17 results on '"Mangili, Paola"'
Search Results
2. Knowledge-based automatic plan optimization for left-sided whole breast tomotherapy
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Esposito, Pier Giorgio, Castriconi, Roberta, Mangili, Paola, Broggi, Sara, Fodor, Andrei, Pasetti, Marcella, Tudda, Alessia, Di Muzio, Nadia Gisella, del Vecchio, Antonella, and Fiorino, Claudio
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- 2022
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3. Impact of molecular subtype on 1325 early-stage breast cancer patients homogeneously treated with hypofractionated radiotherapy without boost: Should the indications for radiotherapy be more personalized?
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Fodor, Andrei, Brombin, Chiara, Mangili, Paola, Borroni, Fulvio, Pasetti, Marcella, Tummineri, Roberta, Zerbetto, Flavia, Longobardi, Barbara, Perna, Lucia, Dell’Oca, Italo, Deantoni, Chiara L., Deli, Aniko M., Chiara, Anna, Broggi, Sara, Castriconi, Roberta, Esposito, Pier Giorgio, Slim, Najla, Passoni, Paolo, Baroni, Simone, Villa, Stefano L., Rancoita, Paola M.V., Fiorino, Claudio, Del Vecchio, Antonella, Bianchini, Giampaolo, Gentilini, Oreste D., Di Serio, Mariaclelia S., and Di Muzio, N.G.
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- 2021
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4. Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices
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Rossi, Eleonora, Fiorino, Claudio, Fodor, Andrei, Deantoni, Chiara, Mangili, Paola, Di Muzio, Nadia Gisella, Del Vecchio, Antonella, and Broggi, Sara
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- 2020
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5. Comparing Performances of Predictive Models of Toxicity after Radiotherapy for Breast Cancer Using Different Machine Learning Approaches.
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Ubeira-Gabellini, Maria Giulia, Mori, Martina, Palazzo, Gabriele, Cicchetti, Alessandro, Mangili, Paola, Pavarini, Maddalena, Rancati, Tiziana, Fodor, Andrei, del Vecchio, Antonella, Di Muzio, Nadia Gisella, and Fiorino, Claudio
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PREDICTIVE tests ,DATABASE management ,DATA analysis ,RECEIVER operating characteristic curves ,RESEARCH funding ,RADIATION injuries ,BREAST tumors ,LOGISTIC regression analysis ,TREATMENT effectiveness ,RADIATION dosimetry ,DESCRIPTIVE statistics ,STATISTICS ,MACHINE learning - Abstract
Simple Summary: Studies comparing performances of machine learning (ML) methods in building predictive models of toxicity in RT are rare. Thanks to the availability of a large cohort (n = 1314) of breast cancer patients homogeneously treated with tangential fields, different ML approaches could be compared. This work shows how more complex models typically achieve higher performances. At the same time, for this test case, the importance is given mainly by a few variables, and toxicity can be predicted by simpler models with similar performances. The availability of more individually characterizing features (here partially missing) is expected to have a likely much higher impact than the choice of the best-performing ML/DL approach. Purpose. Different ML models were compared to predict toxicity in RT on a large cohort (n = 1314). Methods. The endpoint was RTOG G2/G3 acute toxicity, resulting in 204/1314 patients with the event. The dataset, including 25 clinical, anatomical, and dosimetric features, was split into 984 for training and 330 for internal tests. The dataset was standardized; features with a high p-value at univariate LR and with Spearman ρ > 0.8 were excluded; synthesized data of the minority were generated to compensate for class imbalance. Twelve ML methods were considered. Model optimization and sequential backward selection were run to choose the best models with a parsimonious feature number. Finally, feature importance was derived for every model. Results. The model's performance was compared on a training–test dataset over different metrics: the best performance model was LightGBM. Logistic regression with three variables (LR3) selected via bootstrapping showed performances similar to the best-performing models. The AUC of test data is slightly above 0.65 for the best models (highest value: 0.662 with LightGBM). Conclusions. No model performed the best for all metrics: more complex ML models had better performances; however, models with just three features showed performances comparable to the best models using many (n = 13–19) features. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Ten Year Results of Extensive Nodal Radiotherapy and Moderately Hypofractionated Simultaneous Integrated Boost in Unfavorable Intermediate-, High-, and Very High-Risk Prostate Cancer
