeutic management. Furthermore, we presented a case of a locally advanced retro-orbital primary neuroendocrine tumor that was referred to the certified Center of Excellence of Sant'Andrea Hospital, La Sapienza University of Rome, Italy. Results: The final analysis included 63 records on orbital NENs and 11 records focused on primary orbital NENs. The localization was mostly unilateral and in the right orbit; proptosis or exophthalmos represented the initial symptoms. The diagnostic work-up and therapeutic management was discussed and a diagnostic algorithm for the suspicion of primary orbital NENs was proposed. Conclusions: A multidisciplinary approach is required for the management of primary orbital NENs, emphasizing the importance of early referral to dedicated centers for prompt differential diagnosis, tailored treatment, and an improved quality of life and survival. [ABSTRACT FROM AUTHOR]

Simple Summary: The accurate identification of the Oriental fruit fly, Bactrocera dorsalis, is complicated by its similarities to other species and taxonomic uncertainties. This represents a significant threat to fruit crops as it is already present in Europe, and this is a cause for great concern. To expedite identification, a reliable method using a unique technical approach was developed. The initial phase involved collecting specimens from the population present in Italy to create a large and representative sample, enabling us to optimize the method. This method has demonstrated high sensitivity and accuracy in detecting small amounts of B. dorsalis DNA. It now serves as a valuable tool for routine diagnostics, facilitating efficient pest management and detection. Given the recent infestations in Italy, this diagnostic protocol is crucial for monitoring and preventing the passive spread of B. dorsalis in Europe. Accurate identification of Bactrocera dorsalis (Hendel) (Diptera: Tephritidae), commonly known as the Oriental fruit fly, is a significant challenge due to the morphological convergence and taxonomic uncertainties of species belonging to the same genus. This highly polyphagous species poses a significant threat to fruit crops. With its potential establishment in Europe becoming a growing concern, there is an urgent need for rapid and efficient diagnostic methods. The study presented here introduces a diagnostic protocol based on real-time PCR using a TaqMan probe for the early and reproducible identification of B. dorsalis. Specimens representing the genetic diversity of the Italian population were collected and analyzed. Specific primers and probe were designed based on the conserved regions and an in silico analysis confirmed their specificity. The assay conditions were optimized, and analytical sensitivity, specificity, repeatability, and reproducibility were evaluated. The protocol showed high sensitivity and specificity, accurately detecting low DNA concentrations of B. dorsalis. This standardized method provides a reliable tool for routine diagnostics, enhancing the accuracy and efficiency of identifying the Oriental fruit fly at all stages of its development, thereby facilitating effective pest management measures. The development of this diagnostic protocol is crucial for monitoring and supporting efforts to prevent the passive spread of B. dorsalis in Europe, particularly in light of the recent active infestations detected in Italy. [ABSTRACT FROM AUTHOR]

Simple Summary: The beef industry faces the challenge of increasing the supply of high-quality protein to an ever-growing global population. Improving nutrient use efficiency is important to enhancing the sustainability of the beef industry and its environmental footprint. Over the past few decades, advances in dietary innovations and feed supplements have helped to improve feed efficiency in cattle. However, focusing on the rumen microorganisms stands to rapidly advance ruminant nutritional physiology, as the microbes enable ruminant animals to utilize plant-derived feed sources by processing them through microbial-driven fermentation. To address common feed and management practices and their impact on the rumen microbial community, this review addresses the interactions among beta-adrenergic agonists, protein level and source, and the ruminal microbiome. Advancing our understanding of feed and management practices and their association with the rumen microbiome will help to sustainably improve beef cattle performance. Improving beef production efficiency, sustainability, and food security is crucial for meeting the growing global demand for beef while minimizing environmental impact, conserving resources, ensuring economic viability, and promoting animal welfare. Beta-adrenergic agonists and dietary protein have been critical factors in beef cattle production. Beta-agonists enhance growth, improve feed efficiency, and influence carcass composition, while dietary protein provides the necessary nutrients for muscle development and overall health. A balanced approach to their use and incorporation into cattle diets can lead to more efficient and sustainable beef production. However, microbiome technologies play an increasingly important role in beef cattle production, particularly by optimizing rumen fermentation, enhancing nutrient utilization, supporting gut health, and enhancing feed efficiency. Therefore, optimizing rumen fermentation, diet, and growth-promoting technologies has the potential to increase energy capture and improve performance. This review addresses the interactions among beta-adrenergic agonists, protein level and source, and the ruminal microbiome. By adopting innovative technologies, sustainable practices, and responsible management strategies, the beef industry can contribute to a more secure and sustainable food future. Continued research and development in this field can lead to innovative solutions that benefit both producers and the environment. [ABSTRACT FROM AUTHOR]

Optimizing growth and body composition while maintaining health, welfare, and meat quality challenges the broiler industry. The objective of this study is to identify molecular pathways in developing adipose and muscle that underlie differential growth rate and body composition in broiler chickens. A conventional (Cobb700) line and a slow-growing (RedBro) line were compared with lines that represent divergent growth and body composition within the context of commercial broiler genetics. Eggs (n = 60) from each line were obtained from commercial hatcheries and incubated until embryonic d 17 (E17), or until hatch and raised to 5 (D 5) or 10 d (D 10) of age. At each age, breast muscle (BM) and subcutaneous (SQ) fat pad (n = 10) were collected, weighed, and snap frozen. Neck and abdominal (ABD) fat pads (n = 10) were collected at D 10 and D 14. Adipocyte size at E17 and D 10 was determined in H&E-stained tissue sections using ImageJ. T-tests were used to compare body and tissue weights and adipocyte size between lines (α = 0.05). RNA (n = 5 tissue -1ּ age-1 / /age) from adipose and breast was isolated for transcriptomic analyses using 3’ RNAseq. Raw reads were mapped to the chicken genome (bGalGal1.mat.broiler.GRCg7b). Differentially expressed genes (DEGs; fdr P-value < 0.1) were identified using the R package DEseq2 R (version 4.3.1). Sets of DEGs were analyzed for functional annotation using Database for Annotation, Visualization, and Integrated Discovery (david.ncifcrf. gov). Body weight was significantly heavier in Cobb vs. Redbro chicks at each age (P < 0.05). The most notable differences in relative tissue weight occurred for adipose (SQ) at E17 and D5, and for BM at D 10. Relative fat pad weight (SQ) was significantly greater in Cobb vs. Redbro at E17 and D5. In the embryo, this difference was associated with larger adipocytes, suggesting increased capacity for energy storage in fast-growing broilers. In contrast, at D5, Cobb exhibited a significant increase in abundance of small adipocytes, indicating a shift towards adipocyte hyperplasia and/or enhanced mobilization of stored energy post-hatch. Differences in adiposity and adipocyte size were associated with 103 and 153 DEGs at E17 and D5, respectively. These gene sets were enriched in various growth-related functions, including tissue morphogenesis, peptide transport, and mitogenesis. Relative breast weight diverged significantly at D 10, with heavier BM in Cobb chicks. The set of 278 DEGs at this age were enriched in multiple GO categories related to lipid metabolism (16% of genes) and protein metabolism. Although relative breast muscle weight did not differ at E17, 362 DEGs were identified at this age, and were enriched in functions related to skeletal muscle development (n = 43) and mitogenesis, among others. In conclusion, these results identify both phenotypic and transcriptomic differences that underlie, and in some cases precede, divergent growth in broiler chickens. Further investigation is required to determine how these differences affect mature body composition. [ABSTRACT FROM AUTHOR]

