Image-guided radiotherapy (IGRT) in Lombardy, Italy: a survey by the Lombardy section of the Italian Association of Radiotherapy and Clinical Oncology (AIRO-Lombardy).

BACKGROUND: Image-guided radiation therapy (IGRT) has changed clinical practice. We proposed a survey to radiotherapy centers in Lombardy to picture the current clinical practice of its use. RESEARCH DESIGN AND METHODS: The survey consisted of 32 multiple-choice questions, divided into five topics: type of hospital, patients treated in 2019, number of LINACs; presence of protocols and staff involved in IGRT; IGRT in stereotaxis; IGRT in non-stereotactic treatments; availability of medical and technical staff. RESULTS: Twenty-seven directors answered (77%). Most centers (74%) have produced protocols to ensure uniformity in the IGRT process. The most widely used IGRT modality (92%) is cone-beam CT. Daily IGRT control is favored for prostate (100%), head and neck (87%), and lung (78%) neoplasms. The resident doctors can always perform supervised IGRT matching in only six centers. Radiation therapists perform IGRT controls only for some sites in 12 cases (44%) and always in 9 cases (33%). Radiation oncologists are present in real time, in most cases. CONCLUSIONS: Today, IGRT can be considered standard practice but at the price of more time-consuming procedures. A balance between a fully physician-controlled process and an increased role for specifically trained RTTs is actively being sought.

Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature.

BACKGROUND: The standard treatment of locally advanced rectal cancers (LARC) consists on neoadjuvant chemoradiotherapy followed by total mesorectal excision. Different data in literature showed a benefit on tumor downstaging and pathological complete response (pCR) rate using radiotherapy dose escalation, however there is shortage of studies regarding dose escalation using the innovative techniques for LARC (T3-4 or N1-2). AIM: To analyze the role of neoadjuvant radiotherapy dose escalation for LARC using innovative radiotherapy techniques. METHODS: In December 2020, we conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane library. The limit period of research included articles published from January 2009 to December 2020. Screening by title and abstract was carried out to identify only studies using radiation doses equivalent dose 2 Gy fraction (EQD2) ≥ 54 Gy and Volumetric Modulated Arc Therapy (VMAT), intensity-modulated radiotherapy or image-guided radiotherapy (IGRT) techniques. The authors' searches generated a total of 2287 results and, according to PRISMA Group (2009) screening process, 21 publications fulfil selection criteria and were included for the review. RESULTS: The main radiotherapy technique used consisted in VMAT and IGRT modality. The mainly dose prescription was 55 Gy to high risk volume and 45 Gy as prophylactic volume in 25 fractions given with simultaneous integrated boosts technique (42.85%). The mean pCR was 28.2% with no correlation between dose prescribed and response rates (P value ≥ 0.5). The R0 margins and sphincter preservation rates were 98.88% and 76.03%, respectively. After a mean follow-up of 35 months local control was 92.29%. G3 or higher toxicity was 11.06% with no correlation between dose prescription and toxicities. Patients receiving EQD2 dose > 58.9 Gy and BED > 70.7 Gy had higher surgical complications rates compared to other group (P value = 0.047). CONCLUSION: Dose escalation neoadjuvant radiotherapy using innovative techniques is safe for LARC achieving higher rates of pCR. EQD2 doses > 58.9 Gy is associated with higher rate of surgical complications.

The effect of a single yoga class on interoceptive accuracy in patients affected by anorexia nervosa and in healthy controls: a pilot study.

PURPOSE: To evaluate interoceptive accuracy (Iac) before and after a single yoga class in a population of patients with anorexia nervosa (AN) and in a population of healthy controls (HC). METHODS: Fifteen patients with AN and twenty HC were included in the study. All individuals participated in a single yoga class. Before (T0) and after (T1) the yoga class, they underwent the heartbeat detection task for the evaluation of Iac. At T0, all participants also underwent a psychological assessment, including evaluation of depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders psychopathology. RESULTS: Patients with AN had lower Iac than HC at T0. A significant improvement of Iac at T1 was found in the HC group but not in the group of patients with AN. CONCLUSION: We infer that our findings might be linked to the fact that patients with AN, differently from HC, did not properly attend to their bodies, despite the yoga class. This hypothesis is consistent with previous studies showing that patients with AN have decreased Iac during self-focused behavior because of body-related avoidance. Moreover, we surmise that HC might be keener to improve their perception of internal body signals even after a single yoga class because their emotional awareness system is not impaired. Patients with AN, on the contrary, may have an intrinsic impairment of their emotional awareness, making it harder for them to modulate their Iac. LEVEL OF EVIDENCE: Level III, evidence obtained from well-designed cohort or case-control analytical studies.

Management of grade 3 acute dermatitis with moist desquamation after adjuvant chest wall radiotherapy: a case report.

We reported a successful case management of G3 skin acute dermatitis in a 32-year-old woman affected by locally advanced breast cancer underwent adjuvant chest wall irradiation. Skin acute toxicity with dry desquamation areas was treated daily with dressing medication using physiological solution, oxygen therapy and applying hyaluronic acid gauze. At the end of radiotherapy treatment, G3 skin acute dermatitis with moist desquamation was observed, so the patient continued advanced wound dressing shifted to twice weekly with physiological solution, oxygen therapy and applying hydrocolloid dressing. The patient completed radiotherapy treatment without interruption and one month after treatment acute skin toxicity was resolved with pain relief. We suggest that advanced dressing with trained nursing staff is essential in this sub-set of patients due to guaranteed continuation of radiotherapy treatment, indispensable to ensure patient cure.