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Article ; Online: Effects of nuclear interaction corrections and trichrome fragment spectra modelling on dose and linear energy transfer distributions in carbon ion radiotherapy.

Bazani, Alessia / Brunner, Jacob / Russo, Stefania / Carlino, Antonio / Simon Colomar, Daniel / Ikegami Andersson, Walter / Ciocca, Mario / Stock, Markus / Fossati, Piero / Orlandi, Ester / Glimelius, Lars / Molinelli, Silvia / Knäusl, Barbara

Physics and imaging in radiation oncology

2024 Volume 29, Page(s) 100553

Abstract: Background and purpose: Nuclear interaction correction (NIC) and trichrome fragment spectra modelling improve relative biological effectiveness-weighted dose (D: Materials and methods: The effect of the NIC and trichrome algorithm was assessed, ... ...

Abstract	Background and purpose: Nuclear interaction correction (NIC) and trichrome fragment spectra modelling improve relative biological effectiveness-weighted dose (D Materials and methods: The effect of the NIC and trichrome algorithm was assessed, creating single beam plans for a virtual water phantom with standard settings and NIC + trichrome corrections. Reference D Results: Dose deviations comparing Conclusion: Our results showed improved accuracy of the predicted D
Language	English
Publishing date	2024-02-15
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-6316
ISSN (online)	2405-6316
DOI	10.1016/j.phro.2024.100553
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Article ; Online: Is motherhood still possible after pelvic carbon ion radiotherapy? A promising combined fertility-preservation approach.

Barcellini, Amelia / Cassani, Chiara / Orlandi, Ester / Nappi, Rossella E / Broglia, Federica / Delmonte, Maria Paola / Molinelli, Silvia / Vai, Alessandro / Vitolo, Viviana / Gronchi, Alessandro / D'Ambrosio, Gioacchino / Cobianchi, Lorenzo / Fiore, Maria Rosaria

Tumori

2024 Volume 110, Issue 2, Page(s) 132–138

Abstract: Introduction: Preserving the endocrine and reproductive function in young female cancer patients undergoing pelvic radiation is a significant challenge. While the photon beam radiation's adverse effects on the uterus and ovaries are well established, ... ...

Abstract	Introduction: Preserving the endocrine and reproductive function in young female cancer patients undergoing pelvic radiation is a significant challenge. While the photon beam radiation's adverse effects on the uterus and ovaries are well established, the impact of pelvic carbon ion radiotherapy on women's reproductive function is largely unexplored. Strategies such as oocyte cryopreservation and ovarian transposition are commonly recommended for safeguarding future fertility. Methods: This study presents a pioneering case of successful pregnancy after carbon ion radiotherapy for locally advanced sacral chondrosarcoma. Results: A multidisciplinary approach facilitated the displacement of ovaries and uterus before carbon ion radiotherapy, resulting in the preservation of endocrine and reproductive function. Conclusion: The patient achieved optimal oncological response and delivered a healthy infant following the completion of cancer treatment.
MeSH term(s)	Female ; Humans ; Pregnancy ; Cryopreservation/methods ; Fertility/physiology ; Fertility Preservation/methods ; Heavy Ion Radiotherapy/adverse effects ; Ovary ; Adult
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	280962-x
ISSN	2038-2529 ; 0300-8916
ISSN (online)	2038-2529
ISSN	0300-8916
DOI	10.1177/03008916231218794
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Article ; Online: What can particle therapy add to the treatment of prostate cancer?

Schwarz, Marco / Molinelli, Silvia

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)

2016 Volume 32, Issue 3, Page(s) 485–491

Abstract: The treatment of prostate cancer with either protons or carbon ions is not a novelty, and several thousands of patients were treated with hadrontherapy in the past decades. The standard treatment approach consisted in two lateral opposed fields for both ... ...

