Sara Bresciani - Academia.edu (original) (raw)

Papers by Sara Bresciani

Research paper thumbnail of Radiation Oncology Departement

Radiotherapy after partial laryngectomy: an analysis of 36 cases and a proposal to optimize radio... more Radiotherapy after partial laryngectomy: an analysis of 36 cases and a proposal to optimize radiotherapy

Research paper thumbnail of Personalized image-guided radiotherapy with multidisciplinary approach in long-surviving oligo-metastatic prostate cancer patient: A case report

Archivio per le scienze mediche, 2016

Research paper thumbnail of Improving dose delivery accuracy with EPID in vivo dosimetry: results from a multicenter study

Strahlentherapie und Onkologie, 2021

To investigate critical aspects and effectiveness of in vivo dosimetry (IVD) tests obtained by an... more To investigate critical aspects and effectiveness of in vivo dosimetry (IVD) tests obtained by an electronic portal imaging device (EPID) in a multicenter and multisystem context. Eight centers with three commercial systems—SoftDiso (SD, Best Medical Italy, Chianciano, Italy), Dosimetry Check (DC, Math Resolution, LCC), and PerFRACTION (PF, Sun Nuclear Corporation, SNC, Melbourne, FL)—collected IVD results for a total of 2002 patients and 32,276 tests. Data are summarized for IVD software, radiotherapy technique, and anatomical site. Every center reported the number of patients and tests analyzed, and the percentage of tests outside of the tolerance level (OTL%). OTL% was categorized as being due to incorrect patient setup, incorrect use of immobilization devices, incorrect dose computation, anatomical variations, and unknown causes. The three systems use different approaches and customized alert indices, based on local protocols. For Volumetric Modulated Arc Therapy (VMAT) treatments OTL% mean values were up to 8.9% for SD, 18.0% for DC, and 16.0% for PF. Errors due to “anatomical variations” for head and neck were up to 9.0% for SD and DC and 8.0% for PF systems, while for abdomen and pelvis/prostate treatments were up to 9%, 17.0%, and 9.0% for SD, DC, and PF, respectively. The comparison among techniques gave 3% for Stereotactic Body Radiation Therapy, 7.0% (range 4.7–8.9%) for VMAT, 10.4% (range 7.0–12.2%) for Intensity Modulated Radiation Therapy, and 13.2% (range 8.8–21.0%) for 3D Conformal Radiation Therapy. The results obtained with different IVD software and among centers were consistent and showed an acceptable homogeneity. EPID IVD was effective in intercepting important errors.

Research paper thumbnail of PO-1903 Building and comparing treatment quality assessment algorithms among two different clinics

Radiotherapy and Oncology, 2021

Research paper thumbnail of Estimating dose delivery accuracy in stereotactic body radiation therapy: A review of in-vivo measurement methods

Radiotherapy and Oncology, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Comparison of two different EPID-based solutions performing pretreatment quality assurance: 2D portal dosimetry versus 3D forward projection method

Physica Medica, 2018

The aim of this paper is to characterize two different EPID-based solutions for pre-treatment VMA... more The aim of this paper is to characterize two different EPID-based solutions for pre-treatment VMAT quality assurance, the 2D portal dosimetry and the 3D projection technique. Their ability to catch the main critical delivery errors was studied. Methods: Measurements were performed with a linac accelerator equipped with EPID aSi1000, Portal Dose Image Prediction (PDIP), and PerFRACTION softwares. Their performances were studied simulating perturbations of a reference plan through systematic variations in dose values and micromultileaf collimator position. The performance of PDIP, based on 2D forward method, was evaluated calculating gamma passing rate (%GP) between no-error and error-simulated measurements. The impact of errors with PerFRACTION, based on 3D projection technique, was analyzed by calculating the difference between reference and perturbed DVH (%ΔD). Subsequently pre-treatment verification with PerFRACTION was done for 27 patients of different pathologies. Results: The sensitivity of PerFRACTION was slightly higher than sensitivity of PDIP, reaching a maximum of 0.9. Specificity was 1 for PerFRACTION and 0.6 for PDIP. The analysis of patients' DVHs indicated that the mean %ΔD was (1.2 ± 1.9)% for D2%, (0.6 ± 1.7)% for D95% and (−0.0 ± 1.2)% for Dmean of PTV. Regarding OARs, we observed important discrepancies on DVH but that the higher dose variations were in low dose area (< 10 Gy). Conclusions: This study supports the introduction of the new 3D forward projection method for pretreatment QA raising the claim that the visualization of the delivered dose distribution on patient anatomy has major advantages over traditional portal dosimetry QA systems.