Animals with greater feed efficiency use fewer resources to produce skeletal muscle, the primary product in beef production. As muscle represents approximately 50% of BW in beef cattle, efficient utilization of feed is interconnected with growth. However, little is known about molecular pathways interconnecting these two components of production. The overall objective of the study was to determine relationships between feed efficiency and growth at the molecular level in skeletal muscle of beef cattle. The specific objective of this study was to identify genes and pathways that are associated with variation in ADG, as an index of growth. We hypothesize that increased expression of genes involved in energy utilization are associated with greater ADG. Angus steers (n = 100) were enrolled in 70-d feed efficiency trials using the Vytelle GrowSafe 8000 individual feed intake monitoring system. Muscle samples (~ 500 ug) were collected via needle biopsy from the wing of the ileum between the axis and transverse processes of the lumbar vertebrae during the last 30 d of the trial. Samples were snap-frozen in liquid nitrogen and stored at -80°C. Frozen tissue was pulverized and RNA extracted from ~ 50mg/sample using a commercial kit (zymoresearch.com). Quality was verified using Agilent 4200 Tapestation (agilent.com). Libraries were constructed using SMART Seq v4 3’ DE Kit. Libraries were assessed for quality and quantity, and subsequently pooled for sequencing using a Novaseq 6000 (illumina.com). STAR RNA-seq aligner was used to map the reads to the bovine genome (ARS-UCD_2.0). Animals were ranked according to ADG and grouped by 20th percentile; the first, third, and fifth groups were designated as “Very Low”, “Medium”, and “Very High”, respectively. Expression profiles between the groups were compared using DESeq2 in R (version 3.5). A total of 1,199 genes were identified as differentially expressed (fdr P-value < 0.05). Gene sets were functionally annotated using Database for Annotation, Visualization and Integrated Discovery (david.ncifcrf. gov). Genes expressed at greater levels in Very High ADG steers were significantly enriched (fdr P -value < 0.05) in Gene Ontology(GO) functions related to cellular metabolism (226 of 1199 genes). In addition, 92 genes in this set were associated with the KEGG pathway for VEGF/VEGFR-2 signaling, which regulates angiogenesis and has been associated with muscle growth. Genes expressed at greater levels in Very Low ADG steers were significantly enriched in GO terms related to proteasome degradation and mitophagy, both of which have been associated with muscle loss. In conclusion, these results support that variation in cellular metabolism contributes to variation in muscle growth, as reflected by ADG. They also highlight angiogenesis as a pathway that is worthy of further investigation for its role in beef cattle production. [ABSTRACT FROM AUTHOR]

Simple Summary: This study was carried out with the aim of emphasizing the importance of checking the plant material that can be imported in the baggage of airline passengers. Travelers are often unaware of the regulations in place and of the risks connected with such importation. The risk of the introduction of harmful organisms correlated with this pathway is yet not well studied and its frequency is underestimated. The results of the research underline the need for continuous checks at entry points and the establishment of a specialized position for inspections. Among European countries, Italy is the most exposed to the risk of biological invasions, principally for its numerous entry points (ports and airports) and for climatic conditions favorable for the acclimatization of several invasive species. Here it was assessed that the greatest threats to our agro-ecosystems come mainly from the passenger baggage in which a variety of fruits and vegetables are carried. From 2016 to 2021, large quantities of plant products were found in the luggage of passengers travelling from outside the EU and seized at the BCPs (border control posts) in the Campania region. Inspections and the following laboratory analyses were conducted on the plant material to assess the presence of exotic pests. Inspections led to several non-native species being recorded, and among the intercepted organisms, some should be considered "alarming", such as Bactrocera dorsalis, Anastrepha obliqua, and Leucinodes africensis. Despite a well-organized border inspection system, travelers transporting infested material unknowingly contribute to increasing the risk of the introduction of exotic species. Given the current situation, it is necessary to impose stricter controls and greater attention, ensuring compliance with the requirements of the new phytosanitary regulations by the actors involved in the transport of plant material. Finally, it is essential to improve awareness through a phytosanitary campaign on plant health risks, especially for people wishing to transport fruits and vegetables in their luggage. [ABSTRACT FROM AUTHOR]

Copyright of EPPO Bulletin is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Question (1669-6581) is the property of Universidad Nacional de La Plata and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: We aimed at updating our previous researches about the burden of hip fractures in elderly Italian population. Methods: We analyzed national hospitalizations records from 2000 to 2014 to compute age- and sex-specific standardized rates. Results: 1,335,375 hospitalizations were recorded in people ≥ 65 (1,031,816 women: 77.27% and 303,559 men: 22.73%) over 15 years, passing from 73,493 in year 2000 to 94,525 in 2014, with an overall increase of 28.62% over the 15-year period (females: + 25.1%; males: + 41.2%). About 84.9% of total hip fractures were suffered by patients aged ≥ 75 years old. Direct hospitalization costs and rehabilitation costs increased from 343 to 457 million Euros and from 392 to 504 million Euros from year 2000 to 2014, respectively. Overall costs of hip fractures raised from 735 to 961 million Euros (+ 30.74% from 2000 to 2014). Conclusion: The number of hip fractures and related hospitalizations costs in Italian elderly population is still increasing due to the absolute number of fractures occurring in people ≥ 65 years old and particularly over 75 years old. [ABSTRACT FROM AUTHOR]