Abstract	The treatment of prostate cancer with either protons or carbon ions is not a novelty, and several thousands of patients were treated with hadrontherapy in the past decades. The standard treatment approach consisted in two lateral opposed fields for both protons and carbon ions, mostly delivered with scattered beams and using conventional fractionation and hypofractionation for protons and carbon ions, respectively. Similar (RBE-weighted and BED) doses to photon therapy (XRT) have been delivered, with comparable results in terms of both local control and toxicity. The advancements in dose deposition and image guidance of the early '00s that improved the quality of XRT treatments and then allowed for hypofractionation, are being matched with some delay by hadrontherapy in these very years. Pencil beam scanning is now the norm in proton therapy, and volumetric image guidance is being developed in all new hadrontherapy facilities. There is therefore the possibility of truly taking advantage of superior dose distributions of hadrons and safely apply it to innovative treatment protocols, such as an intraprostatic boost and the treatment of larger volume for advanced stage disease. This full integration between the best of technology and new clinical approaches is probably necessary in order to obtain clinical results that are truly superior to the current state of the art of XRT.
MeSH term(s)	Heavy Ion Radiotherapy/methods ; Humans ; Male ; Prostatic Neoplasms/radiotherapy
Language	English
Publishing date	2016-03
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1122650-x
ISSN	1724-191X ; 1120-1797
ISSN (online)	1724-191X
ISSN	1120-1797
DOI	10.1016/j.ejmp.2016.03.017
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Article ; Online: The role of multiple anatomical scenarios in plan optimization for carbon ion radiotherapy of pancreatic cancer.

Molinelli, Silvia / Vai, Alessandro / Russo, Stefania / Loap, Pierre / Meschini, Giorgia / Paganelli, Chiara / Barcellini, Amelia / Vitolo, Viviana / Orlandi, Ester / Ciocca, Mario

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2022 Volume 176, Page(s) 1–8

Abstract: Purpose /objective: To quantify benefits of robust optimization on multiple 4DCT acquisitions combined with off-line treatment adaptation for neoadjuvant carbon ion therapy (CIRT) of pancreatic cancer.: Material/methods: For 10 previously treated ... ...

Abstract	Purpose /objective: To quantify benefits of robust optimization on multiple 4DCT acquisitions combined with off-line treatment adaptation for neoadjuvant carbon ion therapy (CIRT) of pancreatic cancer. Material/methods: For 10 previously treated patients, 4DCTs were acquired around -15 (CT Results: (A) No recalculation exceeded the D Conclusion: Anatomical variations highlighted at multiple RE
MeSH term(s)	Humans ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy Dosage ; Heavy Ion Radiotherapy ; Organs at Risk ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/radiotherapy ; Radiotherapy, Intensity-Modulated/methods ; Proton Therapy/methods ; Pancreatic Neoplasms
Language	English
Publishing date	2022-09-14
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2022.09.005
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Article: Synthetic CT in Carbon Ion Radiotherapy of the Abdominal Site.

Parrella, Giovanni / Vai, Alessandro / Nakas, Anestis / Garau, Noemi / Meschini, Giorgia / Camagni, Francesca / Molinelli, Silvia / Barcellini, Amelia / Pella, Andrea / Ciocca, Mario / Vitolo, Viviana / Orlandi, Ester / Paganelli, Chiara / Baroni, Guido

Bioengineering (Basel, Switzerland)

2023 Volume 10, Issue 2

Abstract: The generation of synthetic CT for carbon ion radiotherapy (CIRT) applications is challenging, since high accuracy is required in treatment planning and delivery, especially in an anatomical site as complex as the abdomen. Thirty-nine abdominal MRI-CT ... ...

Abstract	The generation of synthetic CT for carbon ion radiotherapy (CIRT) applications is challenging, since high accuracy is required in treatment planning and delivery, especially in an anatomical site as complex as the abdomen. Thirty-nine abdominal MRI-CT volume pairs were collected and a three-channel cGAN (accounting for air, bones, soft tissues) was used to generate sCTs. The network was tested on five held-out MRI volumes for two scenarios: (i) a CT-based segmentation of the MRI channels, to assess the quality of sCTs and (ii) an MRI manual segmentation, to simulate an MRI-only treatment scenario. The sCTs were evaluated by means of similarity metrics (e.g., mean absolute error, MAE) and geometrical criteria (e.g., dice coefficient). Recalculated CIRT plans were evaluated through dose volume histogram, gamma analysis and range shift analysis. The CT-based test set presented optimal MAE on bones (86.03 ± 10.76 HU), soft tissues (55.39 ± 3.41 HU) and air (54.42 ± 11.48 HU). Higher values were obtained from the MRI-only test set (MAE
Language	English
Publishing date	2023-02-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2746191-9
ISSN	2306-5354
ISSN	2306-5354
DOI	10.3390/bioengineering10020250
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Article ; Online: Characterization of a flat-panel detector for 2D dosimetry in scanned proton and carbon ion beams.

