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Start Over Author "Greto D" Publication Type Academic Journals
290 results on '"Greto D"'

1. Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives

Author

Loi M, Nuyttens JJ, Desideri I, Greto D, and Livi L

Subjects
sbrt, stereotactic radiotherapy, radiosurgery, bone metastases, spine, non-spine, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Mauro Loi,1 Joost J Nuyttens,2 Isacco Desideri,1 Daniela Greto,1 Lorenzo Livi1 1Radiotherapy Department, University of Florence, Florence, Italy; 2Radiotherapy Department, Erasmus MC Cancer Center, Rotterdam, The NetherlandsCorrespondence: Mauro LoiRadiotherapy Department, University of Florence, L.go Brambilla 3, Florence 50100, ItalyEmail mauro.loi@unifi.itAbstract: Bone metastases are a frequent and important source of morbidity in cancer patients. Stereotactic body radiation therapy (SBRT) is an established treatment option for local control and pain relief of bone metastases, and it is increasingly used as upfront treatment, postoperative consolidation or salvage treatment after prior RT. However, heterogeneity of dose schedules described in literature represents a severe limitation in the definition of the role of SBRT as a standard of care. No consensus is available on the use of single versus multiple fraction SBRT for bone metastases. Advantages of single-fraction SBRT include shorter overall duration of treatment, absence of inter-fraction uncertainty, improved compliance, theoretical increased efficacy, and lower costs. However, caution has been advised due to reports of severe late toxicities, in particular, vertebral collapse fracture (VCF). The aim of this paper is to review dose fractionation and indications for the management of bone metastases using SBRT.Keywords: SBRT, stereotactic radiotherapy, radiosurgery, bone metastases, spine, non-spine

Published
2019

2. Oligometastatic sarcoma treated with Curative intent Ablative Radiotherapy (OSCAR): A multicenter study on behalf of AIRO (Italian association of Radiotherapy and clinical Oncology)

Author

Franceschini, D., Greto, D., Dicuonzo, S., Navarria, F., Federico, M., La Vecchia, M., Sangalli, C., Allajbej, A., Di Cristina, L., Mazzola, R., Pontoriero, A., Montesi, G., Navarria, P., Baldaccini, D., Clerici, E., Lo Faro, L., Franzese, C., Di Biase, S., Pergolizzi, S., Alongi, F., Bignardi, M., Fazio, I., Mascarin, M., Jereczek-Fossa, B.A., Livi, L., and Scorsetti, M.

Published
2024
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11. Neoadjuvant (Chemo-) Radiotherapy for Locally Advanced Soft Tissue Sarcoma.

Author

Greto, D., Loi, M., Banini, M., Salvestrini, V., Francolini, G., Mangoni, M., Desideri, I., Arilli, C., Talamonti, C., Calusi, S., Meattini, I., Simontacchi, G., and Livi, L.

Subjects
*EXTERNAL beam radiotherapy, *SARCOMA, *SYNOVIOMA, *INJURY complications, *SURGICAL margin, *LIPOSARCOMA, *RADIOTHERAPY
Abstract

Management of locally advanced Soft Tissue Sarcoma (STS) is based on surgery and external beam radiation therapy (EBRT). Theoretical benefits of neoadjuvant EBRT include reduced volume and dose requirements and possible tumor shrinkage, particularly in association with concurrent chemotherapy (CT), that may facilitate clear margin resection, although at the price of increased wound complications rate in up to 35% of patients. The aim of this study is to evaluate outcome and toxicity results of neoadjuvant radiotherapy in STS patients candidate to surgical excision and to assess prognostic-related features to guide treatment personalization. Clinical and treatment related data were retrospectively retrieved from a consecutive cohort of non-metastatic STS patients treated at our Institution with neoadjuvant RT followed by surgery from 1991 to 2023. CT consisted of an Epirubicin-Ifosfamide regimen for 3 cycles during EBRT delivery in selected candidates. Overall survival (OS), Distant-metastasis free survival (DMFS), Local control (LC) data were extrapolated using Kaplan-Meier method. Chi-square, log-rank test and Cox model were performed to identify factors related with outcome and toxicity. 156 patients were included in our study. Median age was 55 years. Tumors were mostly located in the limbs (94%). Disease stage was T≥3 in 71% of cases. Most represented histologic subtypes were liposarcoma (LPS) (34%), undifferentiated pleomorphic sarcoma (UPS) (24%) and synovial sarcoma (5%). Neoadjuvant EBRT was administered to a dose of 50 Gy in 25 daily fractions concurrently with CT in 82 % patients. IMRT was used in 34% of case. R0 and R1 resection were obtained in 93% and 7% of patients respectively. Wound complications were observed in 16% of patients. Grade (G) 3 disease was found in 70% patients. After a median follow-up of 32 months, 5-year OS, DMFS and LC rates were 72%, 57% and 82%, respectively. At multivariate analysis only R1 resection was significantly associated to worse LC rates (p = 0.0214), while G3 disease was correlated with impaired DMFS (p = 0.0029). UPS (p = 0.0028), G3 (p = 0.004) and R1 (p = 0.05) correlated with poorer OS rates. None of the examined variables, particularly use of IMRT and CT, were associated with higher occurrence of wound complications. In this large STS cohort, neoadjuvant RT resulted in excellent RO rate and favorable outcomes. Wound complications rate was inferior to historical data from landmark trials. R1 resection and G3 disease correlated respectively with impaired LC and DMFS. Both factors were associated with poorer OS, as well as UPS subtype, suggesting an unmet need for treatment intensification in selected patients. Use of IMRT and concurrent CT were not correlated with wound complications occurrence. [ABSTRACT FROM AUTHOR]

Published
2024
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32. TomoTherapy treatments of multiple brain lesions: an in-phantom accuracy evaluation.

