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Zaja F.,Clinica Ematologica | Baldini L.,University of Milan | Ferreri A.J.M.,San Raffaele Scientific Institute | Luminari S.,University of Modena and Reggio Emilia | And 5 more authors.
Annals of Hematology | Year: 2013

Treatment of relapsed/refractory T cell neoplasms represents an unmet medical need. We recorded, retrospectively, data on 20 consecutive adult patients with T cell neoplasms (8 T cell lymphoma not otherwise specified (T-NOS), 4 angioimmunoblastic (AILT), 3 prolymphocytic leukemia (T-PLL), 3 advance-stage mycosis fungoides (MF) or Sézary syndrome (SS), and 2 T cell large granular lymphocytic leukemia (T-LGL)), treated with bendamustine. Partial (PR) and complete response (CR) rates were reached in nine (45 %) and two (10 %) patients, respectively, including three PR in T-NOS, one CR in AILT, three PR in T-PLL, two PR in MF/SS, and one CR and one PR in T-LGL lymphoma. The 6 months estimated progression free and overall survival was 44 and 67 %, respectively. Grade 3-4 neutropenia and thrombocytopenia were registered in 44 and 25 % of cases. Four patients developed major infectious complications. At a median follow-up of 6 months (range 1-18), 13 patients are alive and 7 patients died all because of lymphoma progression. Bendamustine deserves further investigation in patients with T cell neoplasms. © 2013 Springer-Verlag Berlin Heidelberg.

Research by Plymouth University showed coastal communities were generally supportive of the aims of Marine Protected Areas (MPAs), introduced in the UK in 2013. But that support could be enhanced by involving communities throughout the designation process, and continually informing them about the costs, benefits and management being employed. The study, published in Marine Policy, was funded by the Devon and Severn Inshore Fisheries and Conservation Authority (IFCA), and led by Sarah Gall, a PhD student in the School of Marine Science and Engineering at Plymouth University. "When MPAs were first proposed, there was a wide level of engagement with those they were designed to benefit and, as a result, there was recognition of their aims and support for their objectives. But in recent years that has fallen away to some extent as the communication between government and communities decreased. This study shows there is still general acceptance of the principles, and that reintroducing previous engagement could prevent communities from feeling excluded as currently appears to be the case." The first legislation to develop a coherent network of MPAs around the UK coastline was introduced in 2009, with the aim being to protect the marine environment while enabling its sustainable use. This study is one of the first to seek stakeholder views about MPAs' ongoing effectiveness, and participants were presented with a series of statements about their impacts. The results identified three distinct groups who were either pro-conservation, pro-fisheries or win-win, with the latter group believing the current approach to marine management would allow both fisheries and conservation goals to be met. The win-win and pro-conservation groups were most similar in their views, believing the environment should be prioritised over any commercial interests, while pro-fisheries respondents held some scepticism over whether MPAs would work due to limited resources with which to implement and enforce their objectives. However, all the groups felt that the switch to a process that was almost entirely top-down – rather than being driven by the communities themselves, as had been the original intention – had resulted in the exclusion of local stakeholders and a loss of social acceptability. Tim Robbins, Chief Officer of the Devon and Severn IFCA, said: "The findings from this study reinforce the belief of the Devon & Severn IFCA that consultation with all parties is the key to developing balanced management solutions which will deliver greater protection of the marine environment for the benefit of all." More information: Sarah C. Gall et al. Evaluating the social acceptability of Marine Protected Areas, Marine Policy (2016). DOI: 10.1016/j.marpol.2015.12.004

PubMed | University of Turin, Regina Elena Cancer Center, AUSL Piacenza, A.O.U. Citta della Salute e della Science di Turin and 11 more.
Type: | Journal: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) | Year: 2016

