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Pancreatic Neoplasms: HELP
Articles by Valentino Bettinardi
Based on 5 articles published since 2009
(Why 5 articles?)

Between 2009 and 2019, Valentino Bettinardi wrote the following 5 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Clinical Trial Hypofractionated image-guided IMRT in advanced pancreatic cancer with simultaneous integrated boost to infiltrated vessels concomitant with capecitabine: a phase I study. 2013

Passoni, Paolo / Reni, Michele / Cattaneo, Giovanni M / Slim, Najla / Cereda, Stefano / Balzano, Gianpaolo / Castoldi, Renato / Longobardi, Barbara / Bettinardi, Valentino / Gianolli, Luigi / Gusmini, Simone / Staudacher, Carlo / Calandrino, Riccardo / Di Muzio, Nadia. ·Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy. Electronic address: passoni.paolo@hsr.it. ·Int J Radiat Oncol Biol Phys · Pubmed #24267968.

ABSTRACT: PURPOSE: To determine the maximum tolerated radiation dose (MTD) of an integrated boost to the tumor subvolume infiltrating vessels, delivered simultaneously with radical dose to the whole tumor and concomitant capecitabine in patients with pretreated advanced pancreatic adenocarcinoma. METHODS AND MATERIALS: Patients with stage III or IV pancreatic adenocarcinoma without progressive disease after induction chemotherapy were eligible. Patients underwent simulated contrast-enhanced four-dimensional computed tomography and fluorodeoxyglucose-labeled positron emission tomography. Gross tumor volume 1 (GTV1), the tumor, and GTV2, the tumor subvolume 1 cm around the infiltrated vessels, were contoured. GTVs were fused to generate Internal Target Volume (ITV)1 and ITV2. Biological tumor volume (BTV) was fused with ITV1 to create the BTV+Internal Target Volume (ITV) 1. A margin of 5/5/7 mm (7 mm in cranium-caudal) was added to BTV+ITV1 and to ITV2 to create Planning Target Volume (PTV) 1 and PTV2, respectively. Radiation therapy was delivered with tomotherapy. PTV1 received a fixed dose of 44.25 Gy in 15 fractions, and PTV2 received a dose escalation from 48 to 58 Gy as simultaneous integrated boost (SIB) in consecutive groups of at least 3 patients. Concomitant chemotherapy was capecitabine, 1250 mg/m(2) daily. Dose-limiting toxicity (DLT) was defined as any treatment-related G3 nonhematological or G4 hematological toxicity occurring during the treatment or within 90 days from its completion. RESULTS: From June 2005 to February 2010, 25 patients were enrolled. The dose escalation on the SIB was stopped at 58 Gy without reaching the MTD. One patient in the 2(nd) dose level (50 Gy) had a DLT: G3 acute gastric ulcer. Three patients had G3 late adverse effects associated with gastric and/or duodenal mucosal damage. All patients received the planned dose of radiation. CONCLUSIONS: A dose of 44.25 Gy in 15 fractions to the whole tumor with an SIB of 58 Gy to small tumor subvolumes concomitant with capecitabine is feasible in chemotherapy-pretreated patients with advanced pancreatic cancer.

2 Clinical Trial Planning design of locally advanced pancreatic carcinoma using 4DCT and IMRT/IGRT technologies. 2011

Sangalli, Giulia / Passoni, Paolo / Cattaneo, Giovanni M / Broggi, Sara / Bettinardi, Valentino / Reni, Michele / Slim, Najla / Muzio, Nadia Di / Calandrino, Riccardo. ·Medical Physics Department, San Raffaele Scientific Institute, Milan, Italy. ·Acta Oncol · Pubmed #20482224.

ABSTRACT: BACKGROUND AND PURPOSE: to study the impact of the 4DCT imaging technique on radiotherapy planning for pancreatic carcinoma. To evaluate the possibility of IMRT/IGRT to increase the dose to PTV subvolume. MATERIAL AND METHODS: contrast-enhanced 4DCT scans of 15 patients (PTs) with unresectable pancreatic cancer were acquired. A 4DCT based PTV (4D-PTV) was created by the convolution of contours and then expanded for geometric uncertainties; a standard PTV (STD-PTV) was derived from a single CTV plus conventional margins. Two 3D conformal treatment (3DCRT) plans and one Helical Tomotherapy (HT) plan were generated with a prescription of 60 Gy. Regarding the 3DCRT plans, the 4D-PTV was considered as the target volume for one, and the STD-PTV for the other; the HT plans were performed only for 4D-PTV. Twelve of 15 PTs were admitted to a Phase I hypofractionated study (15 fractions). The prescribed dose was 44.25 Gy to the 4D-PTV and the PTV subvolume around vascular involvement was boosted from 50 to 55 Gy; before treatment, daily patient position was corrected using MVCT. RESULTS: 4D-PTVs were smaller than STD-PTVs with a volume reduction equal to 37%. 3DCRT plans on 4D-PTV showed a significant sparing of most OARs, the use of IMRT allowed a further significant dose reduction. In the Phase I study the PTV subvolume received up to 55 Gy with modest increase in dose to OARs. CONCLUSIONS: the 4DCT procedure decreases the overlap between PTV and OARs. HT technique, compared with 3DCRT, allows efficient dose sparing in particular for the duodenum. The IMRT/IGRT approach allows a safe dose escalation to PTV subvolume.

