Publications by authors named "Marta Bottero"

13 Publications

  • Page 1 of 1

The Italian Association of Radiotherapy and Oncology Recommendation for Breast Tumor Recurrence: Grades of Recommendation, Assessment, Development and Evaluation Criteria.

J Breast Cancer 2021 Jun 13;24(3):241-252. Epub 2021 May 13.

Radioterapia, Dipartimento di Biomedicina e prevenzione, Università degli Studi di Roma Tor Vergata, Roma, Italy.

Salvage mastectomy is currently considered the standard of care for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and postoperative radiotherapy (RT). Alternative treatment options for these patients, such as a second BCS followed by repeated RT, have been suggested. The panel of the Italian Association of Radiotherapy and Clinical Oncology developed clinical recommendations for second BCS followed by re-irradiation over mastectomy alone for women with IBTR using the Grades of Recommendation, Assessment, Development, and Evaluation methodology and the evidence to decision framework. The following outcomes were identified by the panel: locoregional control, metastasis-free survival, overall survival, and cancer-specific survival; acute and late toxicity, specific late toxicity, second locoregional tumor, and death related to treatment. An Embase and PubMed literature search was performed by two independent authors. Five retrospective observational studies were eligible for inclusion in the present analysis. According to the reports in the literature and our analysis, the advantages of second quadrantectomy and re-irradiation (re-QUART) outweigh its side effects, with overall good rates of survival and adequate toxicity without increasing costs. Given the very low level of evidence, the panel stated that a second BCS plus re-irradiation can be considered as an alternative to salvage mastectomy for selected patients with IBTR.
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http://dx.doi.org/10.4048/jbc.2021.24.e27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250101PMC
June 2021

A decision support system for territorial resilience assessment and planning: An application to the Douro Valley (Portugal).

Sci Total Environ 2021 Feb 26;756:143806. Epub 2020 Nov 26.

Centre of Mathematics, University of Minho, Braga, Portugal.

This paper aims to assess the territorial resilience of a socio-ecological system through an innovative integrated evaluation framework to aid the decision-making process in the planning of transformation scenarios. This framework employs a set of resilience indicators through a Multicriteria Decision Analysis (MCDA) coupled with a Lotka-Volterra mathematical model of cooperative type. The set of indicators aims to calculate a composite index of Territorial Resilience (TRI), whereas the mathematical model is an extension of an existing model, aimed to predict possible long-time scenarios. The proposed operational framework for rural and vineyard landscapes aims to bridge the existing gap between territorial resilience theory and practice, with an innovative Decision Support System able to assist Decision Makers and territory planners in the planning and management of resilient territorial systems. This integrated evaluation framework is applied to a famous wine region in Portugal, the Douro Valley, where Port-wine grows. Such framework, especially in a context of adaptive governance, proves to be a suitable support in the field of landscape and urban planning to evaluate the dynamics of socio-ecological systems and to envision long-term policies and actions.
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http://dx.doi.org/10.1016/j.scitotenv.2020.143806DOI Listing
February 2021

Radiotherapy in the era of COVID-19.

Expert Rev Anticancer Ther 2020 08 7;20(8):625-627. Epub 2020 Jul 7.

Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia , Perugia, Italy.

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http://dx.doi.org/10.1080/14737140.2020.1785290DOI Listing
August 2020

Radiotherapy treatment volumes for oligorecurrent nodal prostate cancer: a systematic review.

Acta Oncol 2020 Oct 13;59(10):1224-1234. Epub 2020 Jun 13.

Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.

Background: Radiotherapy is an emerging treatment strategy for nodal oligorecurrent prostate cancer (PCa) patients. However, large heterogeneities exist in the RT regimens used, with series reporting the use of elective nodal radiotherapy (ENRT) strategies and others the delivery of focal treatments to the relapsing nodes with Stereotactic Body Radiotherapy (SBRT). In this systematic review of the literature we compared the oncological outcomes and toxicity of the different RT regimens for nodal oligorecurrent PCa patients, with the aim of defining the optimal RT target volume in this setting.