Copyright of Question (1669-6581) is the property of Universidad Nacional de La Plata and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Feed efficiency is an important factor for improving the sustainability and economic value of beef production. Although feed efficiency is moderately heritable, it is a complex trait affected by numerous factors such as diet, the rumen microbiome, and energy metabolism. Recent work has examined the molecular control of cattle divergent in feed efficiency; however, limited work has focused on the transcriptomic regulation of variation in feed efficiency, specifically, the genes contributing to muscle growth and the variation in feed efficiency in beef production. The hypothesis of this study was that cattle with greater feed efficiency will have increased expression of genes that promote muscle growth and energy metabolism. A total of 100 Angus steers weighing approximately 400 kg were enrolled in 70 d feed efficiency trials to determine residual feed intake (RFI) using the Vytelle GrowSafe 8000 individual feed intake monitoring system. At mid-test, 500-mg of muscle tissue was collected from the wing of the ileum between the axis and transverse processes of the lumbar vertebrae and was punched with a biopsy probe tool. The collected biopsy samples were flash frozen in liquid nitrogen for storage until processing. RNA was extracted and 3' RNA sequencing was conducted on the Novaseq 6000 to determine the differential skeletal muscle transcrip-tomes of steers differing in RFI. Differential expression analysis was performed with the DESeq2 R package. To determine connections between the differentially expressed genes identified via transcriptional profiling and RFI, gene expression results were examined for correlations. To visualize the correlation matrices, the Corrplot package in R (version 3.4) was utilized. Varying numbers of differentially expressed gene transcripts were detected between steers divergent in RFI (P < 0.05), and were identified with significant correlations to RFI (P < 0.05). Specifically, the genes identified were related to muscle growth and energy metabolism. These results further define the molecular control of muscle growth with regard to RFI, and the opportunity to improve feed efficiency and muscle growth while meeting the needs for food production and sustainability for the growing population. [ABSTRACT FROM AUTHOR]

The Fåhræus-Lindqvist effect is usually explained from a physical point of view with the so-called Haynes' marginal zone theory, i.e., migration of red blood cells (RBCs) to a core layer surrounded by an annular RBCs-free plasma layer. In this paper we show that the marginal layer, though causing a substantial reduction in flow resistance and increasing discharge, does not reduce the rate of energy dissipation. This fact is not surprising if one considers the electric analog of the flow in a vessel: a resistance reduction increases both the current intensity (i.e., the discharge) and the energy dissipation. This result is obtained by considering six rheological models that relate the blood viscosity to hematocrit (volume fraction occupied by erythrocytes). Some physiological implications are discussed. [ABSTRACT FROM AUTHOR]

Background: In Europe the number of elderly people is increasing. This population growth has resulted in higher healthcare costs. The purpose of this project was to try to promote active ageing in people aged 65-80 with mild cognitive impairment through cognitive games delivered via a tablet computer. Objectives: Age-appropriate cognitive games were developed targeting different aspects of cognition and then experiences of elderly people using these games were evaluated. Methods: The design of games was developed through iterative user-centered design focus groups with elderly people as participants. The experiences of participants playing the games over a 47 day period were explored through semi-structured interviews. Results: Four games were developed that addressed a range of cognitive functions such as perception, attention, memory, language, comprehension and executive function. The participants were able to play these games without external intervention over an extended period and reported positively on their experiences. Conclusion: Cognitive games can be used successfully by people with mild cognitive impairment to promote active ageing. [ABSTRACT FROM AUTHOR]

Objective: The colorectal cancer (CRC) might present loco-regional recurrence, including lymph-node metastasis. Stereotactic body radiotherapy (SBRT) is a non-invasive and well-tolerated ablative treatment. Aim of the present study is to evaluate efficacy and toxicity of SBRT with volumetric modulated arc therapy (VMAT) in this setting. Methods: 35 patients presenting a total of 47 nodal recurrences from CRC, treated with VMAT-SBRT from 2008 to 2015, were selected. About three fourth of the treatments delivered 45 Gy in 6 daily fractions. End-points were the detection of toxicities, overall survival (OS), local control (LC), disease progression free incidence (DPFI) and disease free survival (DFS). Tumour response was assessed according to the RECIST criteria. Results: Only Grade 1 and 2 toxicities were recorded. Median follow-up was 15 months (range 2–68). Local relapse was reported in 6 patients, regional relapse in 10 patients. Complete remission was reported in 20 cases (53%), partial remission in 14 (37%). Rates of LC at 1, 2 and 3 years were 85.3, 75.0 and 75.0%, respectively. At 1 year the actuarial OS was 100%, at 2 and 3 years was 81.4%. Median DFS was estimated in 16 months, with an incidence of 69.4, 33.3 and 19.4% at 1, 2 and 3 years, respectively. Conclusion: The use of the VMAT-SBRT in lymph-node recurrence of CRC could prevent severe complications and achieve satisfying rates of disease control. Advances in knowledge: The use of VMAT-SBRT is a viable approach for lymph-node recurrence of CRC. [ABSTRACT FROM AUTHOR]

