Antonella Ciabattoni - Academia.edu (original) (raw)

Papers by Antonella Ciabattoni

BMC Cancer, 2012

Background: To evaluate disease control, overall survival and prognostic factors in patients with... more Background: To evaluate disease control, overall survival and prognostic factors in patients with locally recurrent rectal cancer after IOERT-containing multimodal therapy. Methods: Between 1991 and 2006, 97 patients with locally recurrent rectal cancer have been treated with surgery and IOERT. IOERT was preceded or followed by external beam radiation therapy (EBRT) in 54 previously untreated patients (median dose 41.4 Gy) usually combined with 5-Fluouracil-based chemotherapy (89%). IOERT was delivered via cylindric cones with doses of 10-20 Gy. Adjuvant CHT was given only in a minority of patients (34%). Median follow-up was 51 months. Results: Margin status was R0 in 37%, R1 in 33% and R2 in 30% of the patients. Neoadjuvant EBRT resulted in significantly increased rates of free margins (52% vs. 24%). Median overall survival was 39 months. Estimated 5-year rates for central control (inside the IOERT area), local control (inside the pelvis), distant control and overall survival were 54%, 41%, 40% and 30%. Resection margin was the strongest prognostic factor for overall survival (3-year OS of 80% (R0), 37% (R1), 35% (R2)) and LC (3-year LC 82% (R0), 41% (R1), 18% (R2)) in the multivariate model. OS was further significantly affected by clinical stage at first diagnosis and achievement of local control after treatment in the univariate model. Distant failures were found in 46 patients, predominantly in the lung. 90-day postoperative mortality was 3.1%. Conclusion: Long term OS and LC can be achieved in a substantial proportion of patients with recurrent rectal cancer using a multimodality IOERT-containing approach, especially in case of clear margins. LC and OS remain limited in patients with incomplete resection. Preoperative re-irradiation and adjuvant chemotherapy may be considered to improve outcome.

European Urology Supplements, 2002

Clinical and Translational Oncology

Cancers

Aim. Breast IRRADIATA (Italian Repository of RADIotherapy dATA) is a collaborative nationwide pro... more Aim. Breast IRRADIATA (Italian Repository of RADIotherapy dATA) is a collaborative nationwide project supported by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) and the Italian League Against Cancer (LILT). It focuses on breast cancer (BC) patients treated with radiotherapy (RT) and was developed to create a national registry and define the patterns of care in Italy. A dedicated tool for data collection was created and pilot tested. The results of this feasibility study are reported here. Methods. To validate the applicability of a user-friendly data collection tool, a feasibility study involving 17 Italian Radiation Oncology Centers was conducted from July to October 2021, generating a data repository of 335 BC patients treated between January and March 2020, with a minimum follow-up time of 6 months. A snapshot of the clinical presentation, treatment modalities and radiotherapy toxicity in these patients was obtained. A Data Entry Survey and a Satisfaction Quest...

Critical Reviews in Oncology/Hematology

Tumori Journal

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of... more Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local r...

Radiology and Oncology, 2021

Background Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical pra... more Background Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical practice both as elective irradiation (partial breast irradiation – APBI) in low risk breast cancer patients, and as an anticipated boost. The procedure generally includes the use of a shielding disk between the residual breast and the pectoralis fascia for the protection of the tissues underneath the target volume. The aim of the study was to evaluate the role of intraoperative ultrasound (IOUS) in improving the quality of B-IOERT. Patients and methods B-IOERT was introduced in Trieste in 2012 and its technique was improved in 2014 with IOUS. Both, needle and IOUS were used to measure target thickness and the latter was used even to check the correct position of the shielding disk. The primary endpoint of the study was the evaluation of the effectiveness of IOUS in reducing the risk of a disk misalignment related to B-IOERT and the secondary endpoint was the analysis of acute and late toxi...

