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Pancreatic Neoplasms: HELP
Articles by Gian Carlo Mattiucci
Based on 14 articles published since 2010
(Why 14 articles?)
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Between 2010 and 2020, Gian C. Mattiucci wrote the following 14 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Online adaptive magnetic resonance guided radiotherapy for pancreatic cancer: state of the art, pearls and pitfalls. 2019

Boldrini, Luca / Cusumano, Davide / Cellini, Francesco / Azario, Luigi / Mattiucci, Gian Carlo / Valentini, Vincenzo. ·Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia. · Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Fisica Sanitaria, Fondazione Policlinico Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia. davide.cusumano@policlinicogemelli.it. · Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Fisica Sanitaria, Fondazione Policlinico Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia. ·Radiat Oncol · Pubmed #31036034.

ABSTRACT: BACKGROUND: Different studies have proved in recent years that hypofractionated radiotherapy (RT) improves overall survival of patients affected by locally advanced, unresectable, pancreatic cancer. The clinical management of these patients generally leads to poor results and is considered very challenging, due to different factors, heavily influencing treatment delivery and its outcomes. Firstly, the dose prescribed to the target is limited by the toxicity that the highly radio-sensitive organs at risk (OARs) surrounding the disease can develop. Treatment delivery is also complicated by the significant inter-fractional and intra-fractional variability of therapy volumes, mainly related to the presence of hollow organs and to the breathing cycle. The recent introduction of magnetic resonance guided radiotherapy (MRgRT) systems leads to the opportunity to control most of the aforementioned sources of uncertainty influencing RT treatment workflow in pancreatic cancer. MRgRT offers the possibility to accurately identify radiotherapy volumes, thanks to the high soft-tissue contrast provided by the Magnetic Resonance imaging (MRI), and to monitor the tumour and OARs positions during the treatment fraction using a high-temporal cine MRI. However, the main advantage offered by the MRgRT is the possibility to online adapt the RT treatment plan, changing the dose distribution while the patient is still on couch and successfully addressing most of the sources of variability. SHORT CONCLUSION: Aim of this study is to present and discuss the state of the art, the main pitfalls and the innovative opportunities offered by online adaptive MRgRT in pancreatic cancer treatment.

2 Review Robotic radiosurgery in pancreatic cancer: A systematic review. 2015

Buwenge, Milly / Cellini, Francesco / Silvestris, Nicola / Cilla, Savino / Deodato, Francesco / Macchia, Gabriella / Mattiucci, Gian C / Valentini, Vincenzo / Morganti, Alessio G. ·Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy. ·World J Gastroenterol · Pubmed #26309369.

ABSTRACT: AIM: To present a systematic review of techniques and clinical results. METHODS: A systematic review of published literature was performed. Only studies reporting patient outcome after radiosurgery (single fraction) delivered with robotic devices [i.e., robotic radiosurgery (RRS)] have been analyzed. RESULTS: A total of 96 patients from 5 studies were included. The studies are characterized by small series and different methods in terms of dose, target definition, combination with chemotherapy and/or standard fractionated radiotherapy and evaluation modalities. Preliminary results are positive in terms of tumor response (ORR = 56%) and local control of the tumor (crude rate of local progressions: 19.5%). Results for median overall survival (11.4 mo) seem comparable with the ones of prolonged chemoradiation (range: 8.6-13.0 mo). However, gastrointestinal toxicity seems to be the main limitation of RRS, especially at the duodenal level. CONCLUSION: RRS allows for local treatment in a shortened time (1 fraction) compared to traditional treatments (about 1 mo), providing the possibility for an easy integration with systemic therapies. Preliminary results did not show any outcome differences compared to standard chemoradiation. Thus, further efforts to reduce gastrointestinal toxicity are strongly needed.

