Rivista e Edizione

AHEAD OF PRINT

Volume 56 (2022): Edizione 3 (September 2022)

Volume 56 (2022): Edizione 2 (June 2022)

Volume 56 (2022): Edizione 1 (March 2022)

Volume 55 (2021): Edizione 4 (December 2021)

Volume 55 (2021): Edizione 3 (September 2021)

Volume 55 (2021): Edizione 2 (June 2021)

Volume 55 (2021): Edizione 1 (March 2021)

Volume 54 (2020): Edizione 4 (December 2020)

Volume 54 (2020): Edizione 3 (September 2020)

Volume 54 (2020): Edizione 2 (June 2020)

Volume 54 (2020): Edizione 1 (March 2020)

Volume 53 (2019): Edizione 4 (December 2019)

Volume 53 (2019): Edizione 3 (September 2019)

Volume 53 (2019): Edizione 2 (June 2019)

Volume 53 (2019): Edizione 1 (March 2019)

Volume 52 (2018): Edizione 4 (December 2018)

Volume 52 (2018): Edizione 3 (September 2018)

Volume 52 (2018): Edizione 2 (June 2018)

Volume 52 (2018): Edizione 1 (March 2018)

Volume 51 (2017): Edizione 4 (December 2017)

Volume 51 (2017): Edizione 3 (September 2017)

Volume 51 (2017): Edizione 2 (June 2017)

Volume 51 (2017): Edizione 1 (March 2017)

Volume 50 (2016): Edizione 4 (December 2016)

Volume 50 (2016): Edizione 3 (September 2016)

Volume 50 (2016): Edizione 2 (June 2016)

Volume 50 (2016): Edizione 1 (March 2016)

Volume 49 (2015): Edizione 4 (December 2015)

Volume 49 (2015): Edizione 3 (September 2015)

Volume 49 (2015): Edizione 2 (June 2015)

Volume 49 (2015): Edizione 1 (March 2015)

Volume 48 (2014): Edizione 4 (December 2014)

Volume 48 (2014): Edizione 3 (September 2014)

Volume 48 (2014): Edizione 2 (June 2014)

Volume 48 (2014): Edizione 1 (March 2014)

Volume 47 (2013): Edizione 4 (December 2013)

Volume 47 (2013): Edizione 3 (September 2013)

Volume 47 (2013): Edizione 2 (June 2013)

Volume 47 (2013): Edizione 1 (March 2013)

Volume 46 (2012): Edizione 4 (December 2012)

Volume 46 (2012): Edizione 3 (September 2012)

Volume 46 (2012): Edizione 2 (June 2012)

Volume 46 (2012): Edizione 1 (March 2012)

Volume 45 (2011): Edizione 4 (December 2011)

Volume 45 (2011): Edizione 3 (September 2011)

Volume 45 (2011): Edizione 2 (June 2011)

Volume 45 (2011): Edizione 1 (March 2011)

Volume 44 (2010): Edizione 4 (December 2010)

Volume 44 (2010): Edizione 3 (September 2010)

Volume 44 (2010): Edizione 2 (June 2010)

Volume 44 (2010): Edizione 1 (March 2010)

Volume 43 (2009): Edizione 4 (December 2009)

Volume 43 (2009): Edizione 3 (September 2009)

Volume 43 (2009): Edizione 2 (June 2009)

Volume 43 (2009): Edizione 1 (March 2009)

Volume 42 (2008): Edizione 4 (December 2008)

Volume 42 (2008): Edizione 3 (September 2008)

Volume 42 (2008): Edizione 2 (June 2008)

Volume 42 (2008): Edizione 1 (March 2008)

Volume 41 (2007): Edizione 4 (December 2007)

Volume 41 (2007): Edizione 3 (September 2007)

Volume 41 (2007): Edizione 2 (June 2007)

Volume 41 (2007): Edizione 1 (March 2007)

Dettagli della rivista
Formato
Rivista
eISSN
1581-3207
Pubblicato per la prima volta
30 Apr 2007
Periodo di pubblicazione
4 volte all'anno
Lingue
Inglese

