Dosimetric Comparison Between Proton and Photon Radiation Therapies for Pediatric Neuroblastoma.

Purpose: The aim of this study is to determine the most beneficial radiation treatment technique for pediatric patients with thoracic and abdominal neuroblastoma (NBL), through a dosimetric comparison between photon Volumetric Modulated Arc Therapy and proton Intensity-Modulated Proton Therapy treatment plans.

Materials And Methods: A retrospective analysis was conducted on a multicentre case series of 19 patients with thoracic and/or abdominal NBL who underwent radiation therapy, following the recommendations of the European protocol for high-risk NBL (HR-NBL2/SIOPEN). The prescribed dose was 21.

Ten Daily Fractions for Whole Breast Cancer Irradiation: Long Term Results.

Background/aim: To report the feasibility and oncological outcomes in breast cancer patients treated with a short hypofractionated radiotherapy schedule.

Patients And Methods: We evaluated 380 breast cancer patients treated with ten daily fractions of radiotherapy up to 39 Gy on tumor bed. Primary endpoint was local relapse rate (LRR).

A dedicated cloud system for real-time upfront quality assurance in pediatric radiation therapy.

Purpose: Pediatric radiotherapy (RT) is a highly specialized field, requiring great experience to delineate correctly tumor targets and organs at risk. To reduce treatment failures related to planning inaccuracies and to obtain robust clinical results despite the limited numbers of enrolled pediatric patients, the SIOP PNET5MB clinical trial on medulloblastoma requires a real-time, pre-radiation review of the RT treatment (craniospinal irradiation and boost plan) under the direct responsibility of the national coordinator center. Here we describe the centralized radiotherapy quality assurance (QA) program developed in Italy for this purpose.

Tumor Size-driven Dose of Intraoperative Radiotherapy for Breast Cancer: 18 Gy 21 Gy.

Aim: To test whether a reduced total single dose of 18 Gy of intraoperative radiotherapy with electrons (IORT) may be tailored to safely treat patients in comparison with the standard dose of 21 Gy. (NCT01276938).

Patients And Methods: From October 2009 to December 2011, 199 females affected by breast cancer were treated with conservative surgery and IORT with two different exclusive doses, 18 or 21 Gy.

Comparison of Local Recurrence Among Early Breast Cancer Patients Treated With Electron Intraoperative Radiotherapy vs Hypofractionated Photon Radiotherapy an Observational Study.

Purpose: To evaluate local recurrence (LR) in women with early breast cancer (BC) who underwent intraoperative radiation therapy with electrons particles (IORT-E) or adjuvant hypofractionated external radiotherapy (HYPOFX).

Materials And Methods: We retrospectively analyzed 470 patients with early BC treated at our center from September 2009 to December 2012. 235 women were treated with breast-conserving surgery and immediate IORT-E (21 Gy/1 fraction) while 235 patients underwent wide excision followed by hypofractionated whole-breast irradiation.

Moderate hypofractionated radiotherapy after prostatectomy for cancer patients: toxicity and clinical outcome.

Background: After radical prostatectomy (RP) radiotherapy (RT) plays a role, both as adjuvant or salvage treatment. If negative features are present such as extracapsular extension, seminal vesicle invasion, lymph invasion, and positive surgical margins, RT after RP reduces the risk of recurrence, although it is associated with an increased risk of acute and late toxicities. An intensified RT delivered in a shortened time could improve clinical outcome and be safely combined with hormonal therapy (HT).

Neuroendocrine late effects after tailored photon radiotherapy for children with low grade gliomas: Long term correlation with tumour and treatment parameters.

Purpose: To evaluate neuroendocrine late effects in paediatric patients with low grade glioma (LGG) who underwent radiotherapy.

Methods And Material: We performed a retrospective evaluation of 40 children with LGG treated from July 2002 to January 2015 with external radiotherapy. Tumour locations were cerebral hemisphere (n=2); posterior fossa (n=15); hypothalamic-pituitary axis (HPA, n=15); spine (n=5).

Adjuvant intraoperative radiotherapy for selected breast cancers in previously irradiated women: Evidence for excellent feasibility and favorable outcomes.

Background: The present report provides preliminary outcomes with intraoperative radiotherapy delivered to women with breast cancer included in a re-irradiation program.

Materials And Methods: From October 2010 to April 2014, thirty women were included in a re-irradiation protocol by exploiting IORT technique. The median time between the two irradiations was 10 years (range 3-50).

Use of parallel-plate ionization chambers in reference dosimetry of NOVAC and LIAC mobile electron linear accelerators for intraoperative radiotherapy: a multi-center survey.