The extent of surgical resection (EOR) has been recorded as conditioning outcome in glioblastoma multiforme (GBM) patients but no significant improvements were recorded in survival. The study aimed to evaluate the impact of EOR on survival, investigating the role of fluid-attenuated inversion recovery (FLAIR) abnormalities removal. 282 newly diagnosed GBM patients were treated with surgery followed by concurrent and adjuvant chemo-radiotherapy. The EOR was defined as: SUPr, in case of resection amounting to 100% of enhanced and FLAIR areas; gross total (GTR) in case of resection between 90 and 100% of enhanced areas with variable amount of FLAIR abnormalities; sub-total (STR), between 10 and 89%; biopsy (B) <10%. FLAIR-RTV was dichotomized in percentage values to identify the best separation threshold for progression free survival (PFS) and overall survival (OS). SUPr was obtained in 21 patients (7.4%), GTR in 60 (21.3%), STR in 143 (50.7%) and biopsy only in 58 (20.6%). The median, 1, 2-year PFS were 10.4 ± 0.4 months, 39.0 ± 3.0, and 17.0 ± 2.0%; the median, 1, 2-year OS were 14.5 ± 0.5 months, 63.3 ± 3.0, and 23.1 ± 3.1%. EOR was significantly influencing survival (p < 0.001). The median, 1, 2-year OS were 28.6 ± 5.2 months, 90.0 ± 6.0, 71.0 ± 10.0% for patients underwent SUPr vs. 16.2 ± 1.2 months, 81.0 ± 5.0, 24.0 ± 6.0% for GTR. The FLAIR removal threshold conditioning survival was 45%. Minor complications were recorded in 14 (5%) patients and major in 8 (2.8%). surgical resection beyond contrast-enhancing boundaries could represent a promising strategy to improve outcome in GBM patients. The identification of a FLAIR-RTV threshold can be useful in clinical practice and it was recorded as factor influencing survival. [ABSTRACT FROM AUTHOR]

Objectives: A retrospective analysis was performed on patients treated for lung oligo-metastatic disease from radio-resistant histology groups. Methods: The primary end point was local control (LC), secondary end points were overall survival (OS) and progression free survival (PFS). Toxicity was scored according to CTCAE 4.03. Results: 200 patients were analyzed: 49.5% of the cases derived from colorectal primary tumors, 20.5% from sarcomas, 12.0% from renal cell carcinoma and the rest from other mixed origin. The mean follow-up was 24.2 months. LC at 1 and 2 years was 91, 84.9%. Primary histology and the presence of extra-pulmonary disease had a significant impact on LC. OS at 1 and 2 years was 88.7, 65.4%. Primary histology, disease free interval, presence of extra-pulmonary disease, number of irradiated lung lesions and age showed a correlation with prognosis at univariate analysis. PFS at 1 and 2 years was 84, 57.7%. The presence of extra-pulmonary disease and the number of irradiated lung lesions correlated with prognosis. Treatment was well tolerated with no G3-4 acute or late toxicity recorded. Conclusion: Colorectal metastases showed a higher rate of local relapse. However, the factors mostly influencing prognosis were the presence of extra-pulmonary disease and the number of lung lesions. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the relationship between C-methionine PET (C-METH PET) findings and molecular biomarkers in patients with supratentorial glioma who underwent surgery. Methods: A consecutive series of 109 patients with pathologically proven glioma (64 men, 45 women; median age 43 years) referred to our Institution from March 2012 to January 2015 for tumour resection and who underwent preoperative C-METH PET were analysed. Semiquantitative evaluation of the C-METH PET images included SUVmax, region of interest-to-normal brain SUV ratio (SUVratio) and metabolic tumour volume (MTV). Imaging findings were correlated with disease outcome in terms of progression-free survival (PFS), and compared with other clinical biological data, including IDH1 mutation status, 1p/19q codeletion and MGMT promoter methylation. The patients were monitored for a mean period of 16.7 months (median 13 months). Results: In all patients, the tumour was identified on C-METH PET. Significant differences in SUVmax, SUVratio and MTV were observed in relation to tumour grade ( p < 0.001). IDH1 mutation was found in 49 patients, 1p/19q codeletion in 58 patients and MGMT promoter methylation in 74 patients. SUVmax and SUVratio were significantly inversely correlated with the presence of IDH1 mutation ( p < 0.001). Using the 2016 WHO classification, SUVmax and SUVratio were significantly higher in patients with primary glioblastoma (IDH1-negative) than in those with other diffuse gliomas ( p < 0.001). Relapse or progression was documented in 48 patients (median PFS 8.7 months). Cox regression analysis showed that SUVmax and SUVratio, tumour grade, tumour type on 2016 WHO classification, IDH1 mutation status, 1p/19q codeletion and MGMT promoter methylation were significantly associated with PFS. None of these factors was found to be an independent prognostic factor in multivariate analysis. Conclusion: C-METH PET parameters are significantly correlated with histological grade and IDH1 mutation status in patients with glioma. Grade, pathological classification, molecular biomarkers, SUVmax and SUVratio were prognostic factors for PFS in this cohort of patients. The trial was registered with ClinicalTrials.gov (registration: NCT02518061). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcome of patients with non-small-cell lung cancer (NSCLC) with limited brain metastases (BMs) treated with local approaches omitting whole-brain radiation therapy (WBRT). Methods: Surgery was performed in case of a single, large BM, controlled extracranial disease and Karnofsky Performance Status (KPS) 90–100; stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiosurgery (HSRS) was performed in all other cases. The prescribed dose was 24 Gy/1 fraction for lesions <2.5 cm, and a median of 30 Gy (24–40 Gy) in 3–5 fractions for lesions >2.5 cm. Results: 156 patients treated for 228 BMs were retrospectively evaluated. The median age was 62 years. The majority of patients had a KPS 90–100, recursive partitioning analysis Class II, diagnosis-specific graded prognostic assessment score 2.5–3 and 1–2 BMs. Surgical resection was performed in 18 cases, and SRS/HSRS was performed in 210 cases. The 1–2-year local control was 87.2 ± 3.0% and 72.8 ± 5.0%; the 1.2-year brain distant failure was 30.8 ± 4.0% and 58.1 ± 6.0%; the 1–2-year overall survival was 60.9 ± 3.9% and 31.4 ± 4.0%. On univariate and multivariate analysis, the following factors influenced survival: age (p = 0.01), the presence of lymph node involvement (p = 0.03), KPS (p << 0.01), the presence of extracranial metastases at the time of BM treatment (p < 0.01), the number of BMs (p = 0.02) and the treatment performed (p < 0.01). Conclusion: The choice of an adequate local treatment can impact on survival in patients with limited BMs from NSCLC. A careful evaluation of prognostic and predictive factors is a pivotal additional aid. [ABSTRACT FROM AUTHOR]

