341 results on '"V. Fusco"'
Search Results
252. [Adjuvant radiochemotherapy in the elderly affected by glioblastoma: single-institution experience and literature review].
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Fiorentino A, Chiumento C, Caivano R, Cozzolino M, Pedicini P, and Fusco V
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- Aged, Aged, 80 and over, Biopsy, Chemoradiotherapy, Adjuvant, Dacarbazine therapeutic use, Female, Glioblastoma pathology, Glioblastoma surgery, Humans, Male, Radiotherapy, Conformal, Retrospective Studies, Survival Rate, Temozolomide, Treatment Outcome, Antineoplastic Agents, Alkylating therapeutic use, Brain Neoplasms therapy, Dacarbazine analogs & derivatives, Glioblastoma therapy
- Abstract
Purpose: Radiochemotherapy (RCT) is the standard adjuvant treatment for patients affected by glioblastoma (GBM). As there is no evidence in elderly patients with GBM, combined, single modality or best supportive care is used. The aim of this retrospective study was to evaluate acute toxicity and outcome of elderly patients with GBM treated with RCT with temozolomide (TMZ)., Materials and Methods: Patients >65 years with newly diagnosed GBM who underwent surgery or biopsy and RCT were evaluated. Recursive Partitioning Analysis (RPA) class and National Cancer Institute--Common Toxicity Criteria (NCI-CTC) version 3 were used to classify patients and evaluate acute toxicity, respectively., Results: From April 2005 to January 2011, 35 patients (18 women and 17 men) with GBM were treated at our institution. Only 31.43% of cases underwent complete resection. Median progression-free survival (PFS) was 8 months and median overall survival (OS) 13 months. At univariate and multivariate analysis, only RPA class correlated with OS (p=0.01, p=0.03, respectively). During RCT, toxicity was mild (thrombocytopaenia G3-4, 11.43%; neurological toxicity, G3-4, 8.57%)., Conclusions: Our data suggest that RCT with TMZ seems to produce a better outcome with a mild toxicity profile in elderly patients affected by GBM.
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- 2013
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253. Do comorbidity influences acute toxicity and outcome in elderly patients with endometrial cancer treated by adjuvant radiotherapy plus brachytherapy?
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Fiorentino A, Chiumento C, and Fusco V
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- Aged, Aged, 80 and over, Comorbidity, Endometrial Neoplasms epidemiology, Female, Humans, Retrospective Studies, Brachytherapy adverse effects, Endometrial Neoplasms radiotherapy, Radiotherapy, Adjuvant adverse effects
- Abstract
Purpose: To correlate comorbidity and acute radiation toxicity in elderly patients treated with adjuvant external beam radiotherapy (EBRT) plus brachytherapy-high dose rate (HDR-BRT) for endometrial cancer (EC)., Methods: Endometrial cancer patients over 65 were treated and evaluated for comorbidity assessment with ACE-27 and Charlson comorbidity index (CCI). EBRT total dose was 45-50.4 Gy (1.8 Gy/day). The vault vagina boost of dose was performed by HDR-BRT with 2/3 fractions with a total dose of 10-15 Gy., Results: From 2008 to 2011, 35 patients were analyzed. Eighteen patients (51.43 %) had not ACE-27 comorbidity; while 27 patients (77.14 %) had CCI lower than three. During treatment, acute toxicity was mild and not influenced by the comorbidity score. Two-year Progression Free and Overall Survival were 69 and 80 %. ACE-27 and CCI did not affect progression-free survival (p = 0.51, p = 0.3) and OS (p = 0.26, p = 0.5)., Conclusion: External beam radiotherapy plus BRT-HDR are well tolerated in EC elderly with good performance status and low comorbidity profile.
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- 2013
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254. Impact of comorbidity in elderly prostate cancer patients treated with brachytherapy.
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Chiumento C, Fiorentino A, Cozzolino M, Caivano R, Clemente S, Pedicini P, and Fusco V
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Objective: To analyze the correlations among comorbidity and overall survival (OS), biochemical progression-free survival (b-PFS) and toxicity in elderly patients with localized prostate cancer treated with (125)I brachytherapy., Methods: Elderly men, aged ≥65 years, with low-intermediate risk prostate cancer, were treated with permanent (125)I brachytherapy as monotherapy. Comorbidity data were obtained from medical reports using age-adjusted Charlson comorbidity index (a-CCI). The patients were categorized into two age groups (<75 and ≥75 years old), and two comorbidity score groups (a-CCI ≤3 and >3). Toxicity was scored with Radiation Therapy Oncology Group (RTOG) scale., Results: From June 2003 to October 2009, a total of 92 elderly patients underwent prostate brachytherapy, including 57 men (62%) with low-risk prostate cancer, and 35 men (38%) with intermediate-risk prostate cancer. The median age of patients was 75 years (range, 65-87 years). Forty-seven patients (51%) had a-CCI ≤3 and 45 patients (49%) a-CCI >3. With a median follow-up period of 56 months (range, 24-103 months), the 5-year actuarial OS and b-PFS were 91.3% and 92.4% respectively, without statistical significance between two Charlson score groups. Toxicity was mild. None of the patients experienced gastrointestinal (GI) toxicity, and only 4 patiens (4%) experienced late genitourinary (GU) grade-3 (G3) toxicity. No correlation between acute GU and GI toxicity and comorbidity was showed (P=0.50 and P=0.70, respectively)., Conclusions: Our data suggest that elderly men with low-intermediate risk prostate cancer and comorbidity can be considered for a radical treatment as (125)I low-dose rate brachytherapy.
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- 2013
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255. Monitor unit optimization in RapidArc plans for prostate cancer.
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Clemente S, Cozzolino M, Chiumento C, Fiorentino A, Caivano R, and Fusco V
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- Cohort Studies, Humans, Male, Prostatic Neoplasms pathology, Radiotherapy Dosage, Organ Sparing Treatments methods, Prostatic Neoplasms radiotherapy, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Intensity-Modulated
- Abstract
Intensity-modulated radiation therapy (IMRT) has become a standard treatment for prostate cancer based on the superior sparing of the bladder, rectum, and other surrounding normal tissues compared to three-dimensional conformal radiotherapy, despite the longer delivery time and the increased number of monitor units (MU). The novel RapidArc technique represents a further step forward because of the lower number of MUs per fraction and the shorter delivery time, compared to IMRT. This paper refers to MU optimization in RA plans for prostate cancer, using a tool incorporated in Varian TPS Eclipse. The goal was to get the lowest MU RA plan for each patient, keeping a well-defined level of PTV coverage and OAR sparing. Seven prostate RA plans (RA MU-Optimized) were retrospectively generated using the MU optimization tool in Varian Eclipse TPS. Dosimetric outcome and nontarget tissue sparing were, compared to those of RA clinical plans (RA Clinical) used to treat patients. Compared to RA Clinical, RA MU-Optimized plans resulted in an about 28% (p = 0.018) reduction in MU. The total integral dose (ID) to each nontarget tissue (but not the penile bulb) showed a consistent average relative reduction, statistically significant only for the femoral heads. Within the intermediate dose region (40-60 Gy), ID reductions (4%-17% p < 0.05) were found for the rectum, while a slight but significant (0.4%-0.9%, p < 0.05) higher ID was found for the whole body. Among the remaining data, the mean dose to the bladder was also reduced (-12%, p = 0.028). Plans using MU optimization are clinically applicable and more MU efficient, ameliorating the exposure of the rectum and the bladder to intermediate doses.
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- 2013
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256. Cone-beam computed tomography dose monitoring during intensity-modulated radiotherapy in head and neck cancer: parotid glands.
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Fiorentino A, Cozzolino M, Caivano R, Pedicini P, Chiumento C, Oliviero C, Clemente S, and Fusco V
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- Head and Neck Neoplasms diagnostic imaging, Humans, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Cone-Beam Computed Tomography, Head and Neck Neoplasms radiotherapy, Parotid Gland radiation effects, Radiotherapy, Intensity-Modulated
- Abstract
Purpose: To evaluate the dosimetric changes of parotid glands (PG) during a course of intensity-modulated radiotherapy (IMRT) in head and neck (H&N) cancer patients., Methods: Ten patients with H&N cancer treated by IMRT were analyzed. The original treatment plan (CT(plan)) was transferred to cone-beam computed tomography (CBCT) acquired at the 15th and 20th treatment day (CBCT(plan) I and II, respectively). The PG mean dose (D(mean)), the dose to 50 % of the volume, and the percent of volume receiving 30 and 50 Gy were measured by the dose volume histogram., Results: 30 IMRT plans were evaluated (3 plans/patient). All dosimetric end points increased significantly for both PG only when CT(plan) was compared to CBCT(plan) I. The D(mean) increased significantly only for ipsilateral PG (p = 0.02) at week 3., Conclusion: During a course of IMRT, CBCT is a feasible method to check the PG dosimetric variations. Perhaps, the 3rd week of radiotherapy could be considered as the time-check-point.
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- 2013
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257. Local tumor control probability to evaluate an applicator-guided volumetric-modulated arc therapy solution as alternative of 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecological cancer.
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Pedicini P, Strigari L, Caivano R, Fiorentino A, Califano G, Nappi A, Improta G, Storto G, Cozzolino M, Chiumento C, Fusco V, Vavassori A, Benassi M, Orecchia R, and Salvatore M
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- Adult, Aged, Data Interpretation, Statistical, Equipment Design, Equipment Failure Analysis, Female, Humans, Middle Aged, Radiometry methods, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated methods, Reproducibility of Results, Retrospective Studies, Sensitivity and Specificity, Treatment Outcome, Vagina, Brachytherapy instrumentation, Genital Neoplasms, Female radiotherapy, Radiometry instrumentation, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Intensity-Modulated instrumentation
- Abstract
The purpose of this study was to evaluate the applicator-guided volumetric-modulated arc therapy (AGVMAT) solution as an alternative to high-dose-rate brachytherapy (HDR-BRT) treatment of the vaginal vault in patients with gynecological cancer (GC). AGVMAT plans for 51 women were developed. The volumetric scans used for plans were obtained with an implanted CT-compatible vaginal cylinder which provides spatial registration and immobilization of the gynecologic organs. Dosimetric and radiobiological comparisons for planning target volume (PTV) and organs at risk (OARs) were performed by means of a dose-volume histogram (DVH), equivalent uniform dose (EUD), and local tumor control probability (LTCP). In addition, the integral dose and the overall delivery time, were evaluated. The HDR-BRT averages of EUD and minimum LTCP were significantly higher than those of AGVMAT. Doses for the OARs were comparable for the bladder and sigmoid, while, although HDR-BRT was able to better spare the bowel, AGVMAT provided a significant reduction of d2cc, d1cc, and dmax (p < 0.01) for the rectum. AGVMAT integral doses were higher than HDR-BRT with low values in both cases. Delivery times were about two or three times higher for HDR-BRT with respect to the single arc technique (AGVMAT1) and dual arc technique (AGVMAT2), respectively. The applicator-guided volumetric-modulated arc therapy seems to have the potential of improving rectum avoidance. However, brachytherapy improves performance in terms of PTV coverage, as demonstrated by a greater EUD and better LTCP curves.