Research paper thumbnail of Radiotherapy after Partial Laryngectomy: An Analysis of 36 Cases and a Proposal to Optimize Radiotherapy

Tumori Journal, 2009

Aims and background Laryngeal cancer treatment options include radical surgery, “organ preservati... more Aims and background Laryngeal cancer treatment options include radical surgery, “organ preservation surgery”, radiotherapy and chemotherapy. There is no proven evidence of a significant increase in late toxicity with adjuvant radiotherapy after conservative surgery. The aim of this retrospective study was to evaluate the toxicity, local-regional control and overall survival of adjuvant radiotherapy after conservative surgery. Methods A total of 36 patients was treated with radiotherapy after partial laryngectomy at the Radiotherapy Department of the Institute for Cancer Treatment and Research (IRCC) of Candiolo and of the Mauriziano Hospital in Turin, between 1994 and 2007. The postoperative treatment doses ranged from 45 to 70.2 Gy with conventional fractionation. The Kaplan-Meier method was applied for statistical analysis. The RTOG-EORTC scale was used to evaluate late and acute toxicity. Results Overall 5- and 10-year survival was 93% and 47%, respectively. Local control was 93....

Research paper thumbnail of PV-0484 In vivo dosimetry using CBCT and EPID device: analysis of sources of errors in VMAT treatments

Radiotherapy and Oncology, 2019

Conclusion The dosimetric accuracy of the MR-linac online adaption workflow was tested for the fi... more Conclusion The dosimetric accuracy of the MR-linac online adaption workflow was tested for the first time using PRESAGE® dosimeters and a phantom mimicking a tumour in the lungs. The dose distributions were accurately delivered to the target by positioning the phantom at the isocenter and by shifting it and applying the adaptive planning workflow. Complex IMRT plans will be evaluated in the future using larger samples of PRESAGE®.

Research paper thumbnail of 16. Predicting neoadjuvant therapy response in locally advanced rectal cancer using texture features

Research paper thumbnail of 141. A preliminary study to evaluate the impact of calculation grid resolution and CT slice thickness on TPS calculated small fields OF

Research paper thumbnail of EP-1290: Helical Tomotherapy plus Brachytherapy boost in cervical cancer: a double dose escalation

Radiotherapy and Oncology, 2017

Purpose or Objective Elderly patients with cervical cancer (CC) are commonly treated with radiati... more Purpose or Objective Elderly patients with cervical cancer (CC) are commonly treated with radiation therapy (RT) alone because agerelated physiologic changes can increase the toxicity of chemotherapy. Thus, brachytherapy (BT) assumes more crucial role for elderly patients with CC. In our institution, treatment technique of BT has moved from 2D-based to CT-based image guided BT (IGBT) in a phased manner. The purpose of this study is to analyze the impact of fraction of IGBT on the clinical outcome for elderly patients with CC. Material and Methods Between January 2001 and September 2014, 104 patients aged≧70 years with CC received external beam RT (EBRT) and high-dose rate BT with curative intent in our institution. EBRT (38.0-56.8 Gy) with central shielding after 20-40 Gy was performed for each patient. We compared clinical results of two groups; the patients treated with IGBT only once (single-IGBT group, n=74) or at least twice (multiple-IGBT group, n=30) out of all sessions of BT. Four fractions of BT were administered once a week with a fraction dose of 6 Gy to Point A,basically. Dose adaptation was initially based on dose changes at Point A in IGBT session. If dose adaptation to Point A could not be achieved as intended, manual optimization of dwell positions and dwell weights was performed to improve dosimetry. We predicted that a 6 Gy isodose line would cover the high-risk clinical target volume (HR CTV) in order to achieve a HR CTV D90 (the minimum dose delivered to 90% of the HR CTV) of >6 Gy. The local control (LC) rate, overall survival (OS) rates, and late toxicities were compared in the 2 groups. Late toxicity was defined using the Radiation Therapy Oncology Group late radiation morbidity scoring system as any toxicity occurring 6 months after the initiation of RT. Results The median follow-up period was 59 months in all patients. Twenty-seven patients had stage IB, 45 had stage II, 29 had stage III, and 3 had stage IVA in FIGO staging. The median dose of all BT sessions in total was 24 (7.8-31) Gy at Point A. There was no statistical difference between the two groups in age, FIGO stage, tumor size, Point A dose, and the number of BT. The 4-year LC and OS rates were 89.5% and 70.2% in single-IGBT group, 87.5% and

Research paper thumbnail of EP-1326: Long term patients clinical outcome after salvage post-prostatectomy Radiation Therapy (RT)