The aim of the study was a multicenter evaluation of MLC&jaws-defined small field output factors (OF) for different linear accelerator manufacturers and for different beam energies using the latest synthetic single crystal diamond detector commercially available. The feasibility of providing an experimental OF data set, useful for on-site measurements validation, was also evaluated.This work was performed in the framework of the Italian Association of Medical Physics (AIFM) SBRT working group. The project was subdivided in two phases: in the first phase each center measured OFs using their own routine detector for nominal field sizes ranging from 1010cmThe project enrolled 30 Italian centers. Micro-ion chambers and silicon diodes were used for OF measurements in 24 and 6 centers respectively. Gafchromic films and TLDs were used for very small field OFs in 3 and 1 centers. Regarding the measurements performed with the users detectors, OF standard deviations (SD) for field sizes down to 22cmThe measured values presented in this multicenter study provide a consistent dataset for OFs that could be a useful tool for improving dosimetric procedures in centers. The microDiamond data present a small variation among the centers confirming that this detector can contribute to improve overall accuracy in radiotherapy.

PubMed | Instituto Europeo Oncologia, Ospedale Di Vicenza, Azienda Sanitaria Firenze, Centro Diagnostico Italiano and 6 more.
Type: Journal Article | Journal: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) | Year: 2016

The aim of the present work was to evaluate small field size output factors (OFs) using the latest diamond detector commercially available, PTW-60019 microDiamond, over different CyberKnife systems. OFs were measured also by silicon detectors routinely used by each center, considered as reference.Five Italian CyberKnife centers performed OFs measurements for field sizes ranging from 5 to 60mm, defined by fixed circular collimators (5 centers) and by Iris() variable aperture collimator (4 centers). Setup conditions were: 80cm source to detector distance, and 1.5cm depth in water. To speed up measurements two diamond detectors were used and their equivalence was evaluated. MonteCarlo (MC) correction factors for silicon detectors were used for comparing the OF measurements.Considering OFs values averaged over all centers, diamond data resulted lower than uncorrected silicon diode ones. The agreement between diamond and MC corrected silicon values was within 0.6% for all fixed circular collimators. Relative differences between microDiamond and MC corrected silicon diodes data for Iris() collimator were lower than 1.0% for all apertures in the totality of centers. The two microDiamond detectors showed similar characteristics, in agreement with the technical specifications.Excellent agreement between microDiamond and MC corrected silicon diode detectors OFs was obtained for both collimation systems fixed cones and Iris(), demonstrating the microDiamond could be a suitable detector for CyberKnife commissioning and routine checks. These results obtained in five centers suggest that for CyberKnife systems microDiamond can be used without corrections even at the smallest field size.

PubMed | TU Ilmenau, Schwarzwald Baar Klinikum, Universitatsklinikum Rostock, Universitatsklinikum Frankfurt am Main and 5 more.
Type: Journal Article | Journal: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) | Year: 2016

High precision radiosurgery demands comprehensive delivery-quality-assurance techniques. The use of a liquid-filled ion-chamber-array for robotic-radiosurgery delivery-quality-assurance was investigated and validated using several test scenarios and routine patient plans.Preliminary evaluation consisted of beam profile validation and analysis of source-detector-distance and beam-incidence-angle response dependence. The delivery-quality-assurance analysis is performed in four steps: (1) Array-to-plan registration, (2) Evaluation with standard Gamma-Index criteria (local-dose-difference2%, distance-to-agreement2mm, pass-rate90%), (3) Dose profile alignment and dose distribution shift until maximum pass-rate is found, and (4) Final evaluation with 1mm distance-to-agreement criterion. Test scenarios consisted of intended phantom misalignments, dose miscalibrations, and undelivered Monitor Units. Preliminary method validation was performed on 55 clinical plans in five institutions.The 1000SRS profile measurements showed sufficient agreement compared with a microDiamond detector for all collimator sizes. The relative response changes can be up to 2.2% per 10cm source-detector-distance change, but remains within 1% for the clinically relevant source-detector-distance range. Planned and measured dose under different beam-incidence-angles showed deviations below 1% for angles between 0 and 80. Small-intended errors were detected by 1mm distance-to-agreement criterion while 2mm criteria failed to reveal some of these deviations. All analyzed delivery-quality-assurance clinical patient plans were within our tight tolerance criteria.We demonstrated that a high-resolution liquid-filled ion-chamber-array can be suitable for robotic radiosurgery delivery-quality-assurance and that small errors can be detected with tight distance-to-agreement criterion. Further improvement may come from beam specific correction for incidence angle and source-detector-distance response.

