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5. External beam radiotherapy boost versus surgical debulking followed by radiotherapy for the treatment of metastatic lymph nodes in cervical cancer: A systematic review and meta-analysis

Author

Bizzarri, Nicolo', Di Berardino, Stefano, Benkortbi, K., Balaya, V., Gambacorta, Maria Antonietta, Macchia, Gabriella, Boulvain, M., Feki, A., Mathevet, P., Lecuru, F., Querleu, D., Ferrandina, Maria Gabriella, Scambia, Giovanni, Guani, B., Bizzarri N., Di Berardino S., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Macchia G. (ORCID:0000-0002-0529-201X), Ferrandina G. (ORCID:0000-0003-4672-4197), Scambia G. (ORCID:0000-0003-2758-1063), Bizzarri, Nicolo', Di Berardino, Stefano, Benkortbi, K., Balaya, V., Gambacorta, Maria Antonietta, Macchia, Gabriella, Boulvain, M., Feki, A., Mathevet, P., Lecuru, F., Querleu, D., Ferrandina, Maria Gabriella, Scambia, Giovanni, Guani, B., Bizzarri N., Di Berardino S., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Macchia G. (ORCID:0000-0002-0529-201X), Ferrandina G. (ORCID:0000-0003-4672-4197), and Scambia G. (ORCID:0000-0003-2758-1063)

Abstract

Objective: We aimed to assess disease-free survival (DFS), overall survival (OS) and treatment-related toxicity of two therapeutic strategies for treating bulky lymph nodes on imaging in patients with locally advanced cervical cancer (LACC): radiotherapy boost versus surgical debulking followed by radiotherapy. Methods: We performed a systematic review of studies published up to October 2023. We selected studies including patients with LACC treated by external beam radiotherapy (EBRT) boost or lymph node debulking followed by EBRT (with or without boost). Results: We included two comparative (included in the meta-analysis) and nine non-comparative studies. The estimated 3-year recurrence rate was 28.2% (95%CI:18.3–38.0) in the EBRT group and 39.9% (95%CI:22.1–57.6) in the surgical debulking plus EBRT group. The estimated 3-year DFS was 71.8% and 60.1%, respectively (p = 0.19). The estimated 3-year death rate was 22.2% (95%CI:11.2–33.2) in the EBRT boost group and 31.9% (95%CI:23.3–40.5) in the surgical debulking plus EBRT group. The estimated 3-year OS was 77.8% and 68.1%, respectively (p = 0.04). No difference in lymph node recurrence between the two comparative studies (p = 0.36). The meta-analysis of the two comparative studies showed no DFS difference (p = 0.13) but better OS in the radiotherapy boost group (p = 0.006). The incidence of grade≥3 toxicities (ranging 0–50%) was not different between the two approaches in the two comparative studies (p = 0.31). Conclusion: No DFS and toxicity difference when comparing EBRT boost with surgical debulking of enlarged lymph nodes and EBRT in patients with cervical cancer was evident. Radiotherapy boost had better OS. Further investigation is required to better understand the prognostic role of surgical lymph node debulking in light of radiotherapy developments.

Published
2024

6. Oncological outcomes of patients not undergoing Total Mesorectal Excision after local excision: rethinking surgical indications

Author

Bao, Q. R., Ferrari, S., Capelli, G., Chiloiro, G., Rega, D., Pucciarelli, S., Spolverato, G., Delrio, P., Guerrieri, M., Ortenzi, M., Cillara, N., Restivo, A., Deidda, S., Spinelli, A., Romano, C., Bianco, F., Sarzo, G., Morpurgo, E., Belluco, C., Palazzari, E., Chiloiro, Giuditta, Meldolesi, Elisa, Coco, Claudio, Pafundi, D. P., Feleppa, C., Aschele, C., Bonomo, M., Muratore, A., Mellano, A., Chiaulon, G., Crimi, F., Maretto, I., Perin, A., Urso, E. D. L., Scarpa, M., Bigon, M., Scognamiglio, F., Bergamo, F., Del Bianco, P., Gambacorta, Maria Antonietta, Chiloiro G., Meldolesi E., Coco C. (ORCID:0000-0002-4713-7093), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Bao, Q. R., Ferrari, S., Capelli, G., Chiloiro, G., Rega, D., Pucciarelli, S., Spolverato, G., Delrio, P., Guerrieri, M., Ortenzi, M., Cillara, N., Restivo, A., Deidda, S., Spinelli, A., Romano, C., Bianco, F., Sarzo, G., Morpurgo, E., Belluco, C., Palazzari, E., Chiloiro, Giuditta, Meldolesi, Elisa, Coco, Claudio, Pafundi, D. P., Feleppa, C., Aschele, C., Bonomo, M., Muratore, A., Mellano, A., Chiaulon, G., Crimi, F., Maretto, I., Perin, A., Urso, E. D. L., Scarpa, M., Bigon, M., Scognamiglio, F., Bergamo, F., Del Bianco, P., Gambacorta, Maria Antonietta, Chiloiro G., Meldolesi E., Coco C. (ORCID:0000-0002-4713-7093), and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

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Published
2024

9. Art and digital technologies to support resilience during the oncological journey: The Art4ART project

Author

Tagliaferri, L, Dinapoli, L, Casa, C, Colloca, G, Marazzi, F, Cornacchione, P, Mazzarella, C, Masiello, V, Chiesa, S, Beghella Bartoli, F, Marconi, E, D'Oria, M, Cesario, A, Chieffo, D, Valentini, V, Gambacorta, M, Tagliaferri L., Dinapoli L., Casa C., Colloca G. F., Marazzi F., Cornacchione P., Mazzarella C., Masiello V., Chiesa S., Beghella Bartoli F., Marconi E., D'Oria M., Cesario A., Chieffo D. P. R., Valentini V., Gambacorta M. A., Tagliaferri, L, Dinapoli, L, Casa, C, Colloca, G, Marazzi, F, Cornacchione, P, Mazzarella, C, Masiello, V, Chiesa, S, Beghella Bartoli, F, Marconi, E, D'Oria, M, Cesario, A, Chieffo, D, Valentini, V, Gambacorta, M, Tagliaferri L., Dinapoli L., Casa C., Colloca G. F., Marazzi F., Cornacchione P., Mazzarella C., Masiello V., Chiesa S., Beghella Bartoli F., Marconi E., D'Oria M., Cesario A., Chieffo D. P. R., Valentini V., and Gambacorta M. A.

Abstract

Introduction: New digital technologies can become a tool for welcoming the patient through the artistic dimension. Cancer patients, in particular, need support that accompanies and supports them throughout their treatment. Materials and methods: The Art4ART project consist in the structural proposal to cancer patients of a web-based digital platform containing several forms of art as video-entertainments; a multimedia immersive room; an art-based welcoming of the patients with several original paintings; an environment with a peacefulness vertical garden; a reconceptualization of the chemotherapy-infusion seats. Data regarding patients’ preference and choices will be stored and analysed also using artificial intelligence (AI) algorithm to measure and predict impact indicators regarding clinical outcomes (survival and toxicity), psychological indicators. Moreover, the same digital platform will contribute to a better organization of the activities. Discussion: Through the systematic acquisition of patient preferences and through integration with other clinical parameters, it will be possible to measure the clinical, psychological, organisational, and social impact of the newly implemented Art4ART project. The use of digital technology leads us to apply the reversal of viewpoint from therapeutic acts to patient-centred care.

Published
2022

10. Radiomics-based prediction of two-year clinical outcome in locally advanced cervical cancer patients undergoing neoadjuvant chemoradiotherapy

Author

Autorino, R., Gui, B., Panza, G., Boldrini, L., Cusumano, D., Russo, L., Nardangeli, A., Persiani, S., Campitelli, M., Ferrandina, G., Macchia, G., Valentini, V., Gambacorta, M. A., Manfredi, R., Autorino R., Gui B., Panza G., Boldrini L., Cusumano D., Russo L., Persiani S., Ferrandina G. (ORCID:0000-0003-4672-4197), Macchia G. (ORCID:0000-0002-0529-201X), Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Manfredi R. (ORCID:0000-0002-4972-9500), Autorino, R., Gui, B., Panza, G., Boldrini, L., Cusumano, D., Russo, L., Nardangeli, A., Persiani, S., Campitelli, M., Ferrandina, G., Macchia, G., Valentini, V., Gambacorta, M. A., Manfredi, R., Autorino R., Gui B., Panza G., Boldrini L., Cusumano D., Russo L., Persiani S., Ferrandina G. (ORCID:0000-0003-4672-4197), Macchia G. (ORCID:0000-0002-0529-201X), Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Manfredi R. (ORCID:0000-0002-4972-9500)

Abstract

Purpose: The aim of this study is to determine if radiomics features extracted from staging magnetic resonance (MR) images could predict 2-year long-term clinical outcome in patients with locally advanced cervical cancer (LACC) after neoadjuvant chemoradiotherapy (NACRT). Materials and methods: We retrospectively enrolled patients with LACC diagnosis who underwent NACRT followed by radical surgery in two different institutions. Radiomics features were extracted from pre-treatment 1.5 T T2w MR images. The predictive performance of each feature was quantified in terms of Wilcoxon–Mann–Whitney test. Among the significant features, Pearson correlation coefficient (PCC) was calculated to quantify the correlation among the different predictors. A logistic regression model was calculated considering the two most significant features at the univariate analysis showing the lowest PCC value. The predictive performance of the model created was quantified out using the area under the receiver operating characteristic curve (AUC). Results: A total of 175 patients were retrospectively enrolled (142 for the training cohort and 33 for the validation one). 1896 radiomic feature were extracted, 91 of which showed significance (p < 0.05) at the univariate analysis. The radiomic model showing the highest predictive value combined the features calculated starting from the gray level co-occurrence-based features. This model achieved an AUC of 0.73 in the training set and 0.91 in the validation set. Conclusions: The proposed radiomic model showed promising performances in predicting 2-year overall survival before NACRT. Nevertheless, the observed results should be tested in larger studies with consistent external validation cohorts, to confirm their potential clinical use.

Published
2022

11. A multicenter LArge retrospectIve daTabase on the personalization of stereotactic ABlative radiotherapy use in lung metastases from colon-rectal cancer: The LaIT-SABR study

Author

Nicosia, L, Franceschini, D, Perrone-Congedi, F, Casamassima, F, Gerardi, M, Rigo, M, Mazzola, R, Perna, M, Scotti, V, Fodor, A, Iurato, A, Pasqualetti, F, Gadducci, G, Chiesa, S, Niespolo, R, Bruni, A, Alicino, G, Frassinelli, L, Borghetti, P, Di Marzo, A, Ravasio, A, De Bari, B, Sepulcri, M, Aiello, D, Mortellaro, G, Sangalli, C, Franceschini, M, Montesi, G, Aquilanti, F, Lunardi, G, Valdagni, R, Fazio, I, Scarzello, G, Corti, L, Vavassori, V, Maranzano, E, Magrini, S, Arcangeli, S, Gambacorta, M, Valentini, V, Paiar, F, Ramella, S, Di Muzio, N, Livi, L, Jereczek-Fossa, B, Osti, M, Scorsetti, M, Alongi, F, Nicosia L., Franceschini D., Perrone-Congedi F., Casamassima F., Gerardi M. A., Rigo M., Mazzola R., Perna M., Scotti V., Fodor A., Iurato A., Pasqualetti F., Gadducci G., Chiesa S., Niespolo R. M., Bruni A., Alicino G., Frassinelli L., Borghetti P., Di Marzo A., Ravasio A., De Bari B., Sepulcri M., Aiello D., Mortellaro G., Sangalli C., Franceschini M., Montesi G., Aquilanti F. M., Lunardi G., Valdagni R., Fazio I., Scarzello G., Corti L., Vavassori V., Maranzano E., Magrini S. M., Arcangeli S., Gambacorta M. A., Valentini V., Paiar F., Ramella S., Di Muzio N. G., Livi L., Jereczek-Fossa B. A., Osti M. F., Scorsetti M., Alongi F., Nicosia, L, Franceschini, D, Perrone-Congedi, F, Casamassima, F, Gerardi, M, Rigo, M, Mazzola, R, Perna, M, Scotti, V, Fodor, A, Iurato, A, Pasqualetti, F, Gadducci, G, Chiesa, S, Niespolo, R, Bruni, A, Alicino, G, Frassinelli, L, Borghetti, P, Di Marzo, A, Ravasio, A, De Bari, B, Sepulcri, M, Aiello, D, Mortellaro, G, Sangalli, C, Franceschini, M, Montesi, G, Aquilanti, F, Lunardi, G, Valdagni, R, Fazio, I, Scarzello, G, Corti, L, Vavassori, V, Maranzano, E, Magrini, S, Arcangeli, S, Gambacorta, M, Valentini, V, Paiar, F, Ramella, S, Di Muzio, N, Livi, L, Jereczek-Fossa, B, Osti, M, Scorsetti, M, Alongi, F, Nicosia L., Franceschini D., Perrone-Congedi F., Casamassima F., Gerardi M. A., Rigo M., Mazzola R., Perna M., Scotti V., Fodor A., Iurato A., Pasqualetti F., Gadducci G., Chiesa S., Niespolo R. M., Bruni A., Alicino G., Frassinelli L., Borghetti P., Di Marzo A., Ravasio A., De Bari B., Sepulcri M., Aiello D., Mortellaro G., Sangalli C., Franceschini M., Montesi G., Aquilanti F. M., Lunardi G., Valdagni R., Fazio I., Scarzello G., Corti L., Vavassori V., Maranzano E., Magrini S. M., Arcangeli S., Gambacorta M. A., Valentini V., Paiar F., Ramella S., Di Muzio N. G., Livi L., Jereczek-Fossa B. A., Osti M. F., Scorsetti M., and Alongi F.

Abstract

Introduction: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD). Material and methods: The study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for freedom from local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC). Results: Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED < 00 Gy, 100–124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p = 0.000). Two-year FLP for lesion measuring ≤10 mm, 10–20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p = 0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11–0.51; p = 0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2–3 or 4–5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p = 0.035). Conclusion: The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.

Published
2022

12. The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery

Author

Pasciuto, Tina, Moro, Francesca, Collarino, A., Gambacorta, Maria Antonietta, Zannoni, Gian Franco, Oradei, Marco, Ferrandina, Maria Gabriella, Gui, Benedetta, Testa, Antonia Carla, Rufini, Vittoria, Pasciuto T. (ORCID:0000-0003-2959-8571), Moro F., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Zannoni G. F. (ORCID:0000-0003-1809-129X), Oradei M., Ferrandina M. G. (ORCID:0000-0003-4672-4197), Gui B., Testa A. C. (ORCID:0000-0003-2217-8726), Rufini V. (ORCID:0000-0002-2052-8078), Pasciuto, Tina, Moro, Francesca, Collarino, A., Gambacorta, Maria Antonietta, Zannoni, Gian Franco, Oradei, Marco, Ferrandina, Maria Gabriella, Gui, Benedetta, Testa, Antonia Carla, Rufini, Vittoria, Pasciuto T. (ORCID:0000-0003-2959-8571), Moro F., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Zannoni G. F. (ORCID:0000-0003-1809-129X), Oradei M., Ferrandina M. G. (ORCID:0000-0003-4672-4197), Gui B., Testa A. C. (ORCID:0000-0003-2217-8726), and Rufini V. (ORCID:0000-0002-2052-8078)

Abstract

Purpose: This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. Methods: Patients with histologically proven LACC, stage IB2–IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment (“baseline”, “early” and “final”, respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed. Results: Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUVmax retrieved at PET/CT “baseline” and “final” examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUVmax collected at “final” evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71–0.90) and 0.81 (0.72–0.90), respectively). Conclusion: The percentage variation in SUVmax in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUVmax obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable.

Published
2023

13. Neoadjuvant radiochemotherapy and perioperative chemotherapy do not represent a standard at the same priority level for esophageal adenocarcinomas (with regard to 'Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up')

Author

Cellini, Francesco, Manfrida, Stefania, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Cellini, F (ORCID:0000-0002-2145-2300), Manfrida, S, Gambacorta, M A (ORCID:0000-0001-5455-8737), Valentini, V (ORCID:0000-0003-4637-6487), Cellini, Francesco, Manfrida, Stefania, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Cellini, F (ORCID:0000-0002-2145-2300), Manfrida, S, Gambacorta, M A (ORCID:0000-0001-5455-8737), and Valentini, V (ORCID:0000-0003-4637-6487)

Abstract

inglese

Published
2023

14. Dabrafenib-Trametinib and Radiotherapy for Oligoprogressive BRAF Mutant Advanced Melanoma

Author

Rossi, Ernesto, Schinzari, Giovanni, Cellini, Francesco, Balducci, Mario, Pasqualoni, Mariangela, Maiorano, Brigida Anna, Fionda, Bruno, Longo, Silvia, Deodato, Francesco, Di Stefani, Alessandro, Peris, Ketty, Gambacorta, Maria Antonietta, Tortora, Giampaolo, Rossi E., Schinzari G. (ORCID:0000-0001-6105-7252), Cellini F. (ORCID:0000-0002-2145-2300), Balducci M. (ORCID:0000-0003-0398-9726), Pasqualoni M., Maiorano B. A., Fionda B., Longo S., Deodato F. (ORCID:0000-0003-1276-5070), Di Stefani A., Peris K. (ORCID:0000-0002-5237-0463), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tortora G. (ORCID:0000-0002-1378-4962), Rossi, Ernesto, Schinzari, Giovanni, Cellini, Francesco, Balducci, Mario, Pasqualoni, Mariangela, Maiorano, Brigida Anna, Fionda, Bruno, Longo, Silvia, Deodato, Francesco, Di Stefani, Alessandro, Peris, Ketty, Gambacorta, Maria Antonietta, Tortora, Giampaolo, Rossi E., Schinzari G. (ORCID:0000-0001-6105-7252), Cellini F. (ORCID:0000-0002-2145-2300), Balducci M. (ORCID:0000-0003-0398-9726), Pasqualoni M., Maiorano B. A., Fionda B., Longo S., Deodato F. (ORCID:0000-0003-1276-5070), Di Stefani A., Peris K. (ORCID:0000-0002-5237-0463), Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Tortora G. (ORCID:0000-0002-1378-4962)

Abstract

The clinical management of metastatic melanoma has been changed by BRAF (BRAFi) and MEK inhibitors (MEKi), which represent a standard treatment for BRAF-mutant melanoma. In oligoprogressive melanoma patients with BRAF mutations, target therapy can be combined with loco-regional radiotherapy (RT). However, the association of BRAF/MEK inhibitors and RT needs to be carefully monitored for potential increased toxicity. Despite the availability of some reports regarding the tolerability of RT + target therapy, data on simultaneous RT and BRAFi/MEKi are limited and mostly focused on the BRAFi vemurafenib. Here, we report a series of metastatic melanoma patients who received fractioned RT regimens for oligoprogressive disease in combination with the BRAFi dabrafenib and the MEKi trametinib, which have continued beyond progression. None of the cases developed relevant adverse events while receiving RT or interrupted dabrafenib and trametinib administration. These cases suggest that a long period of dabrafenib/trametinib interruption during radiotherapy for oligoprogressive disease can be avoided. Prospective trials are warranted to assess the efficacy and safety of the contemporary administration of BRAF/MEK inhibitors and radiotherapy for oligoprogressive disease.