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- 2013
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258. Assessing the risk of osteonecrosis of the jaw due to bisphosphonate therapy in the secondary prevention of osteoporotic fractures.
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Lapi F, Cipriani F, Caputi AP, Corrao G, Vaccheri A, Sturkenboom MC, Di Bari M, Gregori D, Carle F, Staniscia T, Vestri A, Brandi M, Fusco V, Campisi G, and Mazzaglia G
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- Administration, Oral, Aged, Aged, 80 and over, Bisphosphonate-Associated Osteonecrosis of the Jaw epidemiology, Bone Density Conservation Agents administration & dosage, Bone Density Conservation Agents therapeutic use, Case-Control Studies, Diphosphonates administration & dosage, Diphosphonates therapeutic use, Female, Humans, Italy epidemiology, Male, Medical Record Linkage, Middle Aged, Osteoporotic Fractures epidemiology, Risk Assessment methods, Bisphosphonate-Associated Osteonecrosis of the Jaw etiology, Bone Density Conservation Agents adverse effects, Diphosphonates adverse effects, Osteoporotic Fractures prevention & control
- Abstract
Summary: There is evidence that the use oral bisphosphonates can lead to osteronecrosis of the jaws (ONJ). Although the occurrence of ONJ appears rare among oral bisphosphonates (BPs) users, it is important to know that it exists and can be opportunely minimized., Introduction: The purpose of this study is to evaluate the association between BPs prescribed for the secondary prevention of osteoporotic fractures and the occurrence of ONJ., Methods: An Italian record linkage claims database with a target population of around 18 million individuals (6 million over 55 years of age) constituted the data source. We conducted a nested case-control study within a cohort of individuals aged 55+ years old, who were discharged from hospitals with a primary diagnosis of incident osteoporotic fracture. The date related to the discharge diagnosis of ONJ was the index date. Conditional logistic regression for matched data was fitted to estimate the odds ratio (OR) along with 95 % confidence intervals (95 % CI) for the likely association between use of BPs and the risk of ONJ., Results: Any one of the 61 ascertained cases of ONJ (incidence rate, 36.6 per 100,000 person-years) was matched to 20 controls for a total of 1120 controls. When the exposure to BPs was modeled according to recency (i.e., exposure time window prior to the index date) of use, the adjusted OR (95 % CI) for current users was 2.8 (1.3-5.9) against never users. The cumulative use of BPs has shown to increase the incidence of ONJ among patients with primary osteoporotic fractures, although not statistically significant risk has been observed., Conclusions: Although the risk of BP-related ONJ appears low in non-oncological indications, it is important to be aware that it exists and to know how it may be predicted and possibly minimized.
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- 2013
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259. Elderly patients affected by glioblastoma treated with radiotherapy: the role of serum hemoglobin level.
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Fiorentino A and Fusco V
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- Aged, Aged, 80 and over, Brain Neoplasms mortality, Female, Follow-Up Studies, Glioblastoma mortality, Hemoglobins physiology, Humans, Male, Retrospective Studies, Survival Rate trends, Treatment Outcome, Brain Neoplasms blood, Brain Neoplasms radiotherapy, Glioblastoma blood, Glioblastoma radiotherapy, Hemoglobins metabolism
- Abstract
Objective: To investigate the role of serum hemoglobin level for elderly patients with glioblastoma treated with radiotherapy (RT)., Methods: Patients older than 65 years with glioblastoma, who underwent surgical resection/biopsy and RT, were evaluated. Total doses were 30 or 60 Gy:30 Gy in 10 or 5 fractions (palliative approach) and 60 Gy in 30 fractions (standard approach). In the standard approach, temozolomide was administered concomitantly and adjuvantly to RT. Before starting and weekly during RT, serum hemoglobin level was assessed for all patients. Recursive partitioning analysis (RPA) was used to classify patients., Results: From 2005 to 2011, 45 patients (median age 71 years) were treated in our institution. Hemoglobin level less than 12 was confirmed in 11 patients. Median progression-free survival (PFS) and overall survival (OS) were 8 and 13 months, respectively. Only RPA class and extent of surgery correlated to PFS (p = .002, p = .04, respectively). RPA class, surgery, and RT dose affected OS (p = .003, p = .02, p = .03, respectively), whereas age (<70 vs. ≥70 years) and hemoglobin level (<12 vs. ≥12) did not influenced outcome (p = 0.2, p = 0.5, respectively)., Conclusion: Our data suggested that extent of surgery and RPA class remain independent prognostic factor, whereas patients' anemia did not adversely affect prognosis in glioblastoma elderly patients.
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- 2013
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260. Decreasing frequency of osteonecrosis of the jaw in cancer and myeloma patients treated with bisphosphonates: the experience of the oncology network of piedmont and aosta valley (north-Western Italy).
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Fusco V, Galassi C, Berruti A, Ortega C, Ciuffreda L, Scoletta M, Goia F, Migliario M, Baraldi A, Boccadoro M, Loidoris A, and Bertetto O
- Abstract
Background. Data concerning frequency of Osteonecrosis of Jaws (ONJ) are mostly based on single center experiences. Patients and Methods. Since 2005 a multidisciplinary study group collected data of cases of ONJ in patients treated with Bisphosphonates (BP) and observed in oncology and hematology centers of a regional network. Results. By December 2008, 221 cases were registered. We report details of 200 cases, identified after cross-checking reports from centres of medical oncology, haematology, and oral care. Primary neoplasm was breast cancer (39%), myeloma (32%), prostate cancer (16%), and other types of cancer (8%). In about 50% of the cases a history of dental extraction was present. Zoledronic acid was administered (alone or with other BP) to 178 patients (89%). Median time from first infusion to ONJ diagnosis was 21.0 (zoledronic acid only) and 39.0 months (pamidronate only). The number of ONJ cases per year was 3 in 2003, 21 in 2004, 58 in 2005, 60 in 2006, 37 in 2007, and 21 in 2008. Conclusion. The number of new ONJ cases in cancer and myeloma patients increased until 2006 and then reduced. The possible reasons of this trend (introduction of zoledronic acid; increase of ONJ awareness; diffusion of preventive dental measures; late modifications of BP prescription) are herein discussed.
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- 2013
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261. In regard to Miralbell et al. Re: Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5969 patients in seven international institutional datasets: alpha/beta=1.4 (0.9-2.2) Gy.
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Pedicini P, Caivano R, Strigari L, Benassi M, Fiorentino A, and Fusco V
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- Humans, Male, Databases, Factual statistics & numerical data, Dose Fractionation, Radiation, Prostatic Neoplasms radiotherapy, Radiation Tolerance
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- 2013
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262. Comorbidity assessment and adjuvant radiochemotherapy in elderly affected by glioblastoma.
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Fiorentino A, Caivano R, Chiumento C, Cozzolino M, Clemente S, Pedicini P, and Fusco V
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- Aged, Aged, 80 and over, Antineoplastic Agents administration & dosage, Comorbidity, Dacarbazine administration & dosage, Dacarbazine analogs & derivatives, Disease-Free Survival, Female, Humans, Male, Temozolomide, Chemoradiotherapy, Adjuvant methods, Glioblastoma epidemiology, Glioblastoma therapy
- Abstract
To assess the role of comorbidity on outcome in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant Temozolomide, patients over 65 years with glioblastoma, who underwent surgical resection or biopsy and radiochemotherapy, were evaluated. The Adjusted-Age Charlson Comorbidity Index and the Adult Comorbidity Evaluation-27 were used to assess comorbidity. From April 2005 to January 2011, 35 patients (median age 72 years) were treated in our Institution. Thirteen patients had a Charlson score more than 3, while, according to the Adult Comorbidity Evaluation-27, 21 patients had mild or severe comorbid conditions. Patients with low Charlson comorbidity score experienced a longer survival time than those with higher score (22 vs. 10 months, respectively). The Adjusted-Age Charlson Comorbidity Index influenced survival at univariate and multivariate analysis (p = 0.004, p = 0.001, respectively). No comorbidity index was a predictor for progression-free survival. Our data suggested that the association of radiotherapy with TMZ was safe and effective. Perhaps, the comorbidity assessment could be an appropriate tool in the treatment decision for elderly patients with glioblastoma.
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- 2012
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263. Comparative dosimetric and radiobiological assessment among a nonstandard RapidArc, standard RapidArc, classical intensity-modulated radiotherapy, and 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecologic cancer.
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Pedicini P, Caivano R, Fiorentino A, Strigari L, Califano G, Barbieri V, Sanpaolo P, Castaldo G, Benassi M, and Fusco V
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- Aged, Aged, 80 and over, Combined Modality Therapy, Female, Humans, Middle Aged, Radiotherapy Dosage, Treatment Outcome, Brachytherapy methods, Radiometry methods, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Conformal methods, Uterine Neoplasms radiotherapy, Vagina radiation effects
- Abstract
To evaluate a nonstandard RapidArc (RA) modality as alternative to high-dose-rate brachytherapy (HDR-BRT) or IMRT treatments of the vaginal vault in patients with gynecological cancer (GC). Nonstandard (with vaginal applicator) and standard (without vaginal applicator) RapidArc plans for 27 women with GC were developed to compare with HDR-BRT and IMRT. Dosimetric and radiobiological comparison were performed by means of dose-volume histogram and equivalent uniform dose (EUD) for planning target volume (PTV) and organs at risk (OARs). In addition, the integral dose and the overall treatment times were evaluated. RA, as well as IMRT, results in a high uniform dose on PTV compared with HDR-BRT. However, the average of EUD for HDR-BRT was significantly higher than those with RA and IMRT. With respect to the OARs, standard RA was equivalent of IMRT but inferior to HDR-BRT. Furthermore, nonstandard RA was comparable with IMRT for bladder and sigmoid and better than HDR-BRT for the rectum because of a significant reduction of d(2cc), d(1cc), and d(max) (p < 0.01). Integral doses were always higher than HDR-BRT, although the values were very low. Delivery times were about the same and more than double for HDR-BRT compared with IMRT and RA, respectively. In conclusion, the boost of dose on vaginal vault in patients affected by GC delivered by a nonstandard RA technique was a reasonable alternative to the conventional HDR-BRT because of a reduction of delivery time and rectal dose at substantial comparable doses for the bladder and sigmoid. However HDR-BRT provides better performance in terms of PTV coverage as evidenced by a greater EUD., (Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)
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- 2012
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264. Radiotherapy and bevacizumab for intramedullary and leptomenigeal metastatic glioblastoma: a case report and review of the literature.
