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Purpose: In the last months, Italy faced a COVID-19 emergency and implemented preventive measures in order to protect patients and healthcare providers from a disease outbreak. The pandemic control strategies impacted patient experience directly. Questionnaires evaluating patients reported measures (PREMs) may assess critical issues and represent a helpful tool to measure the patient perception of healthcare service. Our aim was to prospectively assess patient satisfaction about doctor-patient interaction in a high-volume radiation therapy and oncology center during the COVID-19 pandemic., Methods: Cancer patients receiving either systemic and/or radiation treatment underwent a survey. Two validated questionnaires (EORTC QLQ-C30, FACIT-TS-G version 1) and 14 specific questions evaluating patients' perception of COVID-19 measures were administered., Results: One hundred twenty-five patients admitted to our department from 1-30 April 2020 completed the questionnaires. The majority (66.4%) of patients were women and the most common disease was breast cancer (40%). The average Global Health Status (GHS) of EORTC QLQ-C30 was 61.67. Emotional functioning, social, and cognitive domains obtained scores of 75.48, 80.13, and 84.67, respectively. FACIT-TS-G results revealed 120 patients rated the treatments effective and 108 patients thought the side effects were the same as expected or better. Most (89.6%) rated their treatment good, very good, or excellent. Concerning COVID-19-related questions, patients reported overall very good level of information., Conclusions: Despite the introduction of strict COVID-19 control measures, there was a high level of cancer outpatient satisfaction. The satisfaction levels may influence compliance, continuity of treatments, and patient-doctor communication, impacting the quality of clinical care in the next phases of the pandemic.

Background and Purpose: COVID-19 constitutes a worldwide threat, prompting Italian Government to implement specific measures on March 8, 2020, to protect patients and health workers from disease transmission. The impact of preventive measures on daily activity of a radiotherapy facility may hamper the ability to fulfill normal workload burden. Thus, we assessed the number of delivered treatments in a specific observation period after the adoption of preventive measures (since March 11 to April 24, 2020) and compared it with the corresponding period of the year 2019., Materials and Methods: Overall number of delivered fractions was related to actual time of platform daily activity and reported as a ratio between number of delivered fractions and activity hours (Fr/Hrs). Fr/Hrs were calculated and compared for two different periods of time, March 11-April 24, 2019 (Fr/Hrs1), and March 11-April 24, 2020 (Fr/Hrs2)., Results: Fr/Hrs1 and Fr/Hrs2 were 2.66 and 2.54 for year 2019 and 2020, respectively, for a Fr/Hrs ratio of 1.07 (95% CI 1.03-1.12, p = 0.0005). Fr/Hrs1 was significantly higher than Fr/Hrs2 for Sli R and Precise R , with Fr/Hrs ratio of 1.92 (95% CI 1.66-2.23, p < 0.0001) and 1.11 (95% CI 1.03-1.2, p = 0.003), respectively. No significant difference was reported for Synergy R and Cyberknife R with Fr/Hrs ratio of 0.99 (95% CI 0.91-1.08, p = 0.8) and 0.9 (95% CI 0.77-1.06, p = 0.2), respectively. Fr/Hrs1 was significantly lower than Fr/Hrs2 for Tomotherapy R , with Fr/Hrs ratio of 0.88 (95% CI 0.8-0.96, p = 0.007)., Conclusion: Preventive measures did not influence workload burden performed. Automation in treatment delivery seems to compensate effectively for health workers number reduction.

