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Pancreatic Neoplasms: HELP
Articles by Alessio Giuseppe Morganti
Based on 22 articles published since 2010
(Why 22 articles?)
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Between 2010 and 2020, Alessio Morganti wrote the following 22 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Radiotherapy of pancreatic cancer in older patients: A systematic review. 2019

Ciabatti, Selena / Cammelli, Silvia / Frakulli, Rezarta / Arcelli, Alessandra / Macchia, Gabriella / Deodato, Francesco / Cilla, Savino / Giaccherini, Lucia / Buwenge, Milly / Morganti, Alessio G. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. · Radiation Oncology Unit, Bellaria Hospital, Via Altura 3, 40139 Bologna, Italy. · Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Largo Agostino Gemelli 1, 86100 Campobasso, Italy. · Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Largo Agostino Gemelli 1, 86100 Campobasso, Italy. · Radiation Oncology Unit, Department of Oncology and Advanced Technology, Arcispedale S. Maria Nuova-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy. · Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. Electronic address: mbuwenge@gmail.com. ·J Geriatr Oncol · Pubmed #30270196.

ABSTRACT: Pancreatic cancer (PaC) will soon be one of the main causes of cancer mortality. Furthermore, its incidence is higher in the older population and radiotherapy (RT) represents a treatment option. The aim of this review was to evaluate feasibility and outcome of RT in older patients with PaC. A systematic literature review of patients aged ≥65 years with PaC treated with RT was performed using the PRISMA methodology. Eleven papers (1830 patients) fulfilled our inclusion criteria and were analyzed. RT was prescribed either alone or as an adjuvant treatment. Prescribed RT dose ranged from 22.0 to 70.0 Gy with conventional fractionation or hypo-fractionated schedule and delivered by three-dimensional conformal RT, intensity modulated RT or stereotactic body RT. Grade ≥ 3 acute and grade ≥ 2 late toxicity rates ranged between 0.0% and 52.6% (median: 0.5%) and between 0.0% and 15.0% (median: 0%), respectively. Median overall survival and two-year survival rate were 11.3 months (range: 6.4-69.0 months) and 49.0% (range 6.6-75.5%), respectively. RT in older patients seems to be tolerable and safe particularly in terms of late toxicity irrespective of the treatment settings. Therefore, RT can represent a treatment option in PaC even in an older population. Further analyses and prospective trials enrolling older patients are needed to better define the risk/benefit ratio in different treatment settings.

2 Review Stereotactic radiotherapy of pancreatic cancer: a systematic review on pain relief. 2018

Buwenge, Milly / Macchia, Gabriella / Arcelli, Alessandra / Frakulli, Rezarta / Fuccio, Lorenzo / Guerri, Sara / Grassi, Elisa / Cammelli, Silvia / Cellini, Francesco / Morganti, Alessio G. ·Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy, rt.unibo@gmail.com. · Radiation Oncology Unit, Research and Care Foundation "Giovanni Paolo II", Catholic University of Sacred Heart, Campobasso, Italy. · Radiation Oncology Unit, Bellaria Hospital, Bologna, Italy. · Department of Medical and Surgical Sciences - DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Radiotherapy, "A. Gemelli" Hospital, Catholic University, Rome, Italy. ·J Pain Res · Pubmed #30323651.

ABSTRACT: Locally advanced pancreatic carcinoma (LAPC) has a poor prognosis and the purpose of treatment is survival prolongation and symptom palliation. Radiotherapy has been reported to reduce pain in LAPC. Stereotactic RT (SBRT) is considered as an emerging radiotherapy technique able to achieve high local control rates with acceptable toxicity. However, its role in pain palliation is not clear. To review the impact on pain relief with SBRT in LAPC patients, a literature search was performed on PubMed, Scopus, and Embase (January 2000-December 2017) for prospective and retrospective articles published in English. Fourteen studies (479 patients) reporting the effect of SBRT on pain relief were finally included in this analysis. SBRT was delivered with both standard and/or robotic linear accelerators. The median prescribed SBRT doses ranged from 16.5 to 45 Gy (median: 27.8 Gy), and the number of fractions ranged from 1 to 6 (median: 3.5). Twelve of the 14 studies reported the percentage of pain relief (in patients with pain at presentation) with a global overall response rate (complete and partial response) of 84.9% (95% CI, 75.8%-91.5%), with high heterogeneity (

