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1.
Clin Transl Oncol ; 23(8): 1561-1570, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33570720

RESUMO

PURPOSE: Radiosurgery (SRS) is an effective treatment option for brain metastases (BMs). Long-term results of the first worldwide experience with a mono-isocentric, non-coplanar, linac-based stereotactic technique in the treatment of multiple BMs are reported. METHODS: patients with multiple BMs, life expectancy > 3 months, and good performance status (≤ 2) were treated with simultaneous SRS with volumetric modulated arc technique. Data were retrospectively evaluated. RESULTS: 172 patients accounting for 1079 BMs were treated at our institution from 2017 to 2020. The median number of treated metastases was 4 (range 2-22). Primary tumor histology was: lung (44.8%), breast (32%), and melanoma (9.4%). The 2-year LPFS was 71.6%, respectively. A biological effective dose (BED) ≥ 51.3 Gy10 correlated with higher local control. Uncontrolled systemic disease and melanoma histology were independent prognostic factors correlated with decreased iPFS. Patients with > 10 BMs had a trend towards shorter iPFS (p = 0.055). 31 patients received multiple SRS courses (2-7) in case of intracranial progression. The median iOS was 22.4 months. Brainstem metastases and total PTV > 7.1 cc correlated with shorter iOS. The 1- and 2-year WBRT-free survival was 83.2% and 61.1%, respectively. CONCLUSION: Long-term results in a large patient population treated with a mono-isocentric, dedicated technique demonstrated its effectiveness and safety also in the case of multiple courses. The shortened treatment time and the possibility to safely spare healthy brain tissue allows the safe treatment of patients with a large number of metastases and to deliver multiple courses of SRS. In selected cases, the administration of WBRT can be delayed.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Neoplasias da Mama/patologia , Estudos de Coortes , Irradiação Craniana/efeitos adversos , Irradiação Craniana/instrumentação , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Melanoma/radioterapia , Melanoma/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Órgãos em Risco/efeitos da radiação , Intervalo Livre de Progressão , Lesões por Radiação/prevenção & controle , Radiocirurgia/efeitos adversos , Radiocirurgia/instrumentação , Dosagem Radioterapêutica , Eficiência Biológica Relativa , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
2.
Clin Transl Oncol ; 18(3): 317-21, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26250766

RESUMO

PURPOSE: To analyze clinical-dosimetric predictors of genitourinary (GU) toxicity in a cohort of prostate cancer (PC) patients treated with moderate hypofractionation and simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique. MATERIALS AND METHODS: 60 patients were selected. Patients were stratified into low (43 %), intermediate (30 %) and high-risk (27 %) groups. Low-risk patients received 73.5 Gy to PTV1; intermediate-risk received 73.5 Gy to PTV1 and 60 Gy to PTV2; high-risk received 73.5 Gy to PTV1, 60 Gy to PTV2, and 54 Gy to PTV3. All patients were treated in 30 fractions. Androgen deprivation therapy (ADT) was prescribed upfront in intermediate and high-risk categories. Toxicity was scored according to Common Terminology Criteria for Adverse Events v4.0 scoring system. RESULTS: Median follow-up was 30 months (range 16-36 months). GU acute toxicity was recorded as followS: G0 = 16/60 (27 %), G1 = 18/60 (30 %); G2 = 26/60 (43 %). GU late toxicity was recorded as follows: G0 = 20/60 (34 %); G1 = 29/60 (48 %); G2 = 11/56 (18 %). The risk of acute G2 GU toxicity was three times higher for prostate volume ≥80 cc. In 60 % of the patients with a prostate volume ≥80 cc, the first 3 weeks are at particular risk for toxicity onset. In the late setting, no statistical significance was found between GU toxicity and prostate gland dimension. CONCLUSION: Prostate volume ≥80 cc resulted a predictive factor of acute G2 GU toxicity, in moderate hypofractionation and volumetric modulated arc radiation therapy for definitive PC.