The role of surgical resection in progressive or recurrent glioblastoma multiforme (GBM) lack of high level of evidence. The aim of this evaluation was to assess the role of surgical resection in relapsing GBM, in relation to the extent of surgical resection (EOR) and the amount of residual tumor volume (RTV). Among patients treated for newly diagnosed GBM between September 2008-December 2014, 64 patients with recurrent GBM were included in this retrospective evaluation. All patients underwent surgical resection followed by adjuvant treatments, chemotherapy and/or radiotherapy Results were evaluated in terms of local control (LC) rate, progression free survival (PFS) and patients overall survival (OS). Gross total resection (GTR) (>90%) was achieved in 48 (75%) patients and subtotal resection (STR) in 16 (25%). RTV was 0 in 40 (62.5%) patients and >0 in 24 (37.5%). No severe postoperative morbidity occurred. The median LC time was 6.0 ± 0.1 months (95% CI 5.29-8.55), with a 1 and 2 years LC rate of 29.4 ± 6.9%. The median PFS time was 6.8 ± 0.8 months, with a 1 year PFS rate of 27.2 ± 7.2% (95% CI 14.2-41.9). The median OS time was 10.3 ± 0.5 months (95% CI 7.6-10.4) with a 1 and 2 years OS rate of 22.5 ± 6.7% (95% CI 10.9-36.6). On univariate analysis EOR and RTV were recorded as conditioning LC and survival. These data was confirmed also in multivariate analysis only for RTV (p < 0.01). Recurrent GBM can take advantage of repeated surgery in selected patients with younger age and good clinical status. The entity of surgical resection was confirmed as conditioning survival. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We examined a series of malignant pleural mesothelioma (MPM) patients who underwent radical surgery to explore relationships among comorbidity, postoperative morbidity and survival. METHODS: A retrospective analysis was carried out of all MPM patients operated on in a single centre from 2000 to 2015. The Charlson Comorbidity Index (CCI) was used to classify patients according to their underlying condition. Postoperative complications were scored according to WHO-derived criteria. Survival comparisons were performed by Cox analysis. RESULTS: Ninety-one patients underwent extrapleural pneumonectomy (EPP), 47 underwent pleurectomy decortication (PD) and 25 underwent palliative pleurectomy. The mean CCI of PD patients was significantly higher compared with that of EPP patients (P = 0.044). The frequency of grade 3+ complications was similar between EPP and PD (27 vs 26%). However, EPP patients had a 6-fold higher frequency of pleural sepsis (24 vs 4%, P = 0.002) occurring up to 695 days postoperatively. Median overall survival was 19 months (95% CI 13-25) after EPP, 30 months (95% CI 20-35) after PD and 13 months (95% CI 5-32) after palliative pleurectomy. At multivariate analysis, CCI (P < 0.001), histology (P = 0.014) and pleural sepsis (P = 0.001), but not complete resection, were significantly associated with survival. There was a trend in favour of PD over palliative resection after adjusting for histology and CCI. CONCLUSIONS: The CCI is an independent predictor of survival in MPM patients undergoing radical surgery. Owing to its significant frequency and adverse impact, pleural sepsis may contribute to a reduced life expectancy after EPP. Surgical treatment of MPM remains debatable. [ABSTRACT FROM AUTHOR]

Background: Current treatments in grade III gliomas include surgery, radiotherapy, and chemotherapy. The value of the entity of surgical resection remains an open question. The aim of this evaluation was to analyze the impact of extent of resection (EOR) and residual tumor volume (RTV) on progression-free survival (PFS) and overall survival (OS) in patients with newly diagnosed grade III gliomas. Methods: Overall, 136 patients were included in this evaluation. EOR and RTV were defined in all patients on postoperative volumetric magnetic resonance imaging, with EOR being defined as the rate of surgical resection, and RTV as contrast-enhancing RTV (CE-RTV) and fluid-attenuated inversion recovery (FLAIR) RTV. A threshold of EOR and RTV was recorded using increments of 2 % and 1 cm. Results: EOR and RTV were the only clinical variables influencing PFS and OS. The EOR cut-off value for conditioning survival was 76 %. For EOR ≥76 % or <76 %, the 5- to 10-year PFS was 57 % and 18 % versus 0 % ( p = 0.03), and 5- to 10-year OS was 68 % and 42 % versus 0 % ( p = 0.06), respectively. Additionally, the RTV cut-off value was 3 cm; for RTV <3 cm or >3 cm, 5- to 10-year PFS was 64.3 % and 48.2 % versus 42 % and 0 % ( p = 0.02), and 5- to 10-year OS was 66.8 % and 33.4 % versus 56 % and 0 % ( p = 0.3), respectively. RTV was a more significant parameter conditioning PFS and OS than EOR ( p = 0.04), and the presence of CE-RTV was an unfavorable prognostic factor compared with FLAIR-RTV. Conclusions: In heterogeneous lesions from a radiological point of view as WHO grade III gliomas if a complete removal is not possible, it would be advisable to maximize the removal of enhancing areas, possibly with an EOR >76 % and an RTV <3 cm. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the benefit of a combined treatment, surgery followed by adjuvant hypofractionated stereotactic radiosurgery (HSRS) on the tumor bed, in oligometastatic patients with single, large brain metastasis (BM). Methods and Materials: Fom January 2011 to March 2015, 69 patients underwent complete surgical resection followed by HSRS with a total dose of 30Gy in 3 daily fractions. Clinical outcome was evaluated by neurological examination and MRI 2 months after radiotherapy and then every 3 months. Local progression was defined as radiographic increase of the enhancing abnormality in the irradiated volume, and brain distant progression as the presence of new brain metastases or leptomeningeal enhancement outside the irradiated volume. Surgical morbidity and radiation-therapy toxicity, local control (LC), brain distant progression (BDP), and overall survival (OS) were evaluated. Results: The median preoperative volume and maximum diameter of BM was 18.5cm3 (range 4.1–64.2cm3) and 3.6cm (range 2.1-5-4cm); the median CTV was 29.0cm3 (range 4.1–203.1cm3) and median PTV was 55.2cm3 (range 17.2–282.9cm3). The median follow-up time was 24 months (range 4–33 months). The 1-and 2-year LC in site of treatment was 100%; the median, 1-and 2-year BDP was 11.9 months, 19.6% and 33.0%; the median, 1-and 2-year OS was 24 months (range 4–33 months), 91.3% and 73.0%. No severe postoperative morbidity or radiation therapy toxicity occurred in our series. Conclusions: Multimodal approach, surgery followed by HSRS, can be an effective treatment option for selected patients with single, large brain metastases from different solid tumors. [ABSTRACT FROM AUTHOR]