3 Review Multimodal treatment of resectable pancreatic ductal adenocarcinoma. 2017

Silvestris, Nicola / Brunetti, Oronzo / Vasile, Enrico / Cellini, Francesco / Cataldo, Ivana / Pusceddu, Valeria / Cattaneo, Monica / Partelli, Stefano / Scartozzi, Mario / Aprile, Giuseppe / Casadei Gardini, Andrea / Morganti, Alessio Giuseppe / Valentini, Vincenzo / Scarpa, Aldo / Falconi, Massimo / Calabrese, Angela / Lorusso, Vito / Reni, Michele / Cascinu, Stefano. ·Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: n.silvestris@oncologico.bari.it. · Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: dr.oronzo.brunetti@tiscali.it. · Department of Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. Electronic address: e.vasile@ao.pisa.toscana.it. · Radiation Oncology Department, Gemelli ART, Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: francesco.cellini@uniroma3.it. · ARC-NET Research Centre, University of Verona, Verona, Italy. Electronic address: cataldo.ivana@gmail.com. · Medical Oncology Unit, University of Cagliari, Cagliari, Italy. Electronic address: oncologiamedica2reparto@gmail.com. · Department of Medical Oncology, University and General Hospital, Udine, Italy. Electronic address: aprile83@gmail.com. · Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy. Electronic address: partelli.stefano@hsr.it. · Medical Oncology Unit, University of Cagliari, Cagliari, Italy. Electronic address: marioscartozzi@gmail.com. · Department of Medical Oncology, University and General Hospital, Udine, Italy; Department of Medical Oncology, General Hospital of Vicenza, Vicenza, Italy. Electronic address: aprile.giuseppe@aoud.sanita.fvg.it. · Medical Oncology Unit, IRCCS, Meldola, Italy. Electronic address: casadeigardini@gmail.com. · Radiation Oncology Center, Dept. of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Italy. Electronic address: alessio.morganti2@unibo.it. · Radiation Oncology Department, Gemelli ART, Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: vincenzo.valentini@unicatt.it. · ARC-NET Research Centre, University of Verona, Verona, Italy. Electronic address: aldo.scarpa@univr.it. · Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy. Electronic address: falconi.massimo@hsr.it. · Radiology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: acalabrese22@gmail.com. · Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: vito.lorusso@oncologico.bari.it. · Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: reni.michele@hsr.it. · Modena Cancer Center, Policlinico di Modena Università di Modena e Reggio Emilia, Italy. Electronic address: cascinu@yahoo.com. ·Crit Rev Oncol Hematol · Pubmed #28259290.

ABSTRACT: After a timing preoperative staging, treatment of resectable pancreatic adenocarcinoma (PDAC) includes surgery and adjuvant therapies, the former representing the initial therapeutic option and the latter aiming to reduce the incidence of both distant metastases (chemotherapy) and locoregional failures (chemoradiotherapy). Herein, we provide a critical overview on the role of multimodal treatment in PDAC and on new opportunities related to current more active poli-chemotherapy regimens, targeted therapies, and the more recent immunotherapy approaches. Moreover, an analysis of pathological markers and clinical features able to help clinicians in the selection of the best therapeutic strategy will be discussed. Lastly, the role of neoadjuvant treatment of initially resectable disease will be considered mostly in patients whose malignancy shows morphological but not clinical or biological criteria of resectability. Depending on the results of these investigational studies, today a multidisciplinary approach can offer the best address therapy for these patients.

4 Review Unusual Thyroid Carcinoma Metastases: a Case Series and Literature Review. 2016

Farina, Eleonora / Monari, Fabio / Tallini, Giovanni / Repaci, Andrea / Mazzarotto, Renzo / Giunchi, Francesca / Panzacchi, Riccardo / Cammelli, Silvia / Padula, Gilbert D A / Deodato, Francesco / Pasquali, Renato / Fanti, Stefano / Fiorentino, Michelangelo / Morganti, Alessio G. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy. · Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy. rt.unibo@gmail.com. · Anatomic Pathology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Bellaria Hospital, University of Bologna, Via Altura 3, 40139, Bologna, Italy. · Division of Endocrinology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy. · Radiotherapy Unit, Azienda Ospedaliera Universitaria Integrata, Ospedale Civile Maggiore, Piazzale Aristide Stefani 1, Verona, Italy. · Pathology Unit of the "F. Addarii" Institute of Oncology, Department of Oncology and Hematology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy. · Department of Pathology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy. · Radiation Oncology Department, The Lacks Cancer Center, Saint Mary's Health Care, 250 Cherry St SE, Grand Rapids, MI, 49503, USA. · Radiation Oncology Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart, Largo Agostino Gemelli, 1, 86100, Campobasso, Italy. · Nuclear Medicine Unit, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy. ·Endocr Pathol · Pubmed #26662609.