PubMed | Instituto Europeo Oncologia, Ospedale di Vicenza, Azienda Sanitaria Firenze, Centro Diagnostico Italiano and 7 more.
Type: Journal Article | Journal: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) | Year: 2016

New promising detectors are available for measuring small field size output factors (OFs). This study focused on a multicenter evaluation of two new generation detectors for OF measurements on CyberKnife systems.PTW-60019 microDiamond and W1 plastic scintillation detector (PSD) were used to measure OFs on eight CyberKnife units of various generations for 5-60mm fixed cones. MicroDiamond and PSD OF were compared to routinely used silicon diodes data corrected applying published Monte Carlo (MC) factors. PSD data were corrected for erenkov Light Ratio (CLR). The uncertainties related to CLR determination were estimated.Considering OF values averaged over all centers, the differences between MC corrected diode and the other two detectors were within 1.5%. MicroDiamond exhibited an over-response of 1.3% at 7.5mm and a trend inversion at 5mm with a difference of 0.2%. This behavior was consistent among the different units. OFs measured by PSD slightly under-responded compared to MC corrected diode for the smaller cones and the differences were within 1%. The observed CLR variability was 2.5% and the related variation in OF values was 1.9%.This study indicates that CyberKnife microDiamond OF require corrections below 2%. The results are enhanced by the consistency observed among different units. Scintillator shows a good agreement to MC corrected diode but CLR determination remains critical requiring further investigations. The results emphasized the value of a multi-center validation over a single center approach.

Masi L.,IFCA | Masi L.,University of Florence | Doro R.,IFCA | Doro R.,University of Florence | And 5 more authors.
Medical Physics | Year: 2013

Purpose: To evaluate the effect of plan parameters on volumetric modulated arc therapy (VMAT) dosimetric accuracy, together with the possibility of scoring plan complexity. Methods: 142 clinical VMAT plans initially optimized using a 4°control point (CP) separation were evaluated. All plans were delivered by a 6 MV Linac to a biplanar diode array for patient-specific quality assurance (QA). Local Γ index analysis (3%, 3 mm and 2%, 2 mm) enabled the comparison between delivered and calculated dose. The following parameters were considered for each plan: average leaf travel (LT), modulation complexity score applied to VMAT (MCSv), MU value, and a multiplicative combination of LT and MCSv (LTMCS). Pearson's correlation analysis was performed between Γ passing rates and each parameter. The effects of CP angular separation on VMAT dosimetric accuracy were also analyzed by focusing on plans with high LT values. Forty out of 142 plans with LT above 350 mm were further optimized using a finer angle spacing (3°or 2°) and Γ analysis was performed. The average Γ passing rates obtained at 4°and at 3°/2°sampling were compared. A further correlation analysis between all parameters and the Γ pass-rates was performed on 142 plans, but including the newly optimized 40 plans (CP every 3°or 2°) in place of the old ones (CP every 4°). Results: A moderate significant (p < 0.05) correlation between each examined parameter and Γ passing rates was observed for the original 142 plans at 4°CP discretization. A negative correlation was found for LT with Pearson's r absolute values above 0.6, suggesting that a lower dosimetric accuracy may be expected for higher LT values when a 4°CP sampling is used. A positive correlation was observed for MCSv and LTMCS with r values above 0.5. In order to score plan complexity, threshold values of LTMCS were defined. The average Γ passing rates were significantly higher for the plans created using the finer CP spacing (3°/2°) compared to the plans optimized using the standard 4°spacing (Student t-test p < 0.05). The correlation between LT and passing rates was strongly diminished when plans with finer angular separations were considered, yielding Pearson's r absolute values below 0.45. Conclusions: At 4°CP sampling, LT, MCSv, and LTMCS were found to be significantly correlated with VMAT dosimetric accuracy, expressed as Γ pass-rates. These parameters were found to be possible candidates for scoring plan complexity using threshold values. A finer CP separation (3°/2°) led to a significant increase in dosimetric accuracy for plans with high leaf travel values, and to a decrease in correlation between LT and Γ passing rates. These results indicated that the influence of LT on VMAT dosimetric accuracy can be controlled by reducing CP separation. CP spacing for all plans requiring large leaf motion should not exceed 3°. The reported data were integrated to optimize our clinical workflow for plan creation, optimization, selection among rival plans, and patient-specific QA of VMAT treatments. © 2013 American Association of Physicists in Medicine.