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Di Muzio, Nadia Gisella, primary, Deantoni, Chiara Lucrezia, additional, Brombin, Chiara, additional, Fiorino, Claudio, additional, Cozzarini, Cesare, additional, Zerbetto, Flavia, additional, Mangili, Paola, additional, Tummineri, Roberta, additional, Dell’Oca, Italo, additional, Broggi, Sara, additional, Pasetti, Marcella, additional, Chiara, Anna, additional, Rancoita, Paola Maria Vittoria, additional, Del Vecchio, Antonella, additional, Di Serio, Mariaclelia Stefania, additional, and Fodor, Andrei, additional
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- 2021
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7. Replacing Manual Planning of Whole Breast Irradiation With Knowledge-Based Automatic Optimization by Virtual Tangential-Fields Arc Therapy
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Castriconi, Roberta, primary, Esposito, Pier Giorgio, additional, Tudda, Alessia, additional, Mangili, Paola, additional, Broggi, Sara, additional, Fodor, Andrei, additional, Deantoni, Chiara L., additional, Longobardi, Barbara, additional, Pasetti, Marcella, additional, Perna, Lucia, additional, del Vecchio, Antonella, additional, Di Muzio, Nadia Gisella, additional, and Fiorino, Claudio, additional
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- 2021
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8. Dosimetric accuracy of tomotherapy dose calculation in thorax lesions
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Mangili Paola, Cattaneo Giovanni, Broggi Sara, Ardu Veronica, and Calandrino Riccardo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background To analyse limits and capabilities in dose calculation of collapsed-cone-convolution (CCC) algorithm implemented in helical tomotherapy (HT) treatment planning system for thorax lesions. Methods The agreement between measured and calculated dose was verified both in homogeneous (Cheese Phantom) and in a custom-made inhomogeneous phantom. The inhomogeneous phantom was employed to mimic a patient's thorax region with lung density encountered in extreme cases and acrylic inserts of various dimensions and positions inside the lung cavity. For both phantoms, different lung treatment plans (single or multiple metastases and targets in the mediastinum) using HT technique were simulated and verified. Point and planar dose measurements, both with radiographic extended-dose-range (EDR2) and radiochromic external-beam-therapy (EBT2) films, were performed. Absolute point dose measurements, dose profile comparisons and quantitative analysis of gamma function distributions were analyzed. Results An excellent agreement between measured and calculated dose distributions was found in homogeneous media, both for point and planar dose measurements. Absolute dose deviations Conclusions Very acceptable accuracy was found for complex lung treatment plans calculated with CCC algorithm implemented in the tomotherapy TPS even in the heterogeneous phantom with very low lung-density.
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- 2011
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9. Quality assurance multicenter comparison of different MR scanners for quantitative diffusion-weighted imaging
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Belli, Giacomo, Busoni, Simone, Ciccarone, Antonio, Coniglio, Angela, Esposito, Marco, Giannelli, Marco, Mazzoni, Lorenzo N, Nocetti, Luca, Sghedoni, Roberto, Tarducci, Roberto, Zatelli, Giovanna, Anoja, Rosa A, Belmonte, Gina, Bertolino, Nicola, Betti, Margherita, Biagini, Cristiano, Ciarmatori, Alberto, Cretti, Fabiola, Fabbri, Emma, Fedeli, Luca, Filice, Silvano, Fulcheri, Christian P. L, Gasperi, Chiara, Mangili, Paola A, Mazzocchi, Silvia, Meliado', Gabriele, Morzenti, Sabrina, Noferini, Linhsia, Oberhofer, Nadia, Orsingher, Laura, Paruccini, Nicoletta, Princigalli, Goffredo, Quattrocchi, Mariagrazia, Rinaldi, Adele, Scelfo, Danilo, Freixas, Gloria Vilches, Tenori, Leonardo, Zucca, Ileana, Luchinat, Claudio, Gori, Cesare, and Gobbi, Gianni
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Quality Assurance, Health Care ,Phantoms, Imaging ,apparent diffusion coefficient ,diffusion weighted imaging ,magnetic resonance imaging ,quality controls ,Diffusion Magnetic Resonance Imaging ,Equipment Design ,Equipment Failure Analysis ,Image Interpretation, Computer-Assisted ,Italy ,Reproducibility of Results ,Sensitivity and Specificity ,Phantoms ,Imaging ,Health Care ,Computer-Assisted ,Quality Assurance ,Image Interpretation - Abstract