3 Clinical Trial Long-term analysis of gemcitabine-based chemoradiation after surgical resection for pancreatic adenocarcinoma. 2013

Mattiucci, Gian Carlo / Ippolito, Edy / D'Agostino, Giuseppe Roberto / Alfieri, Sergio / Antinori, Armando / Crucitti, Antonio / Balducci, Mario / Deodato, Francesco / Luzi, Stefano / Macchia, Gabriella / Smaniotto, Daniela / Morganti, Alessio Giuseppe / Valentini, Vincenzo. ·Department of Radiotherapy, Policlinico Universitario "Agostino Gemelli", Catholic University, Rome, Italy. ·Ann Surg Oncol · Pubmed #23208130.

ABSTRACT: PURPOSE: To evaluate the efficacy in terms of local control (LC) of 24 h infusion of gemcitabine plus radiotherapy after surgery for pancreatic cancer. METHODS: Weekly gemcitabine (100 mg/m(2)) was provided as a 24-hour infusion during the course of radiotherapy (50.4 Gy to the tumor, 39.6 Gy to the nodes). Patients subsequently received five cycles of gemcitabine monochemotherapy (1,000 mg/m(2) 1, 8, q21). The primary end point of the study was to achieve a 2-year LC rate of ≥80 % with type I and II errors of 5 and 20 %. The study was designed to accrue a maximum sample size of 35 patients. Secondary end points were toxicity evaluation, metastasis-free survival (MFS), and overall survival (OS). RESULTS: Data of 35 patients were available. Most of the patients (n = 27; 77.1 %) had duodeno-cephalo-pancreatectomy, 5 (14.3 %) distal pancreatectomy, and 3 (8.6 %) total pancreatectomy. The pathological stages were T1-T2 (n = 7; 20.0 %), T3-T4 (n = 28; 80.0 %), N0 (n = 17; 48.6 %), and N1 (n = 18; 51.4 %). Thirty patients (85.7 %) completed chemoradiation. Twenty-three patients (65.7 %) received further sequential chemotherapy. Acute toxicity was acceptable. No late toxicity occurred. The median follow-up period was 64 (range 24-118) months, and 2-year crude rate of LC was 83 (median not reached). Median MFS and OS were 26.5 and 22.5 months, respectively. CONCLUSIONS: The rate of LC met the main goal of the study. The regimen resulted in a high LC rate but failed to show a benefit in terms of OS or MFS, thus suggesting the need for a more intensified multimodal approach.

4 Clinical Trial Quality of life and toxicity of stereotactic radiotherapy in pancreatic tumors: a case series. 2012

Macchia, Gabriella / Morganti, Alessio G / Cilla, Savino / Ippolito, Edy / Massaccesi, Mariangela / Picardi, Vincenzo / Mattiucci, Gian Carlo / Bonomo, Pierluigi / Tambaro, Rosa / Pacelli, Fabio / Piermattei, Angelo / De Spirito, Marco / Valentini, Vincenzo / Cellini, Numa / Deodato, Francesco. ·Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università-Cattolica, Campobasso, Italy. gmacchia@rm.unicatt.it ·Cancer Invest · Pubmed #22250589.

ABSTRACT: AIM: To analyze the results of extracranial stereotactic radiotherapy (ESRT) experience in pancreatic cancer patients. METHODS: Four noncoplanar fixed beams were used in all patients. RESULTS: Analysis of 16 patients was carried out. Overall response rate was 56.2%. Fifteen patients experienced local and/or distant progression of disease (median follow-up: 24 months). Two-year local progression-free, distant progression-free, and overall survivals were 85.7%, 58.7%, and 50.0%, respectively. Toxicity was less than grade 2 in all, although 1 patient had severe duodenal bleeding. Quality of life scores were unchanged. CONCLUSIONS: ESRT was associated with low complication rate, and not worsening the patients' quality of life.

5 Clinical Trial Capecitabine based postoperative accelerated chemoradiation of pancreatic carcinoma. A dose-escalation study. 2010

Morganti, Alessio G / Picardi, Vincenzo / Ippolito, Edy / Massaccesi, Mariangela / Macchia, Gabriella / Deodato, Francesco / Mattiucci, Gian Carlo / Caravatta, Luciana / Di Lullo, Liberato / Giglio, Gianfranco / Tambaro, Rosa / Mignogna, Samantha / Caprino, Paola / Ingrosso, Marcello / Sofo, Luigi / Cellini, Numa / Valentini, Vincenzo. ·Radiotherapy Unit, Department of Oncology, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy. ·Acta Oncol · Pubmed #20397772.