European Medical Journal Oncology, 2013

Pancreatic cancer remains one of the leading causes of cancer deaths. Despite improvements in ima... more Pancreatic cancer remains one of the leading causes of cancer deaths. Despite improvements in imaging, surgical techniques, chemotherapy agents, and radiation techniques, the prognosis for patients with pancreatic adenocarcinoma remains poor. Traditionally, radiotherapy (RT) has been utilized as neoadjuvant, adjuvant, or definitive treatment, and represents an important therapeutic option in pancreatic adenocarcinoma. Intensity-modulated radiation therapy (IMRT), a more recent RT technique, has the potential to deliver an adequate dose to the tumour volume with a minimal dose to the surrounding critical structures such as duodenum, small intestine, liver, kidneys, and spinal cord. This article provides a review about the role of IMRT in the treatment of pancreatic cancer, concerning clinical outcomes such as toxicity, local control, and overall survival.

Radiotherapy and Oncology, 2022

To quantify the dosimetric impact of contouring variability of axillary lymph nodes (L2, L3, L4) ... more To quantify the dosimetric impact of contouring variability of axillary lymph nodes (L2, L3, L4) in breast cancer (BC) locoregional radiotherapy (RT). 18 RT centres were asked to plan a locoregional treatment on their own planning target volume (single centre, SC-PTV) which was created by applying their institutional margins to the clinical target volume of the axillary nodes of three BC patients (P1, P2, P3) previously delineated (SC-CTV). The gold standard CTVs (GS-CTVs) of P1, P2 and P3 were developed by BC experts' consensus and validated with STAPLE algorithm. For each participating centre, the GS-PTV of each patient was created by applying the same margins as those used for the SC-CTV to SC-PTV expansion and replaced the SC-PTV in the treatment plan. Datasets were imported into MIM v6.1.7 [MIM Software Inc.], where dose-volume histograms (DVHs) were extracted and differences were analysed. 17/18 centres used intensity-modulated RT (IMRT). The CTV to PTV margins ranged from 0 to 10 mm (median 5 mm). No correlation was observed between GS-CTV coverage by 95% isodose and GS-PTV margins width. Doses delivered to 98% (D98) and 95% (D95) of GS-CTVs were significantly lower than those delivered to the SC-CTVs. No significant difference between SC-CTV and GS-CTV was observed in maximum dose (D2), always under 110%. Mean dose ≥ 99% of the SC-CTVs and GS-CTVs was satisfied in 84% and 50%, respectively. In less than one half of plans, GS-CTV V95% was above 90%. Breaking down the GS-CTV into the three nodal levels (L2, L3 and L4), L4 had the lowest probability to be covered by the 95% isodose. Overall, GS-CTV resulted worse coverage, especially for L4. IMRT was largely used and CTV-to-PTV margins did not compensate for contouring issues. The results highlighted the need for delineation training and standardization.

Journal of Contemporary Brachytherapy, 2021

Interventional radiotherapy (IRT, brachytherapy and intra-operative radiotherapy) is a complex tr... more Interventional radiotherapy (IRT, brachytherapy and intra-operative radiotherapy) is a complex treatment approach that requires a multi-professional approach. The aim of this work was to assess the role of radiation therapy technologist (RTT) in IRT team, with a special focus on brachytherapy as well as to define more appropriate ways to improve skills and training to promote cooperation of multi-professional team. Material and methods: A nationwide survey consisting of 16 questions was proposed between April and May 2020, with collaboration between the Italian Association of Radiation Therapy and Medical Physics Technologists (AITRO) and the Interventional Radiotherapy Study Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO). The survey was sent through the AITRO contact list to RTTs' contacts from all Italian radiotherapy (RT) departments. Results: A total of 37 answered questionnaires returned (36% of all contacts reached), each from different center. 23 centers (62%) presented with dedicated team for IRT treatments, while 15 centers (41%) had dedicated RTT staff. The majority of RTT (86%) did not consider undergraduate training adequate to acquire the skills required to work in IRT departments or units. Conclusions: This survey underlines the need of additional education and training for RTTs that should focus on treatment management optimization in development of an IRT multi-professional team. Specific updates could be the key to develop further collaboration and to improve cancer patient care.