Published
2023

15. MRI-derived radiomics to guide post-operative management of glioblastoma: Implication for personalized radiation treatment volume delineation

Author

Chiesa, Silvia, Russo, Rosellina, Beghella Bartoli, Francesco, Palumbo, I, Sabatino, Giovanni, Cannatà, M C, Gigli, Riccardo, Longo, Silvia, Tran, H E, Boldrini, Luca, Dinapoli, Nicola, Votta, C, Cusumano, Davide, Pignotti, Fabrizio, Lupattelli, M, Camilli, F, Della Pepa, Giuseppe Maria, D'Alessandris, G Q, Olivi, Alessandro, Balducci, Mario, Colosimo, Cesare, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Aristei, Cynthia, Gaudino, Simona, Chiesa, S (ORCID:0000-0003-0168-3459), Russo, R, Beghella Bartoli, F, Sabatino, G (ORCID:0000-0002-4227-0434), Gigli, R, Longo, S, Boldrini, L, Dinapoli, N, Cusumano, D, Pignotti, F, Della Pepa, G M (ORCID:0000-0001-8698-3359), Olivi, A (ORCID:0000-0002-4489-7564), Balducci, M (ORCID:0000-0003-0398-9726), Colosimo, C (ORCID:0000-0003-3800-3648), Gambacorta, M A (ORCID:0000-0001-5455-8737), Valentini, V (ORCID:0000-0003-4637-6487), Aristei, C, Gaudino, S (ORCID:0000-0003-1681-4343), Chiesa, Silvia, Russo, Rosellina, Beghella Bartoli, Francesco, Palumbo, I, Sabatino, Giovanni, Cannatà, M C, Gigli, Riccardo, Longo, Silvia, Tran, H E, Boldrini, Luca, Dinapoli, Nicola, Votta, C, Cusumano, Davide, Pignotti, Fabrizio, Lupattelli, M, Camilli, F, Della Pepa, Giuseppe Maria, D'Alessandris, G Q, Olivi, Alessandro, Balducci, Mario, Colosimo, Cesare, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Aristei, Cynthia, Gaudino, Simona, Chiesa, S (ORCID:0000-0003-0168-3459), Russo, R, Beghella Bartoli, F, Sabatino, G (ORCID:0000-0002-4227-0434), Gigli, R, Longo, S, Boldrini, L, Dinapoli, N, Cusumano, D, Pignotti, F, Della Pepa, G M (ORCID:0000-0001-8698-3359), Olivi, A (ORCID:0000-0002-4489-7564), Balducci, M (ORCID:0000-0003-0398-9726), Colosimo, C (ORCID:0000-0003-3800-3648), Gambacorta, M A (ORCID:0000-0001-5455-8737), Valentini, V (ORCID:0000-0003-4637-6487), Aristei, C, and Gaudino, S (ORCID:0000-0003-1681-4343)

Abstract

BackgroundThe glioblastoma's bad prognosis is primarily due to intra-tumor heterogeneity, demonstrated from several studies that collected molecular biology, cytogenetic data and more recently radiomic features for a better prognostic stratification. The GLIFA project (GLIoblastoma Feature Analysis) is a multicentric project planned to investigate the role of radiomic analysis in GB management, to verify if radiomic features in the tissue around the resection cavity may guide the radiation target volume delineation. Materials and methodsWe retrospectively analyze from three centers radiomic features extracted from 90 patients with total or near total resection, who completed the standard adjuvant treatment and for whom we had post-operative images available for features extraction. The Manual segmentation was performed on post gadolinium T1w MRI sequence by 2 radiation oncologists and reviewed by a neuroradiologist, both with at least 10 years of experience. The Regions of interest (ROI) considered for the analysis were: the surgical cavity +/- post-surgical residual mass (CTV_cavity); the CTV a margin of 1.5 cm added to CTV_cavity and the volume resulting from subtracting the CTV_cavity from the CTV was defined as CTV_Ring. Radiomic analysis and modeling were conducted in RStudio. Z-score normalization was applied to each radiomic feature. A radiomic model was generated using features extracted from the Ring to perform a binary classification and predict the PFS at 6 months. A 3-fold cross-validation repeated five times was implemented for internal validation of the model. ResultsTwo-hundred and seventy ROIs were contoured. The proposed radiomic model was given by the best fitting logistic regression model, and included the following 3 features: F_cm_merged.contrast, F_cm_merged.info.corr.2, F_rlm_merged.rlnu. A good agreement between model predicted probabilities and observed outcome probabilities was obtained (p-value of 0.49 by Hosmer and Lemeshow statistical te

Published
2023

17. MRI-derived radiomics to guide post-operative management of glioblastoma: Implication for personalized radiation treatment volume delineation

Author

Chiesa, S., primary, Russo, R., additional, Beghella Bartoli, F., additional, Palumbo, I., additional, Sabatino, G., additional, Cannatà, M. C., additional, Gigli, R., additional, Longo, S., additional, Tran, H. E., additional, Boldrini, L., additional, Dinapoli, N., additional, Votta, C., additional, Cusumano, D., additional, Pignotti, F., additional, Lupattelli, M., additional, Camilli, F., additional, Della Pepa, G. M., additional, D’Alessandris, G. Q., additional, Olivi, A., additional, Balducci, M., additional, Colosimo, C., additional, Gambacorta, M. A., additional, Valentini, V., additional, Aristei, C., additional, and Gaudino, S., additional

Published
2023
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18. Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Author

Pieralli, F, Vannucchi, V, Nozzoli, C, Augello, G, Dentali, F, De Marzi, G, Uomo, G, Risaliti, F, Morbidoni, L, Mazzone, A, Santini, C, Tirotta, D, Corradi, F, Gerloni, R, Gnerre, P, Gussoni, G, Valerio, A, Campanini, M, Manfellotto, D, Fontanella, A, Attardo, T, Tavecchia, L, Gessi, V, Torrigiani, A, Corbo, L, Gallucci, F, Mastrobuoni, C, Giani, A, Teodora, C, Ricchiuti, E, Rosato, A, Giampaolo, L, Di Gregorio, S, Parodi, L, Pallini, F, Landini, G, Giuri, P, Prampolini, G, Arioli, D, Leone, M, Canale, C, Condemi, F, Lupica, R, Manzola, F, Masciana, R, Agnelli, G, Becattini, C, D'Agostini, E, Mosconi, M, Bogliari, G, Rossi, A, Iannantuoni, G, Bartolino, L, Montagnani, A, Verdiani, V, Gambacorta, M, Lenti, S, Francioni, S, Pierfranceschi, M, Cattabiani, C, Orlandini, F, Scuotri, L, La Regina, M, Corsini, F, Anastasio, L, Mumoli, N, Mazzi, V, Camaiti, A, Balbi, G, Ragazzo, F, Pengo, M, Pieralli F., Vannucchi V., Nozzoli C., Augello G., Dentali F., De Marzi G., Uomo G., Risaliti F., Morbidoni L., Mazzone A., Santini C., Tirotta D., Corradi F., Gerloni R., Gnerre P., Gussoni G., Valerio A., Campanini M., Manfellotto D., Fontanella A., Attardo T., Tavecchia L., Gessi V., Torrigiani A., Corbo L., Gallucci F., Mastrobuoni C., Giani A., Teodora C., Ricchiuti E., Rosato A., Giampaolo L., Di Gregorio S., Parodi L., Pallini F., Landini G., Giuri P., Prampolini G., Arioli D., Leone M. C., Canale C., Condemi F., Lupica R., Manzola F., Masciana R., Agnelli G., Becattini C., D'Agostini E., Mosconi M. G., Bogliari G., Rossi A., Iannantuoni G., Bartolino L., Montagnani A., Verdiani V., Gambacorta M., Lenti S., Francioni S., Pierfranceschi M. G., Cattabiani C., Orlandini F., Scuotri L., La Regina M., Corsini F., Anastasio L., Mumoli N., Mazzi V., Camaiti A., Balbi G., Ragazzo F., Pengo M., Pieralli, F, Vannucchi, V, Nozzoli, C, Augello, G, Dentali, F, De Marzi, G, Uomo, G, Risaliti, F, Morbidoni, L, Mazzone, A, Santini, C, Tirotta, D, Corradi, F, Gerloni, R, Gnerre, P, Gussoni, G, Valerio, A, Campanini, M, Manfellotto, D, Fontanella, A, Attardo, T, Tavecchia, L, Gessi, V, Torrigiani, A, Corbo, L, Gallucci, F, Mastrobuoni, C, Giani, A, Teodora, C, Ricchiuti, E, Rosato, A, Giampaolo, L, Di Gregorio, S, Parodi, L, Pallini, F, Landini, G, Giuri, P, Prampolini, G, Arioli, D, Leone, M, Canale, C, Condemi, F, Lupica, R, Manzola, F, Masciana, R, Agnelli, G, Becattini, C, D'Agostini, E, Mosconi, M, Bogliari, G, Rossi, A, Iannantuoni, G, Bartolino, L, Montagnani, A, Verdiani, V, Gambacorta, M, Lenti, S, Francioni, S, Pierfranceschi, M, Cattabiani, C, Orlandini, F, Scuotri, L, La Regina, M, Corsini, F, Anastasio, L, Mumoli, N, Mazzi, V, Camaiti, A, Balbi, G, Ragazzo, F, Pengo, M, Pieralli F., Vannucchi V., Nozzoli C., Augello G., Dentali F., De Marzi G., Uomo G., Risaliti F., Morbidoni L., Mazzone A., Santini C., Tirotta D., Corradi F., Gerloni R., Gnerre P., Gussoni G., Valerio A., Campanini M., Manfellotto D., Fontanella A., Attardo T., Tavecchia L., Gessi V., Torrigiani A., Corbo L., Gallucci F., Mastrobuoni C., Giani A., Teodora C., Ricchiuti E., Rosato A., Giampaolo L., Di Gregorio S., Parodi L., Pallini F., Landini G., Giuri P., Prampolini G., Arioli D., Leone M. C., Canale C., Condemi F., Lupica R., Manzola F., Masciana R., Agnelli G., Becattini C., D'Agostini E., Mosconi M. G., Bogliari G., Rossi A., Iannantuoni G., Bartolino L., Montagnani A., Verdiani V., Gambacorta M., Lenti S., Francioni S., Pierfranceschi M. G., Cattabiani C., Orlandini F., Scuotri L., La Regina M., Corsini F., Anastasio L., Mumoli N., Mazzi V., Camaiti A., Balbi G., Ragazzo F., and Pengo M.

Abstract

Background: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009). Conclusion: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration: NCT03798457 Registered 10 January 2019 - Retrospectively registered

Published
2021

19. COVID-19 safe and fully operational radiotherapy: An AIRO survey depicting the Italian landscape at the dawn of phase 2

Author

Jereczek-Fossa, B. A., Pepa, M., Zaffaroni, M., Marvaso, G., Bruni, A., Buglione di Monale e Bastia, M., Catalano, G., Filippi, A. R., Franco, P., Gambacorta, M. A., Genovesi, D., Iati, G., Magli, A., Marafioti, L., Meattini, I., Merlotti, A., Mignogna, M., Musio, D., Pacelli, R., Pergolizzi, S., Tombolini, V., Trovo, M., Leonardi, M. C., Ricardi, U., Magrini, S. M., Corvo, R., Donato, V., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Jereczek-Fossa, B. A., Pepa, M., Zaffaroni, M., Marvaso, G., Bruni, A., Buglione di Monale e Bastia, M., Catalano, G., Filippi, A. R., Franco, P., Gambacorta, M. A., Genovesi, D., Iati, G., Magli, A., Marafioti, L., Meattini, I., Merlotti, A., Mignogna, M., Musio, D., Pacelli, R., Pergolizzi, S., Tombolini, V., Trovo, M., Leonardi, M. C., Ricardi, U., Magrini, S. M., Corvo, R., Donato, V., and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

N/A

Published
2021

20. Timing to achieve the highest rate of pCR after preoperative radiochemotherapy in rectal cancer: a pooled analysis of 3085 patients from 7 randomized trials

Author

Gambacorta, M. A., Masciocchi, C., Chiloiro, G., Meldolesi, E., Macchia, G., van Soest, J., Peters, F., Collette, L., Gerard, J. -P., Ngan, S., Rodel, C. C., Damiani, A., Dekker, A., Valentini, V., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Masciocchi C., Chiloiro G., Meldolesi E., Macchia G. (ORCID:0000-0002-0529-201X), Damiani A., Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta, M. A., Masciocchi, C., Chiloiro, G., Meldolesi, E., Macchia, G., van Soest, J., Peters, F., Collette, L., Gerard, J. -P., Ngan, S., Rodel, C. C., Damiani, A., Dekker, A., Valentini, V., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Masciocchi C., Chiloiro G., Meldolesi E., Macchia G. (ORCID:0000-0002-0529-201X), Damiani A., and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

Purpose: Optimal timing of surgery after neoadjuvant chemoradiotherapy (Nad-CRT) is still controversial in locally advanced rectal cancer (LARC). The primary goal of this study was to determine the best surgical interval (SI) to achieve the highest rate of pathological complete response (pCR) and secondly to evaluate the effect on survival outcomes according to the SI. Patients and methods: Patients data were extracted from the international randomized trials: Accord12/0405, EORTC22921, FFCD9203, CAO/ARO/AIO-94, CAO-ARO-AIO-04, INTERACT and TROG01.04. Inclusion criteria were: age≥ 18, cT3–T4 and cN0–2, no clinical evidence of distant metastasis at diagnosis, Nad-CRT followed by surgery. Pearson's Chi-squared test with Yates’ continuity correction for categorical variables, the Mann–Whitney test for continuous variables, Mann–Kendall test, Kaplan–Meier curves with log-rank test, univariate and multivariate logistic regression model was used for data analysis. Results: 3085 patients met the inclusion criteria. Overall, the pCR rate was 14% at a median SI of 6 weeks (range 1–31). The cumulative pCR rate increased significantly when SI lengthened, with 95% of pCR events within 10 weeks from Nad-CRT. At univariate and multivariate logistic regression analysis, lengthening of SI (p< 0.01), radiotherapy dose (p< 0.01), and the addition of oxaliplatin to Nad-CRT (p< 0.01) had a favorable impact on pCR. Furthermore, lengthening of SI was not impact on local recurrences, distance metastases, and overall survival. Conclusion: This pooled analysis suggests that the best time to achieve pCR in LARC is at 10 weeks, considering that the lengthening of SI is not detrimental concerning survival outcomes.

Published
2021

21. Radiotherapy with intensity-modulated (Imrt) techniques in the treatment of anal carcinoma (rainstorm): A multicenter study on behalf of airo (Italian association of radiotherapy and clinical oncology) gastrointestinal study group

Author

Caravatta, L., Mantello, G., Valvo, F., Franco, P., Gasparini, L., Rosa, C., Slim, N., Manfrida, S., De Felice, F., Gerardi, M. A., Vagge, S., Krengli, M., Palazzari, E., Osti, M. F., Gonnelli, A., Catalano, G., Pittoni, P., Ivaldi, G. B., Galardi, A., Lupattelli, M., Rosetto, M. E., Niespolo, R. M., Guido, A., Durante, O., Macchia, G., Munoz, F., El Khouzai, B., Lucido, M. R., Porreca, A., Di Nicola, M., Gambacorta, M. A., Donato, V., Genovesi, D., Manfrida S., Macchia G. (ORCID:0000-0002-0529-201X), Porreca A., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Caravatta, L., Mantello, G., Valvo, F., Franco, P., Gasparini, L., Rosa, C., Slim, N., Manfrida, S., De Felice, F., Gerardi, M. A., Vagge, S., Krengli, M., Palazzari, E., Osti, M. F., Gonnelli, A., Catalano, G., Pittoni, P., Ivaldi, G. B., Galardi, A., Lupattelli, M., Rosetto, M. E., Niespolo, R. M., Guido, A., Durante, O., Macchia, G., Munoz, F., El Khouzai, B., Lucido, M. R., Porreca, A., Di Nicola, M., Gambacorta, M. A., Donato, V., Genovesi, D., Manfrida S., Macchia G. (ORCID:0000-0002-0529-201X), Porreca A., and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

A multi-institutional retrospective study was conducted to evaluate the pattern of care and clinical outcomes of anal cancer patients treated with intensity-modulated radiotherapy (IMRT) techniques. In a cohort of 987 patients, the clinical complete response (CR) rate (beyond 6 months) was 90.6%. The 3-year local control (LC) rate was 85.8% (95% CI: 84.4–87.2), and the 3-year colostomy-free survival (CFS) rate was 77.9% (95% CI: 76.1–79.8). Three-year progression-free survival (PFS) and overall survival (OS) rates were 80.2% and 88.1% (95% CI: 78.8–89.4) (95% CI: 78.5–81.9), respectively. Histological grade 3 and nodal involvement were associated with lower CR (p = 0.030 and p = 0.004, respectively). A statistically significant association was found between advanced stage and nodal involvement, and LC, CFS, PFS, OS and event-free survival (EFS). Overall treatment time (OTT) ≥45 days showed a trend for a lower PFS (p = 0.050) and was significantly associated with lower EFS (p = 0.030) and histological grade 3 with a lower LC (p = 0.025). No statistically significant association was found between total dose, dose/fraction and/or boost modality and clinical outcomes. This analysis reports excellent clinical results and a mild toxicity profile, confirming IMRT techniques as standard of care for the curative treatment of anal cancer patients. Lymph node involvement and histological grade have been confirmed as the most important negative prognostic factors.