3 Article Quantifying the robustness of [ 2018

Belli, Maria Luisa / Mori, Martina / Broggi, Sara / Cattaneo, Giovanni Mauro / Bettinardi, Valentino / Dell'Oca, Italo / Fallanca, Federico / Passoni, Paolo / Vanoli, Emilia Giovanna / Calandrino, Riccardo / Di Muzio, Nadia / Picchio, Maria / Fiorino, Claudio. ·Medical Physics, San Raffaele Scientific Institute, Milano, Italy. · Nuclear Medicine, San Raffaele Scientific Institute, Milano, Italy. · Radiotherapy, San Raffaele Scientific Institute, Milano, Italy. · Medical Physics, San Raffaele Scientific Institute, Milano, Italy. Electronic address: fiorino.claudio@hsr.it. ·Phys Med · Pubmed #29866335.

ABSTRACT: PURPOSE: To investigate the robustness of PET radiomic features (RF) against tumour delineation uncertainty in two clinically relevant situations. METHODS: Twenty-five head-and-neck (HN) and 25 pancreatic cancer patients previously treated with RESULTS: A large disagreement between manual and SUV_max method was found for thresholds  ≥50%. Inter-observer variability showed median DICE values between 0.81 (HN-T) and 0.73 (pancreas). Volumes defined by PET_Edge were better consistent with the manual ones compared to SUV40%. Regarding RF, 19%/19%/47% of the features showed ICC < 0.80 between observers for HN-N/HN-T/pancreas, mostly in the Voxel-alignment matrix and in the intensity-size zone matrix families. RFs with ICC < 0.80 against manual delineation (taking the worst value) increased to 44%/36%/61% for PET_Edge and to 69%/53%/75% for SUV40%. CONCLUSIONS: About 80%/50% of 72 RF were consistent between observers for HN/pancreas patients. PET_edge was sufficiently robust against manual delineation while SUV40% showed a worse performance. This result suggests the possibility to replace manual with semi-automatic delineation of HN and pancreas tumours in studies including PET radiomic analyses.

4 Article Role of PET/CT in the clinical management of locally advanced pancreatic cancer. 2012

Picchio, Maria / Giovannini, Elisabetta / Passoni, Paolo / Busnardo, Elena / Landoni, Claudio / Giovacchini, Giampiero / Bettinardi, Valentino / Crivellaro, Cinzia / Gianolli, Luigi / Di Muzio, Nadia / Messa, Cristina. ·Nuclear Medicine, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy. picchio.maria@hsr.it ·Tumori · Pubmed #23235761.

ABSTRACT: AIM: To evaluate the role of 18F-fluorodeoxyglucose (FDG) PET/CT in: a) the selection of patients with locally advanced pancreatic cancer for helical tomotherapy with concurrent chemotherapy (HTT-ChT); b) monitoring HTT-ChT treatment efficacy in comparison with contrast-enhanced CT (c.e.CT). METHODS: Forty-two consecutive patients with unresectable locally advanced pancreatic cancer referred for HTT-ChT were enrolled in the study. All patients were pretreated with induction ChT. Before the beginning of HTT-ChT treatment patients underwent diagnostic c.e.CT (CT0) and FDG PET/CT (PET/CT0) for staging. After staging, patients received HTT-ChT. Three months after the end of HTT-ChT a control c.e.CT (CT1) was done. FDG PET/CT (PET/CT1) was repeated only in patients with positive PET/CT0. PET/CT1 and CT1 were compared with baseline imaging results to assess treatment efficacy. RESULTS: In 31/42 cases (74%) PET/CT0 documented pathological uptake in pancreatic lesions, while in the remaining 11/42 cases it showed no uptake. In 7/42 (17%) patients, PET/CT0 also detected distant metastases, prompting a change in the therapeutic approach. Compared to PET/CT0, PET/CT1 (n = 18) documented 3 complete metabolic responses, 9 partial metabolic responses, 2 instances of stable metabolic disease, and 4 instances of progressive metabolic disease. In the same group of 18 patients, CT1 showed 0 complete responses, 3 partial responses, 8 instances of stable disease, and 7 instances of progressive disease compared to CT0. Concordance between PET/CT and CT response was seen in 33% of cases. In 50% of cases, PET/CT1 documented a response to therapy that was not evident on CT. CONCLUSIONS: PET/CT influenced the treatment strategy by detecting distant metastases not documented by CT, thus accurately selecting patients for HTT-ChT after induction ChT. In monitoring treatment efficacy, PET/CT can detect a metabolic response to treatment not identified by CT.

5 Article Internal target volume defined by contrast-enhanced 4D-CT scan in unresectable pancreatic tumour: evaluation and reproducibility. 2010

Cattaneo, Giovanni Mauro / Passoni, Paolo / Sangalli, Giulia / Slim, Najla / Longobardi, Barbara / Mancosu, Pietro / Bettinardi, Valentino / Di Muzio, Nadia / Calandrino, Riccardo. ·Medical Physics Department, San Raffaele Scientific Institute, Milano, Italy. mauro.cattaneo@hsr.it ·Radiother Oncol · Pubmed #20826027.

ABSTRACT: We compared customized ITVs obtained with CE-4D-CT imaging (ITV(4D)) with a population-based (ITV(PBC)) in 29 patients (PTs) and evaluated the intra-observer ITV delineation reproducibility in 5 PTs with unresectable pancreatic ductal adenocarcinoma (PDA). The ITV(PBC) was quite different from the ITV(4D), with under/over estimation of volume. Intra-observer volume delineation variability on CE-4D-CT and on a single-phase CE-CT were similar (27.6% vs 24.9%).