Assuntos
Adenocarcinoma/radioterapia , Órgãos em Risco/efeitos da radiação , Próstata , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Sistema Urogenital/efeitos da radiação , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Hipofracionamento da Dose de Radiação , Lesões por Radiação/etiologia , Dosagem Radioterapêutica
3.
Cancer Radiother ; 19(5): 289-94, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26206732

RESUMO

PURPOSE: To investigate the feasibility and tolerance in the use of adjuvant intensity modulated radiation therapy (IMRT) and simultaneous integrated boost in patients with a diagnosis of breast cancer after breast-conserving surgery. PATIENTS AND METHODS: Between September 2011 to February 2013, 112 women with a diagnosis of early breast cancer (T1-2, N0-1, M0) were treated with IMRT and simultaneous integrated boost after breast-conserving surgery in our institution. A dose of 50Gy in 25 fractions was prescribed to the whole breast and an additional dose of radiation was prescribed on the tumour bed. A dose prescription of 60Gy in 25 fractions to the tumour bed was used in patients with negative margins after surgery, whereas if the margins were close (<1mm) or positive (without a new surgical resection) a dose of 64Gy was prescribed. All patients were followed with periodic clinical evaluation. Acute and late toxicity were scored using the EORTC/RTOG radiation morbidity score system. Both patient and physician recorded cosmetic outcome evaluation with a subjective judgment scale at the time of scheduled follow-up. RESULTS: The median follow-up was 28 months (range 24-40 months). The acute skin grade toxicity during the treatment was grade 0 in 8 patients (7%), grade 1 in 80 (72%), grade 2 in 24 cases (21%). No grade 3 or higher acute skin toxicity was observed. At 12 months, skin toxicity was grade 0 in 78 patients (70%), grade 1 in 34 patients (30%). No toxicity grade 2 or higher was registered. At 24 months, skin toxicity was grade 0 in 79 patients (71%), grade 1 in 33 patients (29%). No case of grade 2 toxicity or higher was registered. The pretreatment variables correlated with skin grade 2 acute toxicity were adjuvant chemotherapy (P=0.01) and breast volume ≥700cm(3) (P=0.001). Patients with an acute skin toxicity grade 2 had a higher probability to develop late skin toxicity (P<0.0001). In the 98% of cases, patients were judged to have a good or excellent cosmetic outcome. The 2-year-overall survival and 2-year-local control were 100%. CONCLUSION: These data support the feasibility and safety of IMRT with simultaneous integrated boost in patients with a diagnosis of early breast cancer following breast-conserving surgery with acceptable acute and late treatment-related toxicity. A longer follow-up is needed to define the efficacy on outcomes.


Assuntos
Neoplasias da Mama/terapia , Radioterapia de Intensidade Modulada , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/terapia , Carcinoma Lobular/mortalidade , Carcinoma Lobular/patologia , Carcinoma Lobular/terapia , Estética , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Radiodermite/etiologia , Dosagem Radioterapêutica , Radioterapia Adjuvante , Índice de Gravidade de Doença
4.
Br J Radiol ; 87(1044): 20140543, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25348370

RESUMO

OBJECTIVE: Dysphagia remains a side effect influencing the quality of life of patients with head and neck cancer (HNC) after radiotherapy. We evaluated the relationship between planned dose involvement and acute and late dysphagia in patients with HNC treated with intensity-modulated radiation therapy (IMRT), after a recontouring of constrictor muscles (PCs) and the cricopharyngeal muscle (CM). METHODS: Between December 2011 and December 2013, 56 patients with histologically proven HNC were treated with IMRT or volumetric-modulated arc therapy. The PCs and CM were recontoured. Correlations between acute and late toxicity and dosimetric parameters were evaluated. End points were analysed using univariate logistic regression. RESULTS: An increasing risk to develop acute dysphagia was observed when constraints to the middle PCs were not respected [mean dose (Dmean) ≥50 Gy, maximum dose (Dmax) >60 Gy, V50 >70% with a p = 0.05]. The superior PC was not correlated with acute toxicity but only with late dysphagia. The inferior PC was not correlated with dysphagia; for the CM only, Dmax >60 Gy was correlated with acute dysphagia ≥ grade 2. CONCLUSION: According to our analysis, the superior PC has a major role, being correlated with dysphagia at 3 and 6 months after treatments; the middle PC maintains this correlation only at 3 months from the beginning of radiotherapy, but it does not have influence on late dysphagia. The inferior PC and CM have a minimum impact on swallowing symptoms. ADVANCES IN KNOWLEDGE: We used recent guidelines to define dose constraints of the PCs and CM. Two results emerge in the present analysis: the superior PC influences late dysphagia, while the middle PC influences acute dysphagia.