To propose a magnetic resonance imaging (MRI) quality assurance procedure that can be used for multicenter comparison of different MR scanners for quantitative diffusion-weighted imaging (DWI).Twenty-six centers (35 MR scanners with field strengths: 1T, 1.5T, and 3T) were enrolled in the study. Two different DWI acquisition series (b-value ranges 0-1000 and 0-3000 s/mm(2) , respectively) were performed for each MR scanner. All DWI acquisitions were performed by using a cylindrical doped water phantom. Mean apparent diffusion coefficient (ADC) values as well as ADC values along each of the three main orthogonal directions of the diffusion gradients (x, y, and z) were calculated. Short-term repeatability of ADC measurement was evaluated for 26 MR scanners.A good agreement was found between the nominal and measured mean ADC over all the centers. More than 80% of mean ADC measurements were within 5% from the nominal value, and the highest deviation and overall standard deviation were 9.3% and 3.5%, respectively. Short-term repeatability of ADC measurement was found2.5% for all MR scanners.A specific and widely accepted protocol for quality controls in DWI is still lacking. The DWI quality assurance protocol proposed in this study can be applied in order to assess the reliability of DWI-derived indices before tackling single- as well as multicenter studies.
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- 2015
10. Application of failure mode and effects analysis (FMEA) to pretreatment phases in tomotherapy
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Broggi, Sara, primary, Cantone, Marie Claire, additional, Chiara, Anna, additional, Muzio, Nadia Di, additional, Longobardi, Barbara, additional, Mangili, Paola, additional, and Veronese, Ivan, additional
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- 2013
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11. Prostate/prostate bed salvage stereotactic re-irradiation.
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Tummineri, Roberta, Fodor, Andrei, Broggi, Sara, Deantoni, Chiara Lucrezia, Fiorino, Claudio, Dell’Oca, Italo, Perna, Lucia, Villa, Stefano, Zerbetto, Flavia, Mangili, Paola, Cozzarini, Cesare, Vecchio, Antonella Del, and Di Muzio, Nadia Gisella
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RETENTION of urine ,URINARY urge incontinence ,PROSTATE ,PROSTATE cancer patients ,SALVAGE therapy - Abstract
Objective: To evaluate toxicity and outcomes after salvage robotic stereotactic body radiotherapy-SBRT- (CyberKnife®,Accuray, Sunnyvale, Ca) re-irradiation of patients with intraprostatic/prostatic bed recurrences of pelvic malignancies. Methods: From 11/2018 to 10/2021, 20 patients with intraprostatic/prostatic bed recurrence after radiotherapy, diagnosed on MRI/ PET choline/PSMA and/or biopsyproven, underwent a salvage re-irradiation with SBRT: 9 patients with prostate cancer failure after previous radical radiotherapy, and 11 patients after adjuvant/salvage radiotherapy. Median prior RT dose was 70.7 (38.25- 78) Gy and the median interval to SBRT salvage therapy was 79.3 (11-208) months. Median PSA before robotic SBRT was 2.64 (1.14-26.8) ng/ml. Fiducial markers were implanted into the target in 19 of 20 patients. Median SBRT total dose was 35 (30-35) Gy in 5 fractions (EQD2=85 Gy, for α/β 1.5). Median prescription isodose was 70% (59- 81%). In 12 patients, a “urethral sparing” was used. In 10 cases a precautionary therapy with steroids and alphalytics was prescribed during the salvage treatment. Twelve patients received neoadjuvant or concomitant/adjuvant androgen suppressive therapy during their SBRT course. Toxicity was scored in accordance with CTCAE v 5.0. Results: Median follow-up was 17.4 months (2.35- 38.15) months. Acute genitourinary (GU) toxicity was observed in 40% of patients and was limited to grade (G)1 in 35% of patients and G2 (minimal strangury, urgency and occasional urinary incontinence) in 5%. Ten% of patients reported late GU G3 toxicity (urinary retention requiring catheterization and transurethral resection), and 5% G2 urinary toxicity. No acute and late gastrointestinal toxicity was observed. At the last follow-up 2 patients died due to a non cancer-releated cause. Twenty-four-months Kaplan Meier estimates of biochemical relapse-free survival (bRFS) was 78.2% (see Figure 1), local-relapse-free survival (LRFS) 92.3% and distant-metastases-free survival 85.1%. Conclusions: Prostate SBRT re-irradiation with CK is a feasible treatment option, with good short-term outcomes. Longer follow-up is necessary to assess the long-term benefits and to determine late toxicity. [ABSTRACT FROM AUTHOR]