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Fiorentino A, Caivano R, Chiumento C, Cozzolino M, and Fusco V
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- Adult, Angiogenesis Inhibitors administration & dosage, Bevacizumab, Brain Neoplasms pathology, Brain Neoplasms surgery, Glioblastoma secondary, Glioblastoma surgery, Humans, Male, Meningeal Neoplasms secondary, Meningeal Neoplasms surgery, Spinal Cord Neoplasms secondary, Spinal Cord Neoplasms surgery, Antibodies, Monoclonal, Humanized administration & dosage, Brain Neoplasms therapy, Chemoradiotherapy methods, Glioblastoma therapy, Meningeal Neoplasms therapy, Spinal Cord Neoplasms therapy
- Abstract
Glioblastoma (GBM) developed metastases rarely and the prognosis, in these cases, was very poor. We reported a 30-year patient who, developing intramedullary and leptomeningeal metastases from GBM, underwent palliative spinal radiotherapy (RT) and Bevacizumab.
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- 2012
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265. Technique of whole brain radiotherapy: conformity index and parotid glands.
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Fiorentino A, Caivano R, Chiumento C, Cozzolino M, Pedicini P, Clemente S, and Fusco V
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- Female, Humans, Male, Parotid Gland anatomy & histology, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated methods, Treatment Outcome, Xerostomia etiology, Brain Neoplasms radiotherapy, Cranial Irradiation methods, Parotid Gland radiation effects, Radiotherapy Planning, Computer-Assisted methods
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- 2012
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266. Parotid gland volumetric changes during intensity-modulated radiotherapy in head and neck cancer.
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Fiorentino A, Caivano R, Metallo V, Chiumento C, Cozzolino M, Califano G, Clemente S, Pedicini P, and Fusco V
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- Adult, Aged, Cone-Beam Computed Tomography, Female, Humans, Male, Middle Aged, Organ Size, Organ Sparing Treatments methods, Parotid Gland anatomy & histology, Parotid Gland diagnostic imaging, Prospective Studies, Radiotherapy Dosage, Retrospective Studies, Head and Neck Neoplasms radiotherapy, Parotid Gland radiation effects, Radiotherapy, Intensity-Modulated methods
- Abstract
Objective: To evaluate volumetric changes of parotid glands (PGs) during intensity-modulated radiotherapy (IMRT) in head and neck cancer patients., Methods: During IMRT all patients underwent kilovolt cone-beam CT (CBCT) scans to verify the set-up positioning in a protocol study. On each CBCT scan, the PGs were retrospectively contoured and evaluated with a dose-volume histogram., Results: From February to June 2011, 10 patients were enrolled. 140 CBCT scans were registered (280 PGs): for each patient, a median of 14 CBCT scans were performed (range 14-16). At the start of radiation, the average volume for ipsilateral PGs (iPGs) was 18.77 ml (range 12.9-31.2 ml), whereas for contralateral PGs (cPGs) it was 16.63 ml (range 8.3-28.7 ml). At the last CBCT scan, the average volume loss was 43.5% and 44.0% for the iPG and cPG, respectively. When we analysed the percentage of volume loss, we observed that the volume decreased by linear regression (r(2)=0.92 for iPG; r(2)=0.91 for cPG), with an average volume loss rate of 1.5% per day for both PGs. During the third week of treatment the volume of both PGs reduced by 24-30%., Conclusion: Our data show that, during IMRT, the shrinkage of PGs should be taken into account. A replan could be indicated in the third week of radiotherapy.
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- 2012
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267. Thin agar layer- versus most probable number-PCR to enumerate viable and stressed Escherichia coli O157:H7 and application in a traditional raw milk pasta filata cheese.
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Fusco V, Riccardi M, and Quero GM
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- Agar, Animals, Cheese microbiology, Colony Count, Microbial, Escherichia coli, Food Contamination, Food Microbiology, Milk microbiology, Ointments, Pasteurization, Probability, Escherichia coli O157 genetics, Escherichia coli O157 isolation & purification, Polymerase Chain Reaction methods
- Abstract
A mid-log phase broth culture of Escherichia (E.) coli O157:H7 381 (final concentration 10(4) cfu/mL) was monitored by conventional liquid- and solid-based enumeration techniques combined with PCR while it was subjected to thermal stress in gradually more complex systems (i.e., Tryptone Soya Broth, pasteurized milk and during lab-scale productions of a pasta filata fior di latte cheese obtained from raw or pasteurized milk). Our results highlighted: i) the incapability of the selective medium, ii) the effectiveness of the thin agar layer-PCR method, and iii) the effectiveness of the most probable number (MPN)-PCR method (in comparison with both plating-based methods) in recovering and selectively counting viable and stressed or injured E. coli O157:H7. Moreover, MPN-PCR was superior to both plating-based methods in terms of speed and easiness to get results. The thermal stresses herein applied (heating at 55 °C for 5 and 8 min) were less effective on the pasteurized milk than on the Tryptone Soya Broth and the pathogen was more protected in the raw milk-based matrices than in the pasteurized ones. Moreover, given the contamination level (10(4) cfu/mL of milk) of the strain, the temperature/time of stretching and the hardening and brining conditions herein used, the complete inactivation of the pathogen is not achievable., (Copyright © 2012 Elsevier B.V. All rights reserved.)
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- 2012
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268. Learning from experience. Proposal of a refined definition and staging system for bisphosphonate-related osteonecrosis of the jaw (BRONJ).
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Bedogni A, Fusco V, Agrillo A, and Campisi G
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- Biopsy, Bisphosphonate-Associated Osteonecrosis of the Jaw diagnosis, Bone Density Conservation Agents adverse effects, Decision Trees, Diagnosis, Differential, Diphosphonates administration & dosage, Humans, Bisphosphonate-Associated Osteonecrosis of the Jaw classification, Terminology as Topic
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- 2012
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269. Elderly people with glioblastoma.
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Fiorentino A, Balducci M, Chiesa S, and Fusco V
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- Female, Humans, Male, Antineoplastic Agents, Alkylating therapeutic use, Astrocytoma drug therapy, Astrocytoma radiotherapy, Brain Neoplasms drug therapy, Brain Neoplasms radiotherapy, Dacarbazine analogs & derivatives
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- 2012
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270. Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important?
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Sanpaolo P, Barbieri V, Genovesi D, Fusco V, and Ausili Cèfaro G
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- Aged, Breast Neoplasms mortality, Carcinoma, Ductal, Breast mortality, Combined Modality Therapy, Dose-Response Relationship, Radiation, Female, Humans, Kaplan-Meier Estimate, Middle Aged, Multivariate Analysis, Radiotherapy Dosage, Retrospective Studies, Breast Neoplasms therapy, Carcinoma, Ductal, Breast therapy, Mastectomy, Segmental, Neoplasm Recurrence, Local
- Abstract
To evaluate if biologically effective dose (BED), and in particular the duration of radiation treatment, has an effect on local relapse risk. Between January 2000 and December 2008 a total of 762 patients with T1-2 N0/+ breast cancer was treated with breast-conserving surgery and radiotherapy, with and without hormone therapy and chemotherapy. Adjuvant radiation therapy was administered to a total dose of 60-66 Gy in 30-33 fractions. The computed BEDs were divided in four groups: <43.1, 43.1-44.9, 45.0-46.1, and >46.1 Gy (A-D, respectively). Kaplan-Meier method was used to calculate local relapse rates. Cox regression method was used to identify prognostic factors of local relapse. Evaluated variables were age, tumor histology, tumor size, surgical margin status, axillary nodal status, tumor grading, adjuvant therapies, adjuvant chemotherapy alone, adjuvant hormone therapy alone, adjuvant anthracyclines, and BEDs values. 8-year local relapse rates were 18.0% for group A, 8.5% for group B, 4.6% for group C, and 2.7% for group D (P=0.008). Multivariate Cox regression analysis showed that BEDs values were associated with higher local relapse risk (P=0.001). In our study, a prolongation of radiotherapy treatment, intended as a lower BED value, after breast-conserving surgery is associated with an increased risk of local relapse. Considering the wide range of results published in other studies, hypofractionation for breast cancer should be considered, at the moment, feasible in selected patients.
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- 2012
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271. Her-2 prognostic value in very early-stage breast cancer: a single-institution retrospective analysis.
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Sanpaolo P, Barbieri V, Pedicini P, and Fusco V
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- Adult, Aged, Aged, 80 and over, Breast Neoplasms mortality, Breast Neoplasms pathology, Carcinoma, Ductal, Breast mortality, Carcinoma, Ductal, Breast secondary, Early Diagnosis, Female, Follow-Up Studies, Humans, Immunoenzyme Techniques, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Receptors, Estrogen metabolism, Receptors, Progesterone metabolism, Retrospective Studies, Survival Rate, Young Adult, Breast Neoplasms metabolism, Carcinoma, Ductal, Breast metabolism, Neoplasm Recurrence, Local metabolism, Receptor, ErbB-2 metabolism
- Abstract
To evaluate overall survival, distant metastases-free survival and local relapse-free survival rates in a subgroup of patients affected by breast cancer expressing Her-2/neu. Data of 195 women affected by very early-stage breast cancer (pT1a-b pN0) who underwent whole breast radiotherapy after conservative surgery with or without chemotherapy and/or hormone therapy between January 2000 and December 2006 were evaluated. Chi-square test was used to compare the distribution of variables (age, tumour histology, oestrogens and progesterone receptors, tumour grading and adjuvant chemotherapy) between Her-2-positive and Her-2-negative patients. Survival rates were analysed with Kaplan-Meier curves; impact of variables on poor outcome was evaluated with Cox regression method. Median follow-up time was 63.5 months (range 13.8-113.6). Her-2/neu-positive patients (32/16.4%), compared to Her-2/neu-negative patients (163/83.6%), were younger (P = 0.0001), were affected by ductal infiltrating carcinoma (P = 0.039), had negative oestrogens receptors (P = 0.0001) and were not treated with chemotherapy (P = 0.001). Her-2-positive patients had lower overall survival (P = 0.00001) and lower distant metastases-free survival (P = 0.00001) compared to Her-2-negative patients, but no difference in local relapse-free survival was found between the two groups (P = 0.28). After multivariate analysis, Her-2-positive status was a prognostic factor for overall survival (P = 0.00001) and for distant metastases-free survival (P = 0.0001), but not for local relapse-free survival (P = 0.97). Her-2-positive patients have lower overall survival and distant metastases-free survival when compared to Her-2 negative patients but similar local relapse-free survival rates. These patients could be treated with conservative surgery, if feasible, but should receive more aggressive and tailored systemic adjuvant therapies.