Background: To assess the impact of volumetric-modulated arc therapy (VMAT) compared with 3D-conformal radiotherapy (3DCRT) in patients with newly diagnosed high grade glioma in terms of toxicity, progression free survival (PFS) and overall survival (OS).Methods: From March 2004 to October 2014, 341 patients underwent surgery followed by concomitant and adjuvant chemo-radiotherapy. From 2003 to 2010, 167 patients were treated using 3DCRT; starting from 2011, 174 patients underwent VMAT. The quantitative evaluation of the treatment plans was performed by means of standard dose volume histogram analysis. Response was recorded using the Response Assessment in Neuro-Oncology (RANO) criteria and toxicities graded according to Common Terminology Criteria for Adverse Event version 4.0.Results: Both techniques achieved an adequate dose conformity to the target. The median follow up time was 1.3 years; at the last observation 76 patients (23.4 %) were alive and 249 (76.6 %) dead (16 patients were lot to follow-up). For patients who underwent 3DCRT, the median PFS was 0.99 ± 0.07 years (CI95: 0.9-1.1 years); the 1 and 3 years PFS were, 49.6 ± 4 and 19.1 ± 3.1 %. This shall be compared, respectively, to 1.29 ± 0.13 years (CI95: 1.01-1.5 years), 60.8 ± 3.8, and 29.7 ± 4.6 % for patients who underwent VMAT (p = 0.02). The median OS for 3DCRT patients was 1.21 ± 0.09 years (CI95:1.03-1.3 years); 1 and 5 year OS was, 63.3 ± 3.8 and 21.5 ± 3.3 %. The corresponding results for 3DRCT patients were 1.56 ± 0.09 years (CI95:1.37-1.74 years), 73.4 ± 3.5, 30 ± 4.6 % respectively (p < 0.01). In both groups, prognostic factors conditioning PFS and OS were age, gender, KPS, histology and extent of resection (EOR).Conclusions: VMAT resulted superior to 3DCRT in terms of dosimetric findings and clinical results. [ABSTRACT FROM AUTHOR]

Background: Hypo-fractionated stereotactic radiotherapy (HSRT) is emerging as a valid treatment option for patients with single, large brain metastases (BMs). We analyzed a set of our patients treated with HSRT. The aim of this study was to evaluate local control (LC), brain distant progression (BDP), toxicity and overall survival (OS).Methods: From July 2011 to May 2015, 102 patients underwent HSRT consisting of 27Gy/3fractions for lesions 2.1-3 cm and 32Gy/4 fractions for lesions 3.1-5 cm. Local progression was defined as increase of the enhancing abnormality on MRI, and distant progression as new brain metastases outside the irradiated volume. Toxicity in terms of radio-necrosis was assessed using contrast enhanced T1MRI, T2 weighted-MRI and perfusion- MRI.Result: The median maximum diameter of BM was 2.9 cm (range 2.1-5 cm), the median gross target volume (GTV) was 16.3 cm(3) and the median planning target volume (PTV) was 33.7 cm(3) The median,1,2-year local control rate was 30 months, 96, 96 %; the median, 1-2-year rate of BDP was 24 months, 12, 24 %; the median,1,2-year OS was 14 months, 69, 33 %. KPS and controlled extracranial disease were associated with significant survival benefit (p <0.01). Brain radio-necrosis occurred in six patients (5.8 %).Conclusion: In patients with single, large BMs unsuitable for surgical resection, HSRT is a safe and feasible treatment, with good brain local control and limited toxicity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate outcomes of hypofractionated stereotactic radiation therapy (HSRT) in patients re-treated for recurrent high-grade glioma. Materials and Methods: From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm3 (range, 2.46 to 116.7 cm2), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions). Results: The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurrent tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (⩽ 50 cm2) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm2), respectively (p=0.26). Conclusion: In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the new commercial PTW-60019 synthetic single-crystal microDiamond detector (PTW, Freiburg, Germany) for relative dosimetry measurements on a clinical Leksell Gamma Knife Perfexion radiosurgery system. Methods: Detector output ratios (DORs) for 4 and 8 mm beams were measured using a micro- Diamond (PTW-60019), a stereotactic unshielded diode [IBA stereotactic field detector (SFD)], a shielded diode (IBA photon field detector), and GafChromic EBT3 films. Both parallel and transversal acquisition directions were considered for PTW-60019 measurements. Measured DORs were compared to the new output factor reference values for Gamma Knife Perfexion (0.814 and 0.900 for 4 and 8 mm, respectively). Profiles in the three directions were also measured for the 4 mm beam to evaluate full width at half maximum (FWHM) and penumbra and to compare them with the corresponding Leksell GammaPlan profiles. Results: FWHM and penumbra for PTW-60019 differed from the calculated values by less than 0.2 and 0.3 mm, for the parallel and transversal acquisitions, respectively. GafChromic films showed FWHM and penumbra within 0.1 mm. The output ratio obtained with the PTW-60019 for the 4 mm field was 1.6% greater in transverse direction compared to the nominal value. Comparable differences up to 0.8% and 1.0% for, respectively, GafChromic films and SFD were found. Conclusions: The microDiamond PTW-60019 is a suitable detector for commissioning and routine use of Gamma Knife with good agreement of both DORs and profiles in the three directions. [ABSTRACT FROM AUTHOR]