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- 2022
12. SBRT of oligometastatic gynecological cancer: Predictors of distant progressionfree survival.
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Fodor, Andrei, Brombin, Chiara, Mandurino, Giuseppina, Zerbetto, Flavia, Villa, Stefano, Deantoni, Chiara, Castriconi, Roberta, Tummineri, Roberta, Dell’Oca, Italo, Chiara, Anna, Slim, Najla, Mangili, Paola, Vecchio, Antonella Del, and Muzio, Nadia Di
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GYNECOLOGIC cancer ,INTENSITY modulated radiotherapy ,FALLOPIAN tubes ,STEREOTACTIC radiotherapy ,DISEASE relapse ,VERTEBRAL fractures - Abstract
Aims: This study reports the preliminary results of a monoinstitutional experience with stereotactic body radiotherapy (SBRT) performed on oligometastatic gynecological cancer patients. Methods: From 04/2009 to 07/2021, 85 lesions (46 patients) were treated: 5 lesions (4 patients) with Image Guided-helical Intensity Modulated Radiotherapy (IGIMRT) at a median dose of 54 (35-63) Gy in 6 (5-10) median fractions prescribed at 95% of the Planning Target Volume (PTV), and 80 lesions (42 patients) with robotic SBRT at a median dose of 40 (18-60) Gy in 5 (1- 8) fractions, prescribed at a median isodose of 80% (68- 84%). Ten.6% of lesions were in the field of a previous adjuvant/salvage IG-IMRT performed at a median dose of 50.4 Gy. Primary origin was: uterine in 39.1%, ovarian/ fallopian tubes in 34.8%, and cervical/vulvar/vaginal in 26.1% of patients. Metastatic site was: brain in 6.5%, liver in 4.3%, lymph-nodes in 60.9%, lung in 23.9%, and bone in 4.3% of patients. Number of concomitant lesions was 1 in 67.4%, 2 in 19.6%, 3 in 2.12%, 4 in 4.3%, and 5 in 6.5% of patients. De nuovo oligometastatic were 32.6%, induced 23.9%, and relapsed 43.5% of patients. Results: Median age at the treatment was 67.4 years (Interquartile Range, IQR: 58.6-75.7). Median follow-up from initial diagnosis was 75.6 months (IQR:46.4–164.8). Median Biologically Effective Dose(BED) prescribed: 79.2 Gy (IQR:59.5-102.6). Twelve and 24 month local relapsefree survival(LRFS) was 88.3 and 84.3%, respectively, while 12 and 24 month distant relapse-free survival(DRFS) was 44.6 and 27.6%. Twenty-four and 36 months overall survival (OS) was 100% and 85% respectively. Acute toxicity registered was grade (G) 1 13% and G2 6.5%. Late toxicity was 2.2% G1, 2.2% G2 and 2.2% (1 patient) G3 (vertebral fracture). There were no differences in DRFS (see Fig.1) and OS between the three groups. At the multivariate analysis factors predicting distant relapse were: age at diagnosis HR=1.07 (95%CI:1.03-1.13, p=0.0021), number of lesions≥3 vs 1, HR= 4.16 (95%CI:1.34-12.9, p=0.0135), and induced vs de nuovo oligometastatic lesions HR=8.55 (95%CI:1.96-37.3, p=0.0043), but not relapsed vs de nuovo(p=0.067). Conclusion: SBRT is effective for the local control of oligometastatic disease from gynecological tumors, with low toxicity. Distant relapse remains the primary cause of failure after SBRT in oligometastatic gynecological patients, and a number of lesions≥3, age at diagnosis and induced oligometastatic lesions are predictive for distant relapse. [ABSTRACT FROM AUTHOR]
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- 2022
13. Comparison of two protocols of robotic stereotactic body radiotherapy used in prostate cancer patients in a mono-institutional experience.