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- 2012
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272. Radiotherapy and temozolomide in anaplastic astrocytoma: a retrospective multicenter study by the Central Nervous System Study Group of AIRO (Italian Association of Radiation Oncology).
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Scoccianti S, Magrini SM, Ricardi U, Detti B, Krengli M, Parisi S, Bertoni F, Sotti G, Cipressi S, Tombolini V, Dall'oglio S, Lioce M, Saieva C, Buglione M, Mantovani C, Rubino G, Muto P, Fusco V, Fariselli L, de Renzis C, Masini L, Santoni R, Pirtoli L, and Biti G
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Brain Neoplasms mortality, Dacarbazine therapeutic use, Female, Follow-Up Studies, Humans, Male, Middle Aged, Oligodendroglioma mortality, Radiotherapy Dosage, Retrospective Studies, Survival Rate, Temozolomide, Treatment Outcome, Young Adult, Antineoplastic Agents, Alkylating therapeutic use, Brain Neoplasms therapy, Chemoradiotherapy, Dacarbazine analogs & derivatives, Oligodendroglioma therapy
- Abstract
Although the evidence for the benefit of adding temozolomide (TMZ) to radiotherapy (RT) is limited to glioblastoma patients, there is currently a trend toward treating anaplastic astrocytomas (AAs) with combined RT + TMZ. The aim of the present study was to describe the patterns of care of patients affected by AA and, particularly, to compare the outcome of patients treated exclusively with RT with those treated with RT + TMZ. Data of 295 newly diagnosed AAs treated with postoperative RT ± TMZ in the period from 2002 to 2007 were reviewed. More than 75% of patients underwent a surgical removal. All the patients had postoperative RT; 86.1% of them were treated with 3D-conformal RT (3D-CRT). Sixty-seven percent of the entire group received postoperative chemotherapy with TMZ (n = 198). One-hundred sixty-six patients received both concomitant and sequential TMZ. Prescription of postoperative TMZ increased in the most recent period (2005-2007). One- and 4-year survival rates were 70.2% and 28.6%, respectively. No statistically significant improvement in survival was observed with the addition of TMZ to RT (P = .59). Multivariate analysis showed the statistical significance of age, presence of seizures, Recursive Partitioning Analysis classes I-III, extent of surgical removal, and 3D-CRT. Changes in the care of AA over the past years are documented. Currently there is not evidence to justify the addition of TMZ to postoperative RT for patients with newly diagnosed AA outside a clinical trial. Results of prospective and randomized trials are needed.
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- 2012
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273. Adjuvant chemotherapy of pT1a and pT1b breast carcinoma: results from the NEMESI study.
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Gori S, Clavarezza M, Siena S, Foglietta J, Tarenzi E, Giordano M, Molino A, Graiff C, Fusco V, Alabiso O, Baldini E, Gamucci T, Altavilla G, Dondi D, and Venturini M
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Agents therapeutic use, Breast Neoplasms therapy, Chemotherapy, Adjuvant, Female, Humans, Menopause, Middle Aged, Neoplasm Staging, Prognosis, Receptor, ErbB-2 metabolism, Receptors, Estrogen metabolism, Retrospective Studies, Young Adult, Breast Neoplasms drug therapy, Breast Neoplasms pathology
- Abstract
Background: The prognosis of pT1a-pT1b breast cancer (BC) used to be considered very good, with a 10-y RFS of 90%. However, some retrospective studies reported a 10-y RFS of 81%-86% and suggested benefit from adjuvant systemic therapy., Methods: To evaluate the variables that determined the choice of adjuvant chemotherapy and the type of chemotherapy delivered in pT1a-pT1b BC, we analysed the small tumours enrolled in the NEMESI study., Results: Out of 1,894 patients with pathological stage I-II BC enrolled in NEMESI, 402 (21.2%) were pT1a-pT1b. Adjuvant chemotherapy was delivered in 127/402 (31.59%). Younger age, grading G3, high proliferative index, ER-negative and HER2-positive status were significantly associated with the decision to administer adjuvant chemotherapy. An anthracycline without taxane regimen was administered in 59.1% of patients, anthracycline with taxane in 24.4%, a CMF-like regimen in 14.2% and taxane in 2.4%. Adjuvant chemotherapy was administered in 88.4% triple-negative and 73.46% HER2-positive pT1a-pT1b BC. Adjuvant trastuzumab was delivered in 30/49 HER2-positive BC (61.2%)., Conclusions: Adjuvant chemotherapy was delivered in 31.59% T1a-pT1b BC treated at 63 Italian oncological centres from January 2008 to June 2008. The choice to deliver chemotherapy was based on biological prognostic factors. Anthracycline-based chemotherapy was administered in 83.5% patients.
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- 2012
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274. "Whole brain radiotherapy: are parotid glands organs at risk?".
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Fiorentino A, Chiumento C, Caivano R, Cozzolino M, Clemente S, Pedicini P, and Fusco V
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- Female, Humans, Male, Brain Neoplasms radiotherapy, Cranial Irradiation adverse effects, Parotid Gland radiation effects
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- 2012
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275. Cancer prevention in ulcerative colitis: long-term outcome following fluorescence-guided colonoscopy.
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Fusco V, Ebert B, Weber-Eibel J, Jost C, Fleige B, Stolte M, Oberhuber G, Rinneberg H, Lochs H, and Ortner M
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- Adenocarcinoma pathology, Adenocarcinoma surgery, Adenoma pathology, Adenoma surgery, Adult, Aged, Colectomy, Colonic Neoplasms pathology, Colonic Neoplasms surgery, Female, Fluorescence, Humans, Longitudinal Studies, Male, Middle Aged, Predictive Value of Tests, Time Factors, Adenocarcinoma diagnosis, Adenoma diagnosis, Colitis, Ulcerative pathology, Colonic Neoplasms diagnosis, Colonoscopy, Population Surveillance
- Abstract
Background: Patients with long-standing ulcerative colitis require repeated endoscopies for early detection of neoplasias, which, however, are frequently missed by standard colonoscopy. Fluorescence-guided colonoscopy is known to improve the detection rate but the long-term effects of fluorescence-guided colonoscopy are unknown., Methods: Colitis patients with negative findings at index fluorescence-guided colonoscopy entered a prospective long-term study with conventional colonoscopies at 2-year intervals. Risk and time to progression were evaluated. The positive predictive value was assessed in patients with neoplasias at index fluorescence-guided colonoscopy who underwent immediate total colectomy., Results: Thirty-one patients with negative fluorescence-guided colonoscopy were surveyed for a mean of 7.8 ± 0.9 years. Neoplasia was observed in only two of them (6%) after 7 and 8 years of follow-up, respectively. Neoplasia at index fluorescence-guided colonoscopy was observed in 10 patients. In all of them, multiple flat low-grade intraepithelial neoplasia was diagnosed. At immediate colectomy performed in eight of them, the diagnosis of flat low-grade intraepithelial neoplasia was confirmed, corresponding to a positive predictive value of 100%. However, synchronous more advanced neoplasia was detected in three of the eight patients (38%). All patients, those with and those without neoplasia, were alive at the end of the study., Conclusions: Fluorescence-guided colonoscopy misses, in contrast to standard colonoscopy, few, if any, patients with neoplasia. Most neoplasia-negative patients remain negative during prolonged follow-up. However, when low-grade dysplasia is diagnosed by fluorescence-guided colonoscopy, colectomy is recommended because more than a third of the patients harbor synchronous, more advanced neoplasia., (Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.)
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- 2012
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276. Ewing sarcoma of the thoracic wall in a 54-year-old man.
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Fiorentino A, Chiumento C, Caivano R, and Fusco V
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- Antineoplastic Combined Chemotherapy Protocols administration & dosage, Biomarkers, Tumor analysis, Bone Neoplasms chemistry, Bone Neoplasms pathology, Chemotherapy, Adjuvant, Cyclophosphamide administration & dosage, Dactinomycin administration & dosage, Doxorubicin administration & dosage, Humans, Immunohistochemistry, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm, Residual etiology, Neuroectodermal Tumors, Primitive, Peripheral chemistry, Neuroectodermal Tumors, Primitive, Peripheral pathology, Radiotherapy, Adjuvant, Sarcoma, Ewing chemistry, Sarcoma, Ewing pathology, Tomography, X-Ray Computed, Treatment Outcome, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bone Neoplasms diagnosis, Bone Neoplasms therapy, Neuroectodermal Tumors, Primitive, Peripheral diagnosis, Neuroectodermal Tumors, Primitive, Peripheral therapy, Ribs pathology, Ribs surgery, Sarcoma, Ewing diagnosis, Sarcoma, Ewing therapy
- Abstract
Ewing tumor is the second most common bone tumor in children. Its variant, malignant small cell tumor of the thoracopulmonary region, is infrequent in children and extremely rare in adults. A multimodal treatment approach is preferred for this tumor. We describe a rare case of primitive neuroectodermal tumor/Ewing sarcoma arising from the thoracic wall in a 54-year-old man. He underwent extensive resection of the tumor followed by adjuvant chemotherapy and radiotherapy.
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- 2012
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277. A case of thyroid metastasis of nasopharyngeal cancer.
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Chiumento C, Fiorentino A, Castaldo G, and Fusco V
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- Biopsy, Carcinoma diagnosis, Chemoradiotherapy, Adjuvant, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Docetaxel, Esophageal Neoplasms secondary, Esophageal Neoplasms therapy, Fluorodeoxyglucose F18, Humans, Laryngeal Neoplasms secondary, Laryngeal Neoplasms therapy, Lymphatic Metastasis, Male, Middle Aged, Multimodal Imaging, Nasopharyngeal Carcinoma, Nasopharyngeal Neoplasms secondary, Positron-Emission Tomography, Quality of Life, Radiotherapy Dosage, Radiotherapy, Conformal, Taxoids administration & dosage, Thyroid Neoplasms diagnosis, Tomography, X-Ray Computed, Tracheal Neoplasms secondary, Tracheal Neoplasms therapy, Treatment Outcome, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma secondary, Carcinoma therapy, Nasopharyngeal Neoplasms pathology, Thyroid Neoplasms secondary, Thyroid Neoplasms therapy
- Abstract
Aims and Background: Thyroid metastasis from nasopharyngeal carcinoma is a rare occurrence. We report a case of thyroid metastases from nasopharyngeal carcinoma with a review of the literature., Methods: In April 2007 a 59-year-old man was diagnosed with nasopharyngeal carcinoma; in October 2009 he underwent a thyroid biopsy that revealed G2 infiltrating spinocellular carcinoma with lymph node involvement. He was treated with chemotherapy and radiotherapy at our institute., Results: Currently, after 6 cycles of adjuvant chemotherapy with taxotere and gemcitabine, the patient is asymptomatic with stable disease and improved quality of life., Conclusion: According to the literature, the treatment choice depends on clinical disease extent. Surgery and/or chemo-radiation therapy must therefore be tailored to the individual patient in order to improve clinical outcome and quality of life.