Methods: We performed a systemic search on the Pubmed database to identify articles reporting on the use of ENRT or SBRT for oligometastatic PCa with nodal recurrence.

Results: Twenty-two articles were analyzed, including four prospective phase II trials (3 with SBRT and 1 with ENRT). Focal SBRT, delivered with an involved node, involved site, and involved field modality, was the most commonly used strategy with 2-year progression-free survival (PFS) rates ranging from 16 to 58% and a very low toxicity profile. Improved PFS rates were observed with ENRT strategies (52-80% at 3 years) compared to focal SBRT, despite a slightly higher toxicity rate. One ongoing randomized phase II trial is comparing both modalities in patients with nodal oligorecurrent PCa.

Conclusions: With a large variability in patterns of practice, the optimal RT strategy remains to be determined in the setting of nodal oligorecurrent PCa. Ongoing randomized trials and advances in translational research will help to shed light on the best management for these patients. .
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http://dx.doi.org/10.1080/0284186X.2020.1775291DOI Listing
October 2020

Electromagnetic Transponder Localization and Real-Time Tracking for Prostate Cancer Radiation Therapy: Clinical Impact of Metallic Hip Prostheses.

Pract Radiat Oncol 2020 Nov - Dec;10(6):e538-e542. Epub 2020 Mar 19.

Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland.

Purpose: Our purpose was to assess the ability of electromagnetic transponders (EMTs) to localize and track movements in patients with prostate cancer (PCa) with metallic hip prostheses (MHPs) treated with curative radiation therapy (RT).

Methods And Materials: Data sets of 8 PCa patients with MHPs (3 bilateral and 5 unilateral) treated between 2016 and 2018 with RT and EMT tracking were retrospectively assessed. The distances between the 3 EMTs (apex to left, left to right, right to apex) and the isocenter were calculated both on planning computed tomography (CT) and cone beam CT (CBCT) at the first treatment fraction and compared with data reported by Calypso. EMT position and treatment interruptions triggered by Calypso were analyzed for all evaluable treatment fractions (n = 120). Localization accuracy was quantified by recording the geometric residual value (expected limit ≤0.2 cm) at the RT setup.

Results: The Calypso system was able to localize and track prostate position without any detectable interference from MHP. For every treatment fraction, the agreement between the CBCT images and Calypso guidance was optimal, with EMTs always within the defined tolerance (ie, CT-Calypso or CBCT-Calypso measured differences in inter-EMT distances within 0.3 cm). EMT to isocenter distances measured by Calypso reproduced CT data and were confirmed on CBCT scans. During RT, the EMT centroid exceeded the threshold 24 times (20% of all fractions): 5 times in the left-right, 15 times in the anteroposterior, and 4 times in the superoinferior directions. The largest motions recorded were in the anteroposterior axis: 0.6 cm anteriorly and 0.5 cm posteriorly in patients with unilateral and bilateral MHP, respectively.

Conclusions: Our study represents the first clinical experience assessing the localization and tracking accuracy of Calypso EMTs during curative RT of patients with PCa with unilateral or bilateral MHP.
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http://dx.doi.org/10.1016/j.prro.2020.03.003DOI Listing
March 2020

High-resolution microultrasound imaging for bladder cancer: the birth of a new diagnostic tool?

Transl Androl Urol 2019 Dec;8(Suppl 5):S505-S506

Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy.

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http://dx.doi.org/10.21037/tau.2019.08.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989852PMC
December 2019

Radiotherapy for papillary tumor of the pineal region: A systematic review of the literature.

Clin Neurol Neurosurg 2020 03 21;190:105646. Epub 2019 Dec 21.

Radioterapia Oncologica, Dipartimento di Scienze Chirurgiche e Biomediche, Università degli Studi di Perugia, ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy.

Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial brain tumor, characterized by a high risk of local recurrence (greater than 70 % at 6 years). The aim of our study was to review the available literature on radiotherapy for PTPR in order to evaluate timings, schedules, outcomes and toxicities of this treatment modality. In our review, 72.4 % (84) of the patients diagnosed with PTPR received radiation therapy. There is heterogeneity in the dose prescription, ranging from 45 Gy (25 × 1.8 Gy) to 60 Gy (30 × 2 Gy) for 3D Conformal Radiation Therapy and from 12 Gy to 36 Gy for Stereotactic Radiosurgery. Being considered as a grade II or III tumor, PTPR should receive higher total radiation dose in the adjuvant setting. Our analysis showed a very limited treatment-related toxicity with an expected 10-y OS of 72.5 %. At 5-years from the diagnosis, about 60 % of the patients experienced a local recurrence, whereas at 10 years the rate is higher than 80 %. In the literature, conflicting data about radiotherapy for PTPR are reported, in particular regarding disease progression. Although radiotherapy represents a fundamental treatment in the management of PTPR, prospective studies are required to better define its impact on overall survival and progression-free survival.
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http://dx.doi.org/10.1016/j.clineuro.2019.105646DOI Listing
March 2020

Single fraction urethra-sparing prostate cancer SBRT: Phase I results of the ONE SHOT trial.

Radiother Oncol 2019 10 17;139:83-86. Epub 2019 Aug 17.

Radiation Oncology, Geneva University Hospital, Switzerland; Faculty of Medicine, Geneva University, Switzerland.

The ONE SHOT trial is the first phase I/II prospective, multicenter, single-arm study assessing the efficacy and safety of a single-dose SBRT for men with localized prostate cancer. Aim of this paper is to present the phase I results of a 19 Gy single fraction urethra-sparing SBRT with real-time electromagnetic tracking.
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http://dx.doi.org/10.1016/j.radonc.2019.07.018DOI Listing
October 2019

Whole breast external beam radiotherapy in elderly patients affected by left-sided early breast cancer: a dosimetric comparison between two simple free-breathing techniques.

Aging Clin Exp Res 2020 Jul 19;32(7):1335-1341. Epub 2019 Aug 19.

Radiotherapy Unit, Department of Oncology and Hematology, Tor Vergata General Hospital, Rome, Italy.

Background: Elderly breast cancer patients are frequently affected by significant comorbidities that make sophisticated radiotherapy treatments particularly challenging.

Aims: We dosimetrically analyzed two different simple free-breathing external beam radiotherapy (EBRT) techniques for the hypofractionated treatment of the left breast in elderly patients with a low compliance, to compare target coverage, and heart and left anterior descending coronary artery (LADCA) sparing.

Methods: We developed radiation plans for 24 elderly patients using 3D conformal (3DCRT) field-in-field tangential technique and intensity-modulated (IMRT) tangential beam technique. Dose-Volume-Histograms (DVHs) were used to provide a quantitative comparison between plans.

Results: The median breast volume was 645 cm. IMRT and 3DCRT plans comparison demonstrated no significant differences in terms of organ sparing for the heart. Regarding LADCA, mean dose (10.3 ± 9.5 Gy vs 11.9 ± 9.6 Gy, p = 0.0003), maximum dose (26.1 ± 16.1 Gy vs 29.1 ± 16.1 Gy, p = 0.004) and V (21.5% ± 26.9% vs 25.0% ± 27.2%, p = 0.002) significantly decreased using IMRT compared with 3DCRT. IMRT plans showed a better target coverage compared with 3DCRT (0.91 ± 0.05 vs 0.93 ± 0.04, p = 0.05).

Discussion: Comparing the two different EBRT techniques, we demonstrated few, although substantial, dosimetric differences in terms of doses to the organs at risk characterized by a statistically significant dose reduction of LADCA in the IMRT plans.

