Can multiparametric MRI replace Roach equations in staging prostate cancer before external beam radiation therapy?

Purpose To investigate the agreement between Roach equations (RE) and multiparametric magnetic resonance imaging (mpMRI) in assessing the T-stage of prostate cancer (PCa). Materials and methods Seventy-three patients with biopsy-proven PCa and previous RE assessment prospectively underwent mpMRI on a 3.0T magnet before external beam radiation therapy (EBRT). Using Cohen\u2019s kappa statistic, we assessed the agreement between RE and mpMRI in defining the T-stage ( 65T3 vs.T\u2005 64\u20052) and risk category according to the National comprehensive cancer network criteria ( 64intermediate vs. 65high). We also calculated sensitivity and specificity for 65T3 stage in an additional group of thirty-seven patients with post-prostatectomy histological examination (mpMRI validation group). Results The agreement between RE and mpMRI in assessing the T stage and risk category was moderate (k\u2005=\u20050.53 and 0.56, respectively). mpMRI changed the T stage and risk category in 21.9% (95%C.I. 13.4\u201333-4) and 20.5% (95%C.I. 12.3\u201331.9), respectively, prevalently downstaging PCa compared to RE. Sensitivity and specificity for 65T3 stage in the mpMRI validation group were 81.8% (95%C.I. 65.1\u201391.9) and 88.5% (72.8\u201396.1). Conclusion RE and mpMRI show moderate agreement only in assessing the T-stage of PCa, translating into an mpMRI-induced change in risk assessment in about one fifth of patients. As supported by high sensitivity/specificity for 65T3 stage in the validation group, the discrepancy we found is in favour of mpMRI as a tool to stage PCa before ERBT

Prostate Cancer Treatment-Related Toxicity: Comparison between 3D-Conformal Radiation Therapy (3D-CRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques

Objective: This paper illustrates the results of a mono-institutional registry trial, aimed to test whether gastrointestinal (GI) and genitourinary (GU) toxicity rates were lower in localized prostate cancer patients treated with image-guided volumetric modulated arc therapy (IG-VMAT) compared to those treated with IG-3D conformal radiation therapy (IG-3DCRT). Materials and Methods: Histologically proven prostate cancer patients with organ-confined disease, treated between October 2008 and September 2014 with moderately hypofractionated radiotherapy, were reviewed. Fiducial markers were placed in the prostate gland by transrectal ultrasound guide. The prescribed total dose was 70 Gy in 28 fractions. The mean and median dose volume constraints for bladder and rectum as well as total volume of treatment were analyzed as potentially prognostic factors influencing toxicity. The Kaplan–Meier method was applied to calculate survival. Results: Overall, 83 consecutive patients were included. Forty-two (50.6%) patients were treated with 3D-CRT and 41 (49.4%) with the VMAT technique. The median follow-up for toxicity was 77.26 months for the whole cohort. The VMAT allowed for a dose reduction to the rectum and bladder for the large majority of the considered parameters; nonetheless, the only parameter correlated with a clinical outcome was a rectal dose limit V66 > 8.5% for late GI toxicity G ≥ 2 (p = 0.045). Rates of G ≥ 2 toxicities were low among the whole cohort of these patients treated with IGRT. The analysis for rectum dose volume histograms (DVHs) showed that a severe (grade ≥ 2) late GI toxicity was related with the rectal dose limit V66 > 8.5% (p = 0.045). Conclusions: This study shows that moderate hypofractionation is feasible and safe in patients with intermediate and high-risk prostate cancer. Daily IGRT may decrease acute and late toxicity to organs at risk and improve clinical benefit and disease control rate, cutting down the risk of PTV geographical missing. The adoption of VMAT allows for promising results in terms of OAR sparing and a reduction in toxicity that, also given the small sample, did not reach statistical significance

Adaptability of sunflower (Helianthus annuus L.) high oleic hybrids to different Italian areas for biodiesel production

Currently the biodiesel chain is promoted by the European energy policy. For the Italian scenario the sunflower is one of the most important crop to be considered for biodiesel production but the chain is not fully profitable. This problem could be solved with the increase of farm incomes through a proper valorization of by-products. From this point of view the oilseed crop is not considered only for oil production but also for producing multiple products with the same economic value. This is the main inspiring concept of the Extravalore project. The sub-project "Raw Materials" investigated about the possible influence of different agro-technics performed in three distinct geographical environments (Northern, Central and Southern Italy) on the characteristics of by-products obtained from sunflower crop. A national net of experimental tests was set during the 2010-2013 period in order to evaluate the adaptability and the potential production of high oleic sunflower hybrids. 7 seed companies supplied the 20 genotypes assessed in total (18 high oleic hybrids and 2 as control), 11 of them were evaluated all the three years. Achene yields of tested high oleic hybrids were extremely variable: from 2.05 t ha(-1) to 4.04 t ha(-1) in Northern Italy, from 2.50 t ha(-1) to 4.24 t ha(-1) in Central Italy and from 2.09 t ha(-1) to 2.68 t ha(-1) in Southern Italy. For this reason, it was necessary a precise characterization of varieties before their cultivation. The cultivar screening showed general difficulty for high oleic hybrids to reach the performances of achene and oil yields of the conventional ones. In particular, LG55.57H0 and PR64H31 resulted the best high oleic cultivars for Northern Italy; many of the high oleic tested cultivars performed well for Central Italy and also for Southern Italy but with a higher variability. The highest potential production was registered in Central Italy; Northern Italy gave decreased but similar results, despite the different latitude; in Southern Italy the productions were 20-30% lower, even with the irrigation support. All high oleic tested cultivars showed oleic acid content in lipid fraction always above the 84% in Central Italy, meaning a stability of the character, very important for the biodiesel production