Published
2021

22. Radiotherapy for benign disorders: Current use in clinical practice

Author

Fionda, B., Lancellotta, V., Casa, C., Boldrini, L., Marazzi, F., Cellini, F., Kovacs, G., Gambacorta, M. A., Tagliaferri, L., Boldrini L., Marazzi F., Cellini F. (ORCID:0000-0002-2145-2300), Kovacs G., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri L. (ORCID:0000-0003-2308-0982), Fionda, B., Lancellotta, V., Casa, C., Boldrini, L., Marazzi, F., Cellini, F., Kovacs, G., Gambacorta, M. A., Tagliaferri, L., Boldrini L., Marazzi F., Cellini F. (ORCID:0000-0002-2145-2300), Kovacs G., Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Tagliaferri L. (ORCID:0000-0003-2308-0982)

Abstract

Objective: The aim of this paper is to provide an update about the current clinical indications of RT in this poorly explored field outside the traditional oncological setting. Materials and Methods: We performed a literature search on the main databases, including PubMed, Scopus and Cochrane from their inception until 31stDecember 2020. An additional manual check of scientific meeting proceedings and books was conducted in order to identify all the potentially useful sources. Only essays published in English have been considered for the purposes of this analysis. The searched items included: "Radiotherapy or Radiation Therapy" and "Benign disorder or Benign disease". Results: We provided a list of current clinical indications for benign disorders based on the latest international surveys available, including major sites: eye, bone, head and neck, skin, brain, heart and peripheral vascular system. Conclusions: Radiotherapy for benign diseases is still a feasible therapeutic strategy, which may allow to treat several invalidating conditions, especially after medical therapies have failed thus avoiding potentially invalidating major surgical procedures. A careful evaluation in selecting the indication is essential and all the choices should be thoroughly discussed with the patients.

Published
2021

23. MRI-guided stereotactic radiation therapy for hepatocellular carcinoma: a feasible and safe innovative treatment approach

Author

Boldrini, L., Romano, A., Mariani, S., Cusumano, D., Catucci, F., Placidi, L., Mattiucci, G. C., Chiloiro, G., Cellini, F., Gambacorta, M. A., Indovina, L., Valentini, V., Boldrini L., Mariani S., Cusumano D., Placidi L., Mattiucci G. C. (ORCID:0000-0001-6500-0413), Chiloiro G., Cellini F. (ORCID:0000-0002-2145-2300), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Valentini V. (ORCID:0000-0003-4637-6487), Boldrini, L., Romano, A., Mariani, S., Cusumano, D., Catucci, F., Placidi, L., Mattiucci, G. C., Chiloiro, G., Cellini, F., Gambacorta, M. A., Indovina, L., Valentini, V., Boldrini L., Mariani S., Cusumano D., Placidi L., Mattiucci G. C. (ORCID:0000-0001-6500-0413), Chiloiro G., Cellini F. (ORCID:0000-0002-2145-2300), Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

Purpose: Hepatocellular carcinoma (HCC) in early stages benefits from local ablative treatments such as radiofrequency ablation (RFA) or transarterial chemoembolization (TACE). In this context, radiotherapy (RT) has shown promising results but has not been thoroughly evaluated. Magnetic resonance-guided RT (MRgRT) may represent a paradigm shifting improvement in stereotactic body radiotherapy (SBRT) for liver tumors. Methods: We retrospectively evaluated HCC patients treated on a hybrid low-tesla MRgRT unit. A total biologically effective dose (BED) > 100 Gy was delivered in 5 consecutive fractions, respecting the appropriate organs-at-risk constraints. Hybrid MR scans were used for treatment planning and cine MR was used for delivery gating. Patients were followed up for toxicity and treatment–response assessment. Results: Ten patients were enrolled, with a total of 12 lesions. All the lesions were irradiated with no interruptions. Six patients had already performed previous local therapies. Median follow-up after SBRT was 6.5 months (1–25). Two cases of acute toxicity were reported (G ≤ 2 according to CTCAE v4.0). At the time of the analysis, 90% of the population presented local control. Child–Pugh before and after treatment remained unchanged in all but one patient. Conclusion: MRgRT is a feasible and safe option showing favorable toxicity profile for HCC treatment.

Published
2021

24. The Role of Radiotherapy in Orbital Pseudotumor: A Systematic Review of Literature

Author

Fionda, B., Pagliara, M. M., Lancellotta, V., Sammarco, M. G., Casa, C., Savino, G., Deodato, F., Morganti, A. G., Gambacorta, M. A., Tagliaferri, L., Blasi, M. A., Pagliara M. M., Savino G. (ORCID:0000-0002-9993-5986), Deodato F. (ORCID:0000-0003-1276-5070), Morganti A. G., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri L. (ORCID:0000-0003-2308-0982), Blasi M. A. (ORCID:0000-0001-7393-7644), Fionda, B., Pagliara, M. M., Lancellotta, V., Sammarco, M. G., Casa, C., Savino, G., Deodato, F., Morganti, A. G., Gambacorta, M. A., Tagliaferri, L., Blasi, M. A., Pagliara M. M., Savino G. (ORCID:0000-0002-9993-5986), Deodato F. (ORCID:0000-0003-1276-5070), Morganti A. G., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri L. (ORCID:0000-0003-2308-0982), and Blasi M. A. (ORCID:0000-0001-7393-7644)

Abstract

Purpose: Orbital pseudotumor (or pseudotumor orbitae) is a benign entity, also known as idiopathic orbital inflammatory syndrome (IOIS), which encompasses a wide range of non-tumoral, space occupying lesions of the orbit. In selected cases of refractory disease or presence of side effects or even comorbidities that limit systemic therapies, radiotherapy could play a role in the management because it has been demonstrated that irradiation is effective in suppressing the inflammatory process. Methods: A systematic review of the literature about the main scientific databases was launched and the time interval included all published articles present in the databases from their inception until September 2020. Results: We were able to identify 19 studies eligible for inclusion in this review from 1978 to 2018. Overall the data of 241 patients were collected and are presented in this systematic review. The response rate varied between 74% and 100% with a median recurrence rate of 10%. The median total dose was 20 Gy whereas the mean total dose was 21 Gy with a range from 4 to 36 Gy. Regarding the fractionation, 2 Gy/fraction daily was the most widely used. Conclusions: Radiotherapy seemed to achieve good response rates however, in most of the studies, inclusion criteria and outcome parameters are not uniform and therefore the results are difficult to compare. Often important parameters such as chronic pain and permanent functional deficits are not assessed in the outcome. Therefore, prospective studies, with good cohort characteristics and a clear definition of the outcome, are required.

Published
2021

25. High-Dose-Rate Interstitial Brachytherapy (Interventional Radiotherapy) for Conjunctival Melanoma with Orbital Extension

Author

Pagliara, M. M., Tagliaferri, L., Savino, G., Fionda, B., D'Aviero, A., Lanza, A., Lancellotta, V., Midena, G., Gambacorta, M. A., Blasi, M. A., Pagliara M. M., Tagliaferri L. (ORCID:0000-0003-2308-0982), Savino G. (ORCID:0000-0002-9993-5986), D'Aviero A., Lanza A. (ORCID:0000-0003-2187-6653), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Blasi M. A. (ORCID:0000-0001-7393-7644), Pagliara, M. M., Tagliaferri, L., Savino, G., Fionda, B., D'Aviero, A., Lanza, A., Lancellotta, V., Midena, G., Gambacorta, M. A., Blasi, M. A., Pagliara M. M., Tagliaferri L. (ORCID:0000-0003-2308-0982), Savino G. (ORCID:0000-0002-9993-5986), D'Aviero A., Lanza A. (ORCID:0000-0003-2187-6653), Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Blasi M. A. (ORCID:0000-0001-7393-7644)

Abstract

Purpose: To evaluate local control and functional and cosmetic outcomes of postoperative high-dose-rate interventional radiotherapy (HDR-IRT) in patients affected by conjunctival melanoma with orbit invasion. Methods: A retrospective study was conducted in 2 patients affected by conjunctival melanoma infiltrating the orbit, treated with surgical excision and HDR-IRT. The treatment procedures consisted of surgical excision of the orbital infiltrating nodule followed, 1 month after surgery, by adjuvant HDR-IRT. A target dose of 34 Gy was delivered in 10 twice-a-day fractions over 5 consecutive days. Data analysis included local tumor control and metastatic rate, acute and late toxicity, functional and aesthetic results. Results: In both patients, treatment was well tolerated, and there was no orbital recurrence at a median follow-up of 37-40 months. There was an excellent functional outcome, without no significant acute or late side effects. Conclusions: HDR-IRT could be considered a promising, feasible, successful, and well-tolerated option for selected patients affected by ocular tumors with orbital invasion.

Published
2021

26. P02.11.B An hypothesis generating study of MRI-Derived Radiomics on tumor and microenvironment tissue heterogeneity to guide post-operative management of glioblastoma: toward personalized radiation treatment volume delineation

Author

Cannatà, M, primary, Russo, R, additional, Beghella Bartoli, F, additional, Palumbo, I, additional, Tran, H, additional, Votta, C, additional, Lupattelli, M, additional, Boldrini, L, additional, Dinapoli, N, additional, Camilli, F, additional, Balducci, M, additional, Gambacorta, M, additional, Valentini, V, additional, Aristei, C, additional, Sabatino, G, additional, Pignotti, F, additional, Gaudino, S, additional, and Chiesa, S, additional

Published
2022
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27. Developing and validating ultrasound‐based radiomics models for predicting high‐risk endometrial cancer

Author

Moro, F., primary, Albanese, M., additional, Boldrini, L., additional, Chiappa, V., additional, Lenkowicz, J., additional, Bertolina, F., additional, Mascilini, F., additional, Moroni, R., additional, Gambacorta, M. A., additional, Raspagliesi, F., additional, Scambia, G., additional, Testa, A. C., additional, and Fanfani, F., additional

Published
2022
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28. Transanal Endoscopic Microsurgery Versus Total Mesorectal Excision in ypT0-1 Rectal Cancer after Preoperative Radiochemotherapy: Postoperative Morbidity, Functional Results, and Long-term Oncologic Outcome

Author

Rizzo, Gianluca, Pafundi, D. P., Sionne, F., Pietricola, G., D'Agostino, Luca, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Coco, Claudio, Rizzo G., D'Agostino L., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Valentini V. (ORCID:0000-0003-4637-6487), Coco C. (ORCID:0000-0002-4713-7093), Rizzo, Gianluca, Pafundi, D. P., Sionne, F., Pietricola, G., D'Agostino, Luca, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Coco, Claudio, Rizzo G., D'Agostino L., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Valentini V. (ORCID:0000-0003-4637-6487), and Coco C. (ORCID:0000-0002-4713-7093)

Abstract

BACKGROUND: In patients with locally advanced extraperitoneal rectal cancer, a multidisciplinary approach represents the standard treatment. However, considering the favorable prognosis in patients with major or complete response, radical surgery might represent overtreatment. OBJECTIVE: This study aimed to evaluate postoperative short-term morbidity, functional outcome, and oncologic long-term outcome in patients with rectal cancer treated with local excision by transanal endoscopic microsurgery or radical surgery and to determine who achieved a complete or major pathological response (ypT0-1) after neoadjuvant treatment. DESIGN: This was a retrospective study. SETTING: The study was conducted at a single center. PATIENTS: Patients who had received neoadjuvant treatment by local excision with a major or complete pathological response at histological examination (transanal endoscopic microsurgery group) were compared to patients treated by radical surgery with the same pathological response (total mesorectal excision group). INTERVENTIONS: The interventions included local excision by transanal endoscopic microsurgery and radical surgery with total mesorectal excision. MAIN OUTCOME MEASURES: Postoperative short-term morbidity, functional outcome 1 year after surgery, and oncologic long-term outcome were measured. RESULTS: Ninety-three patients were included in the study (35 in the transanal endoscopic microsurgery group and 58 in the mesorectal excision group). In the total mesorectal excision group, a sphincter-saving approach was possible in 89.7% (vs 100%; p = 0.049); a protective temporary stoma was necessary in 74.1% of radical procedures (vs 0%; p < 0.001), and 13.8% of these became permanent. Short-term postoperative morbidity was lower after local excision (14.3% vs 46.6%; p = 0.002). One year after surgery, the transanal endoscopic microsurgery group recorded better evacuation and continence function than the total mesorectal excision group. Oncologic out

Published
2022

29. Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial

Author

Marchegiani, F., Palatucci, V., Capelli, Giovanni, Guerrieri, Maria Chiara, Belluco, C., Rega, D., Morpurgo, E., Coco, Claudio, Restivo, Attilio, De Franciscis, S., Aschele, C., Perin, Alessandro, Bonomo, M., Muratore, A., Spinelli, A., Ramuscello, S., Bergamo, F., Montesi, G., Spolverato, G., Del Bianco, P., Gambacorta, Maria Antonietta, Delrio, P., Pucciarelli, S., Capelli G., Guerrieri M. (ORCID:0000-0001-5782-6936), Coco C. (ORCID:0000-0002-4713-7093), Restivo A., Perin A., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Marchegiani, F., Palatucci, V., Capelli, Giovanni, Guerrieri, Maria Chiara, Belluco, C., Rega, D., Morpurgo, E., Coco, Claudio, Restivo, Attilio, De Franciscis, S., Aschele, C., Perin, Alessandro, Bonomo, M., Muratore, A., Spinelli, A., Ramuscello, S., Bergamo, F., Montesi, G., Spolverato, G., Del Bianco, P., Gambacorta, Maria Antonietta, Delrio, P., Pucciarelli, S., Capelli G., Guerrieri M. (ORCID:0000-0001-5782-6936), Coco C. (ORCID:0000-0002-4713-7093), Restivo A., Perin A., and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

Background: Rectum-preservation for locally advanced rectal cancer has been proposed as an alternative to total mesorectal excision (TME) in patients with major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The purpose of this study was to report on the short-term outcomes of ReSARCh (Rectal Sparing Approach after preoperative Radio- and/or Chemotherapy) trial, which is a prospective, multicenter, observational trial that investigated the role of transanal local excision (LE) and watch-and-wait (WW) as integrated approaches after neoadjuvant therapy for rectal cancer. Methods: Patients with mid-low rectal cancer who achieved mCR or cCR after neoadjuvant therapy and were fit for major surgery were enrolled. Clinical response was evaluated at 8 and 12 weeks after completion of chemoradiotherapy. Treatment approach, incidence, and reasons for subsequent TME were recorded. Results: From 2016 to 2019, 160 patients were enrolled; mCR or cCR at 12 weeks was achieved in 64 and 96 of patients, respectively. Overall, 98 patients were managed with LE and 62 with WW. In the LE group, Clavien–Dindo 3+ complications occurred in three patients. The rate of cCR increased from 8- to 12-week restaging. Thirty-three (94.3%) of 35 patients with cCR had ypT0–1 tumor. At a median 24 months follow-up, a tumor regrowth was found in 15 (24.2%) patients undergoing WW. Conclusions: LE for patients achieving cCR or mCR is safe. A 12-week interval from chemoradiotherapy completion to LE is correlated with an increased cCR rate. The risk of ypT > is reduced when LE is performed after cCR.

Published
2022

30. Art and digital technologies to support resilience during the oncological journey: The Art4ART project

Author

Tagliaferri, Luca, Dinapoli, Loredana, Casa, Cristina, Colloca, Giuseppe Ferdinando, Marazzi, Fabio, Cornacchione, Patrizia, Mazzarella, Maria Cristina, Masiello, Valeria, Chiesa, Silvia, Beghella Bartoli, Francesco, Marconi, Elisa, D'Oria, Marika, Cesario, Alfredo, Chieffo, Daniela Pia Rosaria, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Tagliaferri L. (ORCID:0000-0003-2308-0982), Dinapoli L., Casa C., Colloca G. F., Marazzi F., Cornacchione P., Mazzarella C., Masiello V., Chiesa S. (ORCID:0000-0003-0168-3459), Beghella Bartoli F., Marconi E. (ORCID:0000-0001-6722-8390), D'Oria M., Cesario A. (ORCID:0000-0003-4687-0709), Chieffo D. P. R., Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri, Luca, Dinapoli, Loredana, Casa, Cristina, Colloca, Giuseppe Ferdinando, Marazzi, Fabio, Cornacchione, Patrizia, Mazzarella, Maria Cristina, Masiello, Valeria, Chiesa, Silvia, Beghella Bartoli, Francesco, Marconi, Elisa, D'Oria, Marika, Cesario, Alfredo, Chieffo, Daniela Pia Rosaria, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Tagliaferri L. (ORCID:0000-0003-2308-0982), Dinapoli L., Casa C., Colloca G. F., Marazzi F., Cornacchione P., Mazzarella C., Masiello V., Chiesa S. (ORCID:0000-0003-0168-3459), Beghella Bartoli F., Marconi E. (ORCID:0000-0001-6722-8390), D'Oria M., Cesario A. (ORCID:0000-0003-4687-0709), Chieffo D. P. R., Valentini V. (ORCID:0000-0003-4637-6487), and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

Introduction: New digital technologies can become a tool for welcoming the patient through the artistic dimension. Cancer patients, in particular, need support that accompanies and supports them throughout their treatment. Materials and methods: The Art4ART project consist in the structural proposal to cancer patients of a web-based digital platform containing several forms of art as video-entertainments; a multimedia immersive room; an art-based welcoming of the patients with several original paintings; an environment with a peacefulness vertical garden; a reconceptualization of the chemotherapy-infusion seats. Data regarding patients’ preference and choices will be stored and analysed also using artificial intelligence (AI) algorithm to measure and predict impact indicators regarding clinical outcomes (survival and toxicity), psychological indicators. Moreover, the same digital platform will contribute to a better organization of the activities. Discussion: Through the systematic acquisition of patient preferences and through integration with other clinical parameters, it will be possible to measure the clinical, psychological, organisational, and social impact of the newly implemented Art4ART project. The use of digital technology leads us to apply the reversal of viewpoint from therapeutic acts to patient-centred care.

