Post-Irradiation Hyperamylasemia Is a Prognostic Marker for Allogeneic Hematopoietic Stem Cell Transplantation Outcomes in Pediatric Population: A Retrospective Single-Centre Cohort Analysis.

BACKGROUND: Total body irradiation (TBI) is a mandatory step for patients with acute lymphoblastic leukemia (ALL), undergoing allogeneic hematopoietic stem cell transplantation (HSCT). In the past, amylases have been reported to be a possible sign of TBI toxicity. We investigated the relationship between total amylases (TA) and transplant-related outcomes in pediatric recipients. METHODS: We retrospectively analyzed the medical records of all the patients who underwent allogeneic HSCT between January 2000 and November 2019. The inclusion criteria were the following: recipient's age between 2 and 18, diagnosis of ALL, no previous transplantation, and use of TBI-based conditioning. The serum total amylase and pancreatic amylase were evaluated before, during, and after transplantation. Cytokines and chemokines assays were retrospectively performed. RESULTS: 78 patients fulfilled the inclusion criteria. Fifty-seven patients were treated with fractionated TBI, and 21 with a single-dose regimen. The overall survival (OS) was 62.8%. Elevated values of TA were detected in 71 patients (91%). The TA were excellent in predicting the OS (AUC = 0.773; 95% CI = 0.66-0.86; p < 0.001). TA values below 374 U/L were correlated with a higher OS. The highest mean TA values (673 U/L) were associated with a high disease-progression mortality rate. The TA showed a high predictive performance for disease progression-related death (AUC = 0.865; 95% CI = 0.77-0.93; p < 0.0001). Elevated TA values were also connected with significantly higher levels of proinflammatory cytokines, such as TNF-α, IL-6, and RANTES (p < 0.001). CONCLUSIONS: this study shows that TA is a valuable predictor of post-transplant OS and increased risk of leukemia relapse.

Evaluation of localized region-based segmentation algorithms for CT-based delineation of organs at risk in radiotherapy.

BACKGROUND AND PURPOSE: In radiation therapy, defining the precise borders of cancerous tissues and adjacent normal organs has a significant effect on the therapy outcome. Deformable models offer a unique and robust approach to medical image segmentation. The objective of this study was to investigate the reliability of segmenting organs-at-risk (OARs) using three well-known local region-based level-set techniques. METHODS AND MATERIALS: A total of 1340 non-enhanced and enhanced planning computed tomography (CT) slices of eight OARs (the bladder, rectum, kidney, clavicle, humeral head, femoral head, spinal cord, and lung) were segmented by using local region-based active contour, local Chan-Vese, and local Gaussian distribution models. Quantitative metrics, namely Hausdorff Distance (HD), Mean Absolute Distance (MAD), Dice coefficient (DC), Percentage Volume Difference (PVD) and Absolute Volumetric Difference (AVD), were adopted to measure the correspondence between detected contours and the manual references drawn by experts. RESULTS: The results showed the feasibility of using local region-based active contour methods for defining six of the OARs (the bladder, kidney, clavicle, humeral head, spinal cord, and lung) when adequate intensity information is available. While the most accurate results were achieved for lung (DC = 0.94) and humeral head (DC = 0.92), a poor level of agreement (DC < 0.7) was obtained for both rectum and femur. CONCLUSION: Incorporating local statistical information in level set methods yields to satisfactory results of OARs delineation when adequate intensity information exists between the organs. However, the complexity of adjacent organs and the lack of distinct boundaries would result in a considerable segmentation error.

Same strategy for pitfalls of radiotherapy in different anatomical districts.

Oral mucositis (OM) and radiodermatitis (RD) are serious side effects of radiotherapy (RT), often leading to its suspension, need for analgesics, and enteral/parenteral nutrition. Laser therapy is becoming a recommended treatment option. This prospective study aimed at demonstrating the beneficial effect of class IV laser therapy (HPLT) on RT-induced OM, an off-label use of HPLT to treat RD in breast cancer patients. Fifty-three cancer patients, during/after RT and/or chemotherapy (CT), affected by OM, were treated with HPLT during four consecutive days (970 ± 15 nm, 5 W (50 %), 35-6000 Hz, 240 s). Assessment of OM (Grading Objective Scale, WHO-SCALE), pain (visual analogue scale, VAS), functional ability, subjective parameters, and site/severity of OM were recorded over time. Similarly, 27 breast cancer patients affected by RD were treated by HPLT and monitored over time for grade, discomfort, itching, and bleeding. Progressive improvement of WHO-SCALE from day 7 on, and of VAS from day 2 on (p < 0.000) was registered. All patients' functional capacity improved on day 4 (p < 0.05). All subjective parameters improved on day 14 (p < 0.001) except for voice, which improved on day 21 (p < 0.000). Ulcerations' dimension and erythema's severity significantly decreased in all sites examined (p < 0.05). Similarly, HPLT proved to be beneficial in managing RD for all the parameters considered (p < 0.002). Regardless of OM grade/site and of kind/site of tumor, HPLT proved to be effective in healing OM as well as RD. In both cases, effective treatment can improve life quality through a safe, easy, innovative approach. Therefore, HPLT may become an integral part of everyday practice in the management of RT adverse effects.