Purpose: LIAC and NOVAC are two mobile linear accelerators dedicated to intraoperative radiation therapy (IORT), generating electron beams in the energy range of 3-12 MeV. Due to high dose-per-pulse (up to 70 mGy per pulse), in 2003 the Italian National Institute of Health (ISS) stated that "for the measure of dose to water in reference conditions, ionization chambers cannot be employed and no published dosimetry protocol can be used". As a consequence, ferrous sulphate (or, alternatively alanine) dosimetry was recommended.

Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity.

Background: The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity.

Methods: From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women.

Image guided hypofractionated radiotherapy by helical tomotherapy for prostate carcinoma: toxicity and impact on Nadir PSA.

Aim: To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT) of prostate cancer as well as the value of the nadir PSA (nPSA) and time to nadir PSA (tnPSA) as surrogate efficacy of treatment.

Material And Methods: Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT). A dose of 70.

'In vivo' average glandular dose evaluation: one-to-one comparison between digital breast tomosynthesis and full-field digital mammography.

We analysed 300 patients X rayed with digital breast tomosynthesis (DBT), full-field digital mammography (FFDM) and 'COMBO' (single view both in FFDM and DBT in a single breast compression)-Hologic Selenia Dimension-W/Rh-Ag-Al: three different anode-filter combinations-automatic exposure control modalities. Examination parameter data collection (EPDC) and 'in vivo' dosimetry using metal oxide semiconductor field effect transistor (MOSFET) were utilised to determine and compare entrance skin air kerma (ESAK) and average glandular dose (AGD) from a radioprotection viewpoint in the DBT and COMBO modalities. MOSFET has been tested to be introduced in clinical routine.

Ablative or palliative stereotactic body radiotherapy with helical tomotherapy for primary or metastatic lung tumor.

Aim: To evaluate the feasibility and outcomes of stereotactic body radiotherapy (SBRT) by helical tomotherapy (HT) for patients with primary or secondary lung cancer.

Patients And Methods: Between March 2009 and January 2012, 56 patients were selected as candidates for the study and were divided into two subgroups. The ablative SBRT group included 27 patients with T1-T2 non-small cell lung cancer who received four to five large-dose fractions in two weeks and the palliative SBRT group included 29 patients with lung metastases treated with eight lower-dose fractions in four weeks.

Focus on the actual clinical target volume irradiated with intraoperative radiotherapy for breast cancer.

Aim: Intraoperative radiotherapy (IORT) has been investigated as an exclusive adjuvant treatment option for early-stage breast cancer (BC). We analysed our experience on the technical aspects of this innovative approach in terms of identification of breast volume actually to be treated during IORT.

Patients And Methods: A total of 315 patients at low risk of breast cancer recurrence underwent IORT as exclusive treatment after breast-conservative surgery.

Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software.

Objective: To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software.

Methods: Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM.

On-line optimization of intraoperative electron beam radiotherapy of the breast.

Purpose: To optimize the dose delivery to the breast lumpectomy target treated with intraoperative electron beam radiotherapy (IOERT).

Materials And Methods: Two tools have been developed in our MU calculation software NEMO X to improve the dose homogeneity and the in-vivo dosimetry effectiveness for IOERT treatments. Given the target (tumor bed) thickness measured by the surgeon, NEMO X can provide auto dose normalization to cover 95% of the target volume with 95% of the prescription dose (PD) and a "best guess" of the expected dosimeter dose (EDD) for a deep seated in-vivo dosimeter.

Advances in the implementation of helical tomotherapy-based total marrow irradiation with a novel field junction technique.

Given the limitations in the travel ability of the helical tomotherapy (HT) couch, total marrow irradiation (TMI) has to be split in 2 segments, with the lower limbs treated with feet first orientation. The aim of this work is to present a planning technique useful to reduce the dose inhomogeneity resulting from the matching of the 2 helical dose distributions. Three HT plans were generated for each of the 18 patients enrolled.

One-to-one comparison between digital spot compression view and digital breast tomosynthesis.

Objective: To assess if digital breast tomosynthesis (DBT) is at least equal to digital spot compression view (DSCV).

Methods: Following institutional approval and written informed consent, both DBT and DSCV were obtained in women with a screening abnormality. The diagnostic accuracy of DBT and DSCV was evaluated by two radiologists of varying experience (Reader1 and Reader2).

Adjuvant hypofractionated radiotherapy with weekly concomitant boost for women with early breast cancer: the clinical experience at Genoa university.

Unlabelled: The aim of this investigation was to evaluate the feasibility of a shortened whole-breast irradiation schedule with a concomitant boost delivered to the tumor bed once-a-week in patients with early breast cancer submitted to conservative surgery.

Patients And Methods: Patients with pT1 and pT2 M0 carcinoma of the breast were selected. The basic course consisted of 4600 cGy to the whole breast in 20 fractions, 4 times a week, for 5 weeks.