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  1. Article ; Online: CT-based radiomics prediction of complete response after stereotactic body radiation therapy for patients with lung metastases.

    Cilla, Savino / Pistilli, Domenico / Romano, Carmela / Macchia, Gabriella / Pierro, Antonio / Arcelli, Alessandra / Buwenge, Milly / Morganti, Alessio Giuseppe / Deodato, Francesco

    Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al

    2023  Volume 199, Issue 7, Page(s) 676–685

    Abstract: Purpose: Stereotactic body radiotherapy (SBRT) is a key treatment modality for lung cancer patients. This study aims to develop a machine learning-based prediction model of complete response for lung oligometastatic cancer patients undergoing SBRT.: ... ...

    Abstract Purpose: Stereotactic body radiotherapy (SBRT) is a key treatment modality for lung cancer patients. This study aims to develop a machine learning-based prediction model of complete response for lung oligometastatic cancer patients undergoing SBRT.
    Materials and methods: CT images of 80 pulmonary oligometastases from 56 patients treated with SBRT were analyzed. The gross tumor volumes (GTV) were contoured on CT images. Patients that achieved complete response (CR) at 4 months were defined as responders. For each GTV, 107 radiomic features were extracted using the Pyradiomics software. The concordance correlation coefficients (CCC) between the region of interest (ROI)-based radiomics features obtained by the two segmentations were calculated. Pairwise feature interdependencies were evaluated using the Spearman rank correlation coefficient. The association of clinical variables and radiomics features with CR was evaluated with univariate logistic regression. Two supervised machine learning models, the logistic regression (LR) and the classification and regression tree analysis (CART), were trained to predict CR. The models were cross-validated using a five-fold cross-validation. The performance of models was assessed by receiver operating characteristic curve (ROC) and class-specific accuracy, precision, recall, and F1-measure evaluation metrics.
    Results: Complete response was associated with four radiomics features, namely the surface to volume ratio (SVR; p = 0.003), the skewness (Skew; p = 0.027), the correlation (Corr; p = 0.024), and the grey normalized level uniformity (GNLU; p = 0.015). No significant relationship between clinical parameters and CR was found. In the validation set, the developed LR and CART machine learning models had an accuracy, precision, and recall of 0.644 and 0.750, 0.644 and 0.651, and 0.635 and 0.754, respectively. The area under the curve for CR prediction was 0.707 and 0.753 for the LR and CART models, respectively.
    Conclusion: This analysis demonstrates that radiomics features obtained from pretreatment CT could predict complete response of lung oligometastases following SBRT.
    MeSH term(s) Humans ; Radiosurgery/methods ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/pathology ; Lung/pathology ; ROC Curve ; Tomography, X-Ray Computed/methods
    Language English
    Publishing date 2023-05-31
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84983-2
    ISSN 1439-099X ; 0179-7158 ; 0039-2073
    ISSN (online) 1439-099X
    ISSN 0179-7158 ; 0039-2073
    DOI 10.1007/s00066-023-02086-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Combination of Electrochemotherapy with Radiotherapy: A Comprehensive, Systematic, PRISMA-Compliant Review of Efficacy and Potential Radiosensitizing Effects in Tumor Control.

    Ferioli, Martina / Perrone, Anna M / Buwenge, Milly / Arcelli, Alessandra / Vadala', Maria / Fionda, Bruno / Malato, Maria C / De Iaco, Pierandrea / Zamagni, Claudio / Cammelli, Silvia / Tagliaferri, Luca / Morganti, Alessio G

    Current oncology (Toronto, Ont.)

    2023  Volume 30, Issue 11, Page(s) 9895–9905

    Abstract: Radiotherapy (RT) and electrochemotherapy (ECT) are established local treatments for cancer. While effective, both therapies have limitations, especially in treating bulky and poorly oxygenated tumors. ECT has emerged as a promising palliative treatment, ...