Published
2022

31. Management of oligometastatic ovarian cancer recurrence during PARP inhibitor maintenance

Author

Palluzzi, E., Marchetti, Claudia, Cappuccio, S., Avesani, Giacomo, Macchia, Gabriella, Gambacorta, Maria Antonietta, Cocciolillo, F., Scambia, Giovanni, Fagotti, Anna, Marchetti C. (ORCID:0000-0001-7098-8956), Avesani G., Macchia G. (ORCID:0000-0002-0529-201X), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Scambia G. (ORCID:0000-0003-2758-1063), Fagotti A. (ORCID:0000-0001-5579-335X), Palluzzi, E., Marchetti, Claudia, Cappuccio, S., Avesani, Giacomo, Macchia, Gabriella, Gambacorta, Maria Antonietta, Cocciolillo, F., Scambia, Giovanni, Fagotti, Anna, Marchetti C. (ORCID:0000-0001-7098-8956), Avesani G., Macchia G. (ORCID:0000-0002-0529-201X), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Scambia G. (ORCID:0000-0003-2758-1063), and Fagotti A. (ORCID:0000-0001-5579-335X)

Abstract

Objective: The benefit of surgery and maintenance treatment with PARP inhibitors (PARPi) has been clearly demonstrated in ovarian cancer. Also, the efficacy and safety of stereotactic body radiotherapy has been shown in patients with metastatic, persistent, and recurrent disease. The aim of this study is to evaluate the management of oligometastatic progression during PARPi maintenance treatment. Methods: This is an observational, retrospective, single-arm study conducted from June 2017 to December 2020 in patients with recurrent ovarian cancer with oligometastatic progression under PARPi maintenance treatment and receiving surgery or stereotactic body radiotherapy for such recurrence. PARPi treatment was continued until further progression of the disease. The primary objective of the study was the median prolongation of the treatment-free interval-p (without platinum) after local treatment. Results: A total of 186 patients with ovarian cancer were treated with PARPi at recurrence. Of these, 30 (16%) developed oligometastatic progression. The median age was 49.5 years (range 35-73). Olaparib, niraparib and rucaparib were administered to 33%, 60%, and 7% of patients, respectively. The median prolongation of the treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy was 6 and 10 months, respectively (p=0.53). The median treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy at the time of oligometastatic progression was 32 and 29 months, respectively (p=0.44). At the time of this publication, 50% of patients are still on treatment with PARPi following progression. Conclusions: Patients with recurrent ovarian cancer who have oligometastic progression during PARPi maintenance may continue to benefit from PARPi if combined with local treatment.

Published
2022

32. Project for interventional Oncology LArge-database in liveR Hepatocellular carcinoma - Preliminary CT-based radiomic analysis (POLAR Liver 1.1)

Author

Iezzi, Roberto, Casà, C, Posa, Alessandro, Cornacchione, Patrizia, Carchesio, F, Boldrini, Luca, Tanzilli, A, Cerrito, Lucia, Fionda, B, Longo, V, Miele, Luca, Lancellotta, V, Cellini, Francesco, Tran, H E, Ponziani, Francesca Romana, Giuliante, Felice, Rapaccini, Gian Ludovico, Grieco, Antonio, Pompili, Maurizio, Gasbarrini, Antonio, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Tagliaferri, Luca, Manfredi, Riccardo, Iezzi, R (ORCID:0000-0002-2791-481X), Posa, A, Cornacchione, P, Boldrini, L, Cerrito, L, Miele, L (ORCID:0000-0003-3464-0068), Cellini, F (ORCID:0000-0002-2145-2300), Ponziani, F R (ORCID:0000-0002-5924-6238), Giuliante, F (ORCID:0000-0001-9517-8220), Rapaccini, G L (ORCID:0000-0002-6467-857X), Grieco, A (ORCID:0000-0002-0544-8993), Pompili, M (ORCID:0000-0001-6699-7980), Gasbarrini, A (ORCID:0000-0002-7278-4823), Valentini, V (ORCID:0000-0003-4637-6487), Gambacorta, M A (ORCID:0000-0001-5455-8737), Tagliaferri, L (ORCID:0000-0003-2308-0982), Manfredi, R (ORCID:0000-0002-4972-9500), Iezzi, Roberto, Casà, C, Posa, Alessandro, Cornacchione, Patrizia, Carchesio, F, Boldrini, Luca, Tanzilli, A, Cerrito, Lucia, Fionda, B, Longo, V, Miele, Luca, Lancellotta, V, Cellini, Francesco, Tran, H E, Ponziani, Francesca Romana, Giuliante, Felice, Rapaccini, Gian Ludovico, Grieco, Antonio, Pompili, Maurizio, Gasbarrini, Antonio, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Tagliaferri, Luca, Manfredi, Riccardo, Iezzi, R (ORCID:0000-0002-2791-481X), Posa, A, Cornacchione, P, Boldrini, L, Cerrito, L, Miele, L (ORCID:0000-0003-3464-0068), Cellini, F (ORCID:0000-0002-2145-2300), Ponziani, F R (ORCID:0000-0002-5924-6238), Giuliante, F (ORCID:0000-0001-9517-8220), Rapaccini, G L (ORCID:0000-0002-6467-857X), Grieco, A (ORCID:0000-0002-0544-8993), Pompili, M (ORCID:0000-0001-6699-7980), Gasbarrini, A (ORCID:0000-0002-7278-4823), Valentini, V (ORCID:0000-0003-4637-6487), Gambacorta, M A (ORCID:0000-0001-5455-8737), Tagliaferri, L (ORCID:0000-0003-2308-0982), and Manfredi, R (ORCID:0000-0002-4972-9500)

Abstract

N/A

Published
2022

33. Modern Management of Esophageal Cancer: Radio-Oncology in Neoadjuvancy, Adjuvancy and Palliation

Author

Cellini, Francesco, Manfrida, Stefania, Casa, C., Romano, Angela, Arcelli, A., Zamagni, A., De Luca, V., Colloca, Giuseppe Ferdinando, D'Aviero, A., Fuccio, L., Lancellotta, V., Tagliaferri, Luca, Boldrini, Luca, Mattiucci, Gian Carlo, Gambacorta, Maria Antonietta, Morganti, Alessio Giuseppe, Valentini, Vincenzo, Cellini F. (ORCID:0000-0002-2145-2300), Manfrida S., Romano A., Colloca G. F., Tagliaferri L. (ORCID:0000-0003-2308-0982), Boldrini L., Mattiucci G. C. (ORCID:0000-0001-6500-0413), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Morganti A. G., Valentini V. (ORCID:0000-0003-4637-6487), Cellini, Francesco, Manfrida, Stefania, Casa, C., Romano, Angela, Arcelli, A., Zamagni, A., De Luca, V., Colloca, Giuseppe Ferdinando, D'Aviero, A., Fuccio, L., Lancellotta, V., Tagliaferri, Luca, Boldrini, Luca, Mattiucci, Gian Carlo, Gambacorta, Maria Antonietta, Morganti, Alessio Giuseppe, Valentini, Vincenzo, Cellini F. (ORCID:0000-0002-2145-2300), Manfrida S., Romano A., Colloca G. F., Tagliaferri L. (ORCID:0000-0003-2308-0982), Boldrini L., Mattiucci G. C. (ORCID:0000-0001-6500-0413), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Morganti A. G., and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

The modern management of esophageal cancer is crucially based on a multidisciplinary and multimodal approach. Radiotherapy is involved in neoadjuvant and adjuvant settings; moreover, it includes radical and palliative treatment intention (with a focus on the use of a stent and its potential integration with radiotherapy). In this review, the above-mentioned settings and approaches will be described. Referring to available international guidelines, the background evidence bases will be reviewed, and the ongoing, more relevant trials will be outlined. Target definitions and radiotherapy doses to administer will be mentioned. Peculiar applications such as brachytherapy (interventional radiation oncology), and data regarding innovative approaches including MRI-guided-RT and radiomic analysis will be reported. A focus on the avoidance of surgery for major clinical responses (particularly for SCC) is detailed.

Published
2022

34. The impact of radiomics in diagnosis and staging of pancreatic cancer

Author

Casa, Cristina, Piras, A., D'Aviero, A., Preziosi, Francesco, Mariani, Silvia, Cusumano, Davide, Romano, Angela, Boskoski, Ivo, Lenkowicz, Jacopo, Dinapoli, Nicola, Cellini, Francesco, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Mattiucci, Gian Carlo, Boldrini, Luca, Casa C., Preziosi F., Mariani S., Cusumano D., Romano A., Boskoski I. (ORCID:0000-0001-8194-2670), Lenkowicz J., Dinapoli N., Cellini F. (ORCID:0000-0002-2145-2300), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Valentini V. (ORCID:0000-0003-4637-6487), Mattiucci G. C. (ORCID:0000-0001-6500-0413), Boldrini L., Casa, Cristina, Piras, A., D'Aviero, A., Preziosi, Francesco, Mariani, Silvia, Cusumano, Davide, Romano, Angela, Boskoski, Ivo, Lenkowicz, Jacopo, Dinapoli, Nicola, Cellini, Francesco, Gambacorta, Maria Antonietta, Valentini, Vincenzo, Mattiucci, Gian Carlo, Boldrini, Luca, Casa C., Preziosi F., Mariani S., Cusumano D., Romano A., Boskoski I. (ORCID:0000-0001-8194-2670), Lenkowicz J., Dinapoli N., Cellini F. (ORCID:0000-0002-2145-2300), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Valentini V. (ORCID:0000-0003-4637-6487), Mattiucci G. C. (ORCID:0000-0001-6500-0413), and Boldrini L.

Abstract

Introduction: Pancreatic cancer (PC) is one of the most aggressive tumours, and better risk stratification among patients is required to provide tailored treatment. The meaning of radiomics and texture analysis as predictive techniques are not already systematically assessed. The aim of this study is to assess the role of radiomics in PC. Methods: A PubMed/MEDLINE and Embase systematic review was conducted to assess the role of radiomics in PC. The search strategy was ‘radiomics [All Fields] AND (“pancreas” [MeSH Terms] OR “pancreas” [All Fields] OR “pancreatic” [All Fields])’ and only original articles referred to PC in humans in the English language were considered. Results: A total of 123 studies and 183 studies were obtained using the mentioned search strategy on PubMed and Embase, respectively. After the complete selection process, a total of 56 papers were considered eligible for the analysis of the results. Radiomics methods were applied in PC for assessment technical feasibility and reproducibility aspects analysis, risk stratification, biologic or genomic status prediction and treatment response prediction. Discussion: Radiomics seems to be a promising approach to evaluate PC from diagnosis to treatment response prediction. Further and larger studies are required to confirm the role and allowed to include radiomics parameter in a comprehensive decision support system.

Published
2022

35. The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes

Author

Meldolesi, Elisa, Chiloiro, Giuditta, Giannini, Roberta, Menghi, Roberta, Persiani, Roberto, Corvari, B., Coco, Claudio, Manfrida, Stefania, Ratto, Carlo, De Luca, V., Sofo, Luigi, Reina, Sara, Crucitti, Antonio, Masiello, V., Dinapoli, Nicola, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Meldolesi E., Chiloiro G., Giannini R., Menghi R., Persiani R. (ORCID:0000-0002-1537-5097), Coco C. (ORCID:0000-0002-4713-7093), Manfrida S., Ratto C. (ORCID:0000-0002-0556-0037), Sofo L. (ORCID:0000-0002-0592-5999), Reina S., Crucitti A. (ORCID:0000-0003-3496-4185), Dinapoli N., Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Meldolesi, Elisa, Chiloiro, Giuditta, Giannini, Roberta, Menghi, Roberta, Persiani, Roberto, Corvari, B., Coco, Claudio, Manfrida, Stefania, Ratto, Carlo, De Luca, V., Sofo, Luigi, Reina, Sara, Crucitti, Antonio, Masiello, V., Dinapoli, Nicola, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Meldolesi E., Chiloiro G., Giannini R., Menghi R., Persiani R. (ORCID:0000-0002-1537-5097), Coco C. (ORCID:0000-0002-4713-7093), Manfrida S., Ratto C. (ORCID:0000-0002-0556-0037), Sofo L. (ORCID:0000-0002-0592-5999), Reina S., Crucitti A. (ORCID:0000-0003-3496-4185), Dinapoli N., Valentini V. (ORCID:0000-0003-4637-6487), and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival ra

Published
2022

36. THUNDER 2: THeragnostic Utilities for Neoplastic DisEases of the Rectum by MRI guided radiotherapy

Author

Chiloiro, Giuditta, Cusumano, Davide, Boldrini, Luca, Romano, Angela, Placidi, Lorenzo, Nardini, Matteo, Meldolesi, Elisa, Barbaro, Brunella, Coco, Claudio, Crucitti, Antonio, Persiani, Roberto, Petruzziello, Lucio, Ricci, Riccardo, Salvatore, Lisa, Sofo, Luigi, Alfieri, Sergio, Manfredi, Riccardo, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Chiloiro G., Cusumano D., Boldrini L., Romano A., Placidi L., Nardini M., Meldolesi E., Barbaro B. (ORCID:0000-0002-9638-543X), Coco C. (ORCID:0000-0002-4713-7093), Crucitti A. (ORCID:0000-0003-3496-4185), Persiani R. (ORCID:0000-0002-1537-5097), Petruzziello L., Ricci R. (ORCID:0000-0002-9089-5084), Salvatore L., Sofo L. (ORCID:0000-0002-0592-5999), Alfieri S. (ORCID:0000-0002-0404-724X), Manfredi R. (ORCID:0000-0002-4972-9500), Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Chiloiro, Giuditta, Cusumano, Davide, Boldrini, Luca, Romano, Angela, Placidi, Lorenzo, Nardini, Matteo, Meldolesi, Elisa, Barbaro, Brunella, Coco, Claudio, Crucitti, Antonio, Persiani, Roberto, Petruzziello, Lucio, Ricci, Riccardo, Salvatore, Lisa, Sofo, Luigi, Alfieri, Sergio, Manfredi, Riccardo, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Chiloiro G., Cusumano D., Boldrini L., Romano A., Placidi L., Nardini M., Meldolesi E., Barbaro B. (ORCID:0000-0002-9638-543X), Coco C. (ORCID:0000-0002-4713-7093), Crucitti A. (ORCID:0000-0003-3496-4185), Persiani R. (ORCID:0000-0002-1537-5097), Petruzziello L., Ricci R. (ORCID:0000-0002-9089-5084), Salvatore L., Sofo L. (ORCID:0000-0002-0592-5999), Alfieri S. (ORCID:0000-0002-0404-724X), Manfredi R. (ORCID:0000-0002-4972-9500), Valentini V. (ORCID:0000-0003-4637-6487), and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

Background: Neoadjuvant chemoradiation therapy (nCRT) is the standard treatment modality in locally advanced rectal cancer (LARC). Since response to radiotherapy (RT) is dose dependent in rectal cancer, dose escalation may lead to higher complete response rates. The possibility to predict patients who will achieve complete response (CR) is fundamental. Recently, an early tumour regression index (ERI) was introduced to predict pathological CR (pCR) after nCRT in LARC patients. The primary endpoints will be the increase of CR rate and the evaluation of feasibility of delta radiomics-based predictive MRI guided Radiotherapy (MRgRT) model. Methods: Patients affected by LARC cT2-3, N0-2 or cT4 for anal sphincter involvement N0-2a, M0 without high risk features will be enrolled in the trial. Neoadjuvant CRT will be administered using MRgRT. The initial RT treatment will consist in delivering 55 Gy in 25 fractions on Gross Tumor Volume (GTV) plus the corresponding mesorectum and 45 Gy in 25 fractions on the drainage nodes. Chemotherapy with 5-fluoracil (5-FU) or oral capecitabine will be administered continuously. A 0.35 Tesla MRI will be acquired at simulation and every day during MRgRT. At fraction 10, ERI will be calculated: if ERI will be inferior than 13.1, the patient will continue the original treatment; if ERI will be higher than 13.1 the treatment plan will be reoptimized, intensifying the dose to the residual tumor at the 11th fraction to reach 60.1 Gy. At the end of nCRT instrumental examinations are to be performed in order to restage patients. In case of stable disease or progression, the patient will undergo surgery. In case of major or complete clinical response, conservative approaches may be chosen. Patients will be followed up to evaluate toxicity and quality of life. The number of cases to be enrolled will be 63: all the patients will be treated at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Discussion: This clinical tri

Published
2022

37. Multidisciplinary Tumor Board Smart Virtual Assistant in Locally Advanced Cervical Cancer: A Proof of Concept

Author

Macchia, Gabriella, Ferrandina, Maria Gabriella, Patarnello, S., Autorino, Rosa, Masciocchi, Carlotta, Pisapia, V., Calvani, C., Iacomini, C., Cesario, Alfredo, Boldrini, Luca, Gui, Benedetta, Rufini, Vittoria, Gambacorta, Maria Antonietta, Scambia, Giovanni, Valentini, Vincenzo, Macchia G. (ORCID:0000-0002-0529-201X), Ferrandina G. (ORCID:0000-0003-4672-4197), Autorino R., Masciocchi C., Cesario A. (ORCID:0000-0003-4687-0709), Boldrini L., Gui B., Rufini V. (ORCID:0000-0002-2052-8078), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Scambia G. (ORCID:0000-0003-2758-1063), Valentini V. (ORCID:0000-0003-4637-6487), Macchia, Gabriella, Ferrandina, Maria Gabriella, Patarnello, S., Autorino, Rosa, Masciocchi, Carlotta, Pisapia, V., Calvani, C., Iacomini, C., Cesario, Alfredo, Boldrini, Luca, Gui, Benedetta, Rufini, Vittoria, Gambacorta, Maria Antonietta, Scambia, Giovanni, Valentini, Vincenzo, Macchia G. (ORCID:0000-0002-0529-201X), Ferrandina G. (ORCID:0000-0003-4672-4197), Autorino R., Masciocchi C., Cesario A. (ORCID:0000-0003-4687-0709), Boldrini L., Gui B., Rufini V. (ORCID:0000-0002-2052-8078), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Scambia G. (ORCID:0000-0003-2758-1063), and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

Aim: The first prototype of the “Multidisciplinary Tumor Board Smart Virtual Assistant” is presented, aimed to (i) Automated classification of clinical stage starting from different free-text diagnostic reports; (ii) Resolution of inconsistencies by identifying controversial cases drawing the clinician’s attention to particular cases worthy for multi-disciplinary discussion; (iii) Support environment for education and knowledge transfer to junior staff; (iv) Integrated data-driven decision making and standardized language and interpretation. Patients and Method: Data from patients affected by Locally Advanced Cervical Cancer (LACC), FIGO stage IB2-IVa, treated between 2015 and 2018 were extracted. Magnetic Resonance (MR), Gynecologic examination under general anesthesia (EAU), and Positron Emission Tomography–Computed Tomography (PET-CT) performed at the time of diagnosis were the items from the Electronic Health Records (eHRs) considered for analysis. An automated extraction of eHR that capture the patient’s data before the diagnosis and then, through Natural Language Processing (NLP), analysis and categorization of all data to transform source information into structured data has been performed. Results: In the first round, the system has been used to retrieve all the eHR for the 96 patients with LACC. The system has been able to classify all patients belonging to the training set and - through the NLP procedures - the clinical features were analyzed and classified for each patient. A second important result was the setup of a predictive model to evaluate the patient’s staging (accuracy of 94%). Lastly, we created a user-oriented operational tool targeting the MTB who are confronted with the challenge of large volumes of patients to be diagnosed in the most accurate way. Conclusion: This is the first proof of concept concerning the possibility of creating a smart virtual assistant for the MTB. A significant benefit could come from the integration of these automate

Published
2022

38. Contact skin radiotherapy (brachytherapy) for the treatment of non-melanoma skin cancers during COVID-19 pandemic

Author

Lancellotta, V., D'Aviero, A., Fionda, B., Di Stefani, Alessandro, Casa, Cristina, Del Regno, L., Gentileschi, Stefano, Colloca, Giuseppe Ferdinando, Rossi, E., Schinzari, Giovanni, Gambacorta, Maria Antonietta, Tagliaferri, Luca, Peris, Ketty, Di Stefani A., Casa C., Gentileschi S. (ORCID:0000-0001-9682-4706), Colloca G. F., Schinzari G. (ORCID:0000-0001-6105-7252), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri L. (ORCID:0000-0003-2308-0982), Peris K. (ORCID:0000-0002-5237-0463), Lancellotta, V., D'Aviero, A., Fionda, B., Di Stefani, Alessandro, Casa, Cristina, Del Regno, L., Gentileschi, Stefano, Colloca, Giuseppe Ferdinando, Rossi, E., Schinzari, Giovanni, Gambacorta, Maria Antonietta, Tagliaferri, Luca, Peris, Ketty, Di Stefani A., Casa C., Gentileschi S. (ORCID:0000-0001-9682-4706), Colloca G. F., Schinzari G. (ORCID:0000-0001-6105-7252), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri L. (ORCID:0000-0003-2308-0982), and Peris K. (ORCID:0000-0002-5237-0463)

Abstract

In the context of the SARS-CoV-2 pandemic, it is important to ensure the quality of cancer treatment as well as patients and health professionals' safety. Individual-based treatment options should be considered in patients with advanced epithelial skin cancer, who are typically elderly and frail. Aim of this study was to assess feasibility and safety of Contact Skin Radiation Therapy (CSRT) to treat basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) during SARS-CoV-2 pandemic. Patients with advanced and difficult-to-treat BCC or SCC were discussed at skin multidisciplinary tumor board (S-MDTB) from February the 21st to May the 4th (phase 1 Italian Pandemic) and retrospectively analyzed. Patient's triage following internal recommendations was daily performed. CSRT was delivered in 8 fractions of 5 Gy each, twice a day. Beyond the clinical outcomes, treatment success indicators, such as the completion of CSRT without SARS-CoV-2 occurrence, were identified to evaluate the feasibility of CSRT during pandemic. A post-treatment psychological assessment regarding patient's safety perception was performed. Six male patients (median age 80 years; range 62–92) with histologically confirmed BCC or SCC were treated with CSRT. Complete clinical remission was achieved in 5/6 patients (83.4%). No high-grade acute toxicities occurred during treatment. No patients or healthcare personnel developed SARS-CoV-2 infection. All the treatment success indicators were achieved. CSRT represents a safe, and feasible treatment option even during the pandemic emergency period. Hypofractionation could be an option to reduce total number of fractions and, consequently, infective risk exposition.

