Unita Operativa di Radioterapia

Borghetto Santo Spirito, Italy

Unita Operativa di Radioterapia

Borghetto Santo Spirito, Italy
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Piermattei A.,1 University Cattolica del S | Piermattei A.,University Cattolica del S | Greco F.,1 University Cattolica del S | Fidanzio A.,1 University Cattolica del S | And 7 more authors.
Journal of Applied Clinical Medical Physics | Year: 2011

A practical and accurate generalized procedure to reconstruct the isocenter dose Diso for 3D conformal radiotherapy (3DCRT) has been developed for X-ray open beams supplied by linacs of different manufacturers and equipped with aSi electronic portal imaging devices (aSi EPIDs). This paper reports an extension of the method, to be applied at the wedged X-ray beams characterized by the wedge attenuation factor WAF. Using water-equivalent solid phantoms (SPs) of different thicknesses, w, and photon square fields of sizes, L, the generalized midplane dosesD0(WAF,w/2,L) and generalized transit signals ST 0(WAF,w/L) by 38 beams of six different linacs were determined. The generalized data were fitted by surface equations and used together with the information of the 'record & verify' network of the centers. In this manner, for every beam, the Diso reconstruction was obtained in about 25 seconds after the treatment. To test the in vivo dosimetric procedure, six pelvic treatments that used conformed wedged beams were carried out with three linacs of different manufacturers. For every beam, the comparison between the reconstructed Diso and the Diso,TPS computed by the TPS, resulted in an acceptable tolerance level of ±5%, estimated for this kind of treatment. Generally the in vivo dosimetry methods that use EPIDs require: (i) a special effort for the dosimetric commissioning with SPs of different thicknesses, and (ii) extra time for the analysis of the EPID signals. The proposed procedure simplifies the commissioning step and supplies for Varian, Elekta, and Siemens linacs equipped with the aSi EPIDs a quasi-real time in vivo dosimetry for open and wedged 3DCRT fields.

Mantini G.,Unita Operativa di Radioterapia | Fersino S.,Unita Operativa di Radioterapia | Alitto A.R.,Unita Operativa di Radioterapia | Frascino V.,Unita Operativa di Radioterapia | And 10 more authors.
BioMed Research International | Year: 2014

Purpose. To perform a preliminary feasibility acute and late toxicity evaluation of an intensified and modulated adjuvant treatment in prostate cancer (PCa) patients after radical prostatectomy. Material and Methods. A phase I/II has been designed. Eligible patients were 79 years old or younger, with an ECOG of 0-2, previously untreated, histologically proven prostate adenocarcinoma with no distant metastases, pT2-4 N0-1, and with at least one of the following risk factors: capsular perforation, positive surgical margins, and seminal vesicle invasion. All patients received a minimum dose on tumor bed of 64.8 Gy, or higher dose (70.2 Gy; 85.4%), according to the pathological stage, pelvic lymph nodes irradiation (57.7%), and/or hormonal therapy (69.1%). Results. 123 patients were enrolled and completed the planned treatment, with good tolerance. Median follow-up was 50.6 months. Grade 3 acute toxicity was only 2.4% and 3.3% for genitourinary (GU) and gastrointestinal (GI) tract, respectively. No patient had late grade 3 GI toxicity, and the GU grade 3 toxicity incidence was 5.8% at 5 years. 5-year BDSF was 90.2%. Conclusions. A modulated and intensified adjuvant treatment in PCa was feasible in this trial. A further period of observation can provide a complete assessment of late toxicity and confirm the BDSF positive results. © 2014 Giovanna Mantini et al.

Piermattei A.,University Cattolica Del ore | Greco F.,University Cattolica Del ore | Azario L.,University Cattolica Del ore | Porcelli A.,University Cattolica Del ore | And 9 more authors.
Nuclear Instruments and Methods in Physics Research, Section B: Beam Interactions with Materials and Atoms | Year: 2012