    Abstract Radiotherapy (RT) and electrochemotherapy (ECT) are established local treatments for cancer. While effective, both therapies have limitations, especially in treating bulky and poorly oxygenated tumors. ECT has emerged as a promising palliative treatment, raising interest in exploring its combination with RT to enhance tumor response. However, the potential benefits and challenges of combining these treatments remain unclear. A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Cochrane libraries were searched. Studies were screened and selected based on predefined inclusion and exclusion criteria. Ten studies were included, comprising in vitro and in vivo experiments. Different tumor types were treated with ECT alone or in combination with RT. ECT plus RT demonstrated superior tumor response compared to that under single therapies or other combinations, regardless of the cytotoxic agent and RT dose. However, no study demonstrated a clear superadditive effect in cell survival curves, suggesting inconclusive evidence of specific ECT-induced radiosensitization. Toxicity data were limited. In conclusion, the combination of ECT and RT consistently improved tumor response compared to that with individual therapies, supporting the potential benefit of their combination. However, evidence for a specific ECT-induced radiosensitization effect is currently lacking. Additional investigations are necessary to elucidate the potential benefits of this combination therapy.
    MeSH term(s) Humans ; Electrochemotherapy ; Radiation-Sensitizing Agents/pharmacology ; Radiation-Sensitizing Agents/therapeutic use ; Neoplasms/drug therapy ; Neoplasms/radiotherapy ; Antineoplastic Agents/therapeutic use ; Palliative Care
    Chemical Substances Radiation-Sensitizing Agents ; Antineoplastic Agents
    Language English
    Publishing date 2023-11-13
    Publishing country Switzerland
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 1236972-x
    ISSN 1718-7729 ; 1198-0052
    ISSN (online) 1718-7729
    ISSN 1198-0052
    DOI 10.3390/curroncol30110719
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  3. Article ; Online: Stereotactic Arrhythmia Radioablation (STAR): A Multidisciplinary Narrative Minireview of Preclinical Studies.

    Galietta, Erika / Strolin, Silvia / Bisello, Silvia / Cellini, Francesco / Lovato, Luigi / Ravegnini, Gloria / Martignani, Cristian / Spadotto, Alberto / Buwenge, Milly / Cammelli, Silvia / Strigari, Lidia / Morganti, Alessio G / Arcelli, Alessandra

    In vivo (Athens, Greece)

    2023  Volume 37, Issue 3, Page(s) 963–971

    Abstract: The aim of this narrative review of the literature was to collect and analyze the results of the published preclinical studies on stereotactic arrhythmia radioablation (STAR) in the treatment of refractory cardiac arrhythmias. A literature search was ... ...

    Abstract The aim of this narrative review of the literature was to collect and analyze the results of the published preclinical studies on stereotactic arrhythmia radioablation (STAR) in the treatment of refractory cardiac arrhythmias. A literature search was conducted on PubMed using the following terms: ("stereotactic" OR "SBRT" OR "SABR" OR "radioablation" OR "radiosurgery") AND ("arrhythmia" OR "tachycardia"). Preclinical and pathological reports published in English without time limit, comprising studies of STAR in animal models and histological analyzes of explanted animal and human hearts were included. The analyzed studies confirm that doses lower than 25 Gy seem to produce sub-optimal therapeutic results whereas doses >35 Gy are less safe in terms of radiation-induced toxicity. However, long-term results (>1 year) are still missing and reporting outcomes based on low dose irradiation (≤15 Gy). Finally, STAR proved to be an effective therapy in the analyzed studies despite the irradiation of rather different cardiac targets. Therefore, additional studies are needed to: 1) compare the outcomes of STAR at doses of 25 Gy versus 30 Gy; 2) evaluate the long-term results (>1 year) in animal models irradiated at doses similar to those used in the clinic; 3) define the optimal target.
    MeSH term(s) Animals ; Humans ; Arrhythmias, Cardiac/etiology ; Arrhythmias, Cardiac/radiotherapy ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Heart ; Models, Animal ; Time Factors
    Language English
    Publishing date 2023-04-27
    Publishing country Greece
    Document type Journal Article ; Review
    ZDB-ID 807031-3
    ISSN 1791-7549 ; 0258-851X
    ISSN (online) 1791-7549
    ISSN 0258-851X
    DOI 10.21873/invivo.13170
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Feasibility-guided automated planning for stereotactic treatments of prostate cancer.