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- 2011
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278. SmartArc-based volumetric modulated arc therapy for oropharyngeal cancer: a dosimetric comparison with both intensity-modulated radiation therapy and helical tomotherapy.
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Clemente S, Wu B, Sanguineti G, Fusco V, Ricchetti F, Wong J, and McNutt T
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- Carcinoma, Squamous Cell pathology, Humans, Organs at Risk diagnostic imaging, Oropharyngeal Neoplasms diagnostic imaging, Oropharyngeal Neoplasms pathology, Radiography, Radiotherapy Dosage, Tumor Burden, Carcinoma, Squamous Cell radiotherapy, Oropharyngeal Neoplasms radiotherapy, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Intensity-Modulated methods
- Abstract
Purpose: To investigate the roles of volumetric modulated arc therapy with SmartArc (VMAT-S), intensity-modulated radiation therapy (IMRT), and helical tomotherapy (HT) for oropharyngeal cancer using a simultaneous integrated boost (SIB) approach., Methods and Materials: Eight patients treated with IMRT were selected at random. Plans were computed for both IMRT and VMAT-S (using Pinnacle TPS for an Elekta Infinity linac) along with HT. A three-dose level prescription was used to deliver 70 Gy, 63 Gy, and 58.1 Gy to regions of macroscopic, microscopic high-risk, and microscopic low-risk disease, respectively. All doses were given in 35 fractions. Comparisons were performed on dose-volume histogram data, monitor units per fraction (MU/fx), and delivery time., Results: VMAT-S target coverage was close to that achieved by IMRT, but inferior to HT. The conformity and homogeneity within the PTV were improved for HT over all strategies. Sparing of the organs at risk (OAR) was achieved with all modalities. VMAT-S (along with HT) shortened delivery time (mean, -38%) and reduced MU/fx (mean, -28%) compared with IMRT., Conclusion: VMAT-S represents an attractive solution because of the shorter delivery time and the lower number of MU/fx compared with IMRT. However, in this complex clinical setting, current VMAT-S does not appear to provide any distinct advantage compared with helical tomotherapy., (Copyright © 2011 Elsevier Inc. All rights reserved.)
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- 2011
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279. Osteonecrosis of the jaw after zoledronic acid and denosumab treatment.
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Fusco V, Galassi C, Berruti A, Ciuffreda L, Ortega C, Ciccone G, Angeli A, and Bertetto O
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- Antibodies, Monoclonal, Humanized, Bone Neoplasms drug therapy, Bone Neoplasms secondary, Denosumab, Humans, Incidence, Osteonecrosis epidemiology, Zoledronic Acid, Antibodies, Monoclonal adverse effects, Bone Density Conservation Agents adverse effects, Diphosphonates adverse effects, Imidazoles adverse effects, Jaw Diseases chemically induced, Osteonecrosis chemically induced, RANK Ligand adverse effects
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- 2011
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280. Cigarette smoking habit does not reduce the benefit from first line trastuzumab-based treatment in advanced breast cancer patients.
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Santini D, Vincenzi B, Adamo V, Addeo R, Fusco V, Russo A, Montemurro F, Roato I, Redana S, Lanzetta G, Satolli MA, Berruti A, Leoni V, Galluzzo S, Antimi M, Ferraro G, Rossi M, Del Prete S, Valerio MR, Marra M, Caraglia M, and Tonini G
- Subjects
- Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Humanized, Breast Neoplasms pathology, Breast Neoplasms, Male drug therapy, Breast Neoplasms, Male mortality, Cohort Studies, Drug Resistance, Neoplasm drug effects, Female, Humans, Male, Middle Aged, Retrospective Studies, Trastuzumab, Antibodies, Monoclonal therapeutic use, Antineoplastic Agents therapeutic use, Breast Neoplasms drug therapy, Breast Neoplasms mortality, Smoking adverse effects
- Abstract
Many ErbB2-positive cancers may show intrinsic resistance, and the frequent development of acquired resistance to ErbB-targeted agents represents a substantial clinical problem. The constitutive NF-κB activation in some HER-2/neu positive breast cancer may represent a potential cause of resistance to trastuzumab therapy. Preclinical data revealed that 4-(N-Methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK), the tobacco-specific nitrosamine is able to enhance NF-κB DNA binding activity and theoretically to increase the resistance to trastuzumab. Two hundred and forty-eight women with pathologically confirmed, uni- or bidimensionally measurable, HER-2-positive metastatic breast cancer (MBC) treated with trastuzumab-based therapy as first line combination for metastatic disease were considered eligible. For all included patients data on smoking habit were detectable from medical records. We retrospectively analysed the smoking habits of 248 MBC patients and correlated these habits with activity and efficacy of trastuzumab-based therapy. No statistically significant difference in terms of response rate (RR), time to progression (TTP) and overall survival (OS) was identified between smokers (former plus active smokers) and never smokers. Moreover, no statistically significant difference in terms of RR, TTP and OS was identified either comparing active smokers and former smokers. Moreover, we did not observed any significant statistical difference in terms of TTP and OS between smokers ≥10 cigarettes/day and <10 cigarettes/day. This study clearly showed lack of any correlation between cigarette smoking habit and both activity and efficacy of trastuzumab-based first line therapy in metastatic HER2/neu positive breast cancer patients.
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- 2011
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281. A retrospective analysis after low-dose-rate prostate brachytherapy with permanent (125)I seed implant: clinical and dosimetric results in 70 patients.
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Chiumento C, Montagna A, Clemente S, Cozzolino M, and Fusco V
- Subjects
- Adenocarcinoma immunology, Aged, Analysis of Variance, Androgen Antagonists administration & dosage, Disease-Free Survival, Dose-Response Relationship, Radiation, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local diagnosis, Prostatic Neoplasms immunology, Radiotherapy Dosage, Retrospective Studies, Treatment Outcome, Adenocarcinoma radiotherapy, Biomarkers, Tumor blood, Brachytherapy methods, Iodine Radioisotopes therapeutic use, Prostate-Specific Antigen blood, Prostatic Neoplasms radiotherapy
- Abstract
Aims and Background: To evaluate the biochemical disease-free survival (bDFS) rate after (125)I permanent-implant prostate brachytherapy., Methods: Patients with a diagnosis of prostate adenocarcinoma and adequate PSA follow-up were selected for this retrospective study. Brachytherapy with permanent (125)I seeds was performed as monotherapy, with a prescribed dose of 145 Gy to the prostate. Patients were stratified into recurrence risk groups according to the National Comprehensive Cancer Network (NCCN) guidelines. Biochemical failure was defined using the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines. The post-implant D90 (defined as the minimum dose covering 90% of the prostate) was obtained for each patient. Two cutoff points were used to test the correlation between D90 and bDFS results: 130 Gy and 140 Gy. bDFS was calculated from the implant date to the date of biochemical recurrence. Univariate and multivariate analysis were performed using the SPSS software and included clinical stage, pretreatment PSA, Gleason score (GS), androgen deprivation therapy, D90, and risk groups. In the univariate analysis we used a cutoff point of 5.89 ng/mL for PSA and 5 for GS., Results: From June 2003 to April 2007, 70 patients were analyzed. The patients' distribution into recurrence risk groups was as follows: 39 patients (56%) in the low-risk group, 23 patients (33%) in the intermediate-risk group, and 8 patients (11%) in the high-risk group. At a median follow-up of 47 months (range, 19-70 months) bDFS was 88.4%, with a global actuarial 5-year bDFS of 86%. Disease-related factors including initial PSA level, GS and risk group were significant predictors of biochemical failure ( P = 0.01, P = 0.01, P = 0.006, respectively). In multivariate analysis, risk group (P = 0.005) and GS (P = 0.03) were statistically significant., Conclusion: Our data are in agreement with those in the literature and, despite the short follow-up, confirm the advantage of brachytherapy for patients at low and intermediate risk of recurrence.
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- 2011
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282. Surgery-triggered and non surgery-triggered Bisphosphonate-related Osteonecrosis of the Jaws (BRONJ): A retrospective analysis of 567 cases in an Italian multicenter study.
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Vescovi P, Campisi G, Fusco V, Mergoni G, Manfredi M, Merigo E, Solazzo L, Gabriele M, Gaeta GM, Favia G, Peluso F, and Colella G
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Imidazoles adverse effects, Italy, Jaw Diseases chemically induced, Male, Middle Aged, Osteonecrosis chemically induced, Retrospective Studies, Risk Factors, Zoledronic Acid, Bone Density Conservation Agents adverse effects, Diphosphonates adverse effects, Jaw Diseases etiology, Orthognathic Surgical Procedures, Osteonecrosis etiology
- Abstract
Invasive local procedures are often reported in clinical history of patients suffering from Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) but over 40% of spontaneous forms have been also described in literature. We compared age, gender, underlying bone disorders, bisphosphonate therapy, clinical features and surgical outcome of 205 cases (36.2%) of BRONJ non surgery-triggered (group 1) with 362 (63.8%) cases of surgery-triggered forms (group 2). Differences between group 1 and 2 were analysed using Mann-Whitney U and χ(2) tests. Statistical analysis was performed using STATA 8. Zoledronate was the most used type of bisphosphonate (63.4% versus 69.0%) and the mandible was the most frequently involved site (63.9% versus 63.4%) in both groups. BRONJ in group 1 was more frequently multicentric (9.3% versus 5%, p<0.05), had a lower clinical stage (45.9% versus 13.8% in stage 1, p<0.01) and had a better outcome after surgical therapy (improvement in 74.1% versus 58.6%, p<0.05). The high prevalence of non surgery-triggered forms of BRONJ should be considered by oncologists, haematologists and general physicians who are advised to inform their patients regarding the importance of preventive dental protocols to control the possible causes of osteonecrosis not related to dental invasive procedures., (Copyright © 2010 Elsevier Ltd. All rights reserved.)
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- 2011
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283. Novel PCR-based identification of Weissella confusa using an AFLP-derived marker.