Rossi, Eleonora / Russo, Stefania / Maestri, Davide / Magro, Giuseppe / Mirandola, Alfredo / Molinelli, Silvia / Vai, Alessandro / Grevillot, Loïc / Bolsa-Ferruz, Marta / Rossomme, Séverine / Ciocca, Mario

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)

2023 Volume 107, Page(s) 102561

Abstract: Purpose: To fully characterize the flat panel detector of the new Sphinx Compact device with scanned proton and carbon ion beams.: Materials and methods: The Sphinx Compact is designed for daily QA in particle therapy. We tested its repeatability and ...

Abstract	Purpose: To fully characterize the flat panel detector of the new Sphinx Compact device with scanned proton and carbon ion beams. Materials and methods: The Sphinx Compact is designed for daily QA in particle therapy. We tested its repeatability and dose rate dependence as well as its proportionality with an increasing number of particles and potential quenching effect. Potential radiation damage was evaluated. Finally, we compared the spot characterization (position and profile FWHM) with our radiochromic EBT3 film baseline. Results: The detector showed a repeatability of 1.7% and 0.9% for single spots of protons and carbon ions, respectively, while for small scanned fields it was inferior to 0.2% for both particles. The response was independent from the dose rate (difference from nominal value < 1.5%). We observed an under-response due to quenching effect for both particles, mostly for carbon ions. No radiation damage effects were observed after two months of weekly use and approximately 1350 Gy delivered to the detector. Good agreement was found between the Sphinx and EBT3 films for the spot position (central-axis deviation within 1 mm). The spot size measured with the Sphinx was larger compared to films. For protons, the average and maximum differences over different energies were 0.4 mm (3%) and 1 mm (7%); for carbon ions they were 0.2 mm (4%) and 0.4 mm (6%). Conclusions: Despite the quenching effect the Sphinx Compact fulfills the requirements needed for constancy checks and could represent a time-saving tool for daily QA in scanned particle beams.
MeSH term(s)	Protons ; Proton Therapy ; Radiometry ; Carbon ; Film Dosimetry
Chemical Substances	Protons ; Carbon (7440-44-0)
Language	English
Publishing date	2023-03-08
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1122650-x
ISSN	1724-191X ; 1120-1797
ISSN (online)	1724-191X
ISSN	1120-1797
DOI	10.1016/j.ejmp.2023.102561
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Article ; Online: "Patient-specific validation of deformable image registration in radiation therapy: Overview and caveats".

Paganelli, Chiara / Meschini, Giorgia / Molinelli, Silvia / Riboldi, Marco / Baroni, Guido

Medical physics

2018 Volume 45, Issue 10, Page(s) e908–e922

Abstract: Over the last few decades, deformable image registration (DIR) has gained popularity in image-guided radiation therapy for a number of applications, such as contour propagation, dose warping, and accumulation. Although this raises promising perspectives ... ...