ABSTRACT: MATERIAL AND METHODS: Patients with resected pancreatic carcinoma were eligible for this study. Capecitabine was administered at a daily dose of 1600 mg/m (2). Regional lymph nodes received a total radiation dose of 45 Gy with 1.8 Gy per fractions. The starting radiation dose to the tumor bed was 50.0 Gy (2.0 Gy/fraction, 25 fractions). Escalation was achieved up to a total dose of 55.0 Gy by increasing the fraction size by 0.2 Gy (2.2 Gy/fraction), while keeping the duration of radiotherapy to five weeks (25 fractions). A concomitant boost technique was used. Dose limiting toxicity (DLT) was defined as any grade>3 hematologic toxicity, grade>2 liver, renal, neurologic, gastrointestinal, or skin toxicity, by RTOG criteria, or any toxicity producing prolonged (> 10 days) radiotherapy interruption. RESULTS AND DISCUSSION: Twelve patients entered the study (median age: 64 years). In the first cohort (six patients), no patient experienced DLT. Similarly in the second cohort, no DLT occurred. All 12 patients completed the planned regimen of therapy. Nine patients experienced grade 1-2 nausea and/or vomiting. Grade 2 hematological toxicity occurred in four patients. The results of our study indicate that a total radiation dose up to 55.0 Gy/5 weeks can be safely administered to the tumor bed, concurrently with capecitabine (1600 mg/m (2)) in patients with resected pancreatic carcinoma.

6 Article Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival. 2019

Morganti, Alessio G / Cellini, Francesco / Buwenge, Milly / Arcelli, Alessandra / Alfieri, Sergio / Calvo, Felipe A / Casadei, Riccardo / Cilla, Savino / Deodato, Francesco / Di Gioia, Giancarmine / Di Marco, Mariacristina / Fuccio, Lorenzo / Bertini, Federica / Guido, Alessandra / Herman, Joseph M / Macchia, Gabriella / Maidment, Bert W / Miller, Robert C / Minni, Francesco / Passoni, Paolo / Valentini, Chiara / Re, Alessia / Regine, William F / Reni, Michele / Falconi, Massimo / Valentini, Vincenzo / Mattiucci, Gian Carlo. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy. · UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy. · Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy. mbuwenge@gmail.com. · Istituto di Clinica Chirurgica, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, Italy. · Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain. · Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy. · Unit of Medical Physics, Fondazione Giovanni Paolo II, Campobasso, Italy. · Radiotherapy Unit, Fondazione Giovanni Paolo II, Campobasso, Italy. · Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA. · Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. · IRCCS, Ospedale S. Raffaele, Milan, Italy. · Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA. · Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital, University "Vita e Salute", Milan, Italy. ·BMC Cancer · Pubmed #31185957.

ABSTRACT: BACKGROUND: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). METHODS: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. RESULTS: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. CONCLUSIONS: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.

