Biomedical subjects

F Foppiano

Publications and source records attributed to F Foppiano.

9 recordsLinked to original sources

PubMed2002

Adjuvant androgen deprivation impacts late rectal toxicity after conformal radiotherapy of prostate carcinoma.

To evaluate whether androgen deprivation impacts late rectal toxicity in patients with localised prostate carcinoma treated with three-dimensional conformal radiotherapy. One hundred and eighty-two consecutive patients treated with 3DCRT between 1995 and 1999 at our Institution and with at least 12 months follow-up were analysed. three-dimensional conformal radiotherapy consisted in 70-76 Gy delivered with a conformal 3-field arrangement to the prostate+/-seminal vesicles. As part of treatment, 117 patients (64%) received neo-adjuvant and concomitant androgen deprivation while 88 (48.4%) patients were continued on androgen deprivation at the end of three-dimensional conformal radiotherapy as well. Late rectal toxicity was graded according to the RTOG morbidity scoring scale. Median follow up is 25.8 (range: 12-70.2 months). The 2-year actuarial likelihood of grade 2-4 rectal toxicity was 21.8+/-3.2%. A multivariate analysis identified the use of adjuvant androgen deprivation (P=0.0196) along with the dose to the posterior wall of the rectum on the central axis (P=0.0055) and the grade of acute rectal toxicity (P=0.0172) as independent predictors of grade 2-4 late rectal toxicity. The 2-year estimates of grade 2-4 late rectal toxicity for patients receiving or not adjuvant hormonal treatment were 30.3+/-5.2% and 14.1+/-3.8%, respectively. Rectal tolerance is reduced in presence of adjuvant androgen deprivation.

Aged↗

PubMed2000

Hamming clustering techniques for the identification of prognostic indices in patients with advanced head and neck cancer treated with radiation therapy.

The aim of the study is to demonstrate the usefulness of a new, non-linear classifier method, called Hamming clustering (HC), in selecting prognostic variables affecting overall survival in patients with head and neck cancer. In particular, the aim is to identify whether tumour proliferation parameters can be predictive factors of response in a set of 115 patients that receive either alternating chemo-radiotherapy or accelerated or conventional radiotherapy. HC is able to generate a set of understandable rules underlying the study objective; it can also select a subset of input variables that represent good prognostic factors. HC has been compared with other standard classifiers, providing better results in terms of classification accuracy. In particular, HC obtains the best accuracy of 74.8% (sensitivity of 51.1% and specificity of 91.2%) about survival. The rules found show that, besides the classical, well-known variables concerning the tumour dimension and the involved lymphonodes, some biological parameters, such as DNA ploidy, are also useful as predictive factors.

Aged↗

PubMed1999

Induction chemotherapy followed by concurrent standard radiotherapy and daily low-dose cisplatin in locally advanced non-small-cell lung cancer.

Both induction chemotherapy and concurrent low-dose cisplatin have been shown to improve results of thoracic irradiation in the treatment of locally advanced non-small-cell lung cancer (NSCLC). This phase II study was designed to investigate activity and feasibility of a novel chemoradiation regimen consisting of induction chemotherapy followed by standard radiotherapy and concurrent daily low-dose cisplatin. Previously untreated patients with histologically/cytologically proven unresectable stage IIIA/B NSCLC were eligible. Induction chemotherapy consisted of vinblastine 5 mg m(-2) intravenously (i.v.) on days 1, 8, 15, 22 and 29, and cisplatin 100 mg m(-2) i.v. on days 1 and 22 followed by continuous radiotherapy (60 Gy in 30 fractions) given concurrently with daily cisplatin at a dose of 5 mg m(-2) i.v. Thirty-two patients were enrolled. Major toxicity during induction chemotherapy was haematological: grade III-IV leukopenia was observed in 31% and grade II anaemia in 16% of the patients. The most common severe toxicity during concurrent chemoradiation consisted of grade III leukopenia (21% of the patients); grade III oesophagitis occurred in only two patients and pulmonary toxicity in one patient who died of this complication. Eighteen of 32 patients (56%, 95% CI 38-73%) had a major response (11 partial response, seven complete response). With a median follow-up of 38.4 months, the median survival was 12.5 months and the actuarial survival rates at 1, 2 and 3 years were 52%, 26% and 19% respectively. The median event-free survival was 8.3 months with a probability of 40%, 23% and 20% at 1, 2 and 3 years respectively. Induction chemotherapy followed by concurrent daily low-dose cisplatin and thoracic irradiation, in patients with locally advanced NSCLC, is active and feasible with minimal non-haematological toxicity. Long-term survival results are promising and appear to be similar to those of more toxic chemoradiation regimens, warranting further testing of this novel chemoradiation strategy.

Aged↗

PubMed1997

[The application of the multileaf collimator in radiotherapy: the dosimetric problems and the technical implications for its clinical use].

INTRODUCTION: The multileaf collimator (MLC) now commercially available as an integral or optional retrofit component of linear accelerator heads, permitting to shield automatically irregular fields by computerized movements of multiple tungsten leaves. In the present paper we discuss the main characteristics of different MLC versions, MLC dosimetric drawbacks and the clinical fields where the MLC could he widely used. MATERIALS AND METHODS: Since February, 1995, we have studied the dosimetric characteristics and clinical implications of a multileaf collimator of a Clinac 2100 C/D linear accelerator used to replace conventional low melting alloy blocks. The scalloping effect of isodoses and the effective penumbra produced by the multileaf collimator in an irregular field were analyzed accurately. Secondly, radiation leakage through tungsten leaves was measured and compared with the values of low melting alloy blocks. Finally, the MLC was extensively used in clinical practice for the radiotherapy of different tumors. RESULTS: Different dosimetric steps were followed to obtain the monitor units/dose ratio. Our single MLC-shielded irregular fields measurements also showed several physical and dosimetric disadvantages related to wider effective penumbra than with conventional shielding when the angle between field margin and the normal to the direction of leaf travel is 45 degrees. In clinical practice, the MLC can be widely used for the conformal radiotherapy of pelvic and thoracic tumors. Conventional low melting alloy blocks should be replaced with MLC for radiotherapy of selected brain and head and neck cancers. DISCUSSION: The current use of a multileaf collimator improves both the accuracy and the effectiveness of radiation therapy and reduces the time for every treatment dose, which potentially increases the number of patients treated every day. The multileaf collimator is presently an important technical tool either to replace conventional shielding for static conformational radiotherapy or to administer 3D-planned dynamic radiotherapy.