Assuntos
Transtornos de Deglutição/etiologia , Deglutição/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Músculos Laríngeos/efeitos da radiação , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Feminino , Seguimentos , Humanos , Músculos Laríngeos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Stud Health Technol Inform ; 180: 1212-4, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22874404

RESUMO

Visually-impaired people can develop several unhealthy behaviors, including the lack of physical activity or sports, due to the incomplete maturity in the control of their body in the space. This research focuses on the creation of an "exergame" - a videogame especially designed to stimulate physical exercise - that, through voice commands, allows the visually impaired users to practice physical activity and train their abilities. This tool has been developed starting from an existing dance-game, by generating some appropriate interfaces that also involve the sensory channel of sight. Our research aims to study the effects related to this exergame on the motor control mechanism in a blind children's group, aged between 8 and 13 years: it focuses also on the joint use of movement analysis systems and of videogames in order to stimulate the physical activity in these subjects.


Assuntos
Biorretroalimentação Psicológica/métodos , Dança , Terapia por Exercício/métodos , Terapia Assistida por Computador/métodos , Interface Usuário-Computador , Jogos de Vídeo , Transtornos da Visão/reabilitação , Humanos
6.
Radiat Res ; 169(5): 575-83, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18439037

RESUMO

The case for a DNA-damaging action produced by radiofrequency (RF) signals remains controversial despite extensive research. With the advent of the Universal Mobile Telecommunication System (UMTS) the number of RF-radiation-exposed individuals is likely to escalate. Since the epigenetic effects of RF radiation are poorly understood and since the potential modifications of repair efficiency after exposure to known cytotoxic agents such as ionizing radiation have been investigated infrequently thus far, we studied the influence of UMTS exposure on the yield of chromosome aberrations induced by X rays. Human peripheral blood lymphocytes were exposed in vitro to a UMTS signal (frequency carrier of 1.95 GHz) for 24 h at 0.5 and 2.0 W/kg specific absorption rate (SAR) using a previously characterized waveguide system. The frequency of chromosome aberrations was measured on metaphase spreads from cells given 4 Gy of X rays immediately before RF radiation or sham exposures by fluorescence in situ hybridization. Unirradiated controls were RF-radiation- or sham-exposed. No significant variations due to the UMTS exposure were found in the fraction of aberrant cells. However, the frequency of exchanges per cell was affected by the SAR, showing a small but statistically significant increase of 0.11 exchange per cell compared to 0 W/kg SAR. We conclude that, although the 1.95 GHz signal (UMTS modulated) does not exacerbate the yield of aberrant cells caused by ionizing radiation, the overall burden of X-ray-induced chromosomal damage per cell in first-mitosis lymphocytes may be enhanced at 2.0 W/kg SAR. Hence the SAR may either influence the repair of X-ray-induced DNA breaks or alter the cell death pathways of the damage response.


Assuntos
Telefone Celular , Aberrações Cromossômicas/efeitos da radiação , Linfócitos/efeitos da radiação , Micro-Ondas/efeitos adversos , Raios X/efeitos adversos , Adulto , Morte Celular/efeitos da radiação , Células Cultivadas , Reparo do DNA/efeitos da radiação , Humanos , Linfócitos/citologia , Linfócitos/metabolismo , Masculino , Modelos Biológicos
7.
Radiol Med ; 113(1): 144-57, 2008 Feb.
Artigo em Inglês, Italiano | MEDLINE | ID: mdl-18338134