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Di Muzio, Nadia, Brombin, Chiara, Deantoni, Chiara, Broggi, Sara, Cozzarini, Cesare, Dell’Oca, Italo, Perna, Lucia, Tummineri, Roberta, Zerbetto, Flavia, Villa, Stefano, Mangili, Paola, Slim, Najla, Fiorino, Claudio, Vecchio, Antonella Del, and Fodor, Andrei
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PROSTATE cancer patients ,STEREOTACTIC radiotherapy ,PATIENTS' attitudes ,ANDROGEN deprivation therapy ,GLEASON grading system - Abstract
Objective: We analyzed initial outcomes and toxicities of the 2 schedules of stereotactic body radiotherapy (SBRT) in use in our department for prostate cancer (PCa) patients. Materials and methods: Between 10/2017-05/2021, 102 PCa patients were treated using robotic SBRT with two different schedules. Group I included 73 patients treated at 36.25 Gy/ 5 fractions at the 79% median isodose, group II 29 patients treated at 38 Gy/ 4 fractions at the 63% median isodose (urethral sparing HDR-like technique). Median age was 74.5 vs 75.8 years, median initial PSA 7.20 vs 7.65 ng/ml. Gleason score was 3+3 in 11% vs 17.2%, 3+4 in 58.9% vs 51.7%, 4+3 in 17.8% vs 20.7% and not accorded (due to previous androgen deprivation) in 1.4% vs 3.5% of patients. Androgen deprivation therapy (ADT) was prescribed in 45% vs 31% of patients, with a median duration of 7 vs 6 months. Fiducial markers were implanted into the prostate in all patients. In 52% of patients steroid therapy and/or alpha-lytics were prescribed to prevent side effects. Toxicity was scored in accordance with CTCAE v 5.0. Biochemical failure was assessed using the nadir + 2 definition. Results: Median follow-up was 23.4 (0-47.2) months in group I vs 12 (2.78-36.07) months in group II. For acute and late toxicities see Table 1. No acute grade(G) 3 toxicities were registered. One (1.4%) late G3 genitourinary toxicity (transurethral incision) occurred in a patient treated with 36.25 Gy. Median post-SBRT PSA level was 0.342 (0.001-231.00) ng/ml in group I and 0.603 (0.05-10.210) ng/ml in group II. At the last follow up 3 pts had died due to a non-cancer related cause, 4 pts had a biochemical failure with PSMA/CholinePET positive progression: 3 treated at 36.25 Gy and 1 treated at 38 Gy. Two-year biochemical relapse-free survival(bRFS) was 94.8% for the patients of group I and 88.9% for the patients of group II, respectively (p= 0.6). Overall survival (OS) was 85.7%vs 98.4% at 2 years(p=0.35). Disease-free survival(DFS) was 94.8% and 88.9%, respectively (p=0.6). No correlation was found between target volume and toxicity. Conclusion: The urethral sparing technique allowed dose escalation (from 2 Gy equivalent dose-EQD2-91 Gy to EQD2 ≥ 120 Gy with α/β 1.5) without increasing G3 toxicity and with non-inferior bRFS despite less ADT prescription. Longer follow-up is needed to confirm these results. [ABSTRACT FROM AUTHOR]
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- 2022
14. Dosimetric accuracy of tomotherapy dose calculation in thorax lesions
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Ardu, Veronica, primary, Broggi, Sara, additional, Cattaneo, Giovanni Mauro, additional, Mangili, Paola, additional, and Calandrino, Riccardo, additional
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- 2011
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15. Development and in vivo assessment of a novel MRI-compatible headframe system for the ovine animal model
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Marco Trovatelli, Andrea Falini, Marco A. Riva, Antonella Castellano, Stefano Brizzola, Dave Johnson, Riccardo Secoli, Lorenzo Bello, Ferdinando Rodriguez y Baena, D. De Zani, Max Woolley, Paola Mangili, Trovatelli, Marco, Brizzola, Stefano, Zani, Davide Danilo, Castellano, Antonella, Mangili, Paola, Riva, Marco, Woolley, Max, Johnson, Dave, Rodriguez Y Baena, Ferdinando, Bello, Lorenzo, Falini, Andrea, and Secoli, Riccardo
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0301 basic medicine ,Linear displacement ,Computer science ,Biophysics ,Neurosurgery ,Neurosurgical Procedures ,03 medical and health sciences ,0302 clinical medicine ,Animal model ,In vivo ,medicine ,Animals ,Humans ,Sheep ,Frame (networking) ,Mri compatible ,Human brain ,Surgical procedures ,Magnetic Resonance Imaging ,Computer Science Applications ,030104 developmental biology ,medicine.anatomical_structure ,Brain size ,Models, Animal ,Surgery ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery ,Biomedical engineering - Abstract