Radiotherapy and Oncology, 2017

Research paper thumbnail of Three years of experience with dose reduction by means of iterative reconstruction algorithm available on CT Siemens Somatom Definition Flash

Research paper thumbnail of EP-1361: Prognostic factors in 1080 prostate cancer treated with radical external beam radiotherapy

Radiotherapy and Oncology, 2016

Figure 1. An example of a patient with large variation in bladder filling between planning CT (th... more Figure 1. An example of a patient with large variation in bladder filling between planning CT (thin light green) and CBCT before a treatment fraction (thick light green). The planning-CT and CBCT are matched to bony anatomy. (Red =CTV, blue=PTV, dark green= rectum) The bladder volumes varied widely both within each patient (see example in Fig. 1), between patients in the same group and between the groups. The individual patient mean bladder volume varied from 79±23 to 269±90 ml in group 1 and between 64±19 to 309±110 ml in group 2. Furthermore, there was no difference in the group mean bladder volume between the groups, 138±82 ml in group 1 and 150±92 ml in group 2 (p-value 0,59). Conclusion: The findings indicate that the use of a strict bladder protocol is not superior to a comfortably filled bladder-regime to ensure a consistent bladder volume throughout the whole treatment course. The conclusion would be to let the patient prepare according to his own preference with a comfortably filled bladder. This could result in an easier patient setup due to a more relaxed patient. The impact of the wide variations in bladder volume on toxicity and dose distribution is further to be determined. EP-1360 Comparing patient and physician-reported GI effects in locally advanced prostate cancer radiotherapy

Research paper thumbnail of EP-1880: Validation of the use of digital camera for the prediction of skin toxicity in breast radiotherapy

Radiotherapy and Oncology, 2016

ESTRO 35 2016 ___________________________________________________________________________________... more ESTRO 35 2016 _____________________________________________________________________________________________________ Conclusion: We demonstrated the feasibility of making and using gel phantoms for the assessment of isotropic diffusion kurtosis to use in the characterization of early stage prostate cancer treated with prostate brachytherapy. We have shown that the rectified noise floor, which exists in standard magnitude data, increases the systematic error of the diffusion coefficients D and K. Further studies are in progress to minimize the impact of noise floor in DKI.

Research paper thumbnail of Prognostic factors in prostate cancer patients treated by radical external beam radiotherapy

Panminerva medica, Sep 1, 2017

The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our... more The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our Centre with external beam radiotherapy, the prognostic factors and their impact on the outcome in terms of cancer-specific survival (CSS), biochemical disease-free survival (BDFS) and clinical disease-free survival (CDFS). From October 1999 and March 2012, 1080 patients were treated with radiotherapy at our Institution: 87% of them were classified as ≤cT2, 83% had a Gleason Score (GS) ≤7, their mean of iPSA was 18 ng/mL, and the rate of clinical positive nodes was 1%. The mean follow-up was 81 months. The statistically significant prognostic factors for all groups of patients at both, univariate and multivariate analysis, were the GS and the iPSA. In intermediate- and high- or very-high-risk patients at multivariate analysis other prognostic factors for CSS were positive nodes on computed tomography (CT) scan and rectal preparation during the treatment; for BDFS, the prognostic factors ...

Research paper thumbnail of Survey on gynecological cancer treatment by Piedmont, Liguria, and Valle d’Aosta group of AIRO (Italian Association of Radiation Oncology)

Journal of Contemporary Brachytherapy, 2016

Purpose: We focused the attention on radiation therapy practices about the gynecological malignan... more Purpose: We focused the attention on radiation therapy practices about the gynecological malignancies in Piedmont, Liguria, and Valle d'Aosta to know the current treatment practice and to improve the quality of care. Material and methods: We proposed a cognitive survey to evaluate the standard practice patterns for gynecological cancer management, adopted from 2012 to 2014 by radiotherapy (RT) centers with a large amount of gynecological cancer cases. There were three topics: 1. Taking care and multidisciplinary approach, 2. Radiotherapy treatment and brachytherapy, 3. Follow-up. Results: Nineteen centers treated gynecological malignancies and 12 of these had a multidisciplinary dedicated team. Radiotherapy option has been used in all clinical setting: definitive, adjuvant, and palliative. In general, 1978 patients were treated. There were 834 brachytherapy (BRT) treatments. The fusion between diagnostic imaging (magnetic resonance imaging-MRI, positron emission tomography-PET) and computed tomography (CT) simulation was used for contouring in all centers. Conformal RT and intensity modulated radiation therapy (IMRT) were the most frequent techniques. The image guided radiation therapy (IGRT) was used in 10/19 centers. There were 8 active BRT centers. Brachytherapy was performed both with radical intent and as boost, mostly by HDR (6/8 centers). The doses for exclusive BRT were between 20 to 30 Gy. The doses for BRT boost were between 10 and 20 Gy. Four centers used CT-MRI compatible applicators but only one used MRI for planning. The BRT plans on vaginal cuff were still performed on traditional radiographies in 2 centers. The plan sum was evaluated in only 1 center. Only 1 center performed in vivo dosimetry. Conclusions: In the last three years, multidisciplinary approach, contouring, treatment techniques, doses, and control systems were similar in Liguria-Piedmont and Valle d'Aosta. However, the technology implementation didn't translate in a real treatment innovation so far.

