factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy

Abstract Purpose To evaluate toxicity in breast cancer patients treated with anthracycline and taxane based chemotherapy and whole breast hypofractionated radiotherapy, and to identify the risk factors for toxicity. Methods and materials 537 early breast cancer patients receiving hypofractionated radiotherapy after conservative surgery were enrolled from April 2009 to December 2014, in an Italian cancer institute. The dose was 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction. The boost to the tumor bed was administered only in grade III breast cancer patients and in patients with close or positive margins. Acute and late toxicity were prospectively assessed during and after radiotherapy according to RTOG scale. The impact of patients clinical characteristics, performed treatments and dose inhomogeneities on the occurrence of an higher level of acute skin toxicity and late fibrosis has been evaluated by univariate and multivariate analysis. Results The mean age was 74 (range 46–91 yrs). 27% of patients received boost. 22% of cases (n = 119) received also chemotherapy. The median follow-up was 32 months. G1 and G2/G3 acute skin toxicity were 61.3% and 20.5% and G1 and G2/G3 late fibrosis 12.6% and 4.3% respectively. Chemotherapy (p = 0.04), diabetes (p = 0.04) and boost administration (p Conclusions The results of our study, according to the large randomized trials, confirmed that hypofractionated whole breast irradiation is safe, and only the boost administration seems to be an important predictor for toxicity. Chemotherapy does not impact on acute and late skin toxicity

Urban Transition and the Return of Neighbourhood Planning. Questioning the Proximity Syndrome and the 15-Minute City

European policies acknowledge cities’ major roles in building greener and just urban habitats. When rethinking cities’ spatial organisation, the call is for creating better liveability conditions at the level closest to citizens. In this frame, research into the impacts of COVID-19 has led to a revival of neighbourhood planning and the 15-Minute City has been proposed as a successful model for cities’ recoveries in the name of regained proximity to collective facilities. This article questions the long-lasting neighbourhood image that the 15-Minute City refers to, by exploring recent experiences that renewed its application. We begin with a literature review, and then develop an evidence-based approach to a deeper analysis of policy design and implementation focusing on the Italian city of Milano. Discussion and conclusions highlight critical issues and potentials of the 15-Minute City. If the threat is that of a simplified and rhetorical use of this idea, its ability to gather plural actions under an appealing flagship can be a powerful driver for urban regeneration policies. However, being more than just a reproducible spatial model, the 15-Minute City needs to be handled as a complex planning device, whose effective implementation depends on the specific characteristics of the urban environments it applies to and on the strong intertwining of different policy fields and tools

Reaction of Dodecacarbonyltriruthenium with 7-Oxabicyclo[2.2.1]Hept-5-En-2-Yl Derivatives - Synthesis of (Mu-3-Eta-2-Benzyne)-Nonacarbonyldihydridotriruthenium and Derivatives

The thermal reaction of [Ru3(CO)12] with 7-oxabicyclo[2.2.1]hept-5-en-2-yl derivatives gave the corresponding [Ru3H2(CO)9(7-oxabicyclo[2.2.1]hept-5-yn-2-yl)] clusters; treatment of the complex derived from 7-oxabicyclo[2.2.1]hept-5-en-2-endo-yl benzoate with (CH3)3SiOSO2CF3 gave a mixture of [Ru3H2(CO)9(benzyne)] and [Ru3H2(CO)9(C6H3-OCOC6H5)]

Bulimia logistica e opzioni di organizzazione territoriale. Note sulla costruzione di un paesaggio operazionale