BACKGROUND The brain of sheep has primarily been used in neuroscience as an animal model because of its similarity to the human brain, in particular if compared to other models such as the lissencephalic rodent brain. Their brain size also makes sheep an ideal model for the development of neurosurgical techniques using conventional clinical CT/MRI scanners and stereotactic systems for neurosurgery. METHODS In this study, we present the design and validation of a new CT/MRI compatible head frame for the ovine model and software, with its assessment under two real clinical scenarios. RESULTS Ex-vivo and in vivo trial results report an average linear displacement of the ovine head frame during conventional surgical procedures of 0.81 mm for ex-vivo trials and 0.68 mm for in vivo tests, respectively. CONCLUSIONS These trial results demonstrate the robustness of the head frame system and its suitability to be employed within a real clinical setting.
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- 2021
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16. Integration of Diffusion Magnetic Resonance Tractography into tomotherapy radiation treatment planning for high-grade gliomas
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Riccardo Calandrino, Luisa Altabella, Antonella del Vecchio, Sara Broggi, Paola Mangili, Valentina Pieri, Nadia Di Muzio, Antonella Castellano, Gian Marco Conte, Antonella Iadanza, Andrea Falini, Nicoletta Anzalone, Altabella, Luisa, Broggi, Sara, Mangili, Paola, Conte, Gian Marco, Pieri, Valentina, Iadanza, Antonella, del Vecchio, Antonella, Anzalone, Nicoletta, di Muzio, Nadia, Calandrino, Riccardo, Falini, Andrea, and Castellano, Antonella
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Adult ,Male ,Radiology, Nuclear Medicine and Imaging ,medicine.medical_treatment ,Biophysics ,Planning target volume ,General Physics and Astronomy ,Tomotherapy ,White matter ,Brain Neoplasm ,03 medical and health sciences ,Physics and Astronomy (all) ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiation treatment planning ,Aged ,medicine.diagnostic_test ,Radiotherapy ,business.industry ,Brain Neoplasms ,Radiotherapy Planning, Computer-Assisted ,Magnetic resonance imaging ,Radiotherapy Dosage ,General Medicine ,Glioma ,Middle Aged ,Radiation therapy ,Brain tumor ,medicine.anatomical_structure ,Diffusion Tensor Imaging ,Biophysic ,030220 oncology & carcinogenesis ,Female ,Diffusion MR Tractography ,Radiotherapy, Intensity-Modulated ,Neoplasm Grading ,Nuclear medicine ,business ,030217 neurology & neurosurgery ,Tractography ,Diffusion MRI ,Human - Abstract
Introduction Fractionated radiotherapy in brain tumors is commonly associated with several detrimental effects, largely related to the higher radiosensitivity of the white matter (WM) with respect to gray matter. However, no dose constraints are applied to preserve WM structures at present. Magnetic Resonance (MR) Tractography is the only technique that allows to visualize in vivo the course of WM eloquent tracts in the brain. In this study, the feasibility of integrating MR Tractography in tomotherapy treatment planning has been investigated, with the aim to spare eloquent WM regions from the dose delivered during treatment. Methods Nineteen high grade glioma patients treated with fractionated radiotherapy were enrolled. All the patients underwent pre-treatment MR imaging protocol including Diffusion Tensor Imaging (DTI) acquisitions for MR Tractography analysis. Bilateral tracts involved in several motor, language, cognitive functions were reconstructed and these fiber bundles were integrated into the Tomotherapy Treatment planning system. The original plans without tracts were compared with the optimized plans incorporating the fibers, to evaluate doses to WM structures in the two differently optimized plans. Results No significant differences were found between plans in terms of planning target volume (PTV) coverage between the original plans and the optimized plans incorporating fiber tracts. Comparing the mean as well as the maximal dose (Dmean and Dmax), a significant dose reduction was found for most of the tracts. The dose sparing was more relevant for contralateral tracts (P Conclusion The integration of MR Tractography into radiotherapy planning is feasible and beneficial to preserve important WM structures without reducing the clinical goal of radiation treatment.