7 Article Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers. 2019

Caravatta, Luciana / Cellini, Francesco / Simoni, Nicola / Rosa, Consuelo / Niespolo, Rita Marina / Lupattelli, Marco / Picardi, Vincenzo / Macchia, Gabriella / Sainato, Aldo / Mantello, Giovanna / Dionisi, Francesco / Rosetto, Maria Elena / Fusco, Vincenzo / Navarria, Federico / De Paoli, Antonino / Guido, Alessandra / Vecchi, Claudio / Basilico, Raffaella / Cianci, Roberta / Delli Pizzi, Andrea / Di Nicola, Marta / Mattiucci, Gian Carlo / Valentini, Vincenzo / Morganti, Alessio Giuseppe / Genovesi, Domenico. ·a Department of Radiotherapy , 'SS Annunziata' Hospital 'G. D'Annunzio' University , Chieti , Italy. · b Gemelli Advanced Radiation Therapy Center Fondazione Policlinico Universitario 'A. Gemelli' Catholic University of Sacred Heart , Rome , Italy. · c Radiotherapy Unit Azienda Ospedaliera Universitaria , Verona , Italy. · d Department of Radiation Oncology , Azienda Ospedaliera S. Gerardo , Monza , Italy. · e Radiation Oncology Section University of Perugia and Perugia General Hospital , Perugia , Italy. · f Radiotherapy Unit Department of Oncology , 'Giovanni Paolo II' Foundation Catholic University of Sacred Heart , Campobasso , Italy. · g Radiotherapy Unit , Azienda Ospedaliera Universitaria Pisana , Pisa , Italy. · h Department of Radiotherapy , State Hospital , Ancona , Italy. · i Proton Therapy Unit, Department of Oncology , Azienda Provinciale per i Servizi Sanitari, APSS , Trento , Italy. · j Department of Radiation Oncology , Ospedale Belcolle , Viterbo , Italy. · k Department of Radiation Oncology , Centro di Riferimento Oncologico Regionale , Rionero in Vulture, Potenza , Italy. · l Department of Radiation Oncology Centro di Riferimento Oncologico , National Cancer Institute , Aviano , Italy. · m Radiation Oncology Center, Department of Experimental Diagnostic and Specialty Medicine - DIMES , University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy. · n Tecnologie Avanzate, Srl , Torino , Italy. · o Department of Radiology , 'SS Annunziata' Hospital 'G. D'Annunzio' University , Chieti , Italy. · p Laboratory of Biostatistics Department of Medical , Oral and Biotechnological Sciences 'G. D'Annunzio' University , Chieti , Italy. ·Acta Oncol · Pubmed #30632876.

ABSTRACT: BACKGROUND: Due to the high soft tissue resolution, magnetic resonance imaging (MRI) could improve the accuracy of pancreatic tumor delineation in radiation treatment planning. A multi-institutional study was proposed to evaluate the impact of MRI on inter-observer agreement in gross tumor volume (GTV) and duodenum delineation for pancreatic cancer compared with computer tomography (CT). MATERIAL AND METHODS: Two clinical cases of borderline resectable (Case 1) and unresectable (Case 2) pancreatic cancer were selected. In two sequential steps, diagnostic contrast-enhanced CT scan and MRI sequences were sent to the participating centers. CT-GTVs were contoured while blinded to MRI data sets. DICE index was used to evaluate the spatial overlap accuracy. RESULTS: Thirty-one radiation oncologists from different Institutions submitted the delineated volumes. CT- and MRI-GTV mean volumes were 21.6 ± 9.0 cm CONCLUSION: Diagnostic MRI resulted in smaller GTV in borderline resectable case with a substantial agreement between observers, and was comparable to CT scan in interobserver variability, in both cases. The greater variability in the unresectable case underlines the critical issues related to the outlining when vascular structures are more involved. The integration of MRI with contrast-enhancement CT, thanks to its high definition of tumor relationship with neighboring vessels, could offer a greater accuracy of target delineation.

8 Article RUNX3 as a Potential Predictor of Metastasis in Human Pancreatic Cancer. 2017

Rossi, Ernesto / Bagalà, Cinzia / Inzani, Frediano / Leoncini, Emanuele / Brunelli, Chiara / Lanza, Paola / Basso, Michele / Mattiucci, Gian Carlo / Cassano, Alessandra / Rindi, Guido / Barone, Carlo / Schinzari, Giovanni. ·Department of Medical Oncology, Fondazione Policlinico "A.Gemelli", Largo A. Gemelli, Rome, Italy ernestorossi.rm@gmail.com. · Department of Medical Oncology, Fondazione Policlinico "A.Gemelli", Largo A. Gemelli, Rome, Italy. · Institute of Anatomic Pathology, Fondazione Policlinico "A.Gemelli", Largo A. Gemelli, Rome, Italy. · Section of Hygiene, Institute of Public Health, Fondazione Policlinico "A.Gemelli", Largo A. Gemelli, Rome, Italy. · Department of Radiation Oncology, Fondazione Policlinico "A.Gemelli", Largo A. Gemelli, Rome, Italy. ·In Vivo · Pubmed #28882948.