Research paper thumbnail of Small field characterization of TrueBeam FFF beams with a new stereotactic diode: A multicenter study

Physica Medica, 2016

3.0 mm (HD) and 0.2 (DSI). T-test confirms these results for all OARs (p < 0.05) except the brain... more 3.0 mm (HD) and 0.2 (DSI). T-test confirms these results for all OARs (p < 0.05) except the brainstem. The mean HD95 in dose registration was 10.9 mm. The DVH dose accumulation comparisons showed differences with a great variability along patients and OARs. Conclusion: Preliminary results quantify the improvement of DIR, compared with RIR, in the accuracy with which the accumulated dose has been determined. However, a valid and efficient QA process of DIR should be done before its clinical application.

Research paper thumbnail of Simultaneous using of two superficial hyperthermia antennas

Physica Medica, 2016

The purpose of this work is the 3D-modeling/simulation of the simultaneous using of two antennas ... more The purpose of this work is the 3D-modeling/simulation of the simultaneous using of two antennas of our hyperthermia equipment. Materials and methods: The hyperthermia device is equipped with double superficial antennas, operating at a frequency of 434 MHz. with a water automatic superficial cooling device (water bolus). The applicators geometry has been reproduced in the CAD environment with a professional software based on the FDTD processing methods. In order to identify the distribution of specific absorption power rate (SAR), simulations have been performed varying the relative antennas positions on several phantoms (skin, fat, muscle). The accuracy of the solver has been set at −40 dB with a time simulation limit of 50 pulses. The SAR calculation has been calculated as point SAR with a default stimulation power of 1 W peak power flowing into the structure. Results: The simulation showed that, increasing the fat thickness, the temperatures were gradually reduced in the underlying muscle tissue (0.2 degrees less for every 5 mm more fat). In the fat layer, for each 5 mm of thickness, the temperature increased by about 0.6 degrees and in the cutting plane the intensity of absorbed power decreases very rapidly with increasing distance from the projection of the slot. Varying the thickness of bolus from 10 to 20 mm, the setting of the applicator coupled to the tissue model underwent small changes of the reflected power and, at the operating frequency, the model with thickness 17.5 mm showed to have the best coefficient of reflection. The simultaneous use of the two antennas demonstrated that, when the relative antennas positions increasing, the second applicator's resonance is distributed. At the relative distance of 0, 1, 2 cm we obtained 52%, 31% and 10% isoSAR maximum. Conclusions: The numerical simulation demonstrates that it is possible to use both antennas in safety without possibility of hot spots in the tissue, varying also the thickness of the bolus.

Research paper thumbnail of Clinical and technical feasibility of ultra-boost irradiation in Dominant Intraprostatic Lesion by Tomotherapy: preliminary experience and revision of literature

Panminerva medica, Jan 29, 2015

The aim of this paper is to present our experience of dominant intra---prostatic lesions (DIL) ir... more The aim of this paper is to present our experience of dominant intra---prostatic lesions (DIL) irradiation up to an EQD2 of 93,2 Gy with Helical Tomotherapy. Between March 2012 and December 2014, 15 staged II-III patients with intermediate--high risk prostate cancer were enrolled in our protocol of DIL dose escalation by Tomotherapy. All patients were submitted to a multiparametric MRI (including DCE and DWI series), in order to visualize DILs. Considering a mean α/β ratio of 3 for prostate cancer the prescribed doses were: 83.2 Gy in 32 fractions of 2.6 per fraction (EQD2 = 93.2 Gy) on the DILs, 75.2 Gy in 32 fractions of 2.35 Gy per fraction (EQD2 = 80.5 Gy) on the prostate gland and 67.2 Gy in 32 fraction of 2.1 (EQD2 = 68.5 Gy) on the seminal vesicles. With a mean follow up of 16 months (range 2-39), no overall severe acute toxicities > G3 were observed; one patient out of 15 (6.6%) had acute gastrointestinal (GI) toxicity equal to G2, while two cases (13.3%) had G2 acute gen...