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- 2018
17. Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer
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Italo Dell'Oca, Elena Busnardo, Paola Mangili, Margarita Kirienko, Luigi Gianolli, Andrei Fodor, Claudio Fiorino, Elena Incerti, Cesare Cozzarini, Marcella Pasetti, Riccardo Calandrino, Maria Picchio, Nadia Di Muzio, G. Berardi, Fodor, Andrei, Berardi, Genoveffa, Fiorino, Claudio, Picchio, Maria, Busnardo, Elena, Kirienko, Margarita, Incerti, Elena, Dell'Oca, Italo, Cozzarini, Cesare, Mangili, Paola, Pasetti, Marcella, Calandrino, Riccardo, Gianolli, Luigi, and Di Muzio, Nadia G
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Biochemical recurrence ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,salvage radiation therapy ,Multimodal Imaging ,Tomotherapy ,030218 nuclear medicine & medical imaging ,Choline ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Retrospective Studie ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Lymph node ,Retrospective Studies ,Aged ,Aged, 80 and over ,Salvage Therapy ,11C- Choline PET/CT ,Genitourinary system ,business.industry ,Hazard ratio ,Prostatic Neoplasms ,lymph node recurrence ,Lymphatic Metastasi ,Middle Aged ,medicine.disease ,prostate cancer ,Radiation therapy ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Toxicity ,Prostatic Neoplasm ,Radiology ,Radiotherapy, Intensity-Modulated ,Neoplasm Recurrence, Local ,business ,Nuclear medicine ,Human ,Radiotherapy, Image-Guided - Abstract
Objective: To report the 3-year toxicity and outcomes of carbon 11 (11C)-choline-positron emission tomography (PET)/computed tomography (CT)-guided radiotherapy (RT), delivered via helical tomotherapy (HTT; Tomotherapy® Hi-Art II® Treatment System, Accuray Inc., Sunnyvale, CA, USA) after lymph node (LN) relapses in patients with prostate cancer. Patients and Methods: From January 2005 to March 2013, 81 patients with biochemical recurrence after surgery, with or without adjuvant/salvage RT or radical RT, and with evidence of LN 11C-choline-PET/CT pathological uptake, underwent HTT (median [range] prostate-specific antigen level 2.59 [0.61â187] ng/mL). Of the 81 patients, 72 were treated at the pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-choline-PET/CT. Nine patients were treated without simultaneous integrated boost (50â65.5 Gy, 25â30 fr). Results: With a median (range) follow-up of 36 (9â116) months, 91.4% of the patients had a PSA reduction 3 months after HTT. The 3-year overall, local relapse-free and clinical relapse-free survival rates were 80.0, 89.8 and 61.8%, respectively. The 3-year actuarial incidences of â¥grade 2 rectal and â¥grade 2 genitourinary toxicity were 6.6% (±2.9%) and 26.3% (±5.5%), respectively. A PSA nadir of â¥0.26 ng/mL (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7â7.7; P = 0.001), extrapelvic 11C-choline-PET/CT-positive LN location (HR 2.4, 95% CI 0.9â6.4; P = 0.07), RT previous to HTT (HR 2.7; 95% CI 1.07â6.9, P = 0.04) and number of positive LNs (HR 1.13, 95% CI 1.04â1.22; P = 0.003) were the main predictors of clinical relapse after HTT. Conclusions: 11C-choline-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of prostate cancer in previously treated patients.
- Published
- 2017
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