The paper reports the results of a National project financed by the Istituto Nazionale di Fisica Nucleare (INFN) for the development of in vivo dosimetric procedures in radiotherapy. In particular, a generalized procedure for the in vivo reconstruction of the isocenter dose, D iso, has been developed for 3D conformal radiotherapy treatments with open and wedged X-ray beams supplied by linacs of different manufacturers and equipped with aSi Electronic Portal Imaging Devices (EPIDs). In this way, the commissioning procedure is very simplified and applicable to Elekta, Siemens and Varian linacs. The method here reported is based on measurements in solid-water phantoms of different thicknesses, w, irradiated by square field sizes, L. Generalized mid-plane doses, D 0, and transit signal by EPIDs, st0, obtained by 19 open and 38 wedged beams of 8 different linacs, were determined taking into account X-ray beam and EPID calibrations. Generalized ratios F 0 = st0/D 0 for open and wedged beams were fitted by surface equations and used by a dedicated software, for the D iso reconstruction. Moreover, for each beam the software supplied a set of transit signal profiles crossing the beam central axis to test the beam irradiation reproducibility. The tolerance level of the comparison between the D iso and the dose computed by the TPS, D iso,TPS, was estimated 5%. The generalized in vivo dosimetry procedure was adopted by 3 centers that used different linacs. The results of 480 tests showed that in absence of errors, the comparison between D iso and D iso,TPS resulted well-within the tolerance level. The presence of errors was detected in 10% of the tests and were due to essentially an incorrect set-up, presence of an attenuator on the beams and patient morphological changes. Moreover, the dedicated software used the information of the Record and Verify system of the centres and consequently the extra-time needed to obtain, for each beam, the D iso reconstruction after the dose delivery, was about 20 s. © 2011 Elsevier B.V. All rights reserved.

Cambria R.,Instituto Europeo Of Oncologia | Jereczek-Fossa B.A.,Instituto Europeo Of Oncologia | Jereczek-Fossa B.A.,University of Milan | Zerini D.,Instituto Europeo Of Oncologia | And 6 more authors.
Strahlentherapie und Onkologie | Year: 2011

Purpose: To assess the dosimetric and clinical implication when applying the full bladder protocol for the treatment of the localized prostate cancer (PCA). Patients and Methods: A total of 26 consecutive patients were selected for the present study. Patients underwent two series of CT scans: the day of the simulation and after 40 Gy. Each series consisted of two consecutive scans: (1) full bladder (FB) and (2) empty bladder (EB). The contouring of clinical target volumes (CTVs) and organs at risk (OAR) were compared to evaluate organ motion. Treatment plans were compared by dose distribution and dose-volume histograms (DVH). Results: CTV shifts were negligible in the laterolateral and superior-inferior directions (the maximum shift was 1.85 mm). Larger shifts were recorded in the anterior-posterior direction (95% CI, 0.83-4.41 mm). From the dosimetric point of view, shifts are negligible: the minimum dose to the CTV was 98.5% (median; 95%CI, 95-99%). The potential advantage for GU toxicity in applying the FB treatment protocol was measured: the ratio between full and empty bladder dose-volume points (selected from our protocol) is below 0.61, excluding the higher dose region where DVHs converge. Conclusion: Having a FB during radiotherapy does not affect treatment effectiveness, on the contrary it helps achieve a more favorable DVH and lower GU toxicities. © 2011 Urban & Vogel.

Serinelli M.,CNR Institute of Clinical Physiology | Gianicolo E.A.L.,CNR Institute of Clinical Physiology | Cervino M.,CNR Institute of atmospheric Sciences and Climate | Mangia C.,CNR Institute of atmospheric Sciences and Climate | And 3 more authors.
Epidemiologia e Prevenzione | Year: 2010

Objective: to evaluate the association between daily air pollutant concentration and daily data regarding mortality and hospital admissions among residents of Brindisi (Southern Italy) in the years 2003-2006. Design: the association between the time series of daily mortality (2003-2005) and hospital admissions (2003-2006) and the time series of daily pollutant concentration were analyzed using a case-crossover method and a conditional logistic regression. Bi-directional control periods were selected using a timestratified approach. Models include mean temperature, relative humidity, influence of epidemics, summer decrease of resident population and holidays as confounders. Specific models with the following variables: cause of death or hospital admission, gender, age and season have been fitted. As hazard periods the following lags have been considered: single lag (from O to five) and cumulative lag (lag 0-1 for mortality and 0-3 for hospital admissions). Main outcome measures: a total of 1,792 subjects deceased of all natural causes (including cardiovascular and respiratory causes) and 6,925 hospital admissions for acute conditions (cardiac, cerebrovascular and respiratory diseases) were considered PM10, NO 2and CO daily pollutant concentration series were examined. Results: PM10 was associated with mortality from all natural causes (10.36%; 95% CI 1.83-19.61 at lag 0-1). The risk was more pronounced for cardiovascular mortality (14.35%; 95% CI 2.11; 28.07 at lag 1). The association with hospitalization for cerebrovascular diseases was statistically significant for PM10 among females (13.4%; 95% CI 1.7; 26.4 at lag 4) and elderly over 75 years old (13.6%; 95% CI 0.4; 28.6 at lag 4). In specific population groups, increased mortality and hospital admissions have been associated with NO2- Conclusion: this study found strong and consistent associations between outdoor air pollution (comingfrom both industrial emissions and urban traffic) and short-term increases in both mortality and morbidity. Precautionary measures should be taken.

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