A SHort course Accelerated RadiatiON therapy (SHARON) dose-escalation trial in older adults head and neck non-melanoma skin cancer

Objectives: To assess feasibility and safety of a SHort-course Accelerated RadiatiON therapy (SHARON) regimen, in the treatment of non-melanoma skin cancers (NMSC) in older patients.Methods: Old patients (age >= 80 years) with histological confirmed non-melanoma skin cancers were enrolled. The primary endpoint was to determine the maximum tolerated dose (MTD). Radiotherapy regimen was based on the delivery of four radiotherapy fractions (5 Gy per fraction) with a twice daily fractionation in two consecutive days, Three different level of dose were administered: 20 Gy (one cycle), 40 Gy (two cycles) and 60 Gy (three cycles).Results: Thirty patients (median age: 91 years; range: 80-96) were included in this analysis, Among fourteen patients who completed the one cycle, only one (7%) experimented acute G4 skin toxicity. Twelve patients reported an improvement or resolution of baseline symptoms (overall palliative response rate: 85.8%). Nine and seven patients underwent to two and three RT cycles, respectively: of these, no G3 toxicities were recorded. The overall response rate was 100% when three cycles were delivered. The overall six-month symptom-free survival was 787% and 77.8% in patients treated with one course and more courses, respectively.Conclusions: Short-course accelerated radiotherapy in older patients with non-melanoma skin cancers is well tolerated. High doses seem to be more effective in terms of response rate.Advances in knowledge: This approach could represent an option for older adults with NMSC, being both palliative (one course) or potentially curative (more courses) in the aim, accordingly to the patient's condition

Aree funerarie a Leopoli-Cencelle. Riflessioni sui primi dati

Leopoli-Cencelle is a medieval town located in via Aurelia km 84, founded in 854 by Pope Leo IV. Two of the three urban cimiterial areas that have been excavated are linked to the main church of the city dedicated to Saint Peter and they have been used respectively from the foundation until the beginning of XII century, when the church was reconstructed, and from XII to XVI century. In addition to all that, the third cimiterial area, located immediately inside the northern city wall, has allowed to unearth nine infant burials that date after 1349 earthquake. Excavation of the cemetery connected to the Romanesque church of Saint Peter, that is still going on, is an interesting opportunity to reconstruct interactions linked to the worship of dead and to the conse‑crated space between the Communes era and late Middle Ages. Different burial phases can be identified; burials analyzed belong to the most intense usage season characterized by soil graves within additional soil accumulation layers, intensively taking up space, overlapping and cutting across each other. The accumulation layers of the necropolis, the layers filling the graves and burials themselves have brought to light a wide range of pottery fragments and objects that reflect different aspects of late Middle Ages life in Leopoli-Cencelle. The sample is composed by 96 individuals: 69% adults and 31% subadults. Anthropological analyses are still going on in order to reconstruct not only biological features (sex, age at death, stature etc) but to achieve a full palaeobiological reconstruction of this medieval population

Radiological and clinical results following high-dose intensity-modulated radiotherapy in recurrent craniopharyngioma: A case report

none9noCraniopharyngiomas (CPs) are rare benign suprasellar tumors. The standard treatment for CP is complete surgical resection or partial resection followed by adjuvant radiotherapy (RT). Adjuvant RT is typically administered at a total dose of 54 Gy with 1.8 Gy/fraction. The current study reported the case of a young patient affected by recurrent craniopharyngioma, who was treated with irradiation subsequent to several surgical resections. Image fusion and intensity‑modulated radiation therapy techniques were employed to deliver a high total dose (63 Gy with 2.1 Gy/fraction) with no severe acute toxicities recorded. At the 6‑year follow‑up, no radiological or clinical signs of disease progression or late sequelae were observed.mixedPierro, Antonio; Cilla, Savino; Picardi, Vincenzo; Ferro, Marica; Macchia, Gabriella; Deodato, Francesco; Buwenge, Milly; Sallustio, Giuseppina; Morganti, Alessio G.Pierro, Antonio; Cilla, Savino; Picardi, Vincenzo; Ferro, Marica; Macchia, Gabriella; Deodato, Francesco; Buwenge, Milly; Sallustio, Giuseppina; Morganti, Alessio G

On the cutting edge of intensity modulated radiotherapy and simultaneous integrated boost (IMRT-SIB): The case of a patient with 8 brain metastases

Background: Patients with multiple brain metastases, especially those with more than 3 lesions, usually undergo to palliative whole brain (WB) radiotherapy (RT). Methods: A breast cancer patient with 8 brain metastases was treated on the brain by a radical RT regimen. Prescription doses were according to the simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) technique with all lesions as well brain irradiated simultaneously in 20 daily fractions. Doses of 40.0 Gy (2.0 Gy/fraction) and 50.0 Gy (2.5 Gy/fraction) were prescribed to the whole brain and to eight individual metastases, respectively. Results: Mean volume of the eight metastases was 8.1 cc (range: 3.8-10.1 cc). For all lesions, the volume receiving 95% of prescribed dose was 100% and dose homogeneity was within 3%. Moreover, maximum doses were less than 105% of prescribed dose, while average mean dose to lesions was 50.6. Gy (range: 49.7-51.5 Gy). Whole brain mean dose was 45.2 Gy. Maximum doses to brainstem and optic chiasma were limited to 44.5 Gy and 42.9 Gy, respectively, while maximum doses to eyes, lens and optic nerves were limited to 9.2 Gy, 4.9 Gy and 41.0 Gy, respectively. From a clinical point of view, subsequent MRI brain controls showed a complete clinical response. Forty months after treatment the patient is disease free and shows no late brain and skin toxicities. Conclusion: This case demonstrates the technical feasibility of a SIB-IMRT treatment in patients with more than 3 brain metastases