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Fusco V, Quero GM, Stea G, Morea M, and Visconti A
- Subjects
- Bacterial Proteins genetics, DNA Primers genetics, DNA, Bacterial genetics, Lactobacillus genetics, Leuconostoc genetics, Phylogeny, RNA, Ribosomal, 16S genetics, Sequence Analysis, DNA, Sequence Homology, Nucleic Acid, Species Specificity, Weissella classification, Amplified Fragment Length Polymorphism Analysis, Polymerase Chain Reaction methods, Weissella genetics
- Abstract
An extensive use of Weissella (W.) confusa is currently being made for the production of a variety of fermented foods and beverages although some strains of this species have emerged as opportunistic pathogens for humans and animals. Nevertheless, no rapid methods are available for the reliable identification of W. confusa. We developed a novel PCR using AFLP (Amplified Fragment Length Polymorphism)-derived primers for the rapid and unequivocal identification of W. confusa. Fluorescent AFLP of 30 strains of W. confusa, Leuconostoc citreum, Lactobacillus (Lb.) brevis, Lb. rossiae, Lb. plantarum and Lb. buchneri allowed us to detect, purify and sequence several W. confusa specific AFLP fragments. The homology search in BLAST of a 303 bp nucleotide sequence revealed a ≤ 77% identity of the purified fragment with the lepA gene of several lactic acid bacteria. A PCR assay targeting 225 bp of this fragment was developed and tested against the DNA of 109 strains, including 34 foodborne and clinical W. confusa and 75 strains of 47 phylogenetically closely and distantly related species, resulting in 100% specificity with a detection limit of 16 pg. Being the first species-specific PCR to date developed for the rapid and unambiguous identification of W. confusa, this novel assay could be a reliable and efficient tool for detecting W. confusa not only in food and beverages, but also in clinical specimens, thus contributing to clarify its real significance in human and animal infections., (Copyright © 2011 Elsevier B.V. All rights reserved.)
- Published
- 2011
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284. Rapid and reliable identification of Staphylococcus aureus harbouring the enterotoxin gene cluster (egc) and quantitative detection in raw milk by real time PCR.
- Author
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Fusco V, Quero GM, Morea M, Blaiotta G, and Visconti A
- Subjects
- Animals, Reproducibility of Results, Sensitivity and Specificity, Enterotoxins genetics, Food Microbiology methods, Milk microbiology, Multigene Family genetics, Polymerase Chain Reaction, Staphylococcus aureus genetics, Staphylococcus aureus isolation & purification
- Abstract
A TaqMan and a SYBR Green real time PCR (rt-PCR) were developed for the reliable identification and quantitative detection of Staphylococcus (S.) aureus strains harbouring the enterotoxin gene cluster (egc) regardless of its variants. Both approaches revealed 100% specificity against a panel of 70 reference strains, including 29 clinical and foodborne S. aureus strains harbouring all the egc variants to date known, 4 egc⁻S. aureus strains and 37 strains of phylogenetically closely and distantly related species. Standard curves made by 10 fold dilutions of either genomic DNA or cells from an egc(+)S. aureus log-phase broth culture showed a good linearity of response (R²≥0.993) for six orders of magnitude, with about 100% relative accuracy and a low inter-assay variability (CV≤3.02). The overall limit of quantification (LOQ) for both rt-PCR assays (about 100% PCR efficiency; running time 30 min) was 10 cfu or 10 genome equivalents per reaction mixture although 1 cfu or 1 genome equivalent was detected with a 33.33% probability. These performances were confirmed in raw milk artificially contaminated with log-phase broth cultures of either a single egc(+)S. aureus strain or a mixture of S. aureus strains harbouring all the egc variants to date known. Similar results were also obtained with a raw milk based standard curve of the S. aureus egc(+) mixture in the presence of 10⁶ cfu/mL of egc⁻S. aureus strains harbouring some of the commonest enterotoxin genes associated to the staphylococcal food poisoning. Nonetheless, the TaqMan based approach resulted in a lower sensitivity (LOQ=100 cfu equivalents per reaction mixture) than the SYBR Green based assay (LOQ=10 cfu equivalents per reaction mixture). When applied to real milk samples, both PCR assays provided a good response with 100% diagnostic specificity and 96-107% relative accuracy, as compared to conventional culture-based PCR approaches. Due to the high specificity, the wide dynamic range of detection and the high sensitivity demonstrated even in a complex and potentially highly contaminated raw milk matrix, the SYBR Green rt-PCR assay is a useful diagnostic tool for quick, high throughput and reliable routine screening of egc(+)S. aureus isolates. Moreover, the SYBR Green based quantitative detection of these pathogens in raw milk could remarkably contribute to clarify their actual role in staphylococcal food poisoning and other clinical syndromes associated with the consumption of milk and milk-based products., (Copyright © 2010 Elsevier B.V. All rights reserved.)
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- 2011
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285. Osteonecrosis of the jaw (ONJ) risk in breast cancer patients after zoledronic acid treatment.
- Author
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Fusco V, Loidoris A, Colella G, Vescovi P, and Campisi G
- Subjects
- Bone Density Conservation Agents therapeutic use, Breast Neoplasms pathology, Diphosphonates therapeutic use, Female, Humans, Imidazoles therapeutic use, Zoledronic Acid, Bone Density Conservation Agents adverse effects, Breast Neoplasms drug therapy, Diphosphonates adverse effects, Imidazoles adverse effects, Jaw pathology, Osteonecrosis chemically induced
- Published
- 2010
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286. The clinical impact of a cardiologic follow-up in breast cancer survivors: an observational study.
- Author
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Gallucci G, Coccaro M, Storto G, Lapadula L, Tartarone A, Nappi A, Cammarota A, Buonerba C, Di Lorenzo G, Fusco V, and Aieta M
- Subjects
- Adult, Aged, Breast Neoplasms mortality, Electrocardiography, Exercise Test, Female, Follow-Up Studies, Heart Diseases diagnosis, Humans, Middle Aged, Survivors, Tomography, Emission-Computed, Single-Photon, Anthracyclines adverse effects, Breast Neoplasms therapy, Heart Diseases etiology, Radiotherapy adverse effects
- Abstract
Anthracycline-containing chemotherapy (A-CHT) can induce late cardiotoxicity adding a considerable burden to cardiovascular risk. Irradiation of left breast cancer has also been associated to an increased risk of cardiovascular disease. The aim of this observational study is to prove the usefulness of an accurate cardiovascular evaluation in left breast cancer survivors treated with radiotherapy (RT) and A-CHT. Patients with left breast cancer, on follow-up after treatment with A-CHT plus RT in an adjuvant setting, were eligible for this observational study. Patients underwent cardiovascular assessment with myocardial perfusion imaging. Thirty patients were enrolled in the study: mean age at diagnosis 55.8 years; stage: I/III; Er and/or pgR status: positive in 24/30 pts; 3 patients in pre-menopausal status. Twenty-two patients (73.3 percent) had normal perfusion imaging, 1 patient (3.3 percent) had a fixed myocardial perfusion defect, 7 patients (23.3 percent) had reversible myocardial perfusion defects; 1 patient (3 percent) with normal perfusion scan showed depressed rest and stress LVEF. Only 1 patient had a large defect and underwent coronary angiography and percutaneous coronary intervention. Five patients with small defect showed normal coronary arteries at Multislice Computed Tomography. Cardiovascular followup may reveal signs of A-CHT or RT-induced cardiotoxicity. A stress test combined with MPI- and GATED-derived data of ventricular systolic performance after stress can give information on the coronary reserve and the contractile reserve and allow early appropriate treatment.
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- 2010
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287. Patterns of care and survival in a retrospective analysis of 1059 patients with glioblastoma multiforme treated between 2002 and 2007: a multicenter study by the Central Nervous System Study Group of Airo (italian Association of Radiation Oncology).
- Author
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Scoccianti S, Magrini SM, Ricardi U, Detti B, Buglione M, Sotti G, Krengli M, Maluta S, Parisi S, Bertoni F, Mantovani C, Tombolini V, De Renzis C, Lioce M, Fatigante L, Fusco V, Muto P, Berti F, Rubino G, Cipressi S, Fariselli L, Lupattelli M, Santoni R, Pirtoli L, and Biti G
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Antineoplastic Agents therapeutic use, Antineoplastic Agents, Alkylating therapeutic use, Brain Neoplasms mortality, Combined Modality Therapy, Dacarbazine analogs & derivatives, Dacarbazine therapeutic use, Databases, Factual, Female, Glioblastoma mortality, Humans, Italy, Kaplan-Meier Estimate, Karnofsky Performance Status, Male, Middle Aged, Neurosurgical Procedures, Patient Care, Radiotherapy, Retrospective Studies, Salvage Therapy, Survival Analysis, Temozolomide, Treatment Outcome, Young Adult, Brain Neoplasms therapy, Glioblastoma therapy
- Abstract
Objective: To investigate the pattern of care and outcomes for newly diagnosed glioblastoma in Italy and compare our results with the previous Italian Patterns of Care study to determine whether significant changes occurred in clinical practice during the past 10 years., Methods: Clinical, pathological, therapeutic, and survival data regarding 1059 patients treated in 18 radiotherapy centers between 2002 and 2007 were collected and retrospectively reviewed., Results: Most patients underwent both computed tomography and magnetic resonance imaging either preoperatively (62.7%) or postoperatively (35.5%). Only 123 patients (11.6%) underwent a biopsy. Radiochemotherapy with temozolomide was the most frequent adjuvant treatment (70.7%). Most patients (88.2%) received 3-dimensional conformal radiotherapy. Median survival was 9.5 months. Two- and 5-year survival rates were 24.8% and 3.9%, respectively. Multivariate analysis showed the statistical significance of age, postoperative Karnofsky Performance Status scale score, surgical extent, use of 3-dimensional conformal radiotherapy, and use of chemotherapy. Use of a more aggressive approach was associated with longer survival in elderly patients. Comparing our results with those of the subgroup of patients included in our previous study who were treated between 1997 and 2001, relevant differences were found: more frequent use of magnetic resonance imaging, surgical removal more common than biopsy, and widespread use of 3-dimensional conformal radiotherapy + temozolomide. Furthermore, a significant improvement in terms of survival was noted (P < .001)., Conclusion: Changes in the care of glioblastoma over the past few years are documented. Prognosis of glioblastoma patients has slightly but significantly improved with a small but noteworthy number of relatively long-term survivors.
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- 2010
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288. Experimental demonstration of emittance compensation with velocity bunching.
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Ferrario M, Alesini D, Bacci A, Bellaveglia M, Boni R, Boscolo M, Castellano M, Chiadroni E, Cianchi A, Cultrera L, Di Pirro G, Ficcadenti L, Filippetto D, Fusco V, Gallo A, Gatti G, Giannessi L, Labat M, Marchetti B, Marrelli C, Migliorati M, Mostacci A, Pace E, Palumbo L, Quattromini M, Ronsivalle C, Rossi AR, Rosenzweig J, Serafini L, Serluca M, Spataro B, Vaccarezza C, and Vicario C
- Abstract
In this Letter we report the first experiments aimed at the simultaneous demonstration of the emittance compensation process and velocity bunching in a high brightness electron source, the SPARC photoinjector in INFN-LNF. While a maximum compression ratio up to a factor 14 has been observed, in a particular case of interest a compression factor of 3, yielding a slice current of 120 A with less than 2 microm slice emittance, has been measured. This technique may be crucial in achieving high brightness beams in photoinjectors aiming at optimized performance of short wavelength single-pass free electron lasers or other advanced applications in laser-plasma accelerators.