A comparative study of oilseed crops (Brassica napus L. subsp. oleifera and Brassica carinata A. Braun) in the biodiesel production chain and their adaptability to different Italian areas

The Extravalore project aims to give added value to oilseed crops, considering them also for producing multiple products with the same economic value and being interesting for the market thanks to their various utilizations.An evaluation of the main cultivars of Brassica napus subsp. oleifera and Brassica carinata has been performed within the project, analyzing them in three Italian locations with different climatic conditions (Palazzolo dello Stella - North Italy, Osimo - Central Italy, Cassibile - South Italy) to assay their adaptability and production potential.During the 2010-2013 period, 43 varieties of rapeseed were evaluated, but only 13 of them for all the period considered; moreover, also 4 varieties of B. carinata were tested.The seed yields of tested cultivars of rapeseed varied a lot among locations, depending also by the seasonal trend. Central Italy was the less disadvantaged by climatic conditions: on average, it was reached a seed yield of 4tha-1, a theoretical oil production of 1.63tha-1 and more than 8tha-1 of crop residues. In Northern and Southern Italy, if compared with Central Italy values, the seed yields were both lower than 30% and theoretical oil productions lower than 60%; moreover, crop residues in Northern Italy were 12% lower than in Central Italy while in Southern Italy 65% lower. The agronomic behavior of varieties differed a lot among the three experimental areas: DK Expower was the best at North; Albatros, Artoga, Exagone and Excalibur in Central Italy; Excalibur, Zoom and PR46W14 at South Italy but none of them reached a seed yield of 2tha-1.Concerning B. carinata, the cultivars did not give good productions in any of the experimental areas, mainly because of the low oil content in the seeds. Even in Central Italy, where the best results were registered, the seed yield was on average 28% lower than in rapeseed and oil production 10% lower; the crop residues were double than rapeseed. In any case, the valorization of the crop residues is important with a wide range of possible utilization from the direct energetic use to the biochemicals extraction with consequent environmental advantages due to the substitution of dedicated or fossil feedstock with crop residues

HFMEA DEL PERCORSO RADIOTERAPICO DEL CARCINOMA MAMMARIO: ESPERIENZA DELL\u2019AZIENDA OSPEDALIERO-UNIVERSITARIA DI UDINE

Presso l\u2019Azienda Ospedaliero-Universitaria \u201cS. Maria della Misericordia\u201d di Udine si \ue8 selezionato, per l\u2019anno 2014, a seguito di segnalazioni di eventi avversi/near miss pervenuti nel 2013 ed al previsto trasferimento presso nuova sede, il percorso radioterapico per carcinoma mammario come processo da valutare tramite Health Care Failure Mode and Effects Analysis (HFMEA) nell\u2019ambito dei programma di qualit\ue0. Metodi: Il gruppo di lavoro comprendeva gli operatori di: Fisica Sanitaria, Radioterapia, Oncologia e Rischio Clinico. E\u2019 stato analizzato tutto il percorso e per ogni Potential Failure Mode (PFM) \ue8 stato assegnato un indice di priorit\ue0 di rischio (IPR), risultato dal prodotto di gravit\ue0, rilevabilit\ue0 e probabilit\ue0 di accadimento (valori da 1 a 5 per ogni variabile). Risultati: Sono state descritte 8 fasi, suddivise in 100 attivit\ue0, all\u2019interno delle quali sono state individuati 153 PFM con corrispondente IPR. 30 attivit\ue0 hanno superato il 3\ub0quartile considerato come cut-off (valori IPR>di 18) e sono state considerate a maggior rischio. La loro re-ingegnerizzazione ha portato un abbassamento degli IPR da un valore medio di 30,46 a 7,16 (diminuzione del 76,49%). Conclusioni: La metodologia di analisi HFMEA si \ue8 dimostrata utile per identificare le diverse criticit\ue0, favorire la comunicazione tra operatori di diverse strutture afferenti ad uno stesso percorso e avviare la re-ingegnerizzazione dei processi

Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: The Pros-IT CNR study

BACKGROUND: The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. METHODS: One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). RESULTS: At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. CONCLUSIONS: Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care