Conclusions: Elderly patients with a low compliance to treatment might benefit from 3DCRT with field-in-field tangential arrangement or from a simple IMRT approach. IMRT should be preferred.
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http://dx.doi.org/10.1007/s40520-019-01312-5DOI Listing
July 2020

Nonsurgical Salvage Local Therapies for Radiorecurrent Prostate Cancer: A Systematic Review and Meta-analysis.

Eur Urol Oncol 2020 04 24;3(2):183-197. Epub 2019 Jan 24.

Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy.

Context: Different nonsurgical therapeutic strategies can be adopted for intraprostatic relapse of prostate cancer after primary radiotherapy, including re-irradiation (with brachytherapy [BT] or external beam radiotherapy [EBRT]), high-intensity focused ultrasound (HIFU), and cryotherapy. The main issues to consider when choosing nonsurgical salvage local therapies are local tumor control and significant genitourinary toxicity.

Objective: To conduct a systematic review and meta-analysis of the role of nonsurgical salvage modalities in patients with radiorecurrent prostate cancer and associated clinical outcomes and toxicity profiles.

Evidence Acquisition: We performed a critical review of the Medline, Scopus, and ClinicalKey databases from January 1, 2000 through February 1, 2018 according to the Preferred Reporting Items and Meta-Analyses statement. To assess the overall quality of the literature reviewed, we used a modified Delphi tool for case-series studies.

Evidence Synthesis: A total of 64 case-series studies were included, corresponding to a cohort of 5585 patients. The modified Delphi checklist evidenced high methodological quality overall (mean quality score of 80.6%). Biochemical control rates were lowest for patients treated with HIFU (58%, 95% confidence interval [CI] 47-68%) and highest for patients treated with BT (69%, 95% CI 62-76%) and EBRT (69%, 95% CI 53-83%). The lowest prevalence of incontinence was for patients treated with BT (3%, 95% CI 0-6%; I=63.4%) and the highest was among patients treated with HIFU (28%, 95% CI 19-38%; I=89.7%).

Conclusions: Nonsurgical therapeutic options, especially BT, showed good outcomes in terms of biochemical control and tolerability in the local recurrence setting.

Patient Summary: The current analysis demonstrated that nonsurgical salvage local therapies offer a chance of a curative local approach in radiorecurrent prostate cancer. However, high-quality data from prospective trials are needed to validate long-term outcomes from nonsurgical strategies for the treatment of intraprostatic recurrence after previous radiotherapy.
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http://dx.doi.org/10.1016/j.euo.2018.12.011DOI Listing
April 2020

Volumetric image-guided conformal radiotherapy for localized prostate cancer: Analysis of dosimetric and clinical factors affecting acute and late toxicity.

Rep Pract Oncol Radiother 2018 Sep-Oct;23(5):315-321. Epub 2018 Aug 13.

Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy.

Aim: To identify factors influencing toxicity in patients affected by localized prostate cancer treated with conformal image-guided radiotherapy.

Background: Image guidance in combination with conformal techniques is the standard of care in localized prostate cancer, but factors affecting toxicity are still under investigation.

Materials And Methods: 294 patients were analyzed. Median age at diagnosis was 71 year. 76 Gy (38 × 2 Gy) were delivered to the target volume. We used the test to analyse associations between toxicity and dosimetric and clinical parameters. Multivariate analysis was performed using binary logistic regression. Kaplan-Meier method was used for survival analysis.