ABSTRACT: The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission.

5 Review Neoadjuvant multimodal treatment of pancreatic ductal adenocarcinoma. 2016

Silvestris, Nicola / Longo, Vito / Cellini, Francesco / Reni, Michele / Bittoni, Alessandro / Cataldo, Ivana / Partelli, Stefano / Falconi, Massimo / Scarpa, Aldo / Brunetti, Oronzo / Lorusso, Vito / Santini, Daniele / Morganti, Alessio / Valentini, Vincenzo / Cascinu, Stefano. ·Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy. Electronic address: n.silvestris@oncologico.bari.it. · Medical Oncology Unit, 'Mons R Dimiccoli' Hospital, Barletta, Italy. · Radiation Oncology Department, Policlinico Universitario Campus Bio-Medico, Rome, Italy. · Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milano, Italy. · Medical Oncology Clinic, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy. · ARC-NET Research Centre, University of Verona, Italy. · Pancreatic Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy. · Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy. · Medical Oncology Unit, University Campus Biomedico, Roma, Italy. · Radiation Oncology Center, Dept. of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Italy. ·Crit Rev Oncol Hematol · Pubmed #26653573.

ABSTRACT: Treatment of pancreatic ductal adenocarcinoma (PDAC) is increasingly multidisciplinary, with neoadjuvant strategies (chemotherapy, radiation, and surgery) administered in patients with resectable, borderline resectable, or locally advanced disease. The rational supporting this management is the achievement of both higher margin-negative resections and conversion rates into potentially resectable disease and in vivo assessment of novel therapeutics. International guidelines suggest an initial staging of the disease followed by a multidisciplinary approach, even considering the lack of a treatment approach to be considered as standard in this setting. This review will focus on both literature data supporting these guidelines and on new opportunities related to current more active chemotherapy regimens. An analysis of the pathological assessment of response to therapy and the potential role of target therapies and translational biomarkers and ongoing clinical trials of significance will be discussed.

6 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.

7 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.

8 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.

9 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.

10 Article Higher Biologically Effective Dose Predicts Survival in SBRT of Pancreatic Cancer: A Multicentric Analysis (PAULA-1). 2020

Arcelli, Alessandra / Guido, Alessandra / Buwenge, Milly / Simoni, Nicola / Mazzarotto, Renzo / Macchia, Gabriella / Deodato, Francesco / Cilla, Savino / Bonomo, Pierluigi / Scotti, Valerio / Belgioia, Liliana / Tolento, Giorgio / Cellini, Francesco / Grassi, Elisa / DI Marco, Mariacristina / Casadei, Riccardo / Morganti, Alessio G / Cammelli, Silvia. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy mbuwenge@gmail.com. · Radiotherapy Unit, Azienda Ospedaliera Universitaria, Verona, Italy. · Radiotherapy Unit, 'Giovanni Paolo II' Foundation, Catholic University of Sacred Heart, Campobasso, Italy. · Medical Physic Unit, 'Giovanni Paolo II' Foundation, Catholic University of Sacred Heart, Campobasso, Italy. · Radiation Oncology Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence, Florence, Italy. · San Rossore Private Hospital, Pisa, Italy. · Department of Radiotherapy, Policlinico San Martino, University of Genoa, Genoa, Italy. · Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy. · Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Medical and Surgical Sciences - DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ·Anticancer Res · Pubmed #31892602.

ABSTRACT: AIM: The purpose of the present multicentric study was to review stereotactic body radiotherapy (SBRT) with or without chemotherapy (CHT) experience in locally advanced pancreatic cancer (LAPC). Endpoints were overall survival (OS), local control (LC), and distant metastasis-free survival (DMFS). Several parameters' impact on these outcomes was assessed. MATERIALS AND METHODS: Fifty-six patients with LAPC undergoing SBRT+/-CHT were included. SBRT median BED RESULTS: At a median follow-up of 15.0 months, 2-year OS, LC, DMFS were: 33.8% 55.4%, and 22.9%, respectively. Patients treated with BED CONCLUSION: SBRT proved to be tolerable and effective in LAPC. Moreover, BED

11 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.

12 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.

