Radiotherapy in the COVID-19 Pandemic Era

Background/Aim: In 2020, because of coronavirus pandemic, medical activities changed. The aim of this report is to compare the volumes of Pisa radiotherapy activities from March 9th to May 31st, 2020, with the same period in 2019. Patients and Methods: We analyzed the activity of our Unit to evaluate how logistics changes, related to the COVID-19 epidemic, impacted on volumes of radiotherapy (RT) activity and on the number of cases of COVID-19 infections observed in healthcare professionals and patients. Results: The total number of first-time visits between March-May 2020 was reduced by 18%, probably due to delays in diagnosis and histological tests as well as the temporary closure of the operating rooms. None of the healthcare professionals and only two patients contracted the infection. Conclusion: We were able to treat all patients referred to our hospital and we were able to reduce risk of infection for both our patients and healthcare staff, guaranteeing continuum of care for our oncological patien

Structural and Functional Network-Level Reorganization in the Coding of Auditory Motion Directions and Sound Source Locations in the Absence of Vision

Epub 2022 May 2hMT+/V5 is a region in the middle occipitotemporal cortex that responds preferentially to visual motion in sighted people. In cases of early visual deprivation, hMT+/V5 enhances its response to moving sounds. Whether hMT+/V5 contains information about motion directions and whether the functional enhancement observed in the blind is motion specific, or also involves sound source location, remains unsolved. Moreover, the impact of this cross-modal reorganization of hMT+/V5 on the regions typically supporting auditory motion processing, like the human planum temporale (hPT), remains equivocal. We used a combined functional and diffusion-weighted MRI approach and individual in-ear recordings to study the impact of early blindness on the brain networks supporting spatial hearing in male and female humans. Whole-brain univariate analysis revealed that the anterior portion of hMT+/V5 responded to moving sounds in sighted and blind people, while the posterior portion was selective to moving sounds only in blind participants. Multivariate decoding analysis revealed that the presence of motion direction and sound position information was higher in hMT+/V5 and lower in hPT in the blind group. While both groups showed axis-of-motion organization in hMT+/V5 and hPT, this organization was reduced in the hPT of blind people. Diffusion-weighted MRI revealed that the strength of hMT+/V5-hPT connectivity did not differ between groups, whereas the microstructure of the connections was altered by blindness. Our results suggest that the axis-of-motion organization of hMT+/V5 does not depend on visual experience, but that congenital blindness alters the response properties of occipitotemporal networks supporting spatial hearing in the sighted.SIGNIFICANCE STATEMENT Spatial hearing helps living organisms navigate their environment. This is certainly even more true in people born blind. How does blindness affect the brain network supporting auditory motion and sound source location? Our results show that the presence of motion direction and sound position information was higher in hMT+/V5 and lower in human planum temporale in blind relative to sighted people; and that this functional reorganization is accompanied by microstructural (but not macrostructural) alterations in their connections. These findings suggest that blindness alters cross-modal responses between connected areas that share the same computational goals.The project was funded in part by a European Research Council starting grant MADVIS (Project 337573) awarded to O.C., the Belgian Excellence of Science (EOS) program (Project 30991544) awarded to O.C., a Flagship ERA-NET grant SoundSight (FRS-FNRS PINT-MULTI R.8008.19) awarded to O.C., and by the European Union Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Grant Agreement No. 701250 awarded to V.O. Computational resources have been provided by the supercomputing facilities of the Université catholique de Louvain (CISM/UCL) and the Consortium des Équipements de Calcul Intensif en Fédération Wallonie Bruxelles (CÉCI) funded by the Fond de la Recherche Scientifique de Belgique (F.R.S.-FNRS) under convention 2.5020.11 and by the Walloon Region. A.G.-A. is supported by the Wallonie Bruxelles International Excellence Fellowship and the FSR Incoming PostDoc Fellowship by Université Catholique de Louvain. O.C. is a research associate, C.B. is postdoctoral researcher, and M.R. is a research fellow at the Fond National de la Recherche Scientifique de Belgique (FRS-FNRS)

Pelvic organ motion during definitive radiotherapy in patients affected by locally advanced cervical cancer