Objective: To report about clinical outcome of stereotactic body radiation therapy (SBRT) in the treatment of oligometastatic disease in elderly patients. Methods: Patients with 1-4 inoperable metastases were treated with SBRT. Dose prescription ranged from 40 to 75 Gy in 3-8 fractions. SBRT was delivered using the volumetric modulated arc therapy technique with flattening filter-free photon beams. The primary end points were in-field local control (LC) and toxicity. Secondary end points were overall survival (OS) and disease-specific survival (DSS). Results: 82 patients with 111 total metastases were treated. Median age was 79 years. 64 patients (78%) had a single lesion; the remaining patients had 2-4 lesions. 16 (14.4%) lesions were localized in the abdomen, 50 (45.0%) in the liver and 45 (40.5%) in the lungs. Local response was observed for 87 lesions (78.4%) while local progression was observed in 24 lesions (21.6%). Actuarial 1-year LC was 86.8% ± 3.3%. Actuarial 1-year OS was 93.6% ± 2.7%. 2-year findings were 76.3% ± 4.4% and 72.0% ± 5.6%, respectively. Actuarial 1- and 2-year DSS results were 97.5% ± 2.0% and 81.6% ± 4.9%, respectively. Treatment-related Grade 2-3 toxicity was observed in five patients (4.2%); Grade 1 toxicity in seven patients (5.9%) and no toxicity was observed in 85.4% of the cases. Conclusion: SBRT is a safe and effective therapeutic option for the treatment of oligometastatic disease in the elderly with acceptable rates of LC and low treatment-related toxicity. [ABSTRACT FROM AUTHOR]

To investigate the role of hypo-fractionated stereotactic radiation treatment (HSRT) in the management of skull base meningioma. Twenty-six patients were included in the study and treated with a dose of 30 Gy in 5 fractions with volumetric modulated arc therapy (RapidArc). Eighteen patients were symptomatic before treatment. Endpoints were local toxicity and relief from symptoms. Tumors were located in anterior skull base in 4/27 cases, in middle skull base in 12/27 and in posterior skull base in 11/27. HSRT was performed as first treatment in 17 (65 %) patients, in 9 (35 %) patients it followed a previous partial resection. Median follow up was 24.5 months (range 5-57 months). clinical remission of symptoms, complete or partial, was obtained in the vast majority of patients after treatment. Out of the 18 symptomatic patients, partial remission occurred in 9 (50 %) patients and complete remission in 9 (50 %). All asymptomatic patients retained their status after treatment. No severe neurologic toxicity grade III-IV was recorded. No increase of meningioma in the same site of treatment occurred; 16 (62 %) patients had stable disease and 9 (38 %) patients had tumor reduction. The mean tumor volume after treatment was 10.8 ± 17.8 cm compared with 13.0 ± 19.1 cm before treatment (p = 0.02). The mean actuarial OS was 54.4 ± 2.8 months. The 1- and 2-years OS was 92.9 ± 0.7 %. HSRT proved to be feasible for these patients not eligible to full surgery or to ablative radiation therapy. Local control and durability of results suggest for a routine application of this approach in properly selected cases. [ABSTRACT FROM AUTHOR]

Background: Long-term local control in Glioblastoma is rarely achieved and nearly all patients relapse. In this study we evaluated the clinical effect of different treatment approaches in recurrent patients. Methods: Forty-three patients, with median age of 51 years were evaluated for salvage treatment: re-resection and/or re-irradiation plus chemotherapy or chemotherapy alone. Response was recorded using the Response Assessment in Neuro-Oncology criteria. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events 4.0. Twenty-one patients underwent chemotherapy combined with local treatment, surgery and/or radiation therapy, and 22 underwent chemotherapy only. Results: The median follow up was 7 months (range 3-28 months). The 1 and 2-years Progression Free Survival was 65 and 10 % for combined treatment and 22 and 0 % for chemotherapy alone (p < 0.01). The 1 and 2-years overall survival was 69 and 29 % for combined and 26 and 0 % for chemotherapy alone (p < 0.01). No toxicity greater than grade 2 was recorded. Conclusion: These data showed that in glioblastoma recurrence the combination of several approaches in a limited group of patients is more effective than a single treatment alone. This stress the importance of multimodality treatment whenever clinically feasible. [ABSTRACT FROM AUTHOR]

Background To appraise the role of volumetric modulated arc (RapidArc, RA) in the treatment of anal canal carcinoma (ACC). Methods A retrospective analysis has been conducted on 36 patients treated with RA since 2009 comparing outcome against a group of 28 patients treated with conformal therapy (CRT). RA treatments were prescribed with SIB technique with 59.4Gy to the primary tumor and nodes and 49.5Gy to the elective nodes. CRT was sequentially delivered with 45Gy to the pelvic target and a boost of 14.4Gy to the primary tumor. Results Median age of patients was 65 yrs for RA (59 yrs for CRT); 90% had Stage II-III (93% in the CRT group). No statistically significant differences were observed concerning survival or control. 5 yrs disease specific survival was 85.7% and 81.2%, loco-regional control was of 78.1% and 82.1% for RA and CRT respectively. RA treatments lead to lower incidence of higher grade of toxicity events (all retrospectively retrieved from charts as worse events). Grade 2-3 toxicity, compared to CRT, reduced from 89% to 68% for GI, from 39% to 33% for GU and from 82% to 75% for the skin. Late toxicity was as follows: 5/36 (14%) and 3/36 (8%) patients had G1 or G2 GI toxicity in the RA group (1/28 (4%) and 4/28 (14%) in the CRT group). GU late toxicity was observed only in 4/28 (14%) patients of the CRT group: 3/28 (11%) had G2 and 1/28 (4%) had G1. Conclusions RA treatments of ACC patients proved to be equally effective than CRT but it was associated to a reduction of toxicity. [ABSTRACT FROM AUTHOR]

Background: To appraise the role of volumetric modulated arc (RapidArc, RA) in the treatment of anal canal carcinoma (ACC). Methods: A retrospective analysis has been conducted on 36 patients treated with RA since 2009 comparing outcome against a group of 28 patients treated with conformal therapy (CRT). RA treatments were prescribed with SIB technique with 59.4 Gy to the primary tumor and nodes and 49.5 Gy to the elective nodes. CRT was sequentially delivered with 45 Gy to the pelvic target and a boost of 14.4 Gy to the primary tumor. Results: Median age of patients was 65 yrs for RA (59 yrs for CRT); 90% had Stage II-III (93% in the CRT group). No statistically significant differences were observed concerning survival or control. 5 yrs disease specific survival was 85.7% and 81.2%, loco-regional control was of 78.1% and 82.1% for RA and CRT respectively. RA treatments lead to lower incidence of higher grade of toxicity events (all retrospectively retrieved from charts as worse events). Grade 2-3 toxicity, compared to CRT, reduced from 89% to 68% for GI, from 39% to 33% for GU and from 82% to 75% for the skin. Late toxicity was as follows: 5/36 (14%) and 3/36 (8%) patients had G1 or G2 GI toxicity in the RA group (1/28 (4%) and 4/28 (14%) in the CRT group). GU late toxicity was observed only in 4/28 (14%) patients of the CRT group: 3/28 (11%) had G2 and 1/28 (4%) had G1. Conclusions: RA treatments of ACC patients proved to be equally effective than CRT but it was associated to a reduction of toxicity. [ABSTRACT FROM AUTHOR]