IL contributo ricostruisce la genesi dell’istituto delle Zone logistiche semplificate in Italia e ne esamina la traduzione e implementazione nel contesto della Regione Emilia-Romagna. Si analizza, in particolare, il sistema di scelte pianificatorie con cui la formazione della ZLS si confronta ed entro cui prende corpo e forma, nonché il processo di selezione delle aree candidate ad esserne parte. In uno degli aspetti di suo maggiore interesse, il caso può osservarsi come una sorta di esperimento di costruzione di un “paesaggio operazionale” che pone (o rinnova) la questione della frizione tra uno spazio regionale pensato come supporto funzionale di dinamiche economiche e le condizioni contestuali d’abitabilità dei territori, in antitesi a ogni riduzione strumentale e/o settoriale.This contribution retraces the genesis of the institution of the Zone logistiche Semplificate (Simplified Logistic Zones) in Italy and examines its interpretation and implementation in the context of the Emilia-Romagna Region. In particular, the system of planning choices within which the ZLS-ER takes shape is analyzed and discussed, as well as the process of selection of candidate areas to be part of it. In one of its most interesting aspects, the case can be seen as a sort of experiment in the construction of an “operational landscape” which raises (or renews) the issue of the friction between a regional space conceived as a functional support for economic dynamics and the contextual habitability conditions of territories, in antithesis to any partial and/or sectorial reductionism

Preemptive treatment with Xonrid®, a medical device to reduce radiation induced dermatitis in head and neck cancer patients receiving curative treatment: a pilot study

Purpose: The purpose of this study was to investigate efficacy, safety and tolerability of Xonrid®, a new medical device, in preventing radiation dermatitis associated with head and neck cancer (HNC) radiotherapy (RT). Methods: In this monocentric, prospective pilot study, adult consecutive HNC patients who were planned to receive curative RT with or without chemotherapy were enrolled. Patients were instructed to apply Xonrid® on the irradiated area during treatment continuing until 2 weeks after the completion of RT or the development of severe skin toxicity. Toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 scale. The patient reported outcome measures included the Skindex-16 questionnaire and patient satisfaction. Skin reflectance spectra were analyzed to objectively evaluate dermatitis. Results: In total, 41 subjects were enrolled (30 males, median age 60 years). No skin adverse events were recorded either in the skin area where the product was applied or in the nearby skin over the entire period of administration. At the end of RT, nine patients (22%) presented G1, 31 (76%) G2, and one patient (2%) G3 skin toxicity (after 5 weeks). Seven and 20 patients reached skin maximum toxicity at the fourth week and after the seventh week, respectively. An increasing trend of median spectrophotometry scores along with skin toxicity grades was observed. A correlation between Skindex-16 scores and skin toxicity grade during treatment was found. Conclusions: Our study results suggest that Xonrid® is well tolerated, safe, and effective in minimizing and delaying high-grade radiation dermatitis in HNC patients

Application of failure mode and effects analysis to optimization of linac quality controls protocol

Purpose: To apply Failure Mode and Effects Analysis (FMEA) to optimize linac quality control (QC) protocol in order to ensure patient safety and treatment quality, taking maximum advantage of the available resources. Material and methods: Each parameter tested by the QC was considered as a potential failure mode (FM). For each FM, likelihood of occurrence (O), severity of effect (S), and lack of detectability (D) were evaluated and corresponding Risk Priority Number (RPN) was calculated from the product of three indexes. The scores were assigned using two methods: (a) A survey submitted to the medical physicists; (b) A semi-quantitative analysis (SQA) performed through: simulation of FMs in the treatment planning system; studies reported in literature; results obtained by the QC data analysis. A weighted RPN for all FMs was calculated taking into account both the methods. For each linac, the tests were then sorted by their frequency and the RPN value. Results: A high variability was found in the scores of the survey, although in many it was reduced in RPN values, highlighting the more relevant tests as on beam output and imaging system. Integrating these results with those obtained by SQA, the RPN-based ranking of tests has been provided considering the specific use of the accelerator: for example, more accurate tests on dose modulation and multileaf collimator speed were required in linacs where intensity-modulated treatment is performed, while, more specific tests on couch and jaw position indicators were necessary where treatments with multiple isocenters and/or junctions between adjacent fields were often delivered. Conclusions: Failure Mode and Effects Analysis is a useful tool to prioritize the linac QCs, taking into account the specific equipment and clinical practice. The integration of SQA and survey results reduces subjectivity of the FMEA scoring and allows to optimize linac QCs without \u201closing\u201d the expertise and experience of medical physicists and clinical staff