Breast Cancer Research, 2021

The British Journal of Radiology, 2021

Objectives: To determine interobserver variability in axillary nodal contouring in breast cancer ... more Objectives: To determine interobserver variability in axillary nodal contouring in breast cancer (BC) radiotherapy (RT) by comparing the clinical target volume of participating single centres (SC-CTV) with a gold-standard CTV (GS-CTV). Methods: The GS-CTV of three patients (P1, P2, P3) with increasing complexity was created in DICOM format from the median contour of axillary CTVs drawn by BC experts, validated using the simultaneous truth and performance-level estimation and peer-reviewed. GS-CTVs were compared with the correspondent SC-CTVs drawn by radiation oncologists, using validated metrics and a total score (TS) integrating all of them. Results: Eighteen RT centres participated in the study. Comparative analyses revealed that, on average, the SC-CTVs were smaller than GS-CTV for P1 and P2 (by −29.25% and −27.83%, respectively) and larger for P3 (by +12.53%). The mean Jaccard index was greater for P1 and P2 compared to P3, but the overlap extent value was around 0.50 or less. ...

Anticancer Research, 2021

Aim: Radiation therapy is a cornerstone of oncological treatment and oncological patients show gr... more Aim: Radiation therapy is a cornerstone of oncological treatment and oncological patients show greater risk of developing complications related to COVID-19 infection. Stringent social restrictions have ensured a significant reduction in the spread of the virus, but also gave rise to a number of critical issues for radiation oncology wards. For this reason, the Directors of the Radiation Oncology Departments (RODs) of Lazio, Abruzzo and Molise regions shared their experience and ideas in order to create a common document that may assist in facing the negative impacts of the pandemic on radiation oncology wards and patients. Patients and Methods: The study was conducted according to the Estimate-Talk-Estimate method. Five issues were proposed and rated. Among approved issues, statements were proposed anonymously, then harmonized and finally voted on according to a Likert scale from 1 to 9. Those for which an agreement of 7-9 was observed were finally approved. Results: The document was developed with 42 statements dealing about safety measures for patients and staff, organization of clinical and work activities, usage of Information Technology systems for meetings/smart working. An agreement was recorded for 34 statements. Conclusion: This document sets out some recommendations for RODs and can provide valuable management information for Oncological Radiotherapy wards.

$Research paper thumbnail of Hypofractionated whole breast irradiation and IOERT in breast cancer: toxicity and cosmetic outcome$

The Breast, 2019

Goals: In East Africa, the estimated incidence of breast cancer comes second only to cervical can... more Goals: In East Africa, the estimated incidence of breast cancer comes second only to cervical cancer. Supraclavicular irradiation post modified mastectomy is a crucial component of breast cancer management; it improves local control and overall survival. This is however associated with adverse effects including hypothyroidism (HT) which is usually under-reported. The purpose of this study was to evaluate the radiation induced thyroid gland functional changes following treatment of supraclavicular lymph nodes in breast cancer patients. Methods: This was a prospective descriptive study of patients with breast cancer from May 1, 2017 to May 30, 2018. Pre and post treatment TSH, fT4 and fT3 values were compared using a Wilcoxon signed-rank test. Results: A total of 42 patients were recruited for this study with a mean age of 55.7 (32-71) years. The mean for baseline TSH level was 2.90(±6.37) (normal range: 0.27-4.2 uIU/mL) while that for T4 and T3 were 15.77(±4.83) (normal range: 10.16-22 pmol/l) and 3.46(±6.22) (normal range: 1.06-3.3 nmol/l) respectively. A Wilcoxon signedrank test indicated that there was a statistically significant rise in mean TSH level over baseline when measured at 3, 6 and 9 months post treatment with a p-values of 0.0047, 0.0002 and less than 0.0001 respectively. In total 4 (10%) patients had thyroid functions tests outside normal ranges. None of the patients developed clinical HT in the time period studied. Conclusions: As it was hypothesized, supraclavicular radiation led to subclinical HT, but the incidence of clinical HT over time remains unknown. Conflict of Interest: No significant relationships. P185 Antihormonal treatment with or without whole breast irradiation in low risk breast cancer patients after breast conserving surgery: 10-year results of the ABCSG 8A trial