Purpose: To report about the outcome of radiation treatment of advanced lung cancer patients with volumetric modulated arcs [RapidArc (RA)]. Patients and methods: Seventy-five consecutive patients (all stages IIIA and IIIB) were treated with RA. Among them 71 % were men; 25.4 % presented unspecified non-small cell lung cancer, 41.3% adenocarcinoma and 33.3 % squamous cell carcinoma. Of them, 54.7 % received sequential chemotherapy while 45.3% were treated with concomitant regimen. Dose prescription ranged from 54 to 72 Gy. Analysis included survival, local control (LC) and toxicity profiles. Results: Median follow-up was 21.2 months (range 6-75). One- two- and five-year actuarial LC was 91.9 ± 3.2, 79.5 ± 5.7 and 67.4 ± 9.5 %, respectively. Median survival was 19.0 ± 1.1 months. Actuarial survival at 1-2-5 years was 80.0 ± 4.6, 38.5 ± 5.9 and 15.2 ± 4.9 %, respectively. Acute toxicity of G2 was reported in 24, 25.3 and 4.0 % of patients for lung, esophageal and hematological profiles. A total of 2.7 % of patients reported G3 toxicity in the esophagus and 5.3 % of the patients experienced G3-G4 hematological toxicity. Significant differences were observed in all cases between concomitant and sequential chemotherapy regiments. Only 1.3 % (1 patient) showed G2 lung late toxicity. No significant correlation was found between toxicity and organ's irradiation levels. Conclusion: RA proved to be a safe and advantageous treatment modality for advanced lung cancer with results in line with expectations from earlier literature. [ABSTRACT FROM AUTHOR]

Background: To assess the safety and efficacy of Stereotactic Ablative Radiotherapy (SABR) in oligometastatic patients from colorectal cancer. Methods: 82 patients with 1-3 inoperable metastases confined to one organ (liver or lung), were treated with SABR for a total of 112 lesions in an observational study. Prescription dose ranged between 48 and 75Gy in 3 or 4 consecutive fractions. Primary end-points were local control (LC), overall survival (OS) and progression-free survival (PFS). Secondary end-point was toxicity. Results: Median follow-up was 24 months (range 3-47). One, two and three years LC rate was 90%,80% and 75% (85%,75% and 70% for lung and 95%, 90% and 85% for liver metastases; no statistically significance was found). The difference in LC between the subgroup of lesions treated with ≥60 Gy (n = 58) and those irradiated with <60 Gy (n = 52) was statistically significant, with a 1, 2 and 3 yrs LC of 97%,92% and 83% for the higher dose, compared to 85%,70% and 70% for the lower dose (p < 0.04). Median OS was 32 months. Actuarial OS rate at 1, 2 and 3 yrs was 85%,65% and 43%. Univariate analysis showed a correlation only between OS and cumulative GTV > 3 cm (p < 0.02). Median PFS was 14 months, with a PFS rate of 56% at 1 yr and 40% at 2-3 yrs, without correlation with the site and prescription dose (p < 0.48 and p < 0.56). No patients experienced radiation-induced liver disease or grade >3 toxicity. Conclusions: SABR is a safe and feasible alternative treatment of oligometastatic colorectal liver and lung metastases in patients not amenable to surgery or other ablative treatments. [ABSTRACT FROM AUTHOR]

Background Data in the literature suggest the existence of oligometastatic disease, a state in which metastases are limited in number and site. Different kinds of local therapies have been used for the treatment of limited metastases and in the recent years reports on the use of Stereotactic Ablative radiotherapy (SABR) are emerging and the early results on local control are promising. Patients and methods From October 2010 to February 2012, 76 consecutive patients for 118 lung lesions were treated. SABR was performed in case of controlled primary tumor, long-term of progression disease, exclusion of surgery, and number of metastatic sites ⩽ 5. Different kinds of primary tumors were treated, the most common were lung and colon-rectal cancer. The total dose prescribed varied according to tumor site and maximum diameter. Dose prescription was 48 Gy in 4 fractions for peripheral lesions, 60 Gy in 8 fractions for central lesions and 60 Gy in 3 fractions for peripheral lesions with diameter ⩽ 2 cm. Results Dosimetric planning objectives were met for the cohort of patients with in particular V98% = 98.1 ± 3.4% for the CTV and mean lung dose of 3.7 ± 3.8Gy. Radiological response was obtained in the vast majority of patients. The local control at 1, 2 and 3 years was 95%, 89% and 89% respectively. No major pulmonary toxicity, chest pain or rib fracture occurred. The median follow up was 20 months (range 6-45 months). Overall Survival (OS) at 1, 2 and 3 years was 84.1%, 73% and 73% respectively. Conclusions SABR is feasible with limited morbidity and promising results in terms of local contro, survival and toxicity. [ABSTRACT FROM AUTHOR]

Noroviruses (NoVs) are among the most frequent causes of acute pediatric gastroenteritis. Although the disease is often self-limiting and recovery is the rule, it constitutes an important health problem because of its highly contagious nature and the high rate of morbidity. NoVs are responsible for 47-96 % of outbreaks of acute pediatric gastroenteritis, and 5-36 % of sporadic cases. NoV-induced gastroenteritis is a frequent cause of hospitalization, and severe and sometimes fatal cases have been reported in immunocompromised children. The increasing recognition of NoVs as the cause of pediatric disease and the limited success in preventing outbreaks have led to consideration of vaccines. However, while awaiting the development of a vaccine, there is an urgent need for more epidemiological data concerning childhood NoV infection, including the impact of NoVs on different age groups, the possible etiological role of NoVs in infections other than gastroenteritis, and the socioeconomic impact of NoVs on households. [ABSTRACT FROM AUTHOR]