ABSTRACT: BACKGROUND/AIM: In genetically engineered murine models of pancreatic ductal adenocarcinomas (PDAC), high levels of Runx3 increase the metastatic potential of cancer cells. In this study we evaluated the role of Runx3 in human pancreatic cancer. MATERIALS AND METHODS: Runx3 was retrospectively assessed by immunohistochemistry in seventy-eight tumor samples of patients who underwent surgical resection for PDCA and were followed at least for 24 months. RESULTS: Thirty-two cases resulted completely negative for Runx3; forty-six showed highly variable expression. We established an optimal cut-off value of Runx3 in predicting distant metastasis equal to 0.04. The odds ratio (ORs) for development of distant metastases at multivariate analysis for patients having Runx3 ≥0.04 was 4.26 (p=0.043) and 4.68 (p=0.032) after adjusting for residual tumor and treatment, respectively; OR for development of metastases in multiple sites was 4.28 (p=0.025) for Runx3 ≥0.04. CONCLUSION: Our results support the ability of Runx3 to contribute to the dissemination of human PDAC thus confirming the observations from murine models.

9 Article Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study. 2016

Buwenge, Milly / Cilla, Savino / Guido, Alessandra / Giaccherini, Lucia / Macchia, Gabriella / Deodato, Francesco / Cammelli, Silvia / Cellini, Francesco / Mattiucci, Gian C / Valentini, Vincenzo / Stock, Markus / Morganti, Alessio G. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Medical Physic Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart, Campobasso, Italy. · Radiotherapy Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart, Campobasso, Italy. · Radiation Oncology Department, Università Cattolica del Sacro Cuore, Rome, Italy. · EBG MedAustron, Wiener Neustadt, Austria. ·Rep Pract Oncol Radiother · Pubmed #27708554.

ABSTRACT: AIM: Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique. BACKGROUND: Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection. MATERIALS AND METHODS: Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique. RESULTS: The primary end-point (PTVv CONCLUSIONS: Although the PTVv

10 Article Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients. 2015

Mattiucci, Gian-Carlo / Falconi, Massimo / VAN Stiphout, Ruud G P M / Alfieri, Sergio / Calvo, Felipe A / Herman, Joseph M / Maidment, Bert W / Miller, Robert C / Regine, William F / Reni, Michele / Sharma, Navesh / Partelli, Stefano / Genovesi, Domenico / Balducci, Mario / Deodato, Francesco / Valentini, Vincenzo / Morganti, Alessio G. ·Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy gcmattiucci@rm.unicatt.it. · Department of Surgery, University of Verona, Verona, Italy. · Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre, Maastricht, the Netherlands. · Department of Surgery, Sacro Cuore Catholic University, Rome, Italy. · Department of Oncology, Gregorio Marañón General Hospital, Complutense University, Madrid, Spain. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A. · Department of Radiation Oncology, University of Virginia, Charlottesville, VA, U.S.A. · Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, U.S.A. · Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy. · Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy. · Department of Radiotherapy, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy. · Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy. ·Anticancer Res · Pubmed #26026108.

ABSTRACT: AIM: To determine the impact of postoperative chemoradiation (POCR) on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in elderly (≥75 years) patients. MATERIALS AND METHODS: A multi-center retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC was performed. Exclusion criteria included age <75 years, metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiotherapy (IORT) and postoperative death. RESULTS: A total of 98 patients were included in the analysis (males=39.8%, females=60.2%; R1 resections=33.7%; pN1=61.2%); 63 patients received POCR and 26 patients received adjuvant chemotherapy alone. The median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1±2.9 (SD) years. No differences were observed between patients receiving or not receiving POCR in terms of age (p=0.081), tumor diameter (p=0.412), rate of R1 resection (p=0.331) and incidence of lymph node-positive disease (p=0.078). The only factor predicting an improved OS was POCR. The median OS was 69.0 months in patients treated by POCR and 23.0 months in patients treated without POCR (p=0.008). Even by Cox multivariate analysis, the only significant predictor of OS was POCR (hazard ratio=0.449; 95% confidence interval=0.212-0.950; p=0.036). CONCLUSION: The study represents the first comparative approach on POCR in elderly patients after resection of PAC. OS was higher in patients who received POCR. Further analyses are warranted to evaluate the toxicity rate/grade and the impact of POCR on patient quality of life.