Results: Median follow-up was 62.9 months. Acute grade ≥2 gastro-intestinal toxicity (GI) was 12.1%. Acute genito-urinary (GU) toxicity of grade ≥2 was 33.9%. Actuarial 4 and 5 years late grade ≥2 GI was 3% and 4%, respectively. Four and 5-year late grade ≥2 GU toxicity was 6% and 10%. At multivariate analysis for acute toxicity rectal was correlated with GI toxicity ( = 0.01, HR 2.73 CI 1.19-6.26), and smoking habit with GU toxicity ( < 0.01, HR 2.50 CI 1.51-4.14). For late toxicity, rectal was correlated with gastro-intestinal toxicity ( = 0.04, HR 4.76 CI 1.07-21.13), and pre-radiotherapy urinary symptoms with genito-urinary toxicity ( = 0.01, HR 2.84 CI 1.29-6.22).

Discussion: Conformal image-guided radiotherapy shows low rates of toxicity. Smoking should be avoided during radiotherapy. Besides the evaluation of high doses received by the organs at risk, individual factors, such as co-morbidities and lifestyle choices, have an impact on normal-tissue complication risk.
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http://dx.doi.org/10.1016/j.rpor.2018.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097402PMC
August 2018

Oligometastatic cancer in elderly patients: the "blitzkrieg" radiotherapy approach : SBRT in oligometastatic elderly patients.

Aging Clin Exp Res 2019 Jan 29;31(1):109-114. Epub 2018 Mar 29.

Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Viale Oxford 81, 00133, Rome, Italy.

Aims: To retrospectively evaluate the outcome of stereotactic body radiation therapy (SBRT) in the treatment of elderly patients affected by isolated body metastasis from different primitive tumors.

Methods: 70 patients with isolated body metastasis were treated. Median age at diagnosis was 75 years (IQR 69-80). The most common SBRT fractionation scheme was 5 × 7 Gy (total dose 35 Gy). The primary endpoints were Local Control (LC) and Toxicity. Secondary endpoints were Overall Survival (OS) and Disease-Specific Survival (DSS). Response to radiotherapy was assessed according to RECIST criteria v1.1. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. We performed survival analysis with the Kaplan-Meier method. The correlation between time actuarial incidence and clinical parameters was studied.

Results: Median follow-up was 26.5 months. 44 patients (62.8%) were alive at the time of analysis, while 22 (31.4%) died because of the disease. Local control at 2 and 3 years was 87%. The 2-year OS and DSS were 84 and 71%, respectively, while the 3-year values were 57 and 62%. PFS at 2 and 3 years was 41 and 25%, respectively. On univariate analysis, KPS ≥ 90 is statistically correlated with improved OS and DSS (p < 0.05). Acute toxicity of grade ≥ 2 occurred in 4 (5.7%) patients, while late toxicity ≥ 2 was recorded in 6 (8.6%) patients.

Conclusions: Ablative Radiotherapy represents a safe, effective, and minimally invasive treatment modality for elderly oligometastatic patients who are judged unfit for systemic therapy.
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http://dx.doi.org/10.1007/s40520-018-0937-6DOI Listing
January 2019

A multi-methodological evaluation approach for assessing the impact of neighbourhood quality on public health.

Epidemiol Prev 2016 Mar-Apr;40(3-4):249-56

Department of Architecture and Urban Studies (DAStU), University Politecnico di Milano, Milan.

Starting from a growing interest for urban neighbourhood health effects, the purpose of this paper is to suggest a multi-methodological approach for providing a comprehensive evaluation of the quality of open spaces under the urban design perspective. Despite the growing body of research and empirical evidence about the relationship among quality of built environment and public health, there is still a lack of studies on urban quality assessment. This paper brings forward a multi-methodological approach for assessing the quality of open spaces by the assignment of a composite score. The study combines Geographic Information Systems (GIS) and Multi-Attribute Value Theory (MAVT) with the aim of proposing urban quality maps. Open spaces, including green and walkable areas, streets and squares are evaluated with respect to the following attributes: accessibility, liveability, vitality, and identity. The urban quality maps provide a robust basis to run different kind of analysis and to support cross-sectorial policies towards the improvement of public health.
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http://dx.doi.org/10.19191/EP16.3-4.P249.092DOI Listing
December 2017
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