Oligometastatic prostate cancer comprises a wide spectrum of conditions, ranging from de novo oligometastatic cancer at diagnosis to oligometastatic castration-resistant disease, which are distinct entities in terms of biology and prognosis. In order to clarify and standardize the clinical role of ablative radiotherapy in oligometastatic prostate cancer, the Italian Association of Radiotherapy and Clinical Oncology (AIRO) formed an expert panel to review the current literature and develop a formal consensus. Oligometastatic prostate cancer was defined as the presence of up to three metastatic lesions involving bones or nodes outside pelvis. Thereafter, four clinical scenarios were explored: metastatic castration-sensitive disease at diagnosis and after primary treatment, and metastatic castration-resistant disease at diagnosis and during treatment, where the role of ablative radiotherapy was defined either in conjunction with systemic therapy or as the only treatment in selected cases. This paper summarizes the current literature about these issues and the proposed recommendations., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In 2018, we published early results from a cohort of patients treated with stereotactic body radiotherapy (SBRT) after previous radiotherapy with definitive or postoperative intent. We sought to provide extended follow-up of this cohort to confirm the safety and efficacy of this approach in a real-world scenario. Fifty patients affected by local relapse after previous definitive or postoperative radiotherapy were treated with SBRT. Treatment provided a total dose of 30 Gy in five fractions. Data about biochemical relapse-free survival (BRFS) and metastasis-free survival (MFS), together with adverse events, were analysed. Toxicity was reported according to Common Terminology Criteria for Adverse Events (CTCAE) score v.4.03. After a median follow-up of 48.2 months, the median BRFS was 43 months. A Gleason score >7 and concomitant androgen deprivation therapy were shown to be predictors of the worst BRFS (hazard ratio 2.42, 95% confidence interval 1.09–5.41, P = 0.02; hazard ratio 2.83, 95% confidence interval 1.17–6.8, P = 0.02, respectively). The median MFS was not reached; concomitant androgen deprivation therapy was confirmed to be predictive of the worst MFS (hazard ratio 4.75, 95% confidence interval 1.52–14.8, P = 0.007). Late grade 1 and 2 rectal and bladder toxicity occurred in three (6%) and 13 (26%) patients, respectively. One patient experienced both grade 3 acute and chronic bladder toxicity. Salvage SBRT re-irradiation after previous postoperative or definitive radiotherapy for local prostate cancer recurrence confirmed promising results in terms of oncological outcomes and the safety of this approach. • Long terms outcomes after reirradiation for prostate cancer. • Promising biochemical control of disease after this approach. • Low rate of reported adverse events after treatment. • Gleason <7 significantly influencing clinical outcomes after treatment. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative prostate cancer patients are a heterogeneous population, and many prognostic factors (e.g., local staging, PSA kinetics, margin status, histopathological features) may influence their clinical management. In this complex scenario, univocal recommendations are often lacking. For these reasons, the present survey was developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of Italian radiation oncologists and delineate a representation of current clinical practice in our country. Methods: A questionnaire was administered online to AIRO (Italian Association of Radiotherapy and Clinical Oncology) members registered in 2020 with a clinical interest in uro-oncological disease. Results: Sixty-one per cent of AIRO members answered the proposed survey. Explored topics included career and expertise, indications to adjuvant RT, additional imaging in biochemical recurrence setting, use of salvage radiotherapy (SRT), management of clinically evident locoregional recurrence and future considerations. Conclusions: Overall, good level of agreement was found between participants for most of the topics. Most debated issues regarded, as expected, implementation of new imaging methods in this setting. Notably, trend in favour of early SRT vs. immediate adjuvant RT was underlined, and preference for global evaluation rather than isolated risk factors for RT indications was noticed. [ABSTRACT FROM AUTHOR]