11 Article Patterns of radiotherapy practice for pancreatic cancer: Results of the Gastrointestinal Radiation Oncology Study Group multi-institutional survey. 2015

Macchia, Gabriella / Sainato, Aldo / Talamini, Renato / Boz, Giovanni / Bacigalupo, Almalina / Caravatta, Luciana / Fiore, Michele / Friso, Maria Luisa / Fusco, Vincenzo / Lupattelli, Marco / Mantello, Giovanna / Mattiucci, Gian Carlo / Slim, Najla / Sciacero, Piera / Turri, Lucia / Valentini, Vincenzo / Morganti, Alessio Giuseppe / Genovesi, Domenico. ·Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Campobasso, Italy. · Radiation Oncology Unit, University Hospital, Pisa, Italy. · Epidemiology and Biostatistics Unit, Oncological Referral Center, Aviano, Italy. · Radiation Oncology Department, Oncological Referral Center, Aviano, Italy. · Radiation Oncology Unit, AOU IRCCS San Martino, IST National Cancer Research Institute, Genoa, Italy. · Radiation Oncology Department, 'A. Businco' Regional Oncological Hospital, Cagliari, Italy. · Radiation Oncology Unit, Campus Bio-Medico University Hospital, Rome, Italy. · Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology-IRCCS, Padua, Italy. · Radiation Oncology Unit, IRCCS CROB, Rionero in Vulture, Potenza, Italy. · Radiation Oncology Unit, 'S. Maria della Misericordia' Hospital, Perugia, Italy. · Radiation Oncology Unit, State Hospital, Ancona, Italy. · Radiation Oncology Department, 'A. Gemelli' Hospital, Catholic University of Sacred Heart, Rome, Italy. · Radiation Oncology Unit, 'San Raffaele' Hospital, Milan, Italy. · Radiation Oncology Unit, ASL TO4, General Hospital, Ivrea, Italy. · Radiation Oncology Unit, 'Maggiore della Carità' Hospital, Novara, Italy. · Radiation Oncology Unit, 'SS Annunziata' Hospital, 'G. D'Annunzio' University, Chieti, Italy. ·Oncol Rep · Pubmed #25955190.

ABSTRACT: No information is currently available regarding pancreatic cancer (PC) pattern of care in Italy. In the present study, a nationwide survey using a questionnaire was performed to enquire the local standards for PC diagnosis and radiotherapy treatment. Fifty-seven percent of 140 Italian centres completed questionnaire. The main causes of no radiotherapy indication were poor general condition (45%) and lack of guidelines (25%). Physicians (38%) employed neoadjuvant therapy in locally advanced PC patients, while in other centres (62%) adjuvant chemoradiation was administered. Adjuvant gemcitabine-based chemotherapy was selected as the treatment of choice by 59% of centres. Patients were treated mostly with doses of 50-54.9 Gy on the tumour (or bed) plus lymph nodes. A 3D-CRT technique was used in 81.2% of centres, while IMRT and IGRT were available in 61.2 and 48.7% of cases, respectively. Extensive variation exists with regard to patterns of care for PC in Italy. Nevertheless, cooperative studies emerging from this survey appeared beneficial.

12 Article Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. 2014

Morganti, Alessio G / Falconi, Massimo / van Stiphout, Ruud G P M / Mattiucci, Gian-Carlo / Alfieri, Sergio / Calvo, Felipe A / Dubois, Jean-Bernard / Fastner, Gerd / Herman, Joseph M / Maidment, Bert W / Miller, Robert C / Regine, William F / Reni, Michele / Sharma, Navesh K / Ippolito, Edy / Valentini, Vincenzo. ·Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy; Unit of Radiotherapy, Unit of General Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy. · Department of Surgery, University of Verona, Verona, Italy. · Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, The Netherlands. · Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. Electronic address: gcmattiucci@rm.unicatt.it. · Department of Surgery, Università Cattolica S. Cuore, Rome, Italy. · Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain. · Département de Radiothérapie, CRLC, Montpellier Cedex, France. · Department of Radiotherapy, PMU, Salzburg, Austria. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia. · Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. · Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy. · Department of Radiation Oncology, University Campus Biomedico, Roma, Italy. · Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. ·Int J Radiat Oncol Biol Phys · Pubmed #25220717.