Research paper thumbnail of Radiation Oncology Departement

Radiotherapy after partial laryngectomy: an analysis of 36 cases and a proposal to optimize radio... more Radiotherapy after partial laryngectomy: an analysis of 36 cases and a proposal to optimize radiotherapy

Research paper thumbnail of Personalized image-guided radiotherapy with multidisciplinary approach in long-surviving oligo-metastatic prostate cancer patient: A case report

Archivio per le scienze mediche, 2016

Research paper thumbnail of Improving dose delivery accuracy with EPID in vivo dosimetry: results from a multicenter study

Strahlentherapie und Onkologie, 2021

To investigate critical aspects and effectiveness of in vivo dosimetry (IVD) tests obtained by an... more To investigate critical aspects and effectiveness of in vivo dosimetry (IVD) tests obtained by an electronic portal imaging device (EPID) in a multicenter and multisystem context. Eight centers with three commercial systems—SoftDiso (SD, Best Medical Italy, Chianciano, Italy), Dosimetry Check (DC, Math Resolution, LCC), and PerFRACTION (PF, Sun Nuclear Corporation, SNC, Melbourne, FL)—collected IVD results for a total of 2002 patients and 32,276 tests. Data are summarized for IVD software, radiotherapy technique, and anatomical site. Every center reported the number of patients and tests analyzed, and the percentage of tests outside of the tolerance level (OTL%). OTL% was categorized as being due to incorrect patient setup, incorrect use of immobilization devices, incorrect dose computation, anatomical variations, and unknown causes. The three systems use different approaches and customized alert indices, based on local protocols. For Volumetric Modulated Arc Therapy (VMAT) treatments OTL% mean values were up to 8.9% for SD, 18.0% for DC, and 16.0% for PF. Errors due to “anatomical variations” for head and neck were up to 9.0% for SD and DC and 8.0% for PF systems, while for abdomen and pelvis/prostate treatments were up to 9%, 17.0%, and 9.0% for SD, DC, and PF, respectively. The comparison among techniques gave 3% for Stereotactic Body Radiation Therapy, 7.0% (range 4.7–8.9%) for VMAT, 10.4% (range 7.0–12.2%) for Intensity Modulated Radiation Therapy, and 13.2% (range 8.8–21.0%) for 3D Conformal Radiation Therapy. The results obtained with different IVD software and among centers were consistent and showed an acceptable homogeneity. EPID IVD was effective in intercepting important errors.

Research paper thumbnail of PO-1903 Building and comparing treatment quality assessment algorithms among two different clinics

Radiotherapy and Oncology, 2021

Research paper thumbnail of Estimating dose delivery accuracy in stereotactic body radiation therapy: A review of in-vivo measurement methods

Radiotherapy and Oncology, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Comparison of two different EPID-based solutions performing pretreatment quality assurance: 2D portal dosimetry versus 3D forward projection method

Physica Medica, 2018

The aim of this paper is to characterize two different EPID-based solutions for pre-treatment VMA... more The aim of this paper is to characterize two different EPID-based solutions for pre-treatment VMAT quality assurance, the 2D portal dosimetry and the 3D projection technique. Their ability to catch the main critical delivery errors was studied. Methods: Measurements were performed with a linac accelerator equipped with EPID aSi1000, Portal Dose Image Prediction (PDIP), and PerFRACTION softwares. Their performances were studied simulating perturbations of a reference plan through systematic variations in dose values and micromultileaf collimator position. The performance of PDIP, based on 2D forward method, was evaluated calculating gamma passing rate (%GP) between no-error and error-simulated measurements. The impact of errors with PerFRACTION, based on 3D projection technique, was analyzed by calculating the difference between reference and perturbed DVH (%ΔD). Subsequently pre-treatment verification with PerFRACTION was done for 27 patients of different pathologies. Results: The sensitivity of PerFRACTION was slightly higher than sensitivity of PDIP, reaching a maximum of 0.9. Specificity was 1 for PerFRACTION and 0.6 for PDIP. The analysis of patients' DVHs indicated that the mean %ΔD was (1.2 ± 1.9)% for D2%, (0.6 ± 1.7)% for D95% and (−0.0 ± 1.2)% for Dmean of PTV. Regarding OARs, we observed important discrepancies on DVH but that the higher dose variations were in low dose area (< 10 Gy). Conclusions: This study supports the introduction of the new 3D forward projection method for pretreatment QA raising the claim that the visualization of the delivered dose distribution on patient anatomy has major advantages over traditional portal dosimetry QA systems.