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- 2010
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289. Time-gated fluorescence spectroscopy improves endoscopic detection of low-grade dysplasia in ulcerative colitis.
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Ortner MA, Fusco V, Ebert B, Sukowski U, Weber-Eibel J, Fleige B, Stolte M, Oberhuber G, Rinneberg H, and Lochs H
- Subjects
- Adult, Aged, Biopsy, Needle, Cell Transformation, Neoplastic pathology, Cross-Over Studies, Female, Humans, Immunohistochemistry, Intestinal Mucosa pathology, Male, Middle Aged, Probability, Prospective Studies, Sensitivity and Specificity, Young Adult, Carcinoma in Situ pathology, Colitis, Ulcerative pathology, Colonoscopy methods, Colorectal Neoplasms pathology, Precancerous Conditions pathology, Spectrometry, Fluorescence methods
- Abstract
Background: Dysplasia in ulcerative colitis is frequently missed with 4-quadrant biopsies. An experimental setup recording delayed fluorescence spectra simultaneously with white light endoscopy was recently developed., Objective: We compared detection of invisible flat intraepithelial neoplasia with protoporphyrin IX fluorescence and standard 4-quadrant biopsies., Design: Prospective, crossover design without randomization of the order of procedures., Setting: Gastroenterology Department, Humboldt University, Charité, Berlin, Germany., Patients: Forty-two patients with extensive ulcerative colitis of more than 10 years' duration were included., Interventions: Colonoscopy with 4-quadrant biopsies and targeted biopsies of macroscopic lesions and time-gated fluorescence-guided colonoscopy were performed 2 weeks apart by 2 blinded endoscopists. Three independent pathologists examined the biopsy specimens., Main Outcome Measurements: The primary outcome criterion was detection rate of invisible flat intraepithelial neoplasia., Results: Invisible flat intraepithelial neoplasia was detected in 3 (7%) patients by white light 4-quadrant biopsies and in 10 (24%) patients by fluorescence-guided endoscopy (P = .02). The sensitivity and specificity for differentiating patients with and without dysplasia were 100% and 81%, respectively. Dysplastic and nondysplastic mucosa could be discriminated with a sensitivity and specificity of 73% and 81%, respectively., Limitations: The trial was not randomized., Conclusion: The detection rate of intraepithelial neoplasia in patients with ulcerative colitis can be improved by fluorescence-guided colonoscopy.
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- 2010
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290. Dose-guided radiotherapy for lung tumors.
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Piermattei A, Fidanzio A, Cilla S, Greco F, Azario L, Sabatino D, Grusio M, Cozzolino M, and Fusco V
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- Aged, Feasibility Studies, Humans, Lung Neoplasms diagnostic imaging, Middle Aged, Phantoms, Imaging, Radiometry, Radiotherapy Dosage, Radiotherapy, Conformal methods, Tomography, X-Ray Computed, Lung Neoplasms radiotherapy
- Abstract
The transit in vivo dosimetry performed by an electronic portal imaging device (EPID) is a very practical method to check error sources in radiotherapy. Recently, the present authors have developed an in vivo dosimetry method based on correlation functions, F (w, L), defined as the ratio between the transit signal, S(t) (w, L), by the EPID and the mid-plane dose, D(m) (w, L), in a solid water phantom as a function of the phantom thickness, w, and of the field dimensions, L. In particular, generalized correlation functions F (w, L) for 6, 10 and 15 MV X-ray beams supplied by a pilot Varian linac, are here used by other three linacs operating in two centers. This way the workload, due to measurements in solid water phantom, needed to implement the in vivo dosimetry method was avoided. This article reports a feasibility study on the potentiality of this procedure for the adaptive radiotherapy of lung tumors treated by 3D conformal radiotherapy techniques. In particular, the dose reconstruction at the isocenter point D(iso) in the lung tumor has been used as dose-guided radiotherapy (DGRT), to detect the inter-fraction tumor anatomy variations that can require new CT scans and an adaptive plan. When a difference greater than 6% between the predicted dose by the treatment planning system (TPS), D (iso,TPS) and the D(iso) was observed, the clinical action started to detect possible anatomical lung tumor changes. Twelve over twenty patients examined presented in vivo dose discrepancies due to the tumor morphological changes during treatments, and these results were successively confirmed by new CT scans. In this work, for a patient that showed for all beams, D (iso) values over the tolerance level, the new CT scan was used for an adaptive plan. The lung dose volume histogram for D (iso,TPS) = 2 Gy per fraction suggested the adaptive plan. In particular, the lung volume included in 2 Gy increased from 350 cm(3) of the original plan to 550 cm(3) of the hybrid plan, while for the adaptive plan the lung volume included in 2 Gy decreased to 15 cm(3). Moreover, the mean doses to the organs at risk were reduced to 70%. The results of this research show that the DGRT procedure by the D(iso) reconstruction, integrated with radiological imaging, was feasible for periodic investigation on morphological lung tumor changes. This feasibility study takes into account the accuracy of two algorithms based on the pencil beam and collapsed cone convolution models for dose calculations where large density inhomogeneities are present.
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- 2010
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291. Diversity of Staphylococcus species strains based on partial kat (catalase) gene sequences and design of a PCR-restriction fragment length polymorphism assay for identification and differentiation of coagulase-positive species (S. aureus, S. delphini, S. hyicus, S. intermedius, S. pseudintermedius, and S. schleiferi subsp. coagulans).
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Blaiotta G, Fusco V, Ercolini D, Pepe O, and Coppola S
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- Cluster Analysis, DNA Fingerprinting methods, DNA Primers genetics, DNA, Bacterial genetics, Humans, Molecular Sequence Data, Phylogeny, Polymorphism, Genetic, Sequence Analysis, DNA, Sequence Homology, Staphylococcal Infections microbiology, Staphylococcus enzymology, Staphylococcus genetics, Staphylococcus isolation & purification, Bacteriological Techniques methods, Catalase genetics, Coagulase genetics, Polymerase Chain Reaction methods, Polymorphism, Restriction Fragment Length, Staphylococcal Infections diagnosis, Staphylococcus classification
- Abstract
A set of degenerate PCR primers was designed and used to amplify and sequence about 75% of the catalase (kat) gene from each of 49 staphylococcal strains. In some strains of Staphylococcus xylosus, S. saprophyticus, and S. equorum, two catalase genes, katA and katB, were found. A phylogenetic tree was generated and showed diversities among 66 partial (about 900-bp) staphylococcal kat nucleotide sequences (including 17 sequences found in GenBank) representing 26 different species. The topology of this tree showed a distribution of staphylococcal species similar, but not identical, to those reported previously based on 16S rRNA, hsp60, sodA, rpoB, tuf, and gap genes. The kat gene sequences were less conserved than those of 16S rRNA, rpoB, hsp60, and tuf genes and slightly more conserved than those of the gap gene. Therefore, kat gene sequence analysis may provide an additional marker for inferring phylogenetic relationships of staphylococci. Moreover, the discrete nucleotide polymorphism revealed in this gene could be exploited for rapid, low-cost identification of staphylococcal species through PCR-restriction fragment length polymorphism (RFLP) analysis. In this study, a PCR-RFLP assay performed by using only the TaqI restriction enzyme was successfully developed for rapid unequivocal identification/differentiation, at species and subspecies levels, of coagulase-positive staphylococci (CPS). The assay was validated by testing the DNA from 100 staphylococcal strains, including reference and wild CPS strains isolated from different environments. This reliable, rapid, and low-cost approach (requiring about 6 h from DNA isolation to the achievement of results and <5 Euros for each strain tested) allowed unambiguous identification of all the strains assayed, including the newly described S. delphini and S. pseudintermedius CPS species.
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- 2010
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292. American Association of Oral and Maxillofacial Surgeons position paper: Bisphosphonate-Related Osteonecrosis of the Jaws-2009 update: the need to refine the BRONJ definition.
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Colella G, Campisi G, and Fusco V
- Subjects
- Humans, Bone Density Conservation Agents adverse effects, Diphosphonates adverse effects, Jaw Diseases chemically induced, Jaw Diseases diagnosis, Osteonecrosis chemically induced, Osteonecrosis diagnosis
- Published
- 2009
- Full Text
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293. 8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial.
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Maranzano E, Trippa F, Casale M, Costantini S, Lupattelli M, Bellavita R, Marafioti L, Pergolizzi S, Santacaterina A, Mignogna M, Silvano G, and Fusco V
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Radiotherapy Dosage, Recurrence, Spinal Cord Neoplasms mortality, Spinal Cord Compression radiotherapy, Spinal Cord Neoplasms radiotherapy, Spinal Cord Neoplasms secondary
- Abstract
Background and Purpose: In a previous randomized trial we showed that the short-course radiotherapy (RT) regimen of 8 Gy x 2 was feasible in patients with metastatic spinal cord compression (MSCC) and short life expectancy. This phase III trial was planned to determine whether in the same category of patients 8 Gy single-dose is as effective as 8 Gy x 2., Materials and Methods: Three hundred and twenty-seven patients with MSCC and short life expectancy were randomly assigned to a short-course of 8 Gy x 2 or to 8 Gy single-dose RT. Median follow-up was 31 months (range, 4-58)., Results: A total of 303 (93%) patients are assessable, 150 treated with the short-course and 153 with the single-dose RT. No difference in response was found between the two RT schedules adopted. Median duration of response was 5 and 4.5 months for short-course and single-dose RT (p=0.4), respectively. The median overall survival was 4 months for all cases. Light acute toxicity was registered in a minority of cases. Late toxicity was never recorded., Conclusions: Both RT schedules adopted were effective. As already shown in several trials evaluating RT regimens in uncomplicated painful bone metastases, also MSCC patients may achieve palliation with minimal toxicity and inconvenience with a single-dose of 8 Gy.
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- 2009
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294. Jaw osteonecrosis associated with intravenous bisphosphonate: is incidence reduced after adoption of dental preventive measures?