Bladder cancer represents the most common type of urothelial carcinoma, with a median overall survival of 12.5–15 months in the case of metastatic disease. We evaluated the role of stereotactic body radiation therapy (SBRT) in the management oligometastatic urothelial cancer. Data on patients with a maximum of five metastases were collected from three institutions. Concomitant systemic therapy was allowed. End points were the local control of treated metastases, distant progression-free survival (PFS), overall PFS and overall survival. Data for 82 lesions and 61 patients were included. The primary tumour was located in the bladder in 82% of patients, followed by kidney pelvis (11.5%). The most common treated site was lung (40.2%). Twenty-nine (47.5%) and 14 (23%) patients received systemic therapy before and during SBRT, respectively. The median BED10 value was 78.7 Gy. The median follow-up was 17.2 months. Rates of local control at 1 and 2 years were 92% and 88.9%, respectively, with correlation with systemic therapy before SBRT (hazard ratio 2.62, P = 0.034). Overall PFS at 1 and 2 years was 47.9% and 38.1%, respectively. The number of metastases was a predictive factor (hazard ratio 2.65, P = 0.008). The median overall survival was 25.6 months. Total dose (hazard ratio 0.93, P = 0.003) and BED10 (hazard ratio 0.97, P = 0.006) were correlated with overall survival. No grade ≥2 adverse events were reported. SBRT represents an effective and safe treatment in metastatic urothelial carcinoma. Prospective randomised trials are necessary to better evaluate the benefit on delaying the onset of new systemic therapies. • Surgical approach for metastases from urothelial carcinoma is not always feasible, due to lesions' or patient's characteristics. • SBRT can be considered an effective non-invasive and well-tolerated local treatment. • Adoption of SBRT early in the management of oligometastatic urothelial carcinoma can improve disease control. [ABSTRACT FROM AUTHOR]

1 English Translation of COVID-19 focused questionnaire Graph: Fig. Correction to: Impact of COVID-19 on patient-doctor interaction in a complex radiation therapy facility 2 Average scores for specific subdomains of EORTC QLQ-C30 questionnaires Note that the errors made during the assembly of this figure did not affect the major conclusions reported in the paper. [Extracted from the article]

Poster: Clinical track: Haematology PO-0932: Preoperative radiotherapy for early breast cancer: quality assessment of the ROCK trial - NCT03520894 G. Francolini, V. Di Cataldo, S. Cipressi, E. Scoccimarro, V. Maragna, L. Masi, R. Doro, G. Simontacchi, I. Desideri, I. Meattini, L. Livi. [Extracted from the article]

[Display omitted] • 13 studies comparing moderate hypofractionation and conventional fractionation prostate cancer patients were included. • Pooled analysis about acute toxicity was performed. • Narrative overview of late toxicity was reported. • Majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. • Pooled analysis showed a 9.8 % and 1.5 % increase in acute GI and GU toxicity, respectively. • Results may have been influenced by effect of to dose escalation rather than hypofractionation. Moderately hypofractionated radiotherapy (RT) currently represents the standard RT approach for all prostate cancer (PCa) risk categories. We performed a systematic review and meta-analysis of available literature, focusing on acute and late genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) of moderate hypofractionation for localized PCa. Literature search was performed and two independent reviewers selected the records according to the following Population (P) Intervention (I) Comparator (C) and Outcomes (O) (PICO) question: "In patients affected by localized PCa (P), moderately hypofractionated RT (defined as a treatment schedule providing a single dose per fraction of 3–4.5 Gy) (I) can be considered equivalent to conventionally fractionated RT (C) in terms of G > 2 GI and GU acute and late adverse events (O)?". Bias assessment was performed using Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias. Thirteen records were identified and a meta-analysis was performed. Risk of acute GI and GU > 2 adverse events in the moderately hypofractionated arm was increased by 9.8 % (95 %CI 4.8 %–14.7 %; I2 = 57 %) and 1.5 % (95 % CI -1.5 %-4.4 %; I2 = 0%), respectively. Overall, majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. Pooled analysis showed a trend to increased GI toxicity after hypofractionated treatment, but this might be related to dose escalation rather than hypofractionation. [ABSTRACT FROM AUTHOR]

C. Franzese, G. Francolini, L. Nicosia, F. Alongi, L. Livi, M. Scorsetti, Poster: Clinical track: Urology-non-prostate PO-1214: Stereotactic Body Radiation Therapy in the management of oligometastases from urothelial cancer. [Extracted from the article]

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]

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]