Abstract	Over the last few decades, deformable image registration (DIR) has gained popularity in image-guided radiation therapy for a number of applications, such as contour propagation, dose warping, and accumulation. Although this raises promising perspectives for the improvement of treatment outcomes and quality of radiotherapy clinical practice, the variety of proposed DIR algorithms, combined with the lack of an effective quantitative quality control metric of the registration, is slowing the transfer of DIR into the clinical routine. Recently, a task group (AAPM TG132) report was published outlining the essential aspects of DIR for image guidance in radiotherapy. However, an accurate and efficient patient-specific validation is not yet defined, and appropriate metrics should be identified to achieve the definition of both geometric and dosimetric accuracy. In this respect, the use of a dense set of anatomical landmarks, along with additional evaluations on contours or deformation field analysis, are likely to drive patient-specific DIR validation in clinical image-guided radiotherapy applications to account for geometric inaccuracies. Automatic and efficient strategies able to provide spatial information of DIR uncertainties and to evaluate monomodal and multimodal image registration, as well as to describe homogenous and un-contrasted regions are believed to represent the future direction in DIR validation. But especially in the case of DIR applications for dose mapping and accumulation, the need of accurate patient-specific validation is not only limited to the evaluation of geometric accuracy. In fact, the need to account for dosimetric inaccuracies due to DIR represents another important area in the field of adaptive treatments. Different approaches are currently being investigated to quantify the effect of DIR error on dose analysis, mainly relying on clinically relevant dose metrics, or on the study of deformation field properties for a voxel-by-voxel evaluation. However, novel research is required for the definition of dedicated and personalized measures capable to relate the geometric and dosimetric inaccuracies, thus bearing useful information for a safe use of DIR by clinical end users. In this paper we provide insights on DIR results evaluation on a patient-specific basis, facing the issues of both geometric and dosimetric paradigms. Challenges on DIR validation are overviewed and discussed, in order to push preliminary clinical guidelines forward on this fundamental topic and boost the implementation of more robust and reliable patient-specific evaluation metrics.
MeSH term(s)	Humans ; Image Processing, Computer-Assisted/methods ; Radiometry ; Radiotherapy Dosage ; Radiotherapy, Image-Guided/methods
Language	English
Publishing date	2018-09-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.13162
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Article ; Online: High-dose hypofractionated pencil beam scanning carbon ion radiotherapy for lung tumors: Dosimetric impact of different spot sizes and robustness to interfractional uncertainties.

Mastella, Edoardo / Mirandola, Alfredo / Russo, Stefania / Vai, Alessandro / Magro, Giuseppe / Molinelli, Silvia / Barcellini, Amelia / Vitolo, Viviana / Orlandi, Ester / Ciocca, Mario

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)

2021 Volume 85, Page(s) 79–86

Abstract: Purpose: The robustness against setup and motion uncertainties of gated four-dimensional restricted robust optimization (4DRRO) was investigated for hypofractionated carbon ion radiotherapy (CIRT) of lung tumors.: Methods: CIRT plans of 9 patients ... ...

Abstract	Purpose: The robustness against setup and motion uncertainties of gated four-dimensional restricted robust optimization (4DRRO) was investigated for hypofractionated carbon ion radiotherapy (CIRT) of lung tumors. Methods: CIRT plans of 9 patients were optimized using 4DRRO strategy with 3 mm setup errors, 3% density errors and 3 breathing phases related to the gate window. The prescription was 60 Gy(RBE) in 4 fractions. Standard spots (SS) were compared to big spots (BS). Plans were recalculated on multiple 4DCTs acquired within 3 weeks from treatment simulation and rigidly registered with planning images using bone matching. Warped dose distributions were generated using deformable image registration and accumulated on the planning 4DCTs. Target coverage (D98%, D95% and V95%) and dose to lung were evaluated in the recalculated and accumulated dose distributions. Results: Comparable target coverage was obtained with both spot sizes (p = 0.53 for D95%). The mean lung dose increased of 0.6 Gy(RBE) with BS (p = 0.0078), still respecting the dose constraint of a 4-fraction stereotactic treatment for the risk of radiation pneumonitis. Statistically significant differences were found in the recalculated and accumulated D95% (p = 0.048 and p = 0.024), with BS showing to be more robust. Using BS, the average degradations of the D98%, D95% and V95% in the accumulated doses were -2.7%, -1.6% and -1.5%. Conclusions: Gated 4DRRO was highly robust against setup and motion uncertainties. BS increased the dose to healthy tissues but were more robust than SS. The selected optimization settings guaranteed adequate target coverage during the simulated treatment course with acceptable risk of toxicity.
MeSH term(s)	Carbon ; Heavy Ion Radiotherapy ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Organs at Risk ; Proton Therapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated
Chemical Substances	Carbon (7440-44-0)
Language	English
Publishing date	2021-05-10
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1122650-x
ISSN	1724-191X ; 1120-1797
ISSN (online)	1724-191X
ISSN	1120-1797
DOI	10.1016/j.ejmp.2021.05.004
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Article: Dosimetric and Clinical Risk Factors for the Development of Maxillary Osteoradionecrosis in Adenoid Cystic Carcinoma (ACC) Patients Treated With Carbon Ion Radiotherapy.