    Romano, Carmela / Viola, Pietro / Craus, Maurizio / Macchia, Gabriella / Ferro, Milena / Bonome, Paolo / Pierro, Antonio / Buwenge, Milly / Arcelli, Alessandra / Morganti, Alessio Giuseppe / Deodato, Francesco / Cilla, Savino

    Medical dosimetry : official journal of the American Association of Medical Dosimetrists

    2023  Volume 48, Issue 3, Page(s) 140–148

    Abstract: Significant improvements in plan quality using automated planning have been previously demonstrated. The aim of this study was to develop an optimal automated class solution for stereotactic radiotherapy (SBRT) planning of prostate cancer using the new ... ...

    Abstract Significant improvements in plan quality using automated planning have been previously demonstrated. The aim of this study was to develop an optimal automated class solution for stereotactic radiotherapy (SBRT) planning of prostate cancer using the new Feasibility module implemented in the pinnacle evolution. Twelve patients were retrospectively enrolled in this planning study. Five plans were designed for each patient. Four plans were automatically generated using the 4 proposed templates for SBRT optimization implemented in the new pinnacle evolution treatment planning systems, differing for different settings of dose-fallout (low, medium, high and veryhigh). Based on the obtained results, the fifth plan (feas) was generated customizing the template with the optimal criteria obtained from the previous step and integrating in the template the "a-priori" knowledge of OARs sparing based on the Feasibility module, able to estimate the best possible dose-volume histograms of OARs before starting optimization. Prescribed dose was 35 Gy to the prostate in 5 fractions. All plans were generated with a full volumetric-modulated arc therapy arc and 6MV flattening filter-free beams, and optimized to ensure the same target coverage (95% of the prescription dose to 98% of the target). Plans were assessed according to dosimetric parameters and planning and delivery efficiency. Differences among the plans were evaluated using a Kruskal-Wallis 1-way analysis of variance. The requests for more aggressive objectives for dose falloff parameters (from low to veryhigh) translated in a statistically significant improvement of dose conformity, but at the expense of a dose homogeneity. The best automated plans in terms of best trade-off between target coverage and OARs sparing among the 4 plans automatically generated by the SBRT module were the high plans. The veryhigh plans reported a significant increase of high-doses to prostate, rectum, and bladder that was considered dosimetrically and clinically unacceptable. The feas plans were optimized on the basis on high plans, reporting significant reduction of rectum irradiation; Dmean, and V18 decreased by 19% to 23% (p = 0.031) and 4% to 7% (p = 0.059), respectively. No statistically significant differences were found in femoral heads and penile bulb irradiation for all dosimetric metrics. feas plans showed a significant increase of MU/Gy (mean: 368; p = 0.004), reflecting an increased level of fluence modulation. Thanks to the new efficient optimization engines implemented in pinnacle evolution (L-BFGS and layered graph), mean planning time was decreased to less than 10 minutes for all plans and all techniques. The integration of dose-volume histograms a-priori knowledge provided by the feasibility module in the automated planning process for SBRT planning has shown to significantly improve plan quality compared to generic protocol values as inputs.
    Language English
    Publishing date 2023-03-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645065-9
    ISSN 1873-4022 ; 0958-3947 ; 0739-0211
    ISSN (online) 1873-4022
    ISSN 0958-3947 ; 0739-0211
    DOI 10.1016/j.meddos.2023.02.003
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  5. Article: Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study-AFRAID Project).