Short-course radiotherapy in elderly patients with early stage non-melanoma skin cancer: a phase II study

To evaluate outcome of an accelerated radiotherapy (RT) regimen in elderly patients with an early stage non-melanoma skin cancer (NMSC)

Radiological and clinical results following high-dose intensity-modulated radiotherapy in recurrent craniopharyngioma: A case report

Craniopharyngiomas (CPs) are rare benign suprasellar tumors. The standard treatment for CP is complete surgical resection or partial resection followed by adjuvant radiotherapy (RT). Adjuvant RT is typically administered at a total dose of 54 Gy with 1.8 Gy/fraction. The current study reported the case of a young patient affected by recurrent craniopharyngioma, who was treated with irradiation subsequent to several surgical resections. Image fusion and intensity-modulated radiation therapy techniques were employed to deliver a high total dose (63 Gy with 2.1 Gy/fraction) with no severe acute toxicities recorded. At the 6-year follow-up, no radiological or clinical signs of disease progression or late sequelae were observed

Results of a Phase II Study of Short-Course Accelerated Radiation Therapy (SHARON) for Multiple Brain Metastases

Objectives: To assess the effectiveness of a SHort-course Accelerated RadiatiON therapy (SHARON) in the treatment of patients with multiple brain metastases. Materials and Methods: A phase II clinical trial was designed. Eligibility criteria included patients with at least 3 brain metastases or metastatic disease in >3 organ systems, and Eastern Cooperative Oncology Group performance status of 643. Fifty patients were treated with whole brain radiotherapy at 18 Gy (4.5 Gy per fraction) in 2 days with a twice daily fractionation. The primary endpoint was the assessment of efficacy in terms of overall survival. Results: Characteristics of the 50 enrolled patients were: male/female: 24/26; median age: 65 years (range, 45 to 80 y). Eastern Cooperative Oncology Group performance status was <3 in 42 patients (84%). Nineteen patients (38%) were considered to have recursive partitioning analysis class 3 disease. Grade 1-2 acute neurological (46%) and skin (24%) toxicities were recorded. Three patients (6%) experienced neurological grade 3 acute toxicity. With a median follow-up time of 6 months (range, 1 to 18 mo) 2 skin grade 1 late toxicities has been observed. Seventeen of 27 symptomatic patients showed an improvement or resolution of baseline symptoms (overall palliative response rate: 63.0%; 95% confidence interval, 36.6%-82.4%).Two-month overall survival was 86% (median survival time=7 mo). Conclusions: Short-course accelerated whole brain radiotherapy of 18 Gy in twice daily fractions for 2 consecutive days is tolerated and effective in terms of symptom relief and median survival time. These results justify a phase III comparison against the standard-of-care in this patient population (30 Gy in 10 fractions)

Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost in Patients With Brain Oligometastases: A Phase 1 Study (ISIDE-BM-1)

Purpose To investigate the maximum tolerated dose of intensity modulated radiation&nbsp;therapy simultaneous integrated boost whole-brain radiation therapy for palliative treatment of patients with &lt;5 brain metastases using a standard linear accelerator. Materials and Methods The whole brain plus 3-mm margin was defined as the planning target volume (PTVwb), whereas each brain metastasis, defined as the contrast-enhancing tumor on MRI T1 scans, plus a 3-mm isotropic margin, was defined as metastases PTV (PTVm). Radiation therapy was delivered in 10 daily fractions (2&nbsp;weeks). Only the dose to PTVm was progressively increased in the patient cohorts (35&nbsp;Gy, 40&nbsp;Gy, 45&nbsp;Gy, 50&nbsp;Gy), whereas the PTVwb was always treated with 30&nbsp;Gy (3&nbsp;Gy per fraction) in all patients. The dose-limiting toxicity was evaluated providing that 3&nbsp;months of follow-up had occurred after the treatment of a 6-patient cohort. Results Thirty patients were enrolled in the study (dose PTVm: 35&nbsp;Gy, 8 patients; 40&nbsp;Gy, 6 patients; 45&nbsp;Gy, 6 patients; 50&nbsp;Gy, 10 patients). The number of treated brain metastases was 1 in 18 patients, 2 in 5 patients, 3 in 6 patients, and 4 in 1 patient. Three patients experienced dose-limiting toxicity: 1 patient at dose level 2 presented grade 3 (G3) skin toxicity; 1 patient at dose level 4 presented G3 neurologic toxicity; and 1 patient at the same level showed brain hemorrhage. Most patients showed G1 to 2 acute toxicity, in most cases skin (n=19) or neurologic (n=10). Twenty-seven were evaluable for response: 6 (22%) stable disease, 18 (67%) partial response, and 3 (11%) complete response. Median survival and 1-year overall survival were 12&nbsp;months and 53%, respectively. No patient showed late toxicity. Conclusions In this first prospective trial on the use of intensity modulated radiation therapy simultaneous integrated boost delivered with a standard linear accelerator in patients with brain oligometastases, a boost dose up to 50&nbsp;Gy in 10 fractions was tolerable according to the study design

Low-dose fractionated radiotherapy and concomitant chemotherapy for recurrent or progressive glioblastoma : Final report of a pilot study

Evaluated in this study were the feasibility and the efficacy of concurrent low dose fractionated radiotherapy (LD-FRT) and chemotherapy as palliative treatment for recurrent/progressive glioblastoma multiforme (GBM)