Published
2022

39. Developing and validating ultrasound-based radiomics models for predicting high-risk endometrial cancer

Author

Moro, Francesca, Albanese, M, Boldrini, Luca, Chiappa, V, Lenkowicz, Jacopo, Bertolina, F, Mascilini, F, Moroni, R, Gambacorta, Maria Antonietta, Raspagliesi, F, Scambia, Giovanni, Testa, Antonia Carla, Fanfani, Francesco, Moro, F, Boldrini, L, Lenkowicz, J, Gambacorta, M A (ORCID:0000-0001-5455-8737), Scambia, G (ORCID:0000-0003-2758-1063), Testa, A C (ORCID:0000-0003-2217-8726), Fanfani, F (ORCID:0000-0003-1991-7284), Moro, Francesca, Albanese, M, Boldrini, Luca, Chiappa, V, Lenkowicz, Jacopo, Bertolina, F, Mascilini, F, Moroni, R, Gambacorta, Maria Antonietta, Raspagliesi, F, Scambia, Giovanni, Testa, Antonia Carla, Fanfani, Francesco, Moro, F, Boldrini, L, Lenkowicz, J, Gambacorta, M A (ORCID:0000-0001-5455-8737), Scambia, G (ORCID:0000-0003-2758-1063), Testa, A C (ORCID:0000-0003-2217-8726), and Fanfani, F (ORCID:0000-0003-1991-7284)

Abstract

n/a

Published
2022

40. Does restaging MRI radiomics analysis improve pathological complete response prediction in rectal cancer patients? A prognostic model development

Author

Chiloiro, Giuditta, Cusumano, Davide, de Franco, P., Lenkowicz, Jacopo, Boldrini, Luca, Carano, Davide, Barbaro, Brunella, Corvari, B., Dinapoli, Nicola, Giraffa, M., Meldolesi, Elisa, Manfredi, Riccardo, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Chiloiro G., Cusumano D., Lenkowicz J., Boldrini L., Carano D., Barbaro B. (ORCID:0000-0002-9638-543X), Dinapoli N., Meldolesi E., Manfredi R. (ORCID:0000-0002-4972-9500), Valentini V. (ORCID:0000-0003-4637-6487), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Chiloiro, Giuditta, Cusumano, Davide, de Franco, P., Lenkowicz, Jacopo, Boldrini, Luca, Carano, Davide, Barbaro, Brunella, Corvari, B., Dinapoli, Nicola, Giraffa, M., Meldolesi, Elisa, Manfredi, Riccardo, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Chiloiro G., Cusumano D., Lenkowicz J., Boldrini L., Carano D., Barbaro B. (ORCID:0000-0002-9638-543X), Dinapoli N., Meldolesi E., Manfredi R. (ORCID:0000-0002-4972-9500), Valentini V. (ORCID:0000-0003-4637-6487), and Gambacorta M. A. (ORCID:0000-0001-5455-8737)

Abstract

Purpose: Our study investigated the contribution that the application of radiomics analysis on post-treatment magnetic resonance imaging can add to the assessments performed by an experienced disease-specific multidisciplinary tumor board (MTB) for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). Materials and methods: This analysis included consecutively retrospective LARC patients who obtained a complete or near-complete response after nCRT and/or a pCR after surgery between January 2010 and September 2019. A three-step radiomics features selection was performed and three models were generated: a radiomics model (rRM), a multidisciplinary tumor board model (yMTB) and a combined model (CM). The predictive performance of models was quantified using the receiver operating characteristic (ROC) curve, evaluating the area under curve (AUC). Results: The analysis involved 144 LARC patients; a total of 232 radiomics features were extracted from the MR images acquired post-nCRT. The yMTB, rRM and CM predicted pCR with an AUC of 0.82, 0.73 and 0.84, respectively. ROC comparison was not significant (p = 0.6) between yMTB and CM. Conclusion: Radiomics analysis showed good performance in identifying complete responders, which increased when combined with standard clinical evaluation; this increase was not statistically significant but did improve the prediction of clinical response.

Published
2022

41. Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty

Author

Latessa I., Ricciardi C., Jacob D., Jónsson H., Jr., Gambacorta M., Improta G., Gargiulo P., Latessa, I., Ricciardi, C., Jacob, D., Jónsson, H., J, R., Gambacorta, M., Improta, G., and Gargiulo, P.

Subjects
total hip arthroplasty, Total cost, medicine.medical_treatment, lcsh:Medicine, Dentistry, Prosthesis, Article, lcsh:QM1-695, 03 medical and health sciences, 0302 clinical medicine, cost analysis, Cost analysi, 0502 economics and business, Medicine, Orthopedics and Sports Medicine, health technology assessment, Molecular Biology, Multinomial logistic regression, 030222 orthopedics, business.industry, lcsh:R, 05 social sciences, DMAIC, six sigma, Six Sigma, Health technology, lcsh:Human anatomy, Cell Biology, Multinomial logistic regression analysis, Neurology (clinical), business, multinomial logistic regression, 050203 business & management, Total hip arthroplasty
Abstract

The purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.

Published
2021
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42. Outcome measures in multimodal rectal cancer trials

Author

Fokas, E., Glynne-Jones, R., Appelt, A., Beets-Tan, R., Beets, G., Haustermans, K., Marijnen, C., Minsky, B. D., Ludmir, E., Quirke, P., Sebag-Montefiore, D., Garcia-Aguilar, J., Gambacorta, M. A., Valentini, V., Buyse, M., Rodel, C., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Valentini V. (ORCID:0000-0003-4637-6487), Fokas, E., Glynne-Jones, R., Appelt, A., Beets-Tan, R., Beets, G., Haustermans, K., Marijnen, C., Minsky, B. D., Ludmir, E., Quirke, P., Sebag-Montefiore, D., Garcia-Aguilar, J., Gambacorta, M. A., Valentini, V., Buyse, M., Rodel, C., Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

There is a large variability regarding the definition and choice of primary endpoints in phase 2 and phase 3 multimodal rectal cancer trials, resulting in inconsistency and difficulty of data interpretation. Also, surrogate properties of early and intermediate endpoints have not been systematically assessed. We provide a comprehensive review of clinical and surrogate endpoints used in trials for non-metastatic rectal cancer. The applicability, advantages, and disadvantages of these endpoints are summarised, with recommendations on clinical endpoints for the different phase trials, including limited surgery or non-operative management for organ preservation. We discuss how early and intermediate endpoints, including patient-reported outcomes and involvement of patients in decision making, can be used to guide trial design and facilitate consistency in reporting trial results in rectal cancer.

Published
2020

43. The role of interventional radiotherapy (brachytherapy) in stage i esophageal cancer: An AIRO (Italian Association of Radiotherapy and Clinical Oncology) systematic review

Author

Lancellotta, V., Cellini, F., Fionda, B., Sanctis, V. D., Vidali, C., Fusco, V., Frassine, F., Tomasini, D., Vavassori, A., Gambacorta, M. A., Franco, P., Genovesi, D., Corva, R., Tagliaferri, L., Cellini F. (ORCID:0000-0002-2145-2300), Vidali C., Fusco V., Vavassori A., Gambacorta M. A. (ORCID:0000-0001-5455-8737), Tagliaferri L. (ORCID:0000-0003-2308-0982), Lancellotta, V., Cellini, F., Fionda, B., Sanctis, V. D., Vidali, C., Fusco, V., Frassine, F., Tomasini, D., Vavassori, A., Gambacorta, M. A., Franco, P., Genovesi, D., Corva, R., Tagliaferri, L., Cellini F. (ORCID:0000-0002-2145-2300), Vidali C., Fusco V., Vavassori A., Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Tagliaferri L. (ORCID:0000-0003-2308-0982)

Abstract

OBJECTIVE: This review aimed at examining efficacy of interventional radiotherapy (brachytherapy-IRT) alone or combined with external beam radiotherapy (EBRT) in stage I esophageal cancer as exclusive treatment. MATERIALS AND METHODS: A systematic research using PubMed, Scopus, and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. We analyzed only clinical study as full-text publication, reporting on patients with stage I esophageal cancer treated with IRT alone or in combination with other treatments (e.g., EBRT). Conference paper, survey, letter, editorial, book chapter, and review were excluded. Patients who underwent previous surgery were excluded. Time restriction (1990-2018) was applied for years of the publication. RESULTS: Twelve studies have been selected. The number of evaluated patients was 514; the median age was 69 years. In the IRT group, the median: Local control (LC) was 77% (range 63%-100%), disease-free survival (DFS) was 68.4% (range 49%-86.3%), the overall survival (OS) was 60% (range 31%-84%), the cancer specific survival (CSS) was 80% (range 55-100%), and grade 3-4 toxicity range was 0%-26%. CONCLUSIONS: IRT alone or combined to EBRT is an effective and safe treatment option for patients with stage I esophageal cancer. Definitive radiation therapy could be an alternative to surgery in patients with superficial cancer.

Published
2020

44. Personalizing vulvar cancer workflow in COVID-19 era: a proposal from Vul.Can MDT

Author

Garganese, G., Tagliaferri, L., Fragomeni, S. M., Lancellotta, V., Colloca, G., Corrado, G., Gentileschi, S., Macchia, G., Tamburrini, E., Gambacorta, M. A., Fagotti, A., Scambia, G., Garganese G. (ORCID:0000-0002-4209-5285), Tagliaferri L. (ORCID:0000-0003-2308-0982), Colloca G., Corrado G., Gentileschi S. (ORCID:0000-0001-9682-4706), Tamburrini E. (ORCID:0000-0003-4930-426X), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), Garganese, G., Tagliaferri, L., Fragomeni, S. M., Lancellotta, V., Colloca, G., Corrado, G., Gentileschi, S., Macchia, G., Tamburrini, E., Gambacorta, M. A., Fagotti, A., Scambia, G., Garganese G. (ORCID:0000-0002-4209-5285), Tagliaferri L. (ORCID:0000-0003-2308-0982), Colloca G., Corrado G., Gentileschi S. (ORCID:0000-0001-9682-4706), Tamburrini E. (ORCID:0000-0003-4930-426X), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Fagotti A. (ORCID:0000-0001-5579-335X), and Scambia G. (ORCID:0000-0003-2758-1063)

Abstract

Introduction: Since the community spread of Coronavirus disease 2019 (COVID-19), the practice of oncologic care at our comprehensive cancer center has changed. Postponing cancer treatment without consideration of its implications could cost more lives than can be saved. In this special situation, we must continue to provide our cancer patients with the highest quality of medical services assuring the safety. This article provides general guidance on supporting curative treatment strategies in vulvar cancer patients. Methods: At our institution, a vulvar cancer multidisciplinary team (Vul.Can MDT) of specialists is responsible for personalized treatment of this disease. The phase 2 period necessarily requires specific procedures for both outpatient and inpatient pathways and to provide strategies concerning the management of vulvar cancer patients even in case of an eventually concomitant SARS-CoV-2 infection. In brief, an accurate remote and in person triage must be provided routinely and patients submitted to specific diagnostic tests prior to every major treatment or procedure (surgery, RT, and CT) or in case of suspicion for COVID-19 syndrome. The decisional workflow for these women often old and frail, have been rapidly adjusted by our Vul.Can MDT to mitigate the potential risks of COVID-19. Results: The team produced two types of recommendations concerning: (1) safety regulations of care pathways, patients and health care providers, (2) personalized treatment strategies. We present a protocol that can be applied in clinical practice: the flowcharts provided, include the modulation of treatment intensity designed for surgical procedures and radiation, stratified for FIGO stage of disease and intention. Conclusion: We suggest that our proposals are applicable in this setting of patients, considering anyway current international recommendations and guidelines.

