Publications by authors named "Livi L"

Background/objectives: HER2-positive breast cancer (HER2BC) is an aggressive subtype, with neoadjuvant treatment (NAT) aiming to achieve a pathological complete response (pCR) to improve long-term outcomes. Trastuzumab emtansine (T-DM1) has been established as the standard of care in the adjuvant setting for HER2BC patients who do not obtain pCR. The ATD study aimed to evaluate the real-world tolerability of T-DM1 in this setting.

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Background: Optimal therapy following breast-conserving surgery in older adults with low-risk, early-stage breast cancer remains uncertain. The EUROPA trial aims to compare the effects of radiotherapy and endocrine therapy as single-modality treatments on health-related quality of life (HRQOL) and ipsilateral breast tumour recurrence (IBTR) outcomes in this population.

Methods: This non-inferiority, phase 3, randomised study was conducted at 18 academic hospitals across Italy (17 centres) and Slovenia (one centre).

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Objective: This study, derived from the phase 3 SAFE trial (ClinicalTrials.gov identifier: NCT2236806), explores subclinical cardiac damage in breast cancer patients receiving anthracycline-based chemotherapy and left-sided breast radiation therapy (RT).

Materials And Methods: Eligible patients were randomized to a cardioprotective pharmacological therapy (bisoprolol, ramipril, or both) or placebo, with cardiac surveillance at multiple time-point using standard and 3-dimensional echocardiography.

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Patients affected by resectable locally advanced gastric cancer (GC) should receive perioperative chemotherapy as a standard of care. However, an additional benefit of adjuvant chemoradiation (CRT) has been negated by modern trials in the era of extended surgical dissection, and CRT is currently only considered on an individual basis in case of suboptimal resection. However, the dismal prognosis of GC and the modest treatment completion rates of perioperative chemotherapy have pushed to reconsider CRT, particularly as a preoperative treatment, in light of modern treatment techniques, advances in the understanding of the immune landscape and development of targeted agents.

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() Over the years, there has been increasing interest in adopting a quality approach in radiology, leading to the strategic pursuit of specific and key performance indicators (KPIs). These indicators in radiology can have significant impacts ranging from radiation protection to integration into digital healthcare. () This study aimed to conduct a narrative review on the integration of key performance indicators (KPIs) in radiology with specific key questions.

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The therapeutic landscape of metastatic prostate cancer has undergone a profound revolution in recent years. In addition to the introduction of novel molecules in the clinics, the field has witnessed a tremendous development of functional imaging modalities adding new biological insights which can ultimately inform tailored treatment strategies, including local therapies. The evolution and rise of Stereotactic Body Radiotherapy (SBRT) have been particularly notable in patients with oligometastatic disease, where it has been demonstrated to be a safe and effective treatment strategy yielding favorable results in terms of disease control and improved oncological outcomes.

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In recent years, alternative methods to dark ink tattoos for patient positioning in radiotherapy have been explored. This review aims to analyse the evidence for alternative strategies to traditional dark tattoos. An electronic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Sciences and SCOPUS.

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The introduction of PARP inhibitors has revolutionized the management and treatment of patients with pathogenic germline variants of BRCA1/2 who have developed breast cancer. The implementation of PARP inhibitors in clinical settings can be challenging due to their overlapping indications with other drugs, including both recently approved medications and those with proven efficacy. This study utilized the Delphi method to present the first Italian consensus regarding genetic testing, the use of PARP inhibitors in both early and metastatic settings, and strategies for managing the potential toxicity of these novel drugs.

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: The main goal of radiotherapy (RT) is to deliver a precise dose to the target while sparing the surrounding normal tissue and minimizing side effects. Appropriate patient immobilization is crucial, especially for head and neck cancer (HNC) and Brain Cancer (BC). Conventional closed-face masks (CFMs), while effective in minimizing head motion, can cause significant discomfort, anxiety, and claustrophobia.

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Objectives: To investigate the potential relationship between trastuzumab emtansine (T-DM1) treatment and radionecrosis induced by brain stereotactic radiosurgery (SRS) in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer.

Materials And Methods: Patients with HER2-positive breast cancer who were diagnosed with brain metastasis and received both SRS and HER2-targeted agents between 2012 and 2022 were retrospectively analyzed. Patients who received T-DM1 within 1 year (either before or after) of SRS were considered as 'T-DM1 exposure (+)'.