13 Article Feasibility of 2D-conformal radiotherapy for pancreatic carcinoma. 2018

Buwenge, Milly / Cilla, Savino / Cammelli, Silvia / Macchia, Gabriella / Arcelli, Alessandra / Farina, Eleonora / Frakulli, Rezarta / Panni, Valeria / Wondemagegnhu, Tigeneh / Uddin, A F M Kamal / Sumon, Mostafa A / Deodato, Francesco / Morganti, Alessio G. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy. · Medical Physic Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Catholic University of Sacred Heart, 86100 Campobasso, Italy. · Radiotherapy Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Catholic University of Sacred Heart, 86100 Campobasso, Italy. · Department of Radiation Oncology, CRO-IRCCS, National Cancer Institute, 33081 Aviano, Italy. · Radiation Oncology Unit, Bellaria Hospital, 40139 Bologna, Italy. · Department of Radiation Oncology, Black Lion Hospital, Addis Ababa 9086, Ethiopia. · Radiation Oncology Department, United Hospital Limited, Gulshan, Dhaka 1212, Bangladesh. ·Oncol Lett · Pubmed #30333867.

ABSTRACT: The purpose of the present study was to propose an optimized 2D technique (2D-conformal) for radiotherapy (RT) of pancreatic cancer (CaP). This technique is based on double simulation which resolves the problems of radiographic image distortion. Five patients with locally advanced CaP were identified and enrolled. Treatment planning was simulated in 3 different ways: Two dimensional-standard (2D-SRT), 2D-conformal (2D-CRT), and three dimensional-conformal (3D-CRT) techniques for 10 MV LINAC. Simulation for a cobalt machine was also performed using only the 2D techniques. 2D-SRT technique was planned with fields definition based on anatomical landmarks (bone and duodenum). 3D-CRT was planned with standard virtual simulation technique, and 3D dose evaluation and optimization. 2D-CRT technique was based on manual information transfer from a diagnostic CT-scan to simulation radiograms. To eliminate the X-ray image distortion, a double simulation was employed and the profile of the GTV was delineated on radiographs bearing the simulator isocenter into the target center. Concerning target irradiation of either LINAC (10 MV) or cobalt source, the PTV constraints (ICRU 62) were met in all patients (D

14 Article Definition of fields margins for palliative radiotherapy of pancreatic carcinoma. 2018

Buwenge, Milly / Marinelli, Alfonso / Deodato, Francesco / Macchia, Gabriella / Wondemagegnhu, Tigeneh / Salah, Tareq / Cammelli, Silvia / Uddin, A F M Kamal / Sumon, Mostafa A / Donati, Constanza M / Cilla, Savino / Morganti, Alessio G. ·Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Radiation Oncology Center, University of Bologna, S. Orsola-Malpighi Hospital, I-40138 Bologna, Italy. · Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy. · Department of Radiation Oncology, Black Lion Hospital, Addis Ababa 9086, Ethiopia. · Faculty of Medicine, Assiut University, Assiut 71515, Egypt. · Radiation Oncology Department, United Hospital Limited, Gulshan, Dhaka 1212, Bangladesh. · Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy. ·Mol Clin Oncol · Pubmed #29844901.

ABSTRACT: The present study aimed to provide practical guidelines for palliative treatment of advanced carcinoma of the pancreas (CAP) with the 2D technique. Fifteen patients with locally advanced CAP consecutively treated with radiation therapy at the Radiation Oncology Center, Research and Care Foundation 'Giovanni Paolo II' (Campobasso, Italy) underwent computed tomography simulation in supine position. Definition of the clinical target volume (CTV) included the head and body of the pancreas, and the retropancreatic space. The planning target volume was defined by adding a margin of 14 mm to the CTV in the cranio-caudal direction and of 11 mm in radial direction. For each patient, 3 treatment plans were calculated using a cobalt source, 6 MV photons and 15 MV photons (box technique). Beams were drawn using the primary collimators without using multileaf collimators, and progressively optimized in order to respect the minimum dose (D

15 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

16 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.

17 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.

18 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.

19 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.

20 Article Palliative two-dimensional radiotherapy of pancreatic carcinoma: a feasibility study. 2013

Morganti, Alessio G / Marinelli, Alfonso / Buwenge, Milly / Macchia, Gabriella / Deodato, Francesco / Massaccesi, Mariangela / Kigula-Mugambe, Joseph / Wondemagegnhu, Tigeneh / Dawotola, David / Caravatta, Luciana / Sallustio, Giuseppina / Piermattei, Angelo / Valentini, Vincenzo / Cilla, Savino. · ·Tumori · Pubmed #24326837.