Published
2020

45. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Author

Morandi, A, Zambon, A, Di Santo, S, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Marengoni, A, Bellelli, G, Rispoli, V, Malara, A, Spadea, F, Di Cello, S, Ceravolo, F, Fabiano, F, Chiaradia, G, Gabriele, A, Lenino, P, Andrea, T, Settembrini, V, Capomolla, D, Citrino, A, Scriva, A, Bruno, I, Secchi, R, De Martino, E, Muccinelli, R, Lupi, G, Paonessa, P, Fabbri, A, Passuti, M, Castellari, S, Po, A, Gaggioli, G, Varesi, M, Moneti, P, Capurso, S, Latini, V, Ghidotti, S, Riccardelli, F, Macchi, M, Rigo, R, Claudio, P, Angelo, B, Flavio, C, Benedetta, B, Boffelli, S, Cassinadri, A, Franzoni, S, Spazzini, E, Andretto, D, Tonini, G, Andreani, L, Coralli, M, Balotta, A, Cancelliere, R, Ballardini, G, Simoncelli, M, Mancini, A, Strazzacapa, M, Fabio, S, De Filippi, F, Giudice, C, Dentizzi, C, Azzini, M, Cazzadori, M, Mastroeni, V, Bertassello, P, Claudia Benati, H, Nesta, E, Tobaldini, C, Guerini, F, Elena, T, Mombelloni, P, Fontanini, F, Gabriella, L, Pizzorni, C, Oliverio, M, Del Grosso, L, Giavedoni, C, Bidoli, G, Mazzei, B, Corsonello, A, Fusco, S, Vena, S, De Vuono, T, Maiuri, G, Luca, F, Andrea, A, Giovanni, S, Rossella, N, Castegnaro, E, De Rosa, S, Sechi, R, Benvenuti, E, Del Lungo, I, Giardini, S, Giulietti, C, Mauro, D, Eleonora, B, Martina, P, Irene, F, Riccardo, B, Federica, S, Ilaria, D, Bertoletti, E, D'Amico, F, Caronzolo, F, Grippa, A, Lombardo, G, Pipicella, T, Antonino, S, Francesco, C, Valeria, P, Daniela, L, Domenico, C, Giorgio, B, March, A, Nitti, M, Felici, A, Pavan, S, Piazzani, F, Lunelli, A, Dimori, S, Margotta, A, Soglia, T, Postacchini, D, Brunelli, R, Santini, S, Francavilla, M, Macchiati, I, Sorvillo, F, Giuli, C, Mecocci, P, Longo, A, Perticone, F, Addesi, D, Rosa, P, Bencardino, G, Falbo, T, Grillo, N, Marco, F, Mirella, F, Fanto, F, Isaia, G, Pezzilli, S, Bergamo, D, Furno, E, Rrodhe, S, Lucarini, S, Dijk, B, Dall'Acqua, F, Cappelletto, F, Calvani, D, Becheri, D, Giuseppe, M, Costanza, M, Vito, A, Francesca, B, Magherini, L, Novella, M, Franca, B, Lucia Gambardella, P, Valente, C, Ilaria, B, Alice, F, Porrino, P, Ceci, G, Giuliana, B, Michela, T, Eleonora, C, Ettore, E, Camellini, C, Servello, A, Grassi, A, Rozzini, R, Tironi, S, Grassi, M, Troisi, E, Carlo, C, Simona Gabriella, D, Flaminia, F, Federica, R, Beatrice, P, Sofia, T, Gabutto, A, Quazzo, L, Rosatello, A, Suraci, D, Tagliabue, B, Perrone, C, Ferrara, L, Castagna, A, Tremolada, M, Giuseppe, C, Stefano, B, Davide, O, Piano, S, Serviddio, G, Lo Buglio, A, Gurrera, T, Merlo, V, Rovai, C, Cotroneo, A, Carlucci, R, Abbaldo, A, Monzani, F, Qasem, A, Bini, G, Tafuto, S, Galli, G, Bruni, A, Mancuso, G, Calipari, D, Giuseppe Massimiliano, D, Bernardini, B, Corsini, C, Michele, C, Sara, D, Cagnin, A, Fragiacomo, F, Pompanin, S, Piero, A, Marco, C, Zurlo, A, Guerra, G, Pala, M, Menozzi, L, Gatti, C, Magon, S, Roberto, M, Alfredo, D, Fabio, F, Ruana, T, Elisa, M, Christian, M, Marco, P, Massimo, G, Di Francesco, V, Faccioli, S, Pellizzari, L, Giorgia, F, Barbagallo, G, Lunardelli, M, Martini, E, Ferrari, E, Macchiarulo, M, Corneli, M, Bacci, M, Battaglia, G, Anastasio, L, Lo Storto, M, Seresin, C, Simonato, M, Loreggian, M, Cestonaro, F, Durando, M, Latella, R, Mazzoleni, M, Russo, G, Ponte, M, Valchera, A, Salustri, G, Petritola, D, Costa, A, Sinforiani, E, Cotta, M, Pizio, R, Cester, A, Formilan, M, Pietro, B, Carbone, P, Cazzaniga, I, Appollonio, I, Cereda, D, Stabile, A, Xhani, R, Acampora, R, Tremolizzo, L, Federico, P, Antonio, C, Valerio, P, Cesare, B, Zhirajr, M, Giovanni, V, Maria, A, Mariaelena, S, Bottacchi, E, Bucciantini, E, Di Giovanni, M, Franchi, F, Lucchetti, L, Mariani, C, Grande, G, Rapazzini, P, Marco, M, Romanelli, G, Franco, N, Alessio, M, Nicola, L, Laura, P, Nazario, P, Chiara, G, Soccorso, P, Andrea, S, Luca, B, Francesca, S, Roberto, A, Anna, C, Fugazza, L, Guerrini, C, De Paduanis, G, Iallonardo, L, Palumbo, P, Zuliani, G, Ortolani, B, Capatti, E, Soavi, C, Bianchi, L, Francesconi, D, Miselli, A, Gloria, B, Tommaso, R, Chiara, P, Agata, M, Marco, D, Luca, M, Gianluca, G, Suardi, T, Zaccarini, C, Manuela, R, Mirra, G, Muti, E, Bottura, R, Gianpaolo, M, Secreto, P, Bisio, E, Cecchettani, M, Naldi, T, Pallavicino, A, Pugliese, M, Iozzo, R, Grassi, G, Bombelli, M, Dell'Oro, R, Quarti Trevano, F, Giussani, G, Paternò, G, Contro, E, Mannironi, A, Giorli, E, Oberti, S, Fierro, B, Piccoli, T, Giacalone, F, Mandas, A, Serchisu, L, Costaggiu, D, Pinna, E, Orru, F, Mannai, M, Cordioli, Z, Pelizzari, L, Turcato, E, Arduini, P, Cacace, C, Chiloiro, R, Cimino, R, Ruberto, C, Giovanni, R, Pietro, G, Laura, G, Alberto, C, Carmen, R, Santo, P, Andriolli, A, Burattin, G, Rossi, L, Andreolli Antonino, C, Tezza, F, Maddalena, P, Laura, S, Crippa, P, Aloisio, P, Di Monda, T, Malighetti, A, Galbassini, G, Salutis, D, Ivaldi, C, Russo, A, Bennati, E, Pino, E, Zavarise, G, Pesci, A, Suigo, G, Faverio, P, Andrea, G, Sabrina, P, Zanasi, M, Moniello, G, Rostagno, C, Cartei, A, Polidori, G, Ungar, A, Melis, M, Martellini, E, Enrico, M, Monica, T, Antonella, G, Giovanna, L, Migliorini, M, Caramelli, F, Battiston, B, Berardino, M, Cavallo, S, Alessandro, M, Anna, S, Lombardi, B, D'Ippolito, P, Furini, A, Villani, D, Clara, R, Guarneri, M, Paolucci, S, Bassi, A, Coiro, P, De Angelis, D, Morone, G, Venturiero, V, Palleschi, L, Raganato, P, Di Niro, G, Rosa, C, Loredana, B, Imoscopi, A, Tibaldi, V, Bottignole G, G, Calvi, E, Clementi, C, Zanocchi, M, Agosta, L, Nortarelli, A, Provenzano, G, Mari, D, Romano, F, Rosini, F, Mansi, M, Rossi, S, Geriatria, A, Inzaghi, L, Bonini, G, Rossi, P, Potena, A, Lichii, M, Candiani, T, Grimaldi, W, Bertani, E, Alessandra, P, Calogero, P, Pinto, D, Bernardi, R, Nicolino, F, Galetti, C, Gianstefani, A, Giulia, C, Lorenzo, M, Odetti, P, Monacelli, F, Prefumo, M, Fiammetta, M, Canepa, M, Minaglia, C, Paolisso, G, Rizzo, M, Prestano, R, Dalise, A, Barra, D, Bosco, L, Asprinio, V, Dallape, L, Perina, E, Incalzi, R, Bartoli, I, Pluderi, A, Maina, A, Pecoraro, E, Sciarra, M, Prudente, A, Paola, M, Francesca, M, Manuel, V, Luisella, C, Maria, P, Tina, S, Benini, L, Levato, F, Mhiuta, V, Alius, F, Davidoaia, D, Giardini, V, Garancini, M, Bellamoli, C, Terranova, L, Bozzini, C, Tosoni, P, Provoli, E, Cascone, L, Dioli, A, Ferrarin, G, Bucci, A, Bua, G, Fenu, S, Bianchi, G, Casella, S, Romano, V, Maurizio, P, Mascherona, I, Belotti, G, Cavaliere, S, Cuni, E, Merciuc, N, Oberti, R, Veneziani, S, Capoferri, E, De Bernardi, E, Colombo, K, Bravi, M, Nicoletta, N, D'Arcangelo, P, Montenegro, N, Montanari, R, Lamanna, P, Gasperini, B, Isabella, M, Stefania, D, Gaia, A, Filippo, C, Palama, C, Di Emidio, C, Scarpini, E, Arighi, A, Fumagalli, G, Basilico, P, De Amicis Margherita, M, Marta, M, Diletta, M, Granata, A, Ranalli, C, Cammilli, A, Cavallini, M, Tricca, M, Natella, D, Gabbani, L, Tesi, F, Martella, L, Imbrici, R, Guerrini, G, Scotuzzi, A, Sozzi, F, Valenti, L, Chiarello, A, Monia, M, Pilotto, A, Prete, C, Senesi, B, Meta, A, Pendenza, E, Pasqualetti, G, Polini, A, Tognini, S, Ballino, E, Dell'Aquila, G, Gasparrini, P, Marotti, E, Migale, M, Scrimieri, A, Falsetti, L, Salvi, A, Toigo, G, Ceschia, G, Rosso, A, Tongiorgi, C, Scarpa, C, De Dominicis, L, Pucci, E, Renzi, S, Cartechini, E, Tomassini, P, Del Gobbo, M, Ugenti, F, Romeo, P, Nardelli, A, Lauretani, F, Visioli, S, Montanari, I, Ermini, F, Giordano, A, Pigato, G, Simeone, E, Barbujani, M, Giampieri, M, Amoruso, R, Piccinini, M, Ferrari, C, Gambetti, C, Sfrappini, M, Semeraro, L, Striuli, R, Pelliccioni, G, Marinelli, D, Fabi, K, Rossi, T, Pesallaccia, M, Sabbatini, D, Gobbi, B, Cerqua, R, Tagliani, G, Schlauser, E, Caser, L, Caramello, E, Sandigliano, F, Rosso, G, Ferrari, A, Bendini, C, Luisa, D, Casella, M, Prampolini, R, Scevola, M, Vitale, E, Roberto, B, Carlo, F, Sergio, F, Alberto, S, Daniela, Z, Giulia, B, Serena, G, Michele, B, Maugeri, D, Sorace, R, Anzaldi, M, De Gesu, R, Morrone, G, Davolio, F, Fabbo, A, Palmieri, M, Zoli, M, Forti, P, Pirazzoli, L, Fabbri, E, Terenzi, L, Bergolari, F, Wenter, C, Ruffini, I, Insam, M, Abraham, E, Kirchlechner, C, Cucinotta, D, Antonino, L, Basile, G, Grazia, A, Parise, P, Boccali, A, Amici, S, Gambacorta, M, Lasagni, A, Lovati, R, Giovinazzo, F, Kimak, E, Zappa, P, Medici, F, Lo Castro, M, Mauro, F, De Luca, A, Sancesario, G, Martorana, A, Scaricamazza, B, Toniolo, S, Di Lorenzo, F, Liguori, C, Lasco, A, Vita, N, Giomi, M, Forte, F, Padovani, A, Rozzini, L, Ceraso, A, Salvatore, C, Cottino, M, Vitali, S, Marelli, E, Tripi, G, Miceli, S, Urso, G, Grioni, G, Vezzadini, G, Misaggi, G, Forlani, C, Avanzi, S, Serena, S, Claudia, C, Marilena, V, Alberto, L, Diego, G, Alessandro, G, Iemolo, F, Sanzaro, E, D'Asta, G, Proietto, M, Carnemolla, A, Razza, G, Spadaro, D, Bertolotti, M, Mussi, C, Neviani, F, Roberto, C, Valentina, G, Linda, M, Francesca, V, Tarozzi, A, Balestri, F, Mannarino, G, Bigolari, M, Natale, A, Grassi, S, Bottaro, C, Stefanelli, S, Bovone, U, Tortorolo, U, Quadri, R, Leone, G, Ponzetto, M, Frasson, P, Annoni, G, Confalonieri, R, Corsi, M, Moretti, D, Teruzzi, F, Umidi, S, Mazzola, P, Perego, S, Persico, I, Olivieri, G, Bonfanti, A, Hajnalka, S, Galeazzi, M, Massariello, F, Anzuini, A, Caffarra, P, Barocco, F, Spallazzi, M, Paolo, C, Simonetta, M, Chioatto, P, Bortolamei, S, Soattin, L, Ruotolo, G, Beneamino, B, Giuseppe, B, Bertazzoli, M, Rota, E, Adobati, A, Scarpa, A, Granziera, S, Zuccher, P, Fabbro, A, Zara, D, Lo Nigro, A, Franchetti, L, Toniolo, M, Marcuzzo, C, Rollone, M, Guerriero, F, Sgarlata, C, Masse, A, Zatti, G, Piatti, M, Graci, J, Benati, G, Boschi, F, Biondi, M, Fiumi, N, Erika, T, Locatelli, S, Mauri, S, Beretta, M, Margheritis, L, Desideri, G, Liberatore, E, Carucci, A, Bonino, P, Caput, M, Antonietti, M, Polistena, G, De la Pierre, F, Mari, M, Massignani, P, Tombesi, F, Selvaggio, F, Verbo, B, Bodoni, P, Marchionni, N, Sabatini, T, Mussio, E, Magni, E, Bianchetti, A, Crucitti, A, Titoldini, G, Cossu, B, Fascendini, S, Licini, C, Tomasoni, A, Calderazzo, M, Daniela, T, Valentina, L, Melotti, R, Lilli, A, Buda, S, Adversi, M, Noro, G, Turco, R, Ubezio, M, Mantovani, A, Viola, M, Serrati, C, Pretta, S, Infante, M, Gentile, S, D'Ambrosio, V, Mazzanti, P, Brambilla, C, Sportelli, S, Platto, C, Faraci, B, Quattrocchi, D, Pernigotti, L, Pisu, C, Sicuro, F, Zagnoni, P, Ghiglia, S, Mosca, M, Corazzin, I, Deola, M, Biagini, C, Bencini, F, Cantini, C, Tonon, E, Pierinelli, S, Onofrj, M, Thomas, A, Filomena, B, Bonanni, L, Gabriella, C, Comi, G, Magnani, G, Santangelo, R, Mazzeo, S, Francesca, C, Giordano, C, Roberto, S, Barbieri, C, Giroldi, L, Bandini, F, Masina, M, Malservisi, S, Cicognani, A, Ricca, L, Piccininni, M, Tassinari, T, Brogi, D, Sugo, A, Alessandra, F, Sonia, M, Valerio, V, Andrea, U, Enrico, C, Vera, R, Assunta, S, Gianmaria, Z, Mauro, P, Barone, A, Razzano, M, Giuseppe, I, Angela, B, Francesco, S, Valeria, D, Federico, G, Lucia, P, Antonella, V, Elisabetta, D, Cristina, R, Nadia, C, Maria, S, Luciano, A, Chiara, C, Bini, P, Pignata, M, Enrico, B, Maria, V, Giovanni, C, Giorgio, C, Piera, R, Alberto, Z, Ceccon, A, Magrin, L, Marin, S, Barbara, S, Matteo, M, Caterina, P, Carla, R, Federica, G, Clara, T, Melania, C, Giampaolo, B, Stefano, G, Valeria, G, Lucia, M, Giovambattista, D, Ester, L, Cecilia, C, Maurizio, T, Nadia, B, Grillo, A, Arenare, F, Tonino, M, David, K, Giorgio, V, Ubaldo, B, Vincenzo, S, Stefano, M, Marino, F, Busonera Flavio, M, Paolo, A, Monica, M, Francesco, B, Roberto, F, Paolo, B, Durantemangoni, E, Testoni, M, Fabio, D, Loredana, S, Valeria, S, Fabiano, M, Annabella, D, Salvatore, D, Greco, A, Grazia, D, Daniele, S, Gianluca, R, Renzo, G, Sergio, M, Morena, B, Vitali, M, Marina, P, Paolo, D, Cristina, S, Orlandini, F, La Regina, M, Desiree, A, Mario, B, Paola, P, Padulo, F, Cristina, M, Dario, R, Giancarla, M, Guido, R, Elena, M, Marileda, N, Igor, B, Nicole, B, Elena, R, Paolillo, C, Riccardi, A, Claudia, B, Barbara, R, Silvia, V, Oliver, B, Mauro, C, Eleonora, M, Giuseppe, P, Rosaria, T, Maria, C, Davide, D, Stefania, C, Massimo, P, Luca, S, Martina, D, Paola, V, Lia, S, Sandro, C, Valentina, D, Erminia, B, Paola, C, Romina, R, Minisola, S, Luciano, C, Pasquale, A, Ilaria, L, Guglielmo, S, Marco, E, Sara, R, Paola, A, Claudio, A, Francesco, R, Alessandro, C, Simona, M, Lara, F, Paola, R, Simonetta, C, Antonella, C, Generoso, U, Fernando, G, Giuliano, C, Emanuela, S, Mariolina, S, Alessandro, D, Giulia, L, Famularo, S, Sandini, M, Pinotti, E, Gianotti, L, Antonella, B, Giulia, P, Sante, G, Rossi, A, Rubele, S, Sant, S, Marco, V, Danila, C, Fabio, R, Bandirali, M, Nicoletta, C, Laura, B, Paolo, T, Luciano, T, Leonello, A, Margherita, S, Pierluigi, D, Laura, R, Fabiana, T, Giovanna, C, Antonino, A, Felice, C, Danilo, F, Giovanna, D, Francesco, L, Salini, S, Giorgetta, C, Giovanni, G, Gerardo, B, Silvio, R, Letizia, S, Davide, B, Rosaria, R, Maria, D, Raffaele, P, Palmieri, V, Palasciano, G, Belfiore, A, Portincasa, P, Carlo, S, Alessia, D, Valiani, V, Carolina, B, Tiziana, C, Paola, T, Ugo, P, Giacomo, P, Castellano, M, Anna, G, Elisa, C, Federica, C, Antonietta, C, Luigi, M, Fabio, L, Salvatore, B, Gelosa, G, Viviana, A, Piras, V, Andrea, C, Alessandra, B, Coen, D, Magliola, R, Milanesio, D, Muzzulini, C, Paolo, F, Marinella, T, Sofia, C, Marta, B, Siano, P, Capo, G, Napoletano, R, Cecilia, P, Mancini, C, Del Buono, C, De Bartolomeo, G, Addolorata, M, Carmen, C, Moschettini, G, Franco, M, Daniela, R, D'Amico, G, Mirella, P, Endrizzi, C, Trotta, L, Ciarambino, T, Orazio, Z, Emanuela, T, Marta, S, Thomas, F, Giacomo, T, Ignazio, D, Andrea, B, Giuseppe, O, Emanuela, F, Serena, A, Elena, D, Serena, B, Erika, N, Elena, S, Manuela, P, Francesca, A, Angelo, T, Morandi A., Zambon A., Di Santo S. G., Mazzone A., Cherubini A., Mossello E., Bo M., Marengoni A., Bellelli G., Rispoli V., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Chiaradia G., Gabriele A., Lenino P., Andrea T., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Lupi G., Paonessa P., Fabbri A., Passuti M. T., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Rigo R., Claudio P., Angelo B., Flavio C., Benedetta B., Boffelli S., Cassinadri A., Franzoni S., Spazzini E., Andretto D., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Ballardini G., Simoncelli M., Mancini A., Strazzacapa M., Fabio S., De Filippi F., Giudice C., Dentizzi C., Azzini M., Cazzadori M., Mastroeni V., Bertassello P., Claudia Benati H. S., Nesta E., Tobaldini C., Guerini F., Elena T., Mombelloni P., Fontanini F., Gabriella L., Pizzorni C., Oliverio M., Del Grosso L. L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Luca F. F., Andrea A., Giovanni S., Rossella N., Castegnaro E., De Rosa S., Sechi R. B., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., Mauro D. B., Eleonora B., Martina P., Irene F., Riccardo B., Federica S., Ilaria D. L., Bertoletti E., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Antonino S., Francesco C., Valeria P. G., Daniela L., Domenico C., Giorgio B., March A., Nitti M. T., Felici A., Pavan S., Piazzani F., Lunelli A., Dimori S., Margotta A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Mecocci P., Longo A., Perticone F., Addesi D., Rosa P. C., Bencardino G., Falbo T., Grillo N., Marco F., Mirella F., Fanto F., Isaia G., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dijk B., Dall'Acqua F., Cappelletto F., Calvani D., Becheri D., Giuseppe M., Costanza M., Vito A., Francesca B., Magherini L., Novella M., Franca B., Lucia Gambardella P. M., Valente C., Ilaria B., Alice F., Porrino P., Ceci G., Giuliana B., Michela T., Eleonora C., Ettore E., Camellini C., Servello A., Grassi A., Rozzini R., Tironi S., Grassi M. G., Troisi E., Carlo C., Simona Gabriella D. S., Flaminia F., Federica R., Beatrice P., Sofia T., Gabutto A., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M. L., Giuseppe C., Stefano B., Davide O., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Cotroneo A. M., Carlucci R., Abbaldo A., Monzani F., Qasem A. A., Bini G., Tafuto S., Galli G., Bruni A. C., Mancuso G., Calipari D., Giuseppe Massimiliano D. L., Bernardini B., Corsini C., Michele C., Sara D. F., Cagnin A., Fragiacomo F., Pompanin S., Piero A., Marco C., Zurlo A., Guerra G., Pala M., Menozzi L., Gatti C. D., Magon S., Roberto M., Alfredo D. G., Fabio F., Ruana T., Elisa M., Christian M., Marco P., Massimo G., Di Francesco V., Faccioli S., Pellizzari L., Giorgia F., Barbagallo G., Lunardelli M. L., Martini E., Ferrari E., Macchiarulo M., Corneli M., Bacci M., Battaglia G., Anastasio L., Lo Storto M. S., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Latella R., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Petritola D., Costa A., Sinforiani E., Cotta M. R., Pizio R. N., Cester A., Formilan M., Pietro B., Carbone P., Cazzaniga I., Appollonio I., Cereda D., Stabile A., Xhani R., Acampora R., Tremolizzo L., Federico P., Antonio C., Valerio P., Cesare B., Zhirajr M., Giovanni V., Maria A., Mariaelena S., Bottacchi E., Bucciantini E., Di Giovanni M., Franchi F., Lucchetti L., Mariani C., Grande G., Rapazzini P., Marco M., Romanelli G., Franco N., Alessio M., Nicola L., Laura P., Nazario P., Chiara G., Soccorso P., Andrea S., Luca B., Francesca S., Roberto A., Anna C., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Zuliani G., Ortolani B., Capatti E., Soavi C., Bianchi L., Francesconi D., Miselli A., Gloria B., Tommaso R., Chiara P., Agata M. M., Marco D. A., Luca M., Gianluca G., Suardi T., Zaccarini C., Manuela R., Mirra G., Muti E., Bottura R., Gianpaolo M., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R. C., Grassi G., Bombelli M., Dell'Oro R., Quarti Trevano F., Giussani G. C., Paternò G., Contro E., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Mandas A., Serchisu L., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Turcato E., Arduini P., Cacace C., Chiloiro R., Cimino R., Ruberto C., Giovanni R., Pietro G., Laura G., Alberto C., Carmen R., Santo P. D., Andriolli A., Burattin G., Rossi L., Andreolli Antonino C. G., Tezza F., Maddalena P., Laura S., Crippa P., Aloisio P., Di Monda T., Malighetti A., Galbassini G., Salutis D., Ivaldi C., Russo A. M., Bennati E., Pino E., Zavarise G., Pesci A., Suigo G., Faverio P., Andrea G., Sabrina P., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Ungar A., Melis M. R., Martellini E., Enrico M., Monica T., Antonella G., Giovanna L., Migliorini M., Caramelli F., Battiston B., Berardino M., Cavallo S., Alessandro M., Anna S., Lombardi B., D'Ippolito P., Furini A., Villani D., Clara R., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Rosa C. A., Loredana B., Imoscopi A., Tibaldi V., Bottignole G G., Calvi E., Clementi C., Zanocchi M., Agosta L., Nortarelli A., Provenzano G., Mari D., Romano F. Y., Rosini F., Mansi M., Rossi S., Geriatria A. R., Inzaghi L., Bonini G., Rossi P., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Alessandra P., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Giulia C., Lorenzo M., Odetti P., Monacelli F., Prefumo M., Fiammetta M., Canepa M., Minaglia C., Paolisso G., Rizzo M. R., Prestano R., Dalise A. M., Barra D., Bosco L. D., Asprinio V., Dallape L., Perina E., Incalzi R. A., Bartoli I. R., Pluderi A., Maina A., Pecoraro E., Sciarra