ABSTRACT: PURPOSE: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. METHODS AND MATERIALS: A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT. RESULTS: Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P<.001) and 27.8 months after CT alone (P<.001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [CI], 0.60-0.87; P=.001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >20 mm (HR = 1.14; CI = 1.05-1.23; P=.002). Multivariate analysis also showed a better prognosis in patients treated in centers with >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) CONCLUSION: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT.

13 Article Inter-observer variability of clinical target volume delineation in radiotherapy treatment of pancreatic cancer: a multi-institutional contouring experience. 2014

Caravatta, Luciana / Macchia, Gabriella / Mattiucci, Gian Carlo / Sainato, Aldo / Cernusco, Nunzia L V / Mantello, Giovanna / Di Tommaso, Monica / Trignani, Marianna / De Paoli, Antonino / Boz, Gianni / Friso, Maria L / Fusco, Vincenzo / Di Nicola, Marta / Morganti, Alessio G / Genovesi, Domenico. ·Radiation Oncology Department, "San Francesco" Hospital, Via Mannironi, 1, 08110 Nuoro, Italy. lcaravatta@hotmail.com. ·Radiat Oncol · Pubmed #25199768.

ABSTRACT: BACKGROUND: An observational multi-institutional study has been conducted aimed to evaluate the inter-observer variability in clinical target volume (CTV) delineation among different radiation oncologists in radiotherapy treatment of pancreatic cancer. METHODS: A multi-institutional contouring dummy-run of two different cases of pancreatic cancer treated by postoperative and preoperative radiotherapy (RT) was performed. Clinical history, diagnostics, and planning CT imaging were available on AIRO website (http://www.radioterapiaitalia.it). Participants were requested to delineate CTVs according to their skills and knowledge. Aiming to quantify interobserver variability of CTVs delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated. Descriptive statistic was calculated. The 95% Confidence Interval (95% CI) for coefficient of variation (CV) was estimated. The Dice Similarity Index (DSI) was used to evaluate the spatial overlap accuracy of the different CTVs compared with the CTVs of a national reference Centre considered as a benchmark. The mean DSI (mDSI) was calculated and reported. RESULTS: A total of 18 radiation oncologists from different Institutes submitted the targets. Less variability was observed for the Elective CTV rather than the Boost CTV, in both cases. The estimated CV were 28.8% (95% CI: 21.2-45.0%) and 20.0% (95% CI: 14.9-30.6%) for the Elective CTV, in adjuvant (Case 1) and neoadjuvant (Case 2) case, respectively. The mDSI value was 0.68 for the Elective CTVs in both cases (range 0.19-0.79 in postoperative vs range 0.35-0.79 in preoperative case). The mDSI was increased to 0.71 (Case 1) and 0.72 (Case 2) if the observers with a worse agreement have been excluded. On the other hand, a CV of 42.4% (95% CI: 30.1-72.4%) and 63.8% (95% CI: 43.9-119.2%) with a mDSI value of 0.44 and 0.52, were calculated for the Boost CTV in Case 1 and Case 2, respectively. CONCLUSIONS: The CV and mDSI obtained values for Elective CTVs showed an acceptable agreement among participants either in postoperative as well in preoperative setting. Additional strategies to reduce the variability in Boost CTV delineation need to be found and promoted.

14 Minor In reply to Yamazaki et al. 2015

Morganti, Alessio G / Mattiucci, Gian C / Valentini, Vincenzo / van Stiphout, Ruud G P M. ·Radiation Oncology Unit, Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Radiation Oncology Department, Catholic University of Sacred Hearth, Rome, Italy. · Department of Radiation Oncology, GROW, University Medical Centre Maastricht, Maastricht, The Netherlands. ·Int J Radiat Oncol Biol Phys · Pubmed #25752404.

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