ABSTRACT: AIMS AND BACKGROUND: The aim of the study was to analyze the dose to be administered with two-dimensional involved-field palliative radiotherapy in advanced pancreatic carcinoma with respect to current dose-volume constraints (QUANTEC). METHODS AND STUDY DESIGN: The following standard regimens were evaluated: 30 Gy at 3 Gy/fraction (regimen A), 36 Gy at 2.4 Gy/fraction (regimen B), 45 Gy at 1.8 Gy/fraction (regimen C), and 50 Gy at 2 Gy /fraction (regimen D). The following constraints were considered: spinal cord Dmax <50 Gy, duodenum Dmax <55 Gy, liver Dmean <30 Gy, kidneys Dmean <15 Gy. For dose/fraction different from 1.8-2 Gy, the correction of constraints using a value of alpha/beta = 3 for late effects was considered. The calculation of dose/volume constraints was repeated for three different radiation beams: cobalt unit, 6 MV photons, and 15 MV photons. Standard field sizes were used and adapted according to the different beam types, using the parameters of our previous study. Respect of dose-volume constraints was assessed for each type of beam and treatment (dose per fractionation) in all patients. Treatments were considered acceptable in case of: 1) respect of the constraints for spinal cord and duodenum in all patients; 2) respect in >10/15 patients of constraints for kidneys and liver. Therefore, minor violations (<10%) of the constraints for these organs were accepted (in less than 5/15 patients), in consideration of the palliative aim of treatment. RESULTS: In regimen A (30 Gy, 3 Gy/fraction), evaluated constraints were respected in all patients, regardless of the type of energy. In regimen B (36 Gy, 2.4 Gy/fraction), constraints were met in all patients undergoing irradiation with 6 and 15 MV photons. However, using the cobalt unit, kidney constraint was respected only in 5 of 15 patients. In regimens C and D (45 Gy, 1.8 Gy/fraction and 50 Gy, 2 Gy/fraction, respectively), the constraint for the kidney was respected only in 2-5 patients, depending on the energy used. Furthermore, using 50 Gy, the spinal cord constraint was not respected in 2-3 patients, depending on the beam used. Therefore, only the following treatments were considered acceptable: 1) 30 Gy, 3 Gy/fraction, regardless of the energy used; 2) 36 Gy, 2.4 Gy/fraction, only for treatments performed with linear accelerator (6-15 MV). CONCLUSIONS: The clinical benefits of radiotherapy in pancreatic tumors should not be withheld from patients treated in centers only with two-dimensional technology. Prospective trials, particularly in developing countries, would be useful to evaluate the efficacy in this setting of involved-field two-dimensional treatments using the dose and fractionation defined in this analysis.

21 Article Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer. 2012

Caravatta, Luciana / Sallustio, Giuseppina / Pacelli, Fabio / Padula, Gilbert D A / Deodato, Francesco / Macchia, Gabriella / Massaccesi, Mariangela / Picardi, Vincenzo / Cilla, Savino / Marinelli, Alfonso / Cellini, Numa / Valentini, Vincenzo / Morganti, Alessio G. ·Radiotherapy Unit, Department of Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del S, Cuore, Largo A, Gemelli 1, 86100, Campobasso, Italy. ·Radiat Oncol · Pubmed #22691275.

ABSTRACT: BACKGROUND: Radiotherapy (RT) is widely used in the treatment of pancreatic cancer. Currently, recommendation has been given for the delineation of the clinical target volume (CTV) in adjuvant RT. Based on recently reviewed pathologic data, the aim of this study is to propose criteria for the CTV definition and delineation including elective nodal irradiation (ENI) in the preoperative and definitive treatment of pancreatic cancer. METHODS: The anatomical structures of interest, as well as the abdominal vasculature were identified on intravenous contrast-enhanced CT scans of two different patients with pancreatic cancer of the head and the body. To delineate the lymph node area, a margin of 10 mm was added to the arteries. RESULTS: We proposed a set of guidelines for elective treatment of high-risk nodal areas and CTV delineation. Reference CT images were provided. CONCLUSIONS: The proposed guidelines could be used for preoperative or definitive RT for carcinoma of the head and body of the pancreas. Further clinical investigations are needed to validate the defined CTVs.

22 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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