    Medici, Federica / Ferioli, Martina / Cammelli, Silvia / Forlani, Ludovica / Laghi, Viola / Ma, Johnny / Cilla, Savino / Buwenge, Milly / Macchia, Gabriella / Deodato, Francesco / Vadalà, Maria / Malizia, Claudio / Tagliaferri, Luca / Perrone, Anna Myriam / De Iaco, Pierandrea / Strigari, Lidia / Bazzocchi, Alberto / Rizzo, Stefania / Arcelli, Alessandra /
    Morganti, Alessio Giuseppe

    Cancers

    2024  Volume 16, Issue 5

    Abstract: Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/ ... ...

    Abstract Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/m
    Language English
    Publishing date 2024-02-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers16050929
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  6. Article: Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis.

    Buwenge, Milly / Macchia, Gabriella / Cavallini, Letizia / Cortesi, Annalisa / Malizia, Claudio / Bianchi, Lorenzo / Ntreta, Maria / Arcelli, Alessandra / Capocaccia, Ilaria / Natoli, Elena / Cilla, Savino / Cellini, Francesco / Tagliaferri, Luca / Strigari, Lidia / Cammelli, Silvia / Schiavina, Riccardo / Brunocilla, Eugenio / Morganti, Alessio Giuseppe / Deodato, Francesco

    Frontiers in oncology

    2023  Volume 13, Page(s) 1281432

    Abstract: Background: The objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).: Materials and methods: This observational study ( ... ...

    Abstract Background: The objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).
    Materials and methods: This observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson's comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed.
    Results: A total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox's regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008).
    Conclusions: The unexpected results of this analysis could be explained by a "response shift bias" concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens.
    Language English
    Publishing date 2023-12-13
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1281432
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  7. Article ; Online: Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) - A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group.

    Chiloiro, Giuditta / Romano, Angela / Mariani, Silvia / Macchia, Gabriella / Giannarelli, Diana / Caravatta, Luciana / Franco, Pierfrancesco / Boldrini, Luca / Arcelli, Alessandra / Bacigalupo, Almalina / Belgioia, Liliana / Fontana, Antonella / Meldolesi, Elisa / Montesi, Giampaolo / Niespolo, Rita Marina / Palazzari, Elisa / Piva, Cristina / Valentini, Vincenzo / Gambacorta, Maria Antonietta

    Clinical and translational radiation oncology

    2023  Volume 39, Page(s) 100579

    Abstract: Background: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development ... ...

    Abstract Background: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has been suggested that inflammation parameters may have a role in predicting tumor response to nCRT and survival outcomes and in rectal cancer, but no definitive conclusion can be drawn at present. The aim of the current study is to evaluate the role of baseline inflammatory markers as prognostic and predictive factors in a large multicentric Italian cohort of LARC pts.
    Methods: Patients diagnosed with LARC from January 2002 to December 2019 in 9 Italian centers were retrospectively collected. Patients underwent long-course RT with chemotherapy based on fluoropyrimidine ± oxaliplatin followed by surgery. Inflammatory markers were retrieved based on a pre-treatment blood sample including HEI (hemo-eosinophils inflammation index), SII (systemic index of inflammation), NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio). Outcomes of interest were pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS).
    Results: 808 pts were analyzed. pCR rate was 22 %, 5yOS and 5yDFS were 84.0% and 63.1% respectively. Multivariate analysis identified that a NLR cut-off value >1.2 and SII cut-off value >500 could predict pCR (p = 0.05 and 0.009 respectively). In addition to age, extramesorectal nodes and RT dose, MLR >0.18 (p = 0.03) and HEI = 3 (p = 0.05) were independent prognostic factors for DFS. Finally, age, RT dose, MLR with a cut-off >0.35 (p = 0.028) and HEI = 3 (p = 0.045) were independent predictors of OS.
    Conclusions: Higher values of baseline composite inflammatory markers can serve as predictors of lower pCR rates and worse survival outcomes in LARC patients undergoing nCRT. More reliable data from prospective studies could lead to the integration of these inexpensive and easy-to-derive tools into clinical practice.
    Language English
    Publishing date 2023-01-12
    Publishing country Ireland
    Document type Journal Article
    ISSN 2405-6308
    ISSN (online) 2405-6308
    DOI 10.1016/j.ctro.2023.100579
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  8. Article: Classical Prognostic Factors Predict Prognosis Better than Inflammatory Indices in Locally Advanced Cervical Cancer: Results of a Comprehensive Observational Study including Tumor-, Patient-, and Treatment-Related Data (ESTHER Study).