Research paper thumbnail of Radiotherapy after Partial Laryngectomy: An Analysis of 36 Cases and a Proposal to Optimize Radiotherapy

Tumori Journal, 2009

Aims and background Laryngeal cancer treatment options include radical surgery, “organ preservati... more Aims and background Laryngeal cancer treatment options include radical surgery, “organ preservation surgery”, radiotherapy and chemotherapy. There is no proven evidence of a significant increase in late toxicity with adjuvant radiotherapy after conservative surgery. The aim of this retrospective study was to evaluate the toxicity, local-regional control and overall survival of adjuvant radiotherapy after conservative surgery. Methods A total of 36 patients was treated with radiotherapy after partial laryngectomy at the Radiotherapy Department of the Institute for Cancer Treatment and Research (IRCC) of Candiolo and of the Mauriziano Hospital in Turin, between 1994 and 2007. The postoperative treatment doses ranged from 45 to 70.2 Gy with conventional fractionation. The Kaplan-Meier method was applied for statistical analysis. The RTOG-EORTC scale was used to evaluate late and acute toxicity. Results Overall 5- and 10-year survival was 93% and 47%, respectively. Local control was 93....

Research paper thumbnail of PV-0484 In vivo dosimetry using CBCT and EPID device: analysis of sources of errors in VMAT treatments

Radiotherapy and Oncology, 2019

Conclusion The dosimetric accuracy of the MR-linac online adaption workflow was tested for the fi... more Conclusion The dosimetric accuracy of the MR-linac online adaption workflow was tested for the first time using PRESAGE® dosimeters and a phantom mimicking a tumour in the lungs. The dose distributions were accurately delivered to the target by positioning the phantom at the isocenter and by shifting it and applying the adaptive planning workflow. Complex IMRT plans will be evaluated in the future using larger samples of PRESAGE®.

Research paper thumbnail of 16. Predicting neoadjuvant therapy response in locally advanced rectal cancer using texture features

Research paper thumbnail of 141. A preliminary study to evaluate the impact of calculation grid resolution and CT slice thickness on TPS calculated small fields OF

Research paper thumbnail of EP-1290: Helical Tomotherapy plus Brachytherapy boost in cervical cancer: a double dose escalation

Radiotherapy and Oncology, 2017

Purpose or Objective Elderly patients with cervical cancer (CC) are commonly treated with radiati... more Purpose or Objective Elderly patients with cervical cancer (CC) are commonly treated with radiation therapy (RT) alone because agerelated physiologic changes can increase the toxicity of chemotherapy. Thus, brachytherapy (BT) assumes more crucial role for elderly patients with CC. In our institution, treatment technique of BT has moved from 2D-based to CT-based image guided BT (IGBT) in a phased manner. The purpose of this study is to analyze the impact of fraction of IGBT on the clinical outcome for elderly patients with CC. Material and Methods Between January 2001 and September 2014, 104 patients aged≧70 years with CC received external beam RT (EBRT) and high-dose rate BT with curative intent in our institution. EBRT (38.0-56.8 Gy) with central shielding after 20-40 Gy was performed for each patient. We compared clinical results of two groups; the patients treated with IGBT only once (single-IGBT group, n=74) or at least twice (multiple-IGBT group, n=30) out of all sessions of BT. Four fractions of BT were administered once a week with a fraction dose of 6 Gy to Point A,basically. Dose adaptation was initially based on dose changes at Point A in IGBT session. If dose adaptation to Point A could not be achieved as intended, manual optimization of dwell positions and dwell weights was performed to improve dosimetry. We predicted that a 6 Gy isodose line would cover the high-risk clinical target volume (HR CTV) in order to achieve a HR CTV D90 (the minimum dose delivered to 90% of the HR CTV) of >6 Gy. The local control (LC) rate, overall survival (OS) rates, and late toxicities were compared in the 2 groups. Late toxicity was defined using the Radiation Therapy Oncology Group late radiation morbidity scoring system as any toxicity occurring 6 months after the initiation of RT. Results The median follow-up period was 59 months in all patients. Twenty-seven patients had stage IB, 45 had stage II, 29 had stage III, and 3 had stage IVA in FIGO staging. The median dose of all BT sessions in total was 24 (7.8-31) Gy at Point A. There was no statistical difference between the two groups in age, FIGO stage, tumor size, Point A dose, and the number of BT. The 4-year LC and OS rates were 89.5% and 70.2% in single-IGBT group, 87.5% and

Research paper thumbnail of EP-1326: Long term patients clinical outcome after salvage post-prostatectomy Radiation Therapy (RT)