M., Prudente A., Paola M., Francesca M., Manuel V., Luisella C., Maria P. L., Tina S., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bellamoli C., Terranova L., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Maurizio P., Mascherona I., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Veneziani S., Capoferri E., De Bernardi E., Colombo K., Bravi M., Nicoletta N., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Isabella M., Stefania D., Gaia A., Filippo C., Palama C., Di Emidio C., Scarpini E., Arighi A., Fumagalli G., Basilico P., De Amicis Margherita M., Marta M., Diletta M., Granata A., Ranalli C., Cammilli A., Cavallini M. C., Tricca M., Natella D., Gabbani L., Tesi F., Martella L., Imbrici R., Guerrini G., Scotuzzi A. M., Sozzi F., Valenti L., Chiarello A., Monia M., Pilotto A., Prete C., Senesi B., Meta A. C., Pendenza E., Pasqualetti G., Polini A., Tognini S., Ballino E., Dell'Aquila G., Gasparrini P. M., Marotti E., Migale M., Scrimieri A., Falsetti L., Salvi A., Toigo G., Ceschia G., Rosso A., Tongiorgi C., Scarpa C., De Dominicis L., Pucci E., Renzi S., Cartechini E., Tomassini P. F., Del Gobbo M., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Barbujani M., Giampieri M., Amoruso R., Piccinini M., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Fabi K., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Ferrari A., Bendini C., Luisa D. M., Casella M., Prampolini R., Scevola M., Vitale E., Roberto B., Carlo F., Sergio F., Alberto S., Daniela Z., Giulia B., Serena G., Michele B., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Fabbo A., Palmieri M., Zoli M., Forti P., Pirazzoli L., Fabbri E., Terenzi L., Bergolari F., Wenter C., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Antonino L., Basile G., Grazia A. M., Parise P., Boccali A., Amici S., Gambacorta M., Lasagni A., Lovati R., Giovinazzo F., Kimak E., Zappa P., Medici F., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Padovani A., Rozzini L., Ceraso A., Salvatore C., Cottino M., Vitali S., Marelli E., Tripi G., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Avanzi S., Serena S., Claudia C., Marilena V., Alberto L., Diego G., Alessandro G., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Mussi C., Neviani F., Roberto C., Valentina G., Linda M., Francesca V., Tarozzi A., Balestri F., Mannarino G., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Annoni G., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Mazzola P., Perego S., Persico I., Olivieri G., Bonfanti A., Hajnalka S., Galeazzi M., Massariello F., Anzuini A., Caffarra P., Barocco F., Spallazzi M., Paolo C. G., Simonetta M., Chioatto P., Bortolamei S., Soattin L., Ruotolo G., Beneamino B., Giuseppe B., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Fabbro A. D., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Boschi F., Biondi M., Fiumi N., Erika T., Locatelli S. M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A. C., Bonino P., Caput M., Antonietti M. P., Polistena G., De la Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Marchionni N., Sabatini T., Mussio E., Magni E., Bianchetti A., Crucitti A., Titoldini G., Cossu B., Fascendini S., Licini C., Tomasoni A., Calderazzo M., Daniela T., Valentina L., Melotti R. M., Lilli A., Buda S., Adversi M., Noro G., Turco R., Ubezio M. C., Mantovani A. R., Viola M. C., Serrati C., Pretta S., Infante M., Gentile S., D'Ambrosio V., Mazzanti P., Brambilla C., Sportelli S., Platto C., Faraci B., Quattrocchi D., Pernigotti L. M., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Biagini C. A., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Filomena B., Bonanni L., Gabriella C., Comi G., Magnani G., Santangelo R., Mazzeo S., Francesca C., Giordano C., Roberto S. A., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Piccininni M., Tassinari T., Brogi D., Sugo A., Alessandra F., Sonia M., Valerio V., Andrea U. C., Enrico C., Vera R. F., Assunta S., Gianmaria Z., Mauro P., Barone A., Razzano M., Giuseppe I., Angela B., Francesco S., Valeria D. A., Federico G., Lucia P., Antonella V., Elisabetta D. C., Cristina R., Nadia C., Maria S., Luciano A., Chiara C., Bini P., Pignata M., Enrico B., Maria V., Giovanni C., Giorgio C., Piera R., Alberto Z., Ceccon A., Magrin L., Marin S., Barbara S., Matteo M., Caterina P. M., Carla R., Federica G., Clara T., Melania C., Giampaolo B., Stefano G., Valeria G., Lucia M., Giovambattista D., Ester L., Cecilia C. A., Maurizio T., Nadia B., Grillo A., Arenare F., Tonino M., David K., Giorgio V. P., Ubaldo B., Vincenzo S., Stefano M., Marino F., Busonera Flavio M. T., Paolo A., Monica M., Francesco B., Roberto F., Paolo B., DuranteMangoni E., Testoni M., Fabio D. S., Loredana S., Valeria S., Fabiano M., Annabella D. G., Salvatore D. C., Greco A., Grazia D. O., Daniele S., Gianluca R., Renzo G., Sergio M., Morena B., Vitali M., Marina P., Paolo D. C., Cristina S., Orlandini F., La Regina M., Desiree A., Mario B., Paola P., Padulo F., Cristina M., Dario R., Giancarla M., Guido R., Elena M., Marileda N., Igor B., Nicole B., Elena R., Paolillo C., Riccardi A., Claudia B., Barbara R., Silvia V., Oliver B., Mauro C., Eleonora M., Giuseppe P., Rosaria T., Maria C., Davide D. A., Stefania C., Massimo P., Luca S., Martina D. F., Paola V., Lia S., Sandro C., Valentina D. S., Erminia B., Paola C., Romina R., Minisola S., Luciano C., Pasquale A., Ilaria L., Guglielmo S., Marco E., Sara R., Paola A., Claudio A., Francesco R., Alessandro C., Simona M., Lara F., Paola R., Simonetta C., Antonella C., Generoso U., Fernando G., Giuliano C., Emanuela S., Mariolina S., Alessandro D., Giulia L., Famularo S., Sandini M., Pinotti E., Gianotti L., Antonella B., Giulia P., Sante G., Rossi A., Rubele S., Sant S., Marco V., Danila C., Fabio R., Bandirali M. P., Nicoletta C., Laura B., Paolo T., Luciano T., Leonello A., Margherita S., Stefania D. N., Pierluigi D. S., Laura R., Fabiana T., Giovanna C., Antonino A., Felice C., Danilo F., Giovanna D. B., Francesco L., Salini S., Angela B. M., Giorgetta C., Giovanni G., Gerardo B., Silvio R., Letizia S., Davide B., Rosaria R. M., Maria D. A., Raffaele P., Palmieri V. O., Palasciano G., Belfiore A., Portincasa P., Carlo S., Alessia D., Valiani V., Carolina B., Tiziana C., Paola T., Ugo P., Giacomo P., Castellano M., Anna G., Elisa C., Federica C., Antonietta C. M., Luigi M., Fabio L., Salvatore B., Gelosa G., Viviana A. T., Piras V., Andrea C., Alessandra B., Coen D., Magliola R., Milanesio D., Muzzulini C. L., Paolo F., Marinella T., Sofia C. M., Marta B., Siano P., Capo G., Napoletano R., Cecilia P., Mancini C., Del Buono C., De Bartolomeo G., Addolorata M., Carmen C., Giovanni V. A., Moschettini G., Franco M., Daniela R., D'Amico G., Mirella P., Endrizzi C., Trotta L., Ciarambino T., Orazio Z., Emanuela T., Marta S., Thomas F., Giacomo T., Ignazio D. F., Andrea B., Giuseppe O., Emanuela F., Serena A., Elena D. I., Serena B., Erika N., Roberto S., Elena S., Manuela P., Francesca A., Angelo T., Morandi, A, Zambon, A, Di Santo, S, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Marengoni, A, Bellelli, G, Rispoli, V, Malara, A, Spadea, F, Di Cello, S, Ceravolo, F, Fabiano, F, Chiaradia, G, Gabriele, A, Lenino, P, Andrea, T, Settembrini, V, Capomolla, D, Citrino, A, Scriva, A, Bruno, I, Secchi, R, De Martino, E, Muccinelli, R, Lupi, G, Paonessa, P, Fabbri, A, Passuti, M, Castellari, S, Po, A, Gaggioli, G, Varesi, M, Moneti, P, Capurso, S, Latini, V, Ghidotti, S, Riccardelli, F, Macchi, M, Rigo, R, Claudio, P, Angelo, B, Flavio, C, Benedetta, B, Boffelli, S, Cassinadri, A, Franzoni, S, Spazzini, E, Andretto, D, Tonini, G, Andreani, L, Coralli, M, Balotta, A, Cancelliere, R, Ballardini, G, Simoncelli, M, Mancini, A, Strazzacapa, M, Fabio, S, De Filippi, F, Giudice, C, Dentizzi, C, Azzini, M, Cazzadori, M, Mastroeni, V, Bertassello, P, Claudia Benati, H, Nesta, E, Tobaldini, C, Guerini, F, Elena, T, Mombelloni, P, Fontanini, F, Gabriella, L, Pizzorni, C, Oliverio, M, Del Grosso, L, Giavedoni, C, Bidoli, G, Mazzei, B, Corsonello, A, Fusco, S, Vena, S, De Vuono, T, Maiuri, G, Luca, F, Andrea, A, Giovanni, S, Rossella, N, Castegnaro, E, De Rosa, S, Sechi, R, Benvenuti, E, Del Lungo, I, Giardini, S, Giulietti, C, Mauro, D, Eleonora, B, Martina, P, Irene, F, Riccardo, B, Federica, S, Ilaria, D, Bertoletti, E, D'Amico, F, Caronzolo, F, Grippa, A, Lombardo, G, Pipicella, T, Antonino, S, Francesco, C, Valeria, P, Daniela, L, Domenico, C, Giorgio, B, March, A, Nitti, M, Felici, A, Pavan, S, Piazzani, F, Lunelli, A, Dimori, S, Margotta, A, Soglia, T, Postacchini, D, Brunelli, R, Santini, S, Francavilla, M, Macchiati, I, Sorvillo, F, Giuli, C, Mecocci, P, Longo, A, Perticone, F, Addesi, D, Rosa, P, Bencardino, G, Falbo, T, Grillo, N, Marco, F, Mirella, F, Fanto, F, Isaia, G, Pezzilli, S, Bergamo, D, Furno, E, Rrodhe, S, Lucarini, S, Dijk, B, Dall'Acqua, F, Cappelletto, F, Calvani, D, Becheri, D, Giuseppe, M, Costanza, M, Vito, A, Francesca, B, Magherini, L, Novella, M, Franca, B, Lucia Gambardella, P, Valente, C, Ilaria, B, Alice, F, Porrino, P, Ceci, G, Giuliana, B, Michela, T, Eleonora, C, Ettore, E, Camellini, C, Servello, A, Grassi, A, Rozzini, R, Tironi, S, Grassi, M, Troisi, E, Carlo, C, Simona Gabriella, D, Flaminia, F, Federica, R, Beatrice, P, Sofia, T, Gabutto, A, Quazzo, L, Rosatello, A, Suraci, D, Tagliabue, B, Perrone, C, Ferrara, L, Castagna, A, Tremolada, M, Giuseppe, C, Stefano, B, Davide, O, Piano, S, Serviddio, G, Lo Buglio, A, Gurrera, T, Merlo, V, Rovai, C, Cotroneo, A, Carlucci, R, Abbaldo, A, Monzani, F, Qasem, A, Bini, G, Tafuto, S, Galli, G, Bruni, A, Mancuso, G, Calipari, D, Giuseppe Massimiliano, D, Bernardini, B, Corsini, C, Michele, C, Sara, D, Cagnin, A, Fragiacomo, F, Pompanin, S, Piero, A, Marco, C, Zurlo, A, Guerra, G, Pala, M, Menozzi, L, Gatti, C, Magon, S, Roberto, M, Alfredo, D, Fabio, F, Ruana, T, Elisa, M, Christian, M, Marco, P, Massimo, G, Di Francesco, V, Faccioli, S, Pellizzari, L, Giorgia, F, Barbagallo, G, Lunardelli, M, Martini, E, Ferrari, E, Macchiarulo, M, Corneli, M, Bacci, M, Battaglia, G, Anastasio, L, Lo Storto, M, Seresin, C, Simonato, M, Loreggian, M, Cestonaro, F, Durando, M, Latella, R, Mazzoleni, M, Russo, G, Ponte, M, Valchera, A, Salustri, G, Petritola, D, Costa, A, Sinforiani, E, Cotta, M, Pizio, R, Cester, A, Formilan, M, Pietro, B, Carbone, P, Cazzaniga, I, Appollonio, I, Cereda, D, Stabile, A, Xhani, R, Acampora, R, Tremolizzo, L, Federico, P, Antonio, C, Valerio, P, Cesare, B, Zhirajr, M, Giovanni, V, Maria, A, Mariaelena, S, Bottacchi, E, Bucciantini, E, Di Giovanni, M, Franchi, F, Lucchetti, L, Mariani, C, Grande, G, Rapazzini, P, Marco, M, Romanelli, G, Franco, N, Alessio, M, Nicola, L, Laura, P, Nazario, P, Chiara, G, Soccorso, P, Andrea, S, Luca, B, Francesca, S, Roberto, A, Anna, C, Fugazza, L, Guerrini, C, De Paduanis, G, Iallonardo, L, Palumbo, P, Zuliani, G, Ortolani, B, Capatti, E, Soavi, C, Bianchi, L, Francesconi, D, Miselli, A, Gloria, B, Tommaso, R, Chiara, P, Agata, M, Marco, D, Luca, M, Gianluca, G, Suardi, T, Zaccarini, C, Manuela, R, Mirra, G, Muti, E, Bottura, R, Gianpaolo, M, Secreto, P, Bisio, E, Cecchettani, M, Naldi, T, Pallavicino, A, Pugliese, M, Iozzo, R, Grassi, G, Bombelli, M, Dell'Oro, R, Quarti Trevano, F, Giussani, G, Paternò, G, Contro, E, Mannironi, A, Giorli, E, Oberti, S, Fierro, B, Piccoli, T, Giacalone, F, Mandas, A, Serchisu, L, Costaggiu, D, Pinna, E, Orru, F, Mannai, M, Cordioli, Z, Pelizzari, L, Turcato, E, Arduini, P, Cacace, C, Chiloiro, R, Cimino, R, Ruberto, C, Giovanni, R, Pietro, G, Laura, G, Alberto, C, Carmen, R, Santo, P, Andriolli, A, Burattin, G, Rossi, L, Andreolli Antonino, C, Tezza, F, Maddalena, P, Laura, S, Crippa, P, Aloisio, P, Di Monda, T, Malighetti, A, Galbassini, G, Salutis, D, Ivaldi, C, Russo, A, Bennati, E, Pino, E, Zavarise, G, Pesci, A, Suigo, G, Faverio, P, Andrea, G, Sabrina, P, Zanasi, M, Moniello, G, Rostagno, C, Cartei, A, Polidori, G, Ungar, A, Melis, M, Martellini, E, Enrico, M, Monica, T, Antonella, G, Giovanna, L, Migliorini, M, Caramelli, F, Battiston, B, Berardino, M, Cavallo, S, Alessandro, M, Anna, S, Lombardi, B, D'Ippolito, P, Furini, A, Villani, D, Clara, R, Guarneri, M, Paolucci, S, Bassi, A, Coiro, P, De Angelis, D, Morone, G, Venturiero, V, Palleschi, L, Raganato, P, Di Niro, G, Rosa, C, Loredana, B, Imoscopi, A, Tibaldi, V, Bottignole G, G, Calvi, E, Clementi, C, Zanocchi, M, Agosta, L, Nortarelli, A, Provenzano, G, Mari, D, Romano, F, Rosini, F, Mansi, M, Rossi, S, Geriatria, A, Inzaghi, L, Bonini, G, Rossi, P, Potena, A, Lichii, M, Candiani, T, Grimaldi, W, Bertani, E, Alessandra, P, Calogero, P, Pinto, D, Bernardi, R, Nicolino, F, Galetti, C, Gianstefani, A, Giulia, C, Lorenzo, M, Odetti, P, Monacelli, F, Prefumo, M, Fiammetta, M, Canepa, M, Minaglia, C, Paolisso, G, Rizzo, M, Prestano, R, Dalise, A, Barra, D, Bosco, L, Asprinio, V, Dallape, L, Perina, E, Incalzi, R, Bartoli, I, Pluderi, A, Maina, A, Pecoraro, E, Sciarra, M, Prudente, A, Paola, M, Francesca, M, Manuel, V, Luisella, C, Maria, P, Tina, S, Benini, L, Levato, F, Mhiuta, V, Alius, F, Davidoaia, D, Giardini, V, Garancini, M, Bellamoli, C, Terranova, L, Bozzini, C, Tosoni, P, Provoli, E, Cascone, L, Dioli, A, Ferrarin, G, Bucci, A, Bua, G, Fenu, S, Bianchi, G, Casella, S, Romano, V, Maurizio, P, Mascherona, I, Belotti, G, Cavaliere, S, Cuni, E, Merciuc, N, Oberti, R, Veneziani, S, Capoferri, E, De Bernardi, E, Colombo, K, Bravi, M, Nicoletta, N, D'Arcangelo, P, Montenegro, N, Montanari, R, Lamanna, P, Gasperini, B, Isabella, M, Stefania, D, Gaia, A, Filippo, C, Palama, C, Di Emidio, C, Scarpini, E, Arighi, A, Fumagalli, G, Basilico, P, De Amicis Margherita, M, Marta, M, Diletta, M, Granata, A, Ranalli, C, Cammilli, A, Cavallini, M, Tricca, M, Natella, D, Gabbani, L, Tesi, F, Martella, L, Imbrici, R, Guerrini, G, Scotuzzi, A, Sozzi, F, Valenti, L, Chiarello, A, Monia, M, Pilotto, A, Prete, C, Senesi, B, Meta, A, Pendenza, E, Pasqualetti, G, Polini, A, Tognini, S, Ballino, E, Dell'Aquila, G, Gasparrini, P, Marotti, E, Migale, M, Scrimieri, A, Falsetti, L, Salvi, A, Toigo, G, Ceschia, G, Rosso, A, Tongiorgi, C, Scarpa, C, De Dominicis, L, Pucci, E, Renzi, S, Cartechini, E, Tomassini, P, Del Gobbo, M, Ugenti, F, Romeo, P, Nardelli, A, Lauretani, F, Visioli, S, Montanari, I, Ermini, F, Giordano, A, Pigato, G, Simeone, E, Barbujani, M, Giampieri, M, Amoruso, R, Piccinini, M, Ferrari, C, Gambetti, C, Sfrappini, M, Semeraro, L, Striuli, R, Pelliccioni, G, Marinelli, D, Fabi, K, Rossi, T, Pesallaccia, M, Sabbatini, D, Gobbi, B, Cerqua, R, Tagliani, G, Schlauser, E, Caser, L, Caramello, E, Sandigliano, F, Rosso, G, Ferrari, A, Bendini, C, Luisa, D, Casella, M, Prampolini, R, Scevola, M, Vitale, E, Roberto, B, Carlo, F, Sergio, F, Alberto, S, Daniela, Z, Giulia, B, Serena, G, Michele, B, Maugeri, D, Sorace, R, Anzaldi, M, De Gesu, R, Morrone, G, Davolio, F, Fabbo, A, Palmieri, M, Zoli, M, Forti, P, Pirazzoli, L, Fabbri, E, Terenzi, L, Bergolari, F, Wenter, C, Ruffini, I, Insam, M, Abraham, E, Kirchlechner, C, Cucinotta, D, Antonino, L, Basile, G, Grazia, A, Parise, P, Boccali, A, Amici, S, Gambacorta, M, Lasagni, A, Lovati, R, Giovinazzo, F, Kimak, E, Zappa, P, Medici, F, Lo Castro, M, Mauro, F, De Luca, A, Sancesario, G, Martorana, A, Scaricamazza, B, Toniolo, S, Di Lorenzo, F, Liguori, C, Lasco, A, Vita, N, Giomi, M, Forte, F, Padovani, A, Rozzini, L, Ceraso, A, Salvatore, C, Cottino, M, Vitali, S, Marelli, E, Tripi, G, Miceli, S, Urso, G, Grioni, G, Vezzadini, G, Misaggi, G, Forlani, C, Avanzi, S, Serena, S, Claudia, C, Marilena, V, Alberto, L, Diego, G, Alessandro, G, Iemolo, F, Sanzaro, E, D'Asta, G, Proietto, M, Carnemolla, A, Razza, G, Spadaro, D, Bertolotti, M, Mussi, C, Neviani, F, Roberto, C, Valentina, G, Linda, M, Francesca, V, Tarozzi, A, Balestri, F, Mannarino, G, Bigolari, M, Natale, A, Grassi, S, Bottaro, C, Stefanelli, S, Bovone, U, Tortorolo, U, Quadri, R, Leone, G, Ponzetto, M, Frasson, P, Annoni, G, Confalonieri, R, Corsi, M, Moretti, D, Teruzzi, F, Umidi, S, Mazzola, P, Perego, S, Persico, I, Olivieri, G, Bonfanti, A, Hajnalka, S, Galeazzi, M, Massariello, F, Anzuini, A, Caffarra, P, Barocco, F, Spallazzi, M, Paolo, C, Simonetta, M, Chioatto, P, Bortolamei, S, Soattin, L, Ruotolo, G, Beneamino, B, Giuseppe, B, Bertazzoli, M, Rota, E, Adobati, A, Scarpa, A, Granziera, S, Zuccher, P, Fabbro, A, Zara, D, Lo Nigro, A, Franchetti, L, Toniolo, M, Marcuzzo, C, Rollone, M, Guerriero, F, Sgarlata, C, Masse, A, Zatti, G, Piatti, M, Graci, J, Benati, G, Boschi, F, Biondi, M, Fiumi, N, Erika, T, Locatelli, S, Mauri, S, Beretta, M, Margheritis, L, Desideri, G, Liberatore, E, Carucci, A, Bonino, P, Caput, M, Antonietti, M, Polistena, G, De la Pierre, F, Mari, M, Massignani, P, Tombesi, F, Selvaggio, F, Verbo, B, Bodoni, P, Marchionni, N, Sabatini, T, Mussio, E, Magni, E, Bianchetti, A, Crucitti, A, 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C., Paternò G., Contro E., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Mandas A., Serchisu L., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Turcato E., Arduini P., Cacace C., Chiloiro R., Cimino R., Ruberto C., Giovanni R., Pietro G., Laura G., Alberto C., Carmen R., Santo P. D., Andriolli A., Burattin G., Rossi L., Andreolli Antonino C. G., Tezza F., Maddalena P., Laura S., Crippa P., Aloisio P., Di Monda T., Malighetti A., Galbassini G., Salutis D., Ivaldi C., Russo A. M., Bennati E., Pino E., Zavarise G., Pesci A., Suigo G., Faverio P., Andrea G., Sabrina P., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Ungar A., Melis M. 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R., Pluderi A., Maina A., Pecoraro E., Sciarra M., Prudente A., Paola M., Francesca M., Manuel V., Luisella C., Maria P. L., Tina S., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bellamoli C., Terranova L., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Maurizio P., Mascherona I., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Veneziani S., Capoferri E., De Bernardi E., Colombo K., Bravi M., Nicoletta N., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Isabella M., Stefania D., Gaia A., Filippo C., Palama C., Di Emidio C., Scarpini E., Arighi A., Fumagalli G., Basilico P., De Amicis Margherita M., Marta M., Diletta M., Granata A., Ranalli C., Cammilli A., Cavallini M. C., Tricca M., Natella D., Gabbani L., Tesi F., Martella L., Imbrici R., Guerrini G., Scotuzzi A. M., Sozzi F., Valenti L., Chiarello A., Monia M., Pilotto A., Prete C., Senesi B., Meta A. C., Pendenza E., Pasqualetti G., Polini A., Tognini S., Ballino E., Dell'Aquila G., Gasparrini P. M., Marotti E., Migale M., Scrimieri A., Falsetti L., Salvi A., Toigo G., Ceschia G., Rosso A., Tongiorgi C., Scarpa C., De Dominicis L., Pucci E., Renzi S., Cartechini E., Tomassini P. F., Del Gobbo M., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Barbujani M., Giampieri M., Amoruso R., Piccinini M., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Fabi K., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Ferrari A., Bendini C., Luisa D. 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F., Andrea B., Giuseppe O., Emanuela F., Serena A., Elena D. I., Serena B., Erika N., Roberto S., Elena S., Manuela P., Francesca A., and Angelo T.