PubMed | IFCA, ISPO and University of Florence
Type: Journal Article | Journal: BMC surgery | Year: 2016

Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer.Between June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated.There were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 0.5 cm and 3.0 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 3.7 and 30.5 2.0, respectively; P = 0.02). The mean operative time was 262.6 8.6 min in the laparoscopic group and 312.6 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups.Within the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes.

PubMed | Accuray, Azienda Sanitaria Firenze, General Hospital, San Bartlolo Hospital and 2 more.
Type: | Journal: Physics in medicine and biology | Year: 2016

Monte Carlo simulation was used to calculate correction factors for output factor (OF), percentage depth-dose (PDD), and off-axis ratio (OAR) measurements with the CyberKnife M6 system. These include the first such data for the InCise MLC. Simulated detectors include diodes, air-filled microchambers, a synthetic microdiamond detector, and point scintillator. Individual perturbation factors were also evaluated. OF corrections show similar trends to previous studies. With a 5mm fixed collimator the diode correction to convert a measured OF to the corresponding point dose ratio varies between -6.1% and -3.5% for the diode models evaluated, while in a 7.6mm x 7.7mm MLC field these are -4.5% to -1.8%. The corresponding microchamber corrections are +9.9% to +10.7% and +3.5% to +4.0%. The microdiamond corrections have a maximum of -1.4% for the 7.5mm and 10mm collimators. The scintillator corrections are <1% in all beams. Measured OF showed uncorrected inter-detector differences >15%, reducing to <3% after correction. PDD corrections at d>dmax were <2% for all detectors except IBA Razor where a maximum 4% correction was observed at 300mm depth. OAR corrections were smaller inside the field than outside. At the beam edge microchamber OAR corrections were up to 15%, mainly caused by density perturbations, which blurs the measured penumbra. With larger beams and depths, PTW and IBA diode corrections outside the beam were up to 20% while the Edge detector needed smaller corrections although these did vary with orientation. These effects are most noticeable for large field size and depth, where they are dominated by fluence and stopping power perturbations. The microdiamond OAR corrections were <3% outside the beam. This paper provides OF corrections that can be used for commissioning new CyberKnife M6 systems and retrospectively checking estimated corrections used previously. We recommend the PDD and OAR corrections are used to guide detector selection and inform the evaluation of results rather than to explicitly correct measurements.

Martinez Rivero C.,IFCA
EPJ Web of Conferences | Year: 2013

In this talk, the latest results from CMS and ATLAS on searches for new physics with multiple leptons in the final state are presented using up to 20/fb of data from the 8 TeV LHC run of 2012. Interpretation of results in terms of SUSY searches for production of gauginos and sleptons are shown. For RP conserving models, both neutralinos and gravitinos as lightest supersymmetric particles are considered. © 2013 Owned by the authors, published by EDP Sciences.

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