    Ferioli, Martina / Benini, Anna / Malizia, Claudio / Forlani, Ludovica / Medici, Federica / Laghi, Viola / Ma, Johnny / Galuppi, Andrea / Cilla, Savino / Buwenge, Milly / Macchia, Gabriella / Zamagni, Claudio / Tagliaferri, Luca / Perrone, Anna Myriam / De Iaco, Pierandrea / Strigari, Lidia / Morganti, Alessio Giuseppe / Arcelli, Alessandra

    Journal of personalized medicine

    2023  Volume 13, Issue 8

    Abstract: Systemic inflammation indices were found to be correlated with therapeutic outcome in several cancers. This study retrospectively analyzes the predictive role of a broad range of systemic inflammatory markers in patients with locally advanced cervical ... ...

    Abstract Systemic inflammation indices were found to be correlated with therapeutic outcome in several cancers. This study retrospectively analyzes the predictive role of a broad range of systemic inflammatory markers in patients with locally advanced cervical cancer (LACC) including patient-, tumor-, and treatment-related potential prognostic factors. All patients underwent definitive chemoradiation and pretreatment values of several inflammatory indices (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, systemic immune inflammation index (SII), leukocyte/lymphocyte ratio, combination of platelet count and NLR, aspartate aminotransferase/platelet ratio index, aspartate aminotransferase/lymphocyte ratio index, systemic inflammatory response index, and aspartate transaminase/neutrophil ratio index) were calculated. Their correlation with local control (LC), distant metastasis-free (DMFS), disease-free (DFS), and overall survival (OS) was analyzed. One hundred and seventy-three patients were included. At multivariable analysis significant correlations were recorded among clinical outcomes and older age, advanced FIGO stage, lower hemoglobin levels, larger tumor size, and higher body mass index values. The multivariate analysis showed only the significant correlation between higher SII values and lower DMFS rates (
    Language English
    Publishing date 2023-08-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662248-8
    ISSN 2075-4426
    ISSN 2075-4426
    DOI 10.3390/jpm13081229
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  9. Article: Decoding the Complexity of Systemic Inflammation Predictors in Locally Advanced Cervical Cancer, with Hemoglobin as the Hidden Key (the ESTHER Study).

    Medici, Federica / Ferioli, Martina / Forlani, Ludovica / Laghi, Viola / Ma, Johnny / Cilla, Savino / Buwenge, Milly / Macchia, Gabriella / Deodato, Francesco / Vadalà, Maria / Malizia, Claudio / Tagliaferri, Luca / Perrone, Anna Myriam / De Iaco, Pierandrea / Strigari, Lidia / Arcelli, Alessandra / Morganti, Alessio Giuseppe

    Cancers

    2023  Volume 15, Issue 20

    Abstract: Locally advanced cervical cancer (LACC) is treated with concurrent chemoradiation (CRT). Predictive models could improve the outcome through treatment personalization. Several factors influence prognosis in LACC, but the role of systemic inflammation ... ...