Strahlentherapie und Onkologie, 2007

Radiotherapy and Oncology, 2011

EXPERIENCE WITH IORT AS INTRAOPERATIVE INTENSIFICATION THERAPY IN THE TREATMENT OF LOCALLY ADVANC... more EXPERIENCE WITH IORT AS INTRAOPERATIVE INTENSIFICATION THERAPY IN THE TREATMENT OF LOCALLY ADVANCED RETROPERITONEAL AND PELVIC SARCOMAS E. Velasco Sanchez1, J. L. Garcia-Sabrido1, F. Calvo2, L. Gomez Lanz1, L. Gonzalez-Bayon1, L. Rodriguez-Bachiller1, B. Diaz-Zorita1, E. Ruiz Ucar1, P. Alvarez de Sierra1 1 HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARANON, Oncological Surgery, Madrid, Spain 2 HOSPITAL GREGORIO MARANON, Oncology and Radiotherapy, Madrid, Spain

International Journal of Radiation Oncology*Biology*Physics, 2002

Purpose: To evaluate the impact of tumor response; tumor and nodal downstaging; and cTNM, yTNM (c... more Purpose: To evaluate the impact of tumor response; tumor and nodal downstaging; and cTNM, yTNM (clinical stage after chemoradiation, based on preoperative imaging), and pTNM classifications on long-term outcome in patients with rectal cancer treated with preoperative 5-fluorouracil (5-FU)-based concurrent chemoradiation. Methods and Materials: Between January 1990 and March 1998, 165 consecutive patients with locally advanced extraperitoneal cancer of the rectum were treated with preoperative chemoradiation. Four patients had a cT2 lesion (2.5%), 120 had a cT3 lesion (74.5%), and 41 had a cT4 lesion (23%). The nodal involvement at combined imaging was cN0 in 21%, cN1 in 41%, cN2 in 34%, and cN3 in 4%. Preoperative chemoradiation was delivered according to 1 of 3 schedules: (1) FUMIR-T3 (from 1990 to 1995) for patients with cT3N0-2 or cT2N1-2 rectal carcinoma (82 patients): 37.8 Gy (1.8 Gy/fraction) plus 5-FU, 1 g/m 2 /d on Days 1-4, continuous infusion, and mitomycin-C, 10 mg/m 2 /d on Day 1; (2) FUMIR-T4 (from 1990 to 1999) for patients with cT4N0-3 or cT3-4N3 rectal carcinoma (40 patients): 45 Gy (1.8 Gy/fraction) plus 5-FU, 1 g/m 2 /d on Days 1-4 and 29-32, continuous infusion, and mitomycin-C, 10 mg/m 2 /d on Days 1 and 29; and (3) PLAFUR-4 (from 1995 to 1998) for patients with cT3N0-2 or cT2N1-2 rectal carcinoma (42 patients): 50.4 Gy (1.8 Gy/fraction) plus 5-FU, 1 g/m 2 /d on Days 1-4 and 29-32, continuous infusion, and cisplatin, 60 mg/m 2 /d on Days 1 and 29. Four to five weeks after chemoradiation, patients were reevaluated for clinical response by imaging studies (CT scan, transrectal ultrasonography, barium enema, liver ultrasonography, chest X-rays) and restaged (yTNM). Surgery was performed 6-8 weeks after chemoradiation. Adjuvant chemotherapy (5-FU ؉ l-folinic acid) was delivered to 26 patients in the FUMIR-T4 protocol group. Local control (LC), freedom from distant metastases (FDM), disease-free survival, and overall survival (OS) were evaluated according to the clinical response and cTNM, yTNM, and pTNM classification. The median follow-up was 67 months. Results: The 5-year survival rate was 100% for cT2, 77% for cT3, and 62% for cT4 (p ‫؍‬ 0.0497); after chemoradiation, it ranged between 81% and 91% for pT0-pT2 and dropped to 66% for pT3 and 47% for pT4 (p ‫؍‬ 0.014). The 5-year local control rate was, at the first staging, 84% for cT3 and 72% for cT4; after chemoradiation, the pT stage correlated significantly with LC (p ‫؍‬ 0.0012): 100% for pT0, 83% for pT1, 88% for pT2, 79% for pT3, and 46% for pT4. N stage was statistically significant in predicting FDM and OS at any staging step. A significant impact of tumor response, tumor downstaging, and nodal downstaging on LC, FDM, disease-free survival, and OS was also recorded. If the residual tumor, before surgery, had a tumor index <30 (i.e., width less than one-quarter of rectal circumference and length in its caudocranial axis <30 mm), the 5-year LC, FDM, disease-free survival, and OS rates were significantly higher at both the univariate and the multivariate analyses. The surgical procedure was tailored according to tumor downstaging, and thus the choice of sphincter-preserving surgery was based on the distance between the lower pole of the tumor and the anorectal ring "after" chemoradiation. In 36 patients with the lower pole of the lesion in the range of 0-30 mm from the anorectal ring, 16 patients (44%) underwent a sphincter-saving procedure. All clinical outcomes were similar compared with 20 patients with tumor located at the same rectum level who received an abdominoperineal resection. Conclusion: After preoperative chemoradiation, clinical response and tumor/nodal pathologic downstaging showed a close correlation with improved outcomes. The better 5-year survival and local control in pT0-2