Author

Zani, M, Marrazzo, L, Calusi, S, Talamonti, C, Scoccianti, S, Greto, D, Desideri, I, Fusi, F, and Pallotta, S

Subjects
BRAIN damage, ANATOMICAL planes, ALGORITHMS, CENTROID
Abstract

Aim of the present study was to evaluate the accuracy which can be obtained with helical TomoTherapy® (HT, Accuray) systems in the case of multiple intracranial targets treatments. Set-up accuracy was measured, for different registration options and MegaVoltage CT (MVCT) slice thickness, by applying known misalignments to an ad-hoc developed phantom. End-to-end (E2E) tests were performed to assess the delivery accuracy in phantoms containing multiple targets by using radiochromic films: measured dose distribution centroids were compared with physical and calculated target positions on axial and coronal planes. A Gamma index analysis was carried out on planned and measured planar dose maps. The bone and tissue algorithm with the fine MVCT reconstruction grid gave the best results among the automatic options. The most accurate registration modality resulted to be the manual one with a sub-voxel accuracy shifts and a capability in the detection of rotations within 0.3°. For the E2E along the coronal plane (six targets), a mean deviation between measured dose distribution centroids and physical barycenters of 0.6 mm (range 0.1 mm–1.3 mm) was observed. Along the axial plane (five targets), a mean deviation of 1.2 mm (range 0.7 mm–2.1 mm) was found for the centroids shifts. Gamma index (5%, 1 mm, local) passing rates higher than 87.5% between planned and delivered dose distributions were measured. These results demonstrate that multiple brain lesion HT treatments are feasible with an accuracy at least comparable to frameless linac-based delivery, when a set-up capable to assure angular corrections and a reliable patient immobilization is employed. [ABSTRACT FROM AUTHOR]

Published
2019
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41. Preoperative Radiotherapy of Soft Tissue Sarcoma with Simultaneous Integrated Boost: A Phase II Study.

Author

Greto, D., Loi, M., Burchini, L., Banini, M., Bonaparte, I., Angelini, L., Carnevale, M.G., Mattioli, C., Ganovelli, M., Talamonti, C., Arilli, C., Zani, M., Francolini, G., Simontacchi, G., Bonomo, P., Campanacci, D.A., and Livi, L.

Subjects
*SARCOMA, *RADIOTHERAPY, *VOLUMETRIC-modulated arc therapy, *SURGICAL wound dehiscence, *SURGICAL margin, *INJURY complications, *PROGRESSION-free survival
Abstract

Neoadjuvant radiotherapy to 50 Gy in 25 fractions is delivered in operable Soft Tissue Sarcoma (STS) patients to downstage the tumor and improve resectability, although at the expense of increased risk of wound dehiscence. Nonetheless, clear margin resection (R0) may not be achieved in tumors located in proximity of critical structures such as the neurovascular bundle (NVB), resulting in impaired local control. The aim of this study is to increase R0 rate through addition of an IMRT boost to the potential sites of suboptimal resection in STS patients receiving neoadjuvant RT. We report hereby the dosimetric results and safety results from the first 5 patients enrolled in this trial. We designed a prospective monocentric interventional single-arm Phase II study enrolling locally advanced STS eligible for surgery. RT is administered in 25 daily fractions to include the MRI-based Gross Tumor Volume (GTV) and peritumoral tissue at risk of microscopic spread (CTV1) to a dose of 50 Gy (2Gy/fraction), with SIB (Simultaneous Integrated Boost) intensification to the tumor/dissection plane interface (CTV2) to a dose of 60 Gy (2.4 Gy/fraction). CTV2 delineation is approved by both a Radiation Oncologist and Surgeon. A margin of 0.5 cm is applied to both CTV to obtain PTV1 and PTV2. Concurrent anthracyclines-based chemotherapy (ChT) is allowed up to 3 cycles. Primary endpoint is R0 resection rate. Secondary endpoints include pathologic complete response rate, objective response rate, overall survival, local and distant progression-free survival, acute and chronic toxicity rate. To assess an increase in R0 rate from 81% to 97% assuming β = 80% e α = 0.05, 33 patients will be included. Dose constraints are summarized in Table1. At least 95% of the PTV1 and PTV2 should be covered by 95% the prescription dose up to a maximum allowed dose of 107%. Five patients were included. Tumor was located in the limbs and in the trunk in respectively 4 and 1 patient. Mean age was 47 years (range: 19-67). Concurrent chemotherapy was performed in 2 patients. Mean GTV size was 228.6 cm3 (range: 59.8-314.5). Mean PTV coverage by the 95% of the dose prescription was 98% (95-100) and 97% (95-100) in PTV1 and PTV2, respectively. Mean PTV1 and PTV2 Dmax were 61.6 Gy (range: 59-63) and 64.1 Gy (range:63-66), in both cases below the 107% threshold. Mean Bone Dmax was 55 Gy (56.6-61.8 Gy). Dmax to the skin corridor exceeded 20 Gy in 1 patient (range 12.5-58.1). While the NVB was overlapping the PTV2 in all cases, Dmax was below 66 Gy. At the time of this report, no Grade ≥3 acute skin toxicity was observed. Two patients underwent surgery with a radiological partial response (RECIST) and pathological complete response. No major wound complication was reported. Planning goals of the first 5 enrolled patients are achieved in most cases. Preliminary results show a benign safety profile and promising tumor response rate. [ABSTRACT FROM AUTHOR]

Published
2023
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