    Abstract Locally advanced cervical cancer (LACC) is treated with concurrent chemoradiation (CRT). Predictive models could improve the outcome through treatment personalization. Several factors influence prognosis in LACC, but the role of systemic inflammation indices (IIs) is unclear. This study aims to assess the correlation between IIs and prognosis in a large patient cohort considering several clinical data. We retrospectively analyzed pretreatment IIs (NLR, PLR, MLR, SII, LLR, COP-NLR, APRI, ALRI, SIRI, and ANRI) in 173 LACC patients. Patient, tumor, and treatment characteristics were also considered. Univariate and multivariate Cox's regressions were conducted to assess associations between IIs and clinical factors with local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Univariate analysis showed significant correlations between age, HB levels, tumor stage, FIGO stage, and CRT dose with survival outcomes. Specific pretreatment IIs (NLR, PLR, APRI, ANRI, and COP-NLR) demonstrated associations only with LC. The multivariate analysis confirmed Hb levels, CRT dose, and age as significant predictors of OS, while no II was correlated with any clinical outcome. The study findings contradict some prior research on IIs in LACC, emphasizing the need for comprehensive assessments of potential confounding variables.
    Language English
    Publishing date 2023-10-19
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15205056
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  10. Article ; Online: Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review.

    Buwenge, Milly / Arcelli, Alessandra / Cellini, Francesco / Deodato, Francesco / Macchia, Gabriella / Cilla, Savino / Galietta, Erika / Strigari, Lidia / Malizia, Claudio / Cammelli, Silvia / Morganti, Alessio G

    Current oncology (Toronto, Ont.)

    2022  Volume 29, Issue 4, Page(s) 2616–2629

    Abstract: Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the ... ...

    Abstract Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the available evidence on pain relief in patients with PDCA. We updated our previous systematic review through a search on PubMed of papers published from 1 January 2018 to 30 June 2021. Studies with full available text, published in English, and reporting pain relief after SBRT on PDCA were included in this analysis. Statistical analysis was carried out using the MEDCALC statistical software. All tests were two-sided. The I2 statistic was used to quantify statistical heterogeneity (high heterogeneity level: >50%). Nineteen papers were included in this updated literature review. None of them specifically aimed at assessing pain and/or quality of life. The rate of analgesics reduction or suspension ranged between 40.0 and 100.0% (median: 60.3%) in six studies. The pooled rate was 71.5% (95% CI, 61.6−80.0%), with high heterogeneity between studies (Q2 test: p < 0.0001; I2 = 83.8%). The rate of complete response of pain after SBRT ranged between 30.0 and 81.3% (median: 48.4%) in three studies. The pooled rate was 51.9% (95% CI, 39.3−64.3%), with high heterogeneity (Q2 test: p < 0.008; I2 = 79.1%). The rate of partial plus complete pain response ranged between 44.4 and 100% (median: 78.6%) in nine studies. The pooled rate was 78.3% (95% CI, 71.0−84.5%), with high heterogeneity (Q2 test: p < 0.0001; I2 = 79.4%). A linear regression with sensitivity analysis showed significantly improved overall pain response as the EQD2α/β:10 increases (p: 0.005). Eight papers did not report any side effect during and after SBRT. In three studies only transient acute effects were recorded. The results of the included studies showed high heterogeneity. However, SBRT of PDCA resulted reasonably effective in producing pain relief in these patients. Further studies are needed to assess the impact of SBRT in this setting based on Patient-Reported Outcomes.
    MeSH term(s) Adenocarcinoma ; Carcinoma, Pancreatic Ductal/physiopathology ; Carcinoma, Pancreatic Ductal/radiotherapy ; Humans ; Pain ; Pancreatic Neoplasms/physiopathology ; Pancreatic Neoplasms/radiotherapy ; Quality of Life ; Radiosurgery ; Pancreatic Neoplasms
    Language English
    Publishing date 2022-04-11
    Publishing country Switzerland
    Document type Journal Article ; Systematic Review
    ZDB-ID 1236972-x
    ISSN 1718-7729 ; 1198-0052
    ISSN (online) 1718-7729
    ISSN 1198-0052
    DOI 10.3390/curroncol29040214
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