Equipment Design↗

PubMed1996

Postoperative radiotherapy for head and neck squamous cell carcinomas: feasibility of a biphasic accelerated treatment schedule.

PURPOSE: It has been suggested that postoperative tumor cell proliferation may influence the outcome of advanced head and neck squamous cell carcinomas treated by surgery and postoperative radiotherapy. This Phase I pilot study was undertaken to determine the feasibility of a biphasic accelerated radiotherapy regimen with early and late concomitant boost delivery for postoperative treatment of patients with advanced head and neck cancers. METHODS AND MATERIALS: From April 1993 to April 1994, 29 patients with advanced head and neck cancers were enrolled in this study after they underwent complete surgical resection. The basic radiation course delivered a median dose of 49 Gy in 25 fractions over 5 weeks at 1.8-2 Gy/fraction. The concomitant boost was delivered to the high-risk areas as a second daily fraction during the first (1.4 Gy/fraction) and fifth weeks (1.6 Gy/fraction). The total dose to the high-risk areas was 64 Gy in 35 fractions over 5 weeks. RESULTS: Twenty-seven patients (93%) completed the treatment without interruptions. Only two patients experienced severe acute toxicity requiring treatment breaks of 6 and 8 days, respectively. All patients developed confluent mucositis; in 69% of the cases it covered >50% of the treated surface. No patient developed Grade 5 (ulceration/bleeding) mucosal reaction. Mucositis required a median time of 7 weeks for complete healing (range 3-43). Two patients developed transient bone exposure. The median weight loss was 5.5% of pretreatment body weight (range 1.2-17.1%), and four patients required nutritional assistance with nasogastric feeding tube. CONCLUSION: The results of this study show that this biphasic acceleration regimen is feasible with acceptable acute toxicity.

Adult↗

PubMed1992

[The proton radiotherapy of melanoma of the uvea. The technic, methodology and first clinical observations].

Since June 1991, a Cyclotron unit with a proton beam of 65 MeV has been working at the Institute Antoine Lacassagne in Nice, France. An international cooperative group has been founded to guarantee the thorough exploitation of the facility through complete cooperation. From June 17 to December 20, 1991, 47 patients with uveal melanoma were treated; 4 of them entered the study by means of the Italian team and were treated in cooperation with the Cyclotron staff. Treatment modalities and preliminary observations are described.

Adolescent↗

PubMedDate not supplied

A prototype 3D CT extension for radiotherapy simulators.

In this paper we present a report on our custom 3D CT extension capable of producing fully 3D tomographic studies from conventional radiotherapy simulator cone-beam fluoro output. The extension consists of a common PC system on which a proprietary software toolkit provides the appropriate environment for reconstruction and acquisition of cone-beam data provided by commercial simulator fluoro video chains. The extension may compare favorably with CT options offered by simulator manufacturers: in particular, multi-slice single-scan reconstruction seems to be achievable while the current commercial solutions are based on single-slice single-scan. Radiotherapy applications include on-line treatment planning, patient treatment verification and registration.

Animals↗

PubMedDate not supplied

Introducing quality assurance in radiotherapy.

Introducing a Quality Assurance methodology appears particularly useful in Radiation Oncology due to the complexity of the procedures involved and the heterogeneity of the standards adopted, if any, in the great majority of the Centers. There are two possible ways of evaluating quality in the Health Environment: a formal, Institutional certification, or a voluntary one obtained through a mechanism of peer review. The European Society for Therapeutic Radiology and Oncology (ESTRO) started in 1994 with the publication of a methodological Report intended to be adopted by the individual national Societies, and this paper is an invitation to do it.

Humans↗

PubMedDate not supplied

On the delineation of the gross tumor volume and clinical target volume for head and neck squamous cell carcinomas.

Gross tumor volume (GTV) and clinical target volume (CTV) delineation on planning computed tomography (pICT) for head and neck squamous cell carcinomas can be troublesome. We highlight the factors which can be crucial for the radiation oncologist in delineating GTV and CTV on pICT and provide some pratical solutions. Regarding GTV, uncertainties are correlated with transfer of information collected by physical examination and diagnostic radiology to pICT. Moreover, reproducibility of delineation can also be highly variable, particularly when diagnostic imaging quality and pICT quality are poor. Once the prescription has been made, clinical target volume identification on pICT is rarely straightforward. Whereas there are some data about the location of major lymph node stations of the neck, there are no reported guidelines on how to draw subclinical extention of primary head and neck tumors on pICT. Such volumes can be derived from those currently included in simulator films or from those addressed by the surgeon. Some examples are provided. A particular situation is represented by the adjuvant setting, when the primary tumor is removed (by surgery) or reduced (by chemotherapy). In conclusion, this paper shows some major problems associated with identification of GTV and CTV on pICT. Apart from selected cases, the use of pICT for target volume delineation (and thus for field shaping) for head and neck squamous cell carcinoma is still to be considered investigational.

Carcinoma, Squamous Cell↗