Radiotherapy and Oncology, 2017

Research paper thumbnail of Three years of experience with dose reduction by means of iterative reconstruction algorithm available on CT Siemens Somatom Definition Flash

Research paper thumbnail of EP-1361: Prognostic factors in 1080 prostate cancer treated with radical external beam radiotherapy

Radiotherapy and Oncology, 2016

Figure 1. An example of a patient with large variation in bladder filling between planning CT (th... more Figure 1. An example of a patient with large variation in bladder filling between planning CT (thin light green) and CBCT before a treatment fraction (thick light green). The planning-CT and CBCT are matched to bony anatomy. (Red =CTV, blue=PTV, dark green= rectum) The bladder volumes varied widely both within each patient (see example in Fig. 1), between patients in the same group and between the groups. The individual patient mean bladder volume varied from 79±23 to 269±90 ml in group 1 and between 64±19 to 309±110 ml in group 2. Furthermore, there was no difference in the group mean bladder volume between the groups, 138±82 ml in group 1 and 150±92 ml in group 2 (p-value 0,59). Conclusion: The findings indicate that the use of a strict bladder protocol is not superior to a comfortably filled bladder-regime to ensure a consistent bladder volume throughout the whole treatment course. The conclusion would be to let the patient prepare according to his own preference with a comfortably filled bladder. This could result in an easier patient setup due to a more relaxed patient. The impact of the wide variations in bladder volume on toxicity and dose distribution is further to be determined. EP-1360 Comparing patient and physician-reported GI effects in locally advanced prostate cancer radiotherapy

Research paper thumbnail of EP-1880: Validation of the use of digital camera for the prediction of skin toxicity in breast radiotherapy

Radiotherapy and Oncology, 2016

ESTRO 35 2016 ___________________________________________________________________________________... more ESTRO 35 2016 _____________________________________________________________________________________________________ Conclusion: We demonstrated the feasibility of making and using gel phantoms for the assessment of isotropic diffusion kurtosis to use in the characterization of early stage prostate cancer treated with prostate brachytherapy. We have shown that the rectified noise floor, which exists in standard magnitude data, increases the systematic error of the diffusion coefficients D and K. Further studies are in progress to minimize the impact of noise floor in DKI.

Research paper thumbnail of Prognostic factors in prostate cancer patients treated by radical external beam radiotherapy

Panminerva medica, Sep 1, 2017

The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our... more The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our Centre with external beam radiotherapy, the prognostic factors and their impact on the outcome in terms of cancer-specific survival (CSS), biochemical disease-free survival (BDFS) and clinical disease-free survival (CDFS). From October 1999 and March 2012, 1080 patients were treated with radiotherapy at our Institution: 87% of them were classified as ≤cT2, 83% had a Gleason Score (GS) ≤7, their mean of iPSA was 18 ng/mL, and the rate of clinical positive nodes was 1%. The mean follow-up was 81 months. The statistically significant prognostic factors for all groups of patients at both, univariate and multivariate analysis, were the GS and the iPSA. In intermediate- and high- or very-high-risk patients at multivariate analysis other prognostic factors for CSS were positive nodes on computed tomography (CT) scan and rectal preparation during the treatment; for BDFS, the prognostic factors ...

Research paper thumbnail of Survey on gynecological cancer treatment by Piedmont, Liguria, and Valle d’Aosta group of AIRO (Italian Association of Radiation Oncology)

Journal of Contemporary Brachytherapy, 2016

Purpose: We focused the attention on radiation therapy practices about the gynecological malignan... more Purpose: We focused the attention on radiation therapy practices about the gynecological malignancies in Piedmont, Liguria, and Valle d'Aosta to know the current treatment practice and to improve the quality of care. Material and methods: We proposed a cognitive survey to evaluate the standard practice patterns for gynecological cancer management, adopted from 2012 to 2014 by radiotherapy (RT) centers with a large amount of gynecological cancer cases. There were three topics: 1. Taking care and multidisciplinary approach, 2. Radiotherapy treatment and brachytherapy, 3. Follow-up. Results: Nineteen centers treated gynecological malignancies and 12 of these had a multidisciplinary dedicated team. Radiotherapy option has been used in all clinical setting: definitive, adjuvant, and palliative. In general, 1978 patients were treated. There were 834 brachytherapy (BRT) treatments. The fusion between diagnostic imaging (magnetic resonance imaging-MRI, positron emission tomography-PET) and computed tomography (CT) simulation was used for contouring in all centers. Conformal RT and intensity modulated radiation therapy (IMRT) were the most frequent techniques. The image guided radiation therapy (IGRT) was used in 10/19 centers. There were 8 active BRT centers. Brachytherapy was performed both with radical intent and as boost, mostly by HDR (6/8 centers). The doses for exclusive BRT were between 20 to 30 Gy. The doses for BRT boost were between 10 and 20 Gy. Four centers used CT-MRI compatible applicators but only one used MRI for planning. The BRT plans on vaginal cuff were still performed on traditional radiographies in 2 centers. The plan sum was evaluated in only 1 center. Only 1 center performed in vivo dosimetry. Conclusions: In the last three years, multidisciplinary approach, contouring, treatment techniques, doses, and control systems were similar in Liguria-Piedmont and Valle d'Aosta. However, the technology implementation didn't translate in a real treatment innovation so far.

