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Montin E.,Polytechnic of Milan | Sero D.,Polytechnic of Milan | Potepan P.,Fond. Istituto Nazionale Tumori | Mainardi L.T.,Polytechnic of Milan
IFMBE Proceedings

In order to assess the evolution of lesions during therapy, radiologists have to integrate information arising from different imaging techniques (e.g. morphological and functional) and time points (e.g. pre and post treatment). The purpose of this study was to quantitatively evaluate the treatment effect of chemotherapy on nasopharyngeal pathological carcinoma (NPC) using a semi-automatic framework integrating these data. The model concerns three main phases: 1) coregistration of volumes arising from the same time point on a common 3D uniform mesh; 2) pathological lymph nodes (PLN) identification in pre and post treatment volumes (PRE, POST); 3) tissues evaluation through apparent diffusion coefficient (ADC). The output of this procedure was compared to a hand made definition, performed on 12 patients longitudinally scanned. Each patient had a strong reduction of the NPC volume as reported by both qualitative and quantitative evaluations (Wilcoxon rank sum test P=0.885), the average volume decrease computed by the radiologist and by the semi-automatic segmentation procedure were: −79.21%±21.49% and −78.26%± 21.23% and the mean magnitude difference among them was 2.60% ± 2.02%. Although therapy induces morphological and functional changes on NPC lesions, this framework demonstrates a high sensibility and specificity. © Springer International Publishing Switzerland 2015 Source

Massimino M.,Fond. Istituto Nazionale Tumori | Spreafico F.,Fond. Istituto Nazionale Tumori | Riva D.,Fond. Istituto Neurologico C. Besta | Biassoni V.,Fond. Istituto Nazionale Tumori | And 13 more authors.
Journal of Neuro-Oncology

After successfully using cisplatin (30 mg/m2/day) and etoposide (150 mg/m2/day) in ten three-day courses for progressive low-grade gliomas, a subsequent protocol reduced the daily doses of cisplatin (to 25 mg) and etoposide (to 100 mg), with the objective of achieving the same response and three-year PFS rates with lower neurotoxicity and myelotoxicity. We treated 37 patients (median age 6 years); 23 had optochiasmatic tumours and nine were metastatic cases. Diagnoses were clinical in 13 cases and histological in 24, and comprised: pilocytic astrocytoma (17), ganglioglioma (3), pilomyxoid astrocytoma (2), and fibrillary astrocytoma (2). Treatment was prompted by radiological evidence of progression and/or clinical deterioration a median 18 months after the first diagnosis. After initial MRI staging, neurological and clinical examinations were performed before each chemotherapy cycle, with MRI after the first three courses and every three months thereafter. After a median 48 months, a volume reduction was appreciable in 24 cases (65%) and response was maximum 12 months after starting treatment. The three-year EFS and OS rates were 65 and 97%, respectively. Clinical, neurological, or functional improvements were seen in 26/37 cases. No children had a WBC nadir below 2,000/mm3. Audiological toxicity caused damage in 4/34 cases. The previous protocol had achieved volume reductions in 70% of cases, causing audiological damage (data updated) in 11/31 (P = 0.023), with three-year PFS and OS rates of 70 and 100%, respectively. Lower doses of cisplatin/etoposide are still effective in progressive low-grade glioma, with less acute and persistent morbidity. © 2010 Springer Science+Business Media, LLC. Source

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