Introduction: The endpoint of this study is to evaluate the effectiveness and accuracy of simulation procedures used to performing radiotherapy treatment for locally advanced cervical cancer treated with definitive concurrent cisplatin-based chemo-radiotherapy (CCRT). Moreover we also have evaluated the dose coverage of the target and organ at risk (bladder and rectum) during radiotherapy, correlating with the clinical outcome. Material and methods: Between Jan. 2015 and Dec. 2019 we retrospectively analysed 30 patients with FIGO stage IB2-IVA cervical cancer who underwent CCRT. All the patients received External Beam Radiotherapy (EBRT) on the cervix and local extension of tumour, uterus, lateral parametria, proximal half of the uterosacral ligaments, upper half of the vagina or two cm below known vaginal disease and pelvic lymph nodes (obturator, external and internal iliac, subaortic presacral and common iliac nodes) up to a total dose of 45-50.4 Gy in 5-6 weeks (daily fractions of 1.8-2Gy).EBRT was delivered with Linac True Beam, 6 MeV Photons and VMAT technique. Concomitant chemotherapy (cisplatin [CDDP] 40mg/m2 weekly) was used in overall patients. Twenty-six (86.6%) women received dose-dense NACT consisted of weekly PTX (80 mg/m2) plus CBDCA (AUC 2) for 6 cycles. Twenty-three (76.6%) patients received additional (4-20Gy) EBRT sequential boost on primary tumor site and 28 (93.3%) received (6-28Gy) HDR-BT boost (daily fractions of 5-7Gy) delivered with a three-way Fletcher-Williamson applicator set (Nucletron B.V., Veenendaal, Netherlands). CTV expansion to PTV was between 5 to 10 mm. Results: Variations in bladder volume was from -77% to +435% and in rectum volume was from -67% to +415%. The displacement ranges were large, though the mean value was within 1 cm except for the superior direction which was +4.71cm. Among the 5 directions, the most prominent 2 positional change was observed in the cranio-caudal direction. We also observed only 2 (6.6%) G3 acute gastrointestinal toxicity and 2 (6.6%) G3 acute genitourinary toxicity. In univariate analysis PTV ≤ 5 mm is associated with lower Overall Survival [OS] (p=0.044), higher Progression Disease [PD] (p=0.029) and higher gastrointestinal toxicity (p=0.088). Also high risk histology (adenocarcinoma) is also associated with higher PD [p=0.016].Multivariate analysis shows that adenocarcinoma histology had lower Progression Free Survival (PFS). Conclusions: So It is necessary to perform an accurate check of patient's positioning and of dimensions of uterus, rectum and bladder through CBCTs. Because variations in volume of organ at risk can cause a shift of our target outside the PTV and an increase of radiation toxicity. Furthermore the contouring of a PTV ≥ 5 mm is strongly recommended; in agreement with literature our study suggest to use an isotropic expansion of about 8-10 mm at CTV1. CBCTs is an effective modality to evaluate and improve the inter-fraction setup reproducibility in radiation treatment for patients with local advanced cervical cancer with higher intrafractional organ motion

Prognostic role of hyponatremia in 564 small cell lung cancer patients treated with topotecan

Objectives: Hyponatremia is reported in about 15% of small cell lung cancer (SCLC). Variable results of the prognostic significance of low plasmatic sodium (Napl) have been reported. Our study was performed to investigate the prognostic role of hyponatremia in SCLC patients treated in second-line with topotecan chemotherapy. Materials and methods: Data were retrospectively collected from a database including clinical data from 631 patients enrolled in 6 prospective topotecan iv studies. Final data were obtained from 564 patients in which data on baseline Napl were available. Univariate and multivariate analysis were carried out to study the possible correlation between Napl and second-line clinical outcomes. Results: Hyponatremia (Napl<135mequiv./l) was present in 101 cases (17.9%). Napl was <125mequiv./l in 16 patients (2.8%), 126-130mequiv./l in 11 (2%), 130-134mequiv./l in 74 (13.1%), while 463 patients (82.1%) showed normal values. The median survival was 28.7 weeks in patients with normal Napl, and 21.1 weeks in patients with hyponatremia (p<0.0001, HR=1.67, 95%CI=1.32-2.10). By Cox multivariate analysis, hyponatremia was associated with poorer prognosis (p=0.0024, HR=1.44, 95%CI=1.13-1.82). A not statistically significant trend of correlation between hyponatremia and progression-free survival (p=0.085, HR=1.23, 95%CI 0.97-1.55) and response rate (p=0.5037, OR=0.81, 95%CI 0.44-1.49) was observed. Conclusion: Hyponatremia is an independent prognostic factor for patients with SCLC treated with topotecan in second-line setting. Further studies are needed to prospectically confirm these results and to develop an optimal therapy for hyponatremic patients

Population genetics and reproductive biology investigations for the conservation of Malcolmia littorea: introduction to a multidisciplinary approach

Malcolmia littorea (L.) R. Br. is a plant species of the Brassicaceae family (Fig. 1) which occurs exclusively in the sandy coastal habitats and is characterised by a disjoint distribution along the coasts of Portugal, Spain, France, Italy, Algeria and Morocco. The continuous fragmentation and degradation of the coastal dune habitats are threatening the persistence of this species, reducing the abundance of its populations, especially the peripheral ones, with the risk of affecting their genetic variability and reproductive success. In several European regions, the species is considered as threatened with extinction, especially in Italy. Here, M. littorea is represented by three small (< 500 mature individuals) populations, all standing in the Latium Region, in particular in the littoral portion between Sabaudia and Terracina. Because of the large and continuous decline of both the number of individuals and suitable sites for its colonization in the Italian territory, in this country it is considered as critically endangered (Rossi et al., 2013). Starting from 2010, several studies have been performed to investigate specific biological and ecological attributes of this species, with the general aim of providing data and practical advices useful for the development of a conservation strategy. The present report introduces the study on the conservation of M. littorea as an example of multidisciplinary approach and collaboration among different institutes/structures