International Journal of Radiation Oncology*Biology*Physics, 1996

Purpose: Today the prognosis for patients with esophageal carcinoma still remains quite poor. In ... more Purpose: Today the prognosis for patients with esophageal carcinoma still remains quite poor. In the last few @%&iieresting results have been obtained by associating radio-and chemotherapy with or without surgery with this type of cancer. In this work we report the results of concomitant radio-and chemotherapy in a spiitcourse schedule preceeding surgery for the treatment of squamous cell carcinomas of the esophagus. Methods and Materials: Fifty-six patients with squamous cell carcinomas of the esophagus were treated between April 1989 and September 1993 in the Centre Hospitalier Universitaire in Brest, France with two courses of preoperative concomitant radiochemotherapy, separated by a 2-week interval, and followed by surgery (each course 18.5 Gy in five fractions, days l-5 with continuous infusion 5fluorouracil (5FU) 800 mg/m" days l-5 and cisplatinum 70 mg/m* day 2). Patients who had responded well to preoperative treatment (response >50%) received four more courses of chemotherapy alone. The two patients who were not operated and those with palliative surgery received a third course of radiochemotherapy (radiotherapy 12 Gy in five fractions, days l-5). Results: Fifty-four patients were operated on. Twenty-one showed histological complete response at surgery (37.5% of the whole group). Actuarial survival for the 56 patients was 55% at 3 years and 30% at 4 years, with a median survival of 37.4 months (40.4 months for complete responders to preoperative treatment). Toxicity of preoperative concomitant radio-chemotherapy was low (5-FU had to be stopped in one patient because of cardiac rythm disturbances and in another patient because of aplasia Grade 4 associated with infection after the first course). Postoperative mortality was 11% (six patients). Conclusion: This combination of preoperative radiochemotherapy followed by surgery seems to improve both response rates and survival in patients with esophageal cancer when compared with previous patients treated with surgery alone in our hospital or with results found in literature and it warrants further studies.

Breast Cancer Research

Background Intraoperative radiotherapy with electrons (IOERT) boost could be not inferior to exte... more Background Intraoperative radiotherapy with electrons (IOERT) boost could be not inferior to external beam radiotherapy (EBRT) boost in terms of local control and tissue tolerance. The aim of the study is to present the long-term follow-up results on local control, esthetic evaluation, and toxicity of a prospective study on early-stage breast cancer patients treated with breast-conserving surgery with an IOERT boost of 10 Gy (experimental group) versus 5 × 2 Gy EBRT boost (standard arm). Both arms received whole-breast irradiation (WBI) with 50 Gy (2 Gy single dose). Methods A single-institution phase III randomized study to compare IOERT versus EBRT boost in early-stage breast cancer was conducted as a non-inferiority trial. Primary endpoints were the evaluation of in-breast true recurrences (IBTR) and out-field local recurrences (LR) as well as toxicity and cosmetic results. Secondary endpoints were overall survival (OS), disease-free survival (DFS), and patient’s grade of satisfa...