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Fusco V, Baraldi A, Loidoris A, Ciuffreda L, Galassi C, Goia F, Scoletta M, Berrone S, Benech A, Ortega C, and Berruti A
- Subjects
- Bone Density Conservation Agents administration & dosage, Diphosphonates administration & dosage, Dose-Response Relationship, Drug, Humans, Injections, Intravenous, Jaw Diseases prevention & control, Osteonecrosis prevention & control, Proportional Hazards Models, Time Factors, Bone Density Conservation Agents adverse effects, Dental Prophylaxis, Diphosphonates adverse effects, Jaw Diseases chemically induced, Osteonecrosis chemically induced
- Published
- 2009
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295. Integration between in vivo dosimetry and image guided radiotherapy for lung tumors.
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Piermattei A, Cilla S, Grimaldi L, Sabatino D, Fidanzio A, Greco F, Mameli A, Balducci M, Mattiucci GC, Frascino V, Stimato G, Gaudino D, Ramella S, Trodella L, D'Onofrio G, Zini G, Macchia G, Digesu' C, Morganti AG, Clemente S, Cozzolino M, Pedicini P, and Fusco V
- Subjects
- Feasibility Studies, Humans, Radiotherapy Dosage, Systems Integration, Treatment Outcome, Lung Neoplasms diagnostic imaging, Lung Neoplasms radiotherapy, Radiographic Image Interpretation, Computer-Assisted methods, Radiometry methods, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Computer-Assisted methods, Tomography, X-Ray Computed methods
- Abstract
The article reports a feasibility study about the potentiality of an in vivo dosimetry method for the adaptive radiotherapy of the lung tumors treated by 3D conformal radiotherapy techniques (3D CRTs). At the moment image guided radiotherapy (IGRT) has been used for this aim, but it requires taking many periodic radiological images during the treatment that increase workload and patient dose. In vivo dosimetry reported here can reduce the above efforts, alerting the medical staff for the commissioning of new radiological images for an eventual adaptive plan. The in vivo dosimetry method applied on 20 patients makes use of the transit signal St on the beam central axis measured by a small ion chamber positioned on an electronic portal imaging device (EPID) or by the EPID itself. The reconstructed in vivo dosimetry at the isocenter point Diso requires a convolution between the transit signal St and a dose reconstruction factor C that essentially depends on (i) tissue inhomogeneities along the beam central axis and (ii) the in-patient isocenter depth. The C factors, one for every gantry angle, are obtained by processing the patient's computed tomography scan. The method has been recently applied in some Italian centers to check the radiotherapy of pelvis, breast, head, and thorax treatments. In this work the dose reconstruction was carried out in five centers to check the Diso in the lung tumor during the 3D CRT, and the results have been used to detect the interfraction tumor anatomy variations that can require new CT imaging and an adaptive plan. In particular, in three centers a small ion chamber was positioned below the patient and used for the St measurement. In two centers, the St signal was obtained directly by 25 central pixels of an a-Si EPID, equipped with commercial software that enabled its use as a stable detector. A tolerance action level of +/- 6% for every checked beam was assumed. This means that when a difference greater than 6% between the predicted dose by the treatment planning system, Diso,TPS, and the Diso was observed, the clinical action started to detect possible errors. 60% of the patients examined presented morphological changes during the treatment that were checked by the in vivo dosimetry and successively confirmed by the new CT scans. In this work, a patient that showed for all beams Diso values outside the tolerance level, new CT scans were commissioned for an adaptive plan. The lung dose volume histograms (DVHs) for a Diso,TPs=2 Gy for fraction suggested the adaptive plan to reduce the dose in lung tissue. The results of this research show that the dose guided radiotherapy (DGRT) by the Diso reconstruction was feasible for daily or periodic investigation on morphological lung tumor changes. In other words, since during 3D CRT treatments the anatomical lung tumor changes occur frequently, the DGRT can be well integrated with the IGRT.
- Published
- 2009
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- View/download PDF
296. Re: Christan Walter, Bilal Al-Nawas, Knut A. Grötz, et al. Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate. Eur Urol 2008;54:1066-72.
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Berruti A, Ortega C, and Fusco V
- Subjects
- Humans, Jaw Diseases epidemiology, Male, Osteonecrosis epidemiology, Prevalence, Risk Factors, Zoledronic Acid, Bone Density Conservation Agents adverse effects, Diphosphonates adverse effects, Imidazoles adverse effects, Jaw Diseases chemically induced, Osteonecrosis chemically induced, Prostatic Neoplasms drug therapy
- Published
- 2009
- Full Text
- View/download PDF
297. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw.
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Campisi G, Fedele S, Colella G, Lo Casto A, and Fusco V
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- Bone Density Conservation Agents adverse effects, Canada epidemiology, Causality, Diagnosis, Differential, Humans, Incidence, Jaw Diseases diagnosis, Jaw Diseases prevention & control, Monitoring, Physiologic standards, Osteonecrosis diagnosis, Osteonecrosis prevention & control, Osteoporosis drug therapy, Periodontal Diseases complications, Periodontal Diseases prevention & control, Preventive Dentistry standards, Risk Reduction Behavior, Diphosphonates adverse effects, Jaw Diseases chemically induced, Osteonecrosis chemically induced, Practice Guidelines as Topic
- Published
- 2009
- Full Text
- View/download PDF
298. Myocardial perfusion defects after radiation therapy and anthracycline chemotherapy for left breast cancer: a possible marker of microvascular damage. Three cases and review of the literature.
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Gallucci G, Capobianco AM, Coccaro M, Venetucci A, Suriano V, and Fusco V
- Subjects
- Adult, Antibiotics, Antineoplastic adverse effects, Biomarkers, Breast Neoplasms drug therapy, Breast Neoplasms radiotherapy, Combined Modality Therapy, Coronary Circulation, Electrocardiography, Female, Humans, Middle Aged, Myocardial Ischemia diagnostic imaging, Radiation Injuries diagnostic imaging, Tomography, Emission-Computed, Single-Photon, Breast Neoplasms therapy, Epirubicin adverse effects, Heart drug effects, Heart radiation effects, Myocardial Ischemia etiology, Radiation Injuries etiology, Radiotherapy adverse effects
- Abstract
Radiation therapy to the thorax may induce early and late cardiac adverse effects if large parts of the heart have been included in the irradiation field and particularly if anthracycline-containing chemotherapy is concomitantly administered. We describe 3 cases of cardiotoxicity in patients with left breast cancer treated with anthracycline-containing chemotherapy and left thoracic radiotherapy. In 2 cases we observed asymptomatic electrocardiographic abnormalities of ventricular repolarization mimicking anterior myocardial ischemia and SPECT reversible myocardial perfusion defects. In 1 case we observed echocardiographic abnormalities of left ventricular wall motion and reversible myocardial perfusion abnormalities. We recommend close cardiac monitoring of patients treated with anthracycline chemotherapy and left thoracic radiotherapy to better understand the clinical impact of these abnormalities.
- Published
- 2008
- Full Text
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299. Lactobacillus strain diversity based on partial hsp60 gene sequences and design of PCR-restriction fragment length polymorphism assays for species identification and differentiation.
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Blaiotta G, Fusco V, Ercolini D, Aponte M, Pepe O, and Villani F
- Subjects
- Cheese microbiology, Cluster Analysis, DNA, Bacterial chemistry, DNA, Bacterial genetics, Deoxyribonucleases, Type II Site-Specific genetics, Deoxyribonucleases, Type II Site-Specific metabolism, Food Microbiology, Meat Products microbiology, Molecular Sequence Data, Peptide Elongation Factor Tu genetics, Phylogeny, RNA, Ribosomal, 16S genetics, Sequence Analysis, DNA, Bacterial Proteins genetics, Chaperonin 60 genetics, Lactobacillus classification, Lactobacillus genetics, Polymerase Chain Reaction methods, Polymorphism, Restriction Fragment Length
- Abstract
A phylogenetic tree showing diversities among 116 partial (499-bp) Lactobacillus hsp60 (groEL, encoding a 60-kDa heat shock protein) nucleotide sequences was obtained and compared to those previously described for 16S rRNA and tuf gene sequences. The topology of the tree produced in this study showed a Lactobacillus species distribution similar, but not identical, to those previously reported. However, according to the most recent systematic studies, a clear differentiation of 43 single-species clusters was detected/identified among the sequences analyzed. The slightly higher variability of the hsp60 nucleotide sequences than of the 16S rRNA sequences offers better opportunities to design or develop molecular assays allowing identification and differentiation of either distant or very closely related Lactobacillus species. Therefore, our results suggest that hsp60 can be considered an excellent molecular marker for inferring the taxonomy and phylogeny of members of the genus Lactobacillus and that the chosen primers can be used in a simple PCR procedure allowing the direct sequencing of the hsp60 fragments. Moreover, in this study we performed a computer-aided restriction endonuclease analysis of all 499-bp hsp60 partial sequences and we showed that the PCR-restriction fragment length polymorphism (RFLP) patterns obtainable by using both endonucleases AluI and TacI (in separate reactions) can allow identification and differentiation of all 43 Lactobacillus species considered, with the exception of the pair L. plantarum/L. pentosus. However, the latter species can be differentiated by further analysis with Sau3AI or MseI. The hsp60 PCR-RFLP approach was efficiently applied to identify and to differentiate a total of 110 wild Lactobacillus strains (including closely related species, such as L. casei and L. rhamnosus or L. plantarum and L. pentosus) isolated from cheese and dry-fermented sausages.
- Published
- 2008
- Full Text
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300. Direct measurement of the double emittance minimum in the beam dynamics of the sparc high-brightness photoinjector.
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Ferrario M, Alesini D, Bacci A, Bellaveglia M, Boni R, Boscolo M, Castellano M, Catani L, Chiadroni E, Cialdi S, Cianchi A, Clozza A, Cultrera L, Di Pirro G, Drago A, Esposito A, Ficcadenti L, Filippetto D, Fusco V, Gallo A, Gatti G, Ghigo A, Giannessi L, Ligi C, Mattioli M, Migliorati M, Mostacci A, Musumeci P, Pace E, Palumbo L, Pellegrino L, Petrarca M, Quattromini M, Ricci R, Ronsivalle C, Rosenzweig J, Rossi AR, Sanelli C, Serafini L, Serio M, Sgamma F, Spataro B, Tazzioli F, Tomassini S, Vaccarezza C, Vescovi M, and Vicario C
- Abstract
In this Letter we report the first experimental observation of the double emittance minimum effect in the beam dynamics of high-brightness electron beam generation by photoinjectors; this effect, as predicted by the theory, is crucial in achieving minimum emittance in photoinjectors aiming at producing electron beams for short wavelength single-pass free electron lasers. The experiment described in this Letter was performed at the SPARC photoinjector site, during the first stage of commissioning of the SPARC project. The experiment was made possible by a newly conceived device, called an emittance meter, which allows a detailed and unprecedented study of the emittance compensation process as the beam propagates along the beam pipe.
- Published
- 2007
- Full Text
- View/download PDF
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