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Article Synopsis
  • A study implemented an electronic checklist to standardize the chart review process for radiation therapists before patient treatments in radiotherapy, improving efficiency and safety.
  • The checklist consisted of 16 mandatory yes/no items, integrated into an existing system, and was evaluated through completion rates, error detection, and feedback from radiation therapists.
  • Results showed a high checklist completion rate, with most errors detected and corrected before treatment, and radiation therapists found the checklist helpful without adding significant workload, indicating its potential as a standard practice.
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Introduction: Lesions of uncertain malignant potential (B3) represent 10% of core needle biopsies (CNBs) or vacuum-assisted breast biopsies (VABBs). Traditionally, B3 lesions are operated on. This study investigated the association between B3 subtypes and malignancy to determine the best management.

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Article Synopsis
  • Neoadjuvant chemotherapy (NAC) significantly affects breast cancer surgery, leading to a national Consensus Conference by the Italian Association of Breast Surgeons (ANISC) involving various specialists.
  • In November 2022, 164 specialists from 74 Breast Centers participated in an online conference to vote on eleven controversial NAC-related issues, achieving consensus on only three.
  • The results showed a general agreement on assessing tumor response via MRI, reassessing biological factors of residual tumors, and possibly skipping formal axillary node dissection for certain patients, highlighting the variability in surgical practices post-NAC.
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Background: Texture analysis extracts many quantitative image features, offering a valuable, cost-effective, and non-invasive approach for individual medicine. Furthermore, multimodal machine learning could have a large impact for precision medicine, as texture biomarkers can underlie tissue microstructure. This study aims to investigate imaging-based biomarkers of radio-induced neurotoxicity in pediatric patients with metastatic medulloblastoma, using radiomic and dosiomic analysis.

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Introduction: Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT.

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Background: Reconstructive options that can be used following conservative mastectomy, skin-, nipple-sparing and skin-reducing mastectomies, allow a remarkable variety of safe methods to restore the natural shape and aesthetics of the breast mound. In case of two-stage breast reconstruction, tissue expanders (TEs) are usually placed in a subpectoral position. The purpose of this retrospective cohort study is to evaluate the feasibility and safety of two-step reconstruction with TE in pre-pectoral position covered by acellular dermal matrix (ADM).

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Purpose: Re-irradiation (re-RT) for recurrent intracranial meningiomas is hindered by the limited radiation tolerance of surrounding tissue and the risk of side effects. This study aimed at assessing outcomes, toxicities and prognostic factors in a cohort of patients with recurrent meningiomas re-treated with different RT modalities.

Materials And Methods: A multi-institutional database from 8 Italian centers including intracranial recurrent meningioma (RM) patients who underwent re-RT with different modalities (SRS, SRT, PT, EBRT) was collected.

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Article Synopsis
  • The study examines the optimal doses and fractionation in stereotactic body radiotherapy (SBRT) for patients with oligometastatic cancer, analyzing 1,099 registered patients from the OligoCare trial.
  • The analysis converted SBRT doses to biological effective doses (BED) using specific cancer types' α/β values, revealing that different cancers received varying doses based on type and metastasis locations.
  • Findings indicate that SBRT doses were adapted according to the primary cancers and metastasis sites, suggesting further research is needed on the safety and efficacy of this tailored approach.
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Characterizations in terms of fractals are typically employed for systems with complex and multiscale descriptions. A prominent example of such systems is provided by the human brain, which can be idealized as a complex dynamical system made of many interacting subunits. The human brain can be modeled in terms of observable variables together with their spatio-temporal-functional relations.

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Self-similar stochastic processes and broad probability distributions are ubiquitous in nature and in many man-made systems. The brain is a particularly interesting example of (natural) complex system where those features play a pivotal role. In fact, the controversial yet experimentally validated "criticality hypothesis" explaining the functioning of the brain implies the presence of scaling laws for correlations.

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Background: Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series.

Materials And Methods: We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers.

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Purpose: Cisplatin-based chemoradiotherapy (CRT) is standard treatment for head and neck squamous cell carcinoma (HNSCC). However, IMRT may increase chemotherapy-induced nausea and vomiting (CINV). The purpose of this study is to investigate the effect of fosaprepitant in preventing CINV.

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