Abstract

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.

Published
2020

46. Management of the elderly cancer patients complexity: The radiation oncology potential

Author

Colloca, G., Tagliaferri, L., Capua, B. D., Gambacorta, M. A., Lanzotti, V., Bellieni, A., Monfardini, S., Balducci, L., Bernabei, R., Cho, W. C., Valentini, V., Colloca G., Tagliaferri L. (ORCID:0000-0003-2308-0982), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Bellieni A., Bernabei R. (ORCID:0000-0002-9197-004X), Valentini V. (ORCID:0000-0003-4637-6487), Colloca, G., Tagliaferri, L., Capua, B. D., Gambacorta, M. A., Lanzotti, V., Bellieni, A., Monfardini, S., Balducci, L., Bernabei, R., Cho, W. C., Valentini, V., Colloca G., Tagliaferri L. (ORCID:0000-0003-2308-0982), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Bellieni A., Bernabei R. (ORCID:0000-0002-9197-004X), and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

Radiation oncology has the potential to be an excellent option for the frail elderly cancer patients because of its limited systemic toxicities. It can be effective for curative, prophylactic, disease control or palliative purposes. Currently about 60% of all cancer patients undergoing active treatment at some point receive radiation treatment. However, though widely used, there are limited clinical trials strictly designed for the elderly. This paper will review the key points in the assessment and treatment of elderly cancer patient including quality of life, active life expectancy, cognitive performance, frailty, sarcopenia and how the new technologies can help to reach the key goal of maintaining autonomy and independence for the elderly cancer patient.

Published
2020

47. Avatar: Analysis for visual acuity prediction after eye interventional radiotherapy

Author

Pagliara, M. M., Tagliaferri, L., Lenkowicz, J., Azario, L., Giattini, D., Fionda, B., Sammarco, M. G., Lancellotta, V., Gambacorta, M. A., Blasi, M. A., Pagliara M. M., Tagliaferri L. (ORCID:0000-0003-2308-0982), Lenkowicz J., Azario L. (ORCID:0000-0001-8575-8627), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Blasi M. A. (ORCID:0000-0001-7393-7644), Pagliara, M. M., Tagliaferri, L., Lenkowicz, J., Azario, L., Giattini, D., Fionda, B., Sammarco, M. G., Lancellotta, V., Gambacorta, M. A., Blasi, M. A., Pagliara M. M., Tagliaferri L. (ORCID:0000-0003-2308-0982), Lenkowicz J., Azario L. (ORCID:0000-0001-8575-8627), Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Blasi M. A. (ORCID:0000-0001-7393-7644)

Abstract

Aim: The aim of this study was to detect clinical factors predictive of loss of visual acuity after treatment in order to develop a predictive model to help identify patients at risk of visual loss. Patients and Methods: This was a retrospective review of patients who underwent interventional radiotherapy (brachytherapy) with 106Ru plaque for primary uveal melanoma. A predictive nomogram for visual acuity loss at 3 years from treatment was developed. Results: A total of 152 patients were selected for the study. The actuarial probability of conservation of 20/40 vision or better was 0.74 at 1 year, 0.59 at 3 years, and 0.54 at 5 years after treatment. Factors positively correlated with loss of visual acuity included: age at start of treatment (p=0.004) and longitudinal basal diameter (p=0.057), while distance of the posterior margin of the tumor from the foveola was inversely correlated (p=0.0007). Conclusion: We identified risk factors affecting visual function and developed a predictive model and decision support tool (AVATAR nomogram).

Published
2020

48. The 2017 Assisi Think Tank Meeting on rectal cancer: A positioning paper

Author

Valentini, V., Marijnen, C., Beets, G., Bujko, K., De Bari, B., Cervantes, A., Chiloiro, G., Coco, C., Gambacorta, M. A., Glynne-Jones, R., Haustermans, K., Meldolesi, E., Peters, F., Rodel, C., Rutten, H., van de Velde, C., Aristei, C., Valentini V. (ORCID:0000-0003-4637-6487), Chiloiro G., Coco C. (ORCID:0000-0002-4713-7093), Gambacorta M. A. (ORCID:0000-0001-5455-8737), Meldolesi E., Valentini, V., Marijnen, C., Beets, G., Bujko, K., De Bari, B., Cervantes, A., Chiloiro, G., Coco, C., Gambacorta, M. A., Glynne-Jones, R., Haustermans, K., Meldolesi, E., Peters, F., Rodel, C., Rutten, H., van de Velde, C., Aristei, C., Valentini V. (ORCID:0000-0003-4637-6487), Chiloiro G., Coco C. (ORCID:0000-0002-4713-7093), Gambacorta M. A. (ORCID:0000-0001-5455-8737), and Meldolesi E.

Abstract

Background and purposes: To describe current practice in the management of rectal cancer, to identify uncertainties that usually arise in the multidisciplinary team (MDT)’s discussions (‘grey zones’) and propose next generation studies which may provide answers to them. Materials and methods: A questionnaire on the areas of controversy in managing T2, T3 and T4 rectal cancer was drawn up and distributed to the Rectal-Assisi Think Tank Meeting (ATTM) Expert European Board. Less than 70% agreement on a treatment option was indicated as uncertainty and selected as a ‘grey zone’. Topics with large disagreement were selected by the task force group for discussion at the Rectal-ATTM. Results: The controversial clinical issues that had been identified within cT2–cT3–cT4 needed further investigation. The discussions focused on the role of (1) neoadjuvant therapy and organ preservation on cT2-3a low-middle rectal cancer; (2) neoadjuvant therapy in cT3 low rectal cancer without high risk features; (3) total neoadjuvant therapy, radiotherapy boost and the best chemo-radiotherapy schedule in T4 tumors. A description of each area of investigation and trial proposals are reported. Conclusion: The meeting successfully identified ‘grey zones’ and, in the light of new evidence, proposed clinical trials for treatment of early, intermediate and advanced stage rectal cancer.

Published
2020

49. Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Author

Pieralli, F., Vannucchi, V., Nozzoli, C., Augello, G., Dentali, F., De Marzi, G., Uomo, G., Risaliti, F., Morbidoni, L., Mazzone, A., Santini, C., Tirotta, D., Corradi, F., Gerloni, R., Gnerre, P., Gussoni, G., Valerio, A., Campanini, M., Manfellotto, D., Fontanella, A., Attardo, T., Tavecchia, L., Gessi, V., Torrigiani, A., Corbo, L., Gallucci, F., Mastrobuoni, C., Giani, A., Teodora, C., Ricchiuti, E., Rosato, A., Giampaolo, L., Di Gregorio, S., Parodi, L., Pallini, F., Landini, G., Giuri, P., Prampolini, G., Arioli, D., Leone, M. C., Canale, C., Condemi, F., Lupica, R., Manzola, F., Masciana, R., Agnelli, G., Becattini, C., D'Agostini, E., Mosconi, M. G., Bogliari, G., Rossi, A., Iannantuoni, G., Bartolino, L., Montagnani, A., Verdiani, V., Gambacorta, M., Lenti, S., Francioni, S., Pierfranceschi, M. G., Cattabiani, C., Orlandini, F., Scuotri, L., La Regina, M., Corsini, F., Anastasio, L., Mumoli, N., Mazzi, V., Camaiti, A., Balbi, G., Ragazzo, F., Pengo, M., Pieralli, F, Vannucchi, V, Nozzoli, C, Augello, G, Dentali, F, De Marzi, G, Uomo, G, Risaliti, F, Morbidoni, L, Mazzone, A, Santini, C, Tirotta, D, Corradi, F, Gerloni, R, Gnerre, P, Gussoni, G, Valerio, A, Campanini, M, Manfellotto, D, Fontanella, A, Attardo, T, Tavecchia, L, Gessi, V, Torrigiani, A, Corbo, L, Gallucci, F, Mastrobuoni, C, Giani, A, Teodora, C, Ricchiuti, E, Rosato, A, Giampaolo, L, Di Gregorio, S, Parodi, L, Pallini, F, Landini, G, Giuri, P, Prampolini, G, Arioli, D, Leone, M, Canale, C, Condemi, F, Lupica, R, Manzola, F, Masciana, R, Agnelli, G, Becattini, C, D'Agostini, E, Mosconi, M, Bogliari, G, Rossi, A, Iannantuoni, G, Bartolino, L, Montagnani, A, Verdiani, V, Gambacorta, M, Lenti, S, Francioni, S, Pierfranceschi, M, Cattabiani, C, Orlandini, F, Scuotri, L, La Regina, M, Corsini, F, Anastasio, L, Mumoli, N, Mazzi, V, Camaiti, A, Balbi, G, Ragazzo, F, and Pengo, M

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Community-acquired pneumonia, Myocardial Infarction, Disease, Cardiovascular event, 030204 cardiovascular system & hematology, lcsh:Infectious and parasitic diseases, Cardiovascular events, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Prevalence, Pneumonia, Bacterial, 80 and over, Humans, Cumulative incidence, lcsh:RC109-216, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Incidence, Bacterial, Correction, Pneumonia, Length of Stay, Middle Aged, medicine.disease, Hospitalization, Community-Acquired Infections, Infectious Diseases, Italy, Heart failure, Observational study, Female, business, Hospital Units, Research Article
Abstract

Background The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p p = 0.009). Conclusion Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration NCT03798457 Registered 10 January 2019 - Retrospectively registered

Published
2021

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