Vischioni, Barbara / Russo, Stefania / Meuli, Martino / Bonora, Maria / Ronchi, Sara / Ingargiola, Rossana / Camarda, Anna Maria / Imparato, Sara / Preda, Lorenzo / Ciocca, Mario / Molinelli, Silvia / Orlandi, Ester

Frontiers in oncology

2022 Volume 12, Page(s) 829502

Abstract: Background: The present study aims to evaluate dosimetric and clinical risk factors for the development of maxillary osteoradionecrosis (ORN) in head and neck adenoid cystic carcinoma (ACC) patients treated with carbon ion radiotherapy (CIRT).: ... ...

Abstract	Background: The present study aims to evaluate dosimetric and clinical risk factors for the development of maxillary osteoradionecrosis (ORN) in head and neck adenoid cystic carcinoma (ACC) patients treated with carbon ion radiotherapy (CIRT). Methods: Clinical data and treatment plans of ACC patients, consecutively treated from January 2013 to September 2016 within the phase II clinical trial CNAO S9/2012/C, were retrospectively reviewed. ORN and other treatment-related toxicity were graded according to the Common Terminology Criteria for Adverse Events (CTACE), version 4.0. The maxillary bone was contoured on the planning CT, and only patients receiving more than 10% of the prescription dose at their maxilla were considered for the analysis (67 patients). The volumes of maxilla receiving doses from 10 Gy (RBE) to 60 Gy (RBE) (V Results: The median time interval from the start of CIRT to ORN appearance was 24 months (range, 8-54 months). Maxillary ORN was observed in 11 patients (16.4%). Grade 1 ORN was observed in 2 patients (18.1%), G2 in 4 (36.3%), G3 in 4 (36.3%) and G4 in 1 (9.3%). From univariate analysis, the site of the tumor, the presence of teeth within the PTV and acute mucositis correlated with the development of maxillary ORN. V Conclusion: The volume of maxilla irradiated with high dose values was relevant for ORN development in our cohort of ACC patients. These results are in line with previously published data obtained with a different radiobiological model. Our findings might be helpful to prevent the risk of ORN in patients receiving CIRT.
Language	English
Publishing date	2022-03-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.829502
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Article: A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients.

Mirandola, Alfredo / Russo, Stefania / Bonora, Maria / Vischioni, Barbara / Camarda, Anna Maria / Ingargiola, Rossana / Molinelli, Silvia / Ronchi, Sara / Rossi, Eleonora / Vai, Alessandro / Iacovelli, Nicola Alessandro / Thariat, Juliette / Ciocca, Mario / Orlandi, Ester

Cancers

2022 Volume 14, Issue 11

Abstract: 1) Background: In this work, we aim to provide selection criteria based on normal tissue complication probability (NTCP) models and additional explanatory dose-volume histogram parameters suitable for identifying locally advanced sinonasal cancer ... ...

Abstract	(1) Background: In this work, we aim to provide selection criteria based on normal tissue complication probability (NTCP) models and additional explanatory dose-volume histogram parameters suitable for identifying locally advanced sinonasal cancer patients with orbital invasion benefitting from proton therapy. (2) Methods: Twenty-two patients were enrolled, and two advanced radiation techniques were compared: intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT). Plans were optimized with a simultaneous integrated boost modality: 70 and 56 Gy(RBE) in 35 fractions were prescribed to the high risk/low risk CTV. Several endpoints were investigated, classified for their severity and used as discriminating paradigms. In particular, when NTCP models were already available, a first selection criterion based on the delta-NTCP was adopted. Additionally, an overall analysis in terms of DVH parameters was performed. Furthermore, a second selection criterion based on a weighted sum of the ΔNTCP and ΔDVH was adopted. (3) Results: Four patients out of 22 (18.2%) were suitable for IMPT due to ΔNTCP > 3% for at least one severe toxicity, 4 (18.2%) due to ΔNTCP > 20% for at least three concurrent intermediate toxicities and 16 (72.7%) due to the mixed sum of ΔNTCP and ΔDVH criterion. Since, for some cases, both criteria were contemporary fulfilled, globally 17/22 patients (77.3%) would benefit from IMPT. (4) Conclusions: For this rare clinical scenario, the use of a strategy including DVH parameters and NTCPs when comparing VMAT and IMPT is feasible. We showed that patients affected by sinonasal cancer could profit from IMPT compared to VMAT in terms of optical and central nervous system organs at risk sparing.
Language	English
Publishing date	2022-05-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14112678
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