RESUMO

PURPOSE: E-learning, an abbreviation of electronic learning, indicates the provision of education and training on the Internet or the World Wide Web. The impact of networks and the Internet on radiology is undoubtedly important, as it is for medicine as a whole. The Internet offers numerous advantages compared with other mass media: it provides access to a large amount of information previously known only to individual specialists; it is flexible, permitting the use of images or video; and it allows linking to Web sites on a specific subject, thus contributing to further expand knowledge. Our purpose is to illustrate the regulatory aspects (including Internet copyright laws), current radiological applications and future prospects of e-learning. Our experience with the installation of an e-learning platform is also presented. MATERIALS AND METHODS: We performed a PubMed search on the published literature (without time limits) dealing with e-learning tools and applications in the health sector with specific reference to radiology. The search included all study types in the English language with the following key words: e-learning, education, teaching, online exam, radiology and radiologists. The Fiaso study was referred to for the regulatory aspects of e-learning. RESULTS: The application of e-learning to radiology requires the development of a model that involves selecting and creating e-learning platforms, creating and technologically adapting multimedia teaching modules, creating and managing a unified catalogue of teaching modules, planning training actions, defining training pathways and Continuing Education in Medicine (CME) credits, identifying levels of teaching and technological complexity of support tools, sharing an organisational and methodological model, training the trainers, operators' participation and relational devices, providing training, monitoring progress of the activities, and measuring the effectiveness of training. Since 2004, a platform--LiveLearning--has been used at our university: this is a Web-oriented application, that is, an Internet software solution that users can access through a Web browser. The pages displayed by the browser are dynamically generated through interaction with a database that collects both data required for the application to work and data related to the courses provided. There are different approaches to developing applications that use databases to store information. The selected approach is based on a modular three-level architecture divided into presentation level, intermediate level, and data level. The LiveLearning platform includes modules to manage multimedia contents and to interface with the streaming server so that the student can access the training contents directly from the platform interfaces. Furthermore, the platform offers its users different modules: Teaching Units, Documents, Forums, and Chats. By appropriately combining these modules, customised training can be devised based on specific requirements. CONCLUSIONS: The increasing diffusion of continuous education will reduce the costs of e-learning and make this training method, which helps keep pace with technological progress, more attractive, with significant professional gains for radiologists.


Assuntos
Educação a Distância/métodos , Internet , Radiologia/educação , Instrução por Computador/legislação & jurisprudência , Instrução por Computador/métodos , Instrução por Computador/tendências , Direitos Autorais , Credenciamento , Currículo , Bases de Dados como Assunto , Educação a Distância/legislação & jurisprudência , Educação a Distância/tendências , Educação Médica Continuada , Europa (Continente) , Previsões , Humanos , Armazenamento e Recuperação da Informação , Internet/legislação & jurisprudência , Internet/tendências , Modelos Educacionais , Multimídia , Radiologia/legislação & jurisprudência , Radiologia/tendências , Controle Social Formal , Software , Ensino/métodos
8.
Minerva Pediatr ; 47(5): 165-70, 1995 May.
Artigo em Italiano | MEDLINE | ID: mdl-7643817

RESUMO

The authors submitted some children examined in the Division of Pediatric Surgery of the Ospedali Galliera in Genoa to a psychodiagnostic evaluation. They presented abdominal pain and defecation disorders, whose organic etiology was not demonstrated. The psychodiagnostic evaluation, consisting in colloquia, tests, drawings and plays, was completed in 11 of the 28 patients referred. A profoundly disturbed and protagonist mother-child relationship and a frequent "border position" of the father was focused. The symptoms disappeared in 8 of the 11 patients during the diagnostic evaluation, that resulted, its own, therapeutic. 3 patients were treated with psychotherapy and a remarkable improvement at 6 months from the beginning of therapy was noticed. Seventeen patients were lost because they didn't come to the outpatient dates or because they were already followed by other specialists in their residential zones. The authors believe that a psychodiagnostic evaluation is important in children with abdominal pain and defecation disorders whose organic origin has not been demonstrated.


Assuntos
Dor Abdominal/psicologia , Encoprese/psicologia , Dor Abdominal/terapia , Adolescente , Criança , Pré-Escolar , Fantasia , Feminino , Humanos , Imaginação , Masculino , Relações Mãe-Filho , Psicoterapia
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