Research paper thumbnail of Small field characterization of TrueBeam FFF beams with a new stereotactic diode: A multicenter study

Physica Medica, 2016

3.0 mm (HD) and 0.2 (DSI). T-test confirms these results for all OARs (p < 0.05) except the brain... more 3.0 mm (HD) and 0.2 (DSI). T-test confirms these results for all OARs (p < 0.05) except the brainstem. The mean HD95 in dose registration was 10.9 mm. The DVH dose accumulation comparisons showed differences with a great variability along patients and OARs. Conclusion: Preliminary results quantify the improvement of DIR, compared with RIR, in the accuracy with which the accumulated dose has been determined. However, a valid and efficient QA process of DIR should be done before its clinical application.

Research paper thumbnail of Simultaneous using of two superficial hyperthermia antennas

Physica Medica, 2016

The purpose of this work is the 3D-modeling/simulation of the simultaneous using of two antennas ... more The purpose of this work is the 3D-modeling/simulation of the simultaneous using of two antennas of our hyperthermia equipment. Materials and methods: The hyperthermia device is equipped with double superficial antennas, operating at a frequency of 434 MHz. with a water automatic superficial cooling device (water bolus). The applicators geometry has been reproduced in the CAD environment with a professional software based on the FDTD processing methods. In order to identify the distribution of specific absorption power rate (SAR), simulations have been performed varying the relative antennas positions on several phantoms (skin, fat, muscle). The accuracy of the solver has been set at −40 dB with a time simulation limit of 50 pulses. The SAR calculation has been calculated as point SAR with a default stimulation power of 1 W peak power flowing into the structure. Results: The simulation showed that, increasing the fat thickness, the temperatures were gradually reduced in the underlying muscle tissue (0.2 degrees less for every 5 mm more fat). In the fat layer, for each 5 mm of thickness, the temperature increased by about 0.6 degrees and in the cutting plane the intensity of absorbed power decreases very rapidly with increasing distance from the projection of the slot. Varying the thickness of bolus from 10 to 20 mm, the setting of the applicator coupled to the tissue model underwent small changes of the reflected power and, at the operating frequency, the model with thickness 17.5 mm showed to have the best coefficient of reflection. The simultaneous use of the two antennas demonstrated that, when the relative antennas positions increasing, the second applicator's resonance is distributed. At the relative distance of 0, 1, 2 cm we obtained 52%, 31% and 10% isoSAR maximum. Conclusions: The numerical simulation demonstrates that it is possible to use both antennas in safety without possibility of hot spots in the tissue, varying also the thickness of the bolus.

Research paper thumbnail of Clinical and technical feasibility of ultra-boost irradiation in Dominant Intraprostatic Lesion by Tomotherapy: preliminary experience and revision of literature

Panminerva medica, Jan 29, 2015

The aim of this paper is to present our experience of dominant intra---prostatic lesions (DIL) ir... more The aim of this paper is to present our experience of dominant intra---prostatic lesions (DIL) irradiation up to an EQD2 of 93,2 Gy with Helical Tomotherapy. Between March 2012 and December 2014, 15 staged II-III patients with intermediate--high risk prostate cancer were enrolled in our protocol of DIL dose escalation by Tomotherapy. All patients were submitted to a multiparametric MRI (including DCE and DWI series), in order to visualize DILs. Considering a mean α/β ratio of 3 for prostate cancer the prescribed doses were: 83.2 Gy in 32 fractions of 2.6 per fraction (EQD2 = 93.2 Gy) on the DILs, 75.2 Gy in 32 fractions of 2.35 Gy per fraction (EQD2 = 80.5 Gy) on the prostate gland and 67.2 Gy in 32 fraction of 2.1 (EQD2 = 68.5 Gy) on the seminal vesicles. With a mean follow up of 16 months (range 2-39), no overall severe acute toxicities > G3 were observed; one patient out of 15 (6.6%) had acute gastrointestinal (GI) toxicity equal to G2, while two cases (13.3%) had G2 acute gen...