Cerca

Volume 55 (2021): Edizione 1 (March 2021)

Dettagli della rivista
Formato
Rivista
eISSN
1581-3207
Pubblicato per la prima volta
30 Apr 2007
Periodo di pubblicazione
4 volte all'anno
Lingue
Inglese

Cerca

15 Articoli

Review

access type Accesso libero

Artificial intelligence in musculoskeletal oncological radiology

Pubblicato online: 10 Nov 2020
Pagine: 1 - 6

Astratto

AbstractBackground

Due to the rarity of primary bone tumors, precise radiologic diagnosis often requires an experienced musculoskeletal radiologist. In order to make the diagnosis more precise and to prevent the overlooking of potentially dangerous conditions, artificial intelligence has been continuously incorporated into medical practice in recent decades. This paper reviews some of the most promising systems developed, including those for diagnosis of primary and secondary bone tumors, breast, lung and colon neoplasms.

Conclusions

Although there is still a shortage of long-term studies confirming its benefits, there is probably a considerable potential for further development of computer-based expert systems aiming at a more efficient diagnosis of bone and soft tissue tumors.

Key words

  • artificial intelligence
  • deep learning
  • tumor recognition
  • cancer imaging
  • image segmentation
access type Accesso libero

Physical activity and cancer risk. Actual knowledge and possible biological mechanisms

Pubblicato online: 12 Jan 2021
Pagine: 7 - 17

Astratto

AbstractBackground

Scientific evidence has shown that an increase in regular physical activity is associated with a decrease in the development of many types of cancer. Potential mechanisms that link physical activity to reduced cancer risk include a decrease in systemic inflammation, hyperinsulinemia, insulin-like growth factor (IGF-I), sex hormones, pro-inflammatory leptin and other obesity-related cytokines, and a significant increase in anti-inflammatory adiponectin levels. In addition, physical activity improves immune function and the composition and diversity of the gastrointestinal microbiota. Moderate physical activity is important for cancer protection, but the most significant changes in the inflammatory profile are conferred by physical activity performed at higher intensities. Thus, there is a need for further investigation into the type, intensity, and duration of physical activity for the prevention of some types of cancer and the development of effective recommendations.

Conclusions

There is a strong evidence that physical activity of moderate to vigorous intensity protects against colon and breast cancer, and probably against cancer at all other sites.

Key words

  • physical activity
  • cancer
  • pro-inflammatory and anti-inflammatory cytokines
  • biological mechanisms

Research Article

access type Accesso libero

Clinical relevance of 18F-FDG PET/CT in the postoperative follow-up of patients with history of medullary thyroid cancer

Pubblicato online: 22 Nov 2020
Pagine: 18 - 25

Astratto

AbstractBackground

The aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC).

Patients and methods

18F-FDG PET/CT investigation was performed in 67 patients, investigated from 2010 to 2019. _ Follow up was performed from 6 to 116 months after surgery (median 16.5 months, x± SD = 29±28.9 months). Twenty five of 67 patients underwent 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy, 11 underwent somatostatin receptor scintigraphy (SRS) with 99mTc-HYNIC TOC while 11 123I-metaiodobenzylguanidine (MIBG) scintigraphy.

Results

From 67 patients, 35 (52.2%) had true positive 18F-FDG PET/CT findings (TP). Average maximal standardized uptake value (SUVmax) for all TP lesions was 5.01+3.6. In 25 (37.3%) patients findings were true negative (TN). Four (6%) patients had false positive (FP) findings while three (4.5%) were false negative (FN). Thus, sensitivity of the 18F-FDG PET/ CT was 92.11%, specificity 86.21%, positive predictive value 89.74%, negative predictive value 89.29% and accuracy 89.55%. In 27 patients (40%) 18F-FDG PET/CT finding influenced further management of the patient.

Conclusions

18F-FDG PET/CT has high accuracy in the detection of metastases/recurrences of MTC in patients after thyroidectomy as well as in evaluation and the appropriate choice of the therapy.

Key words

  • F-FDG PET/CT
  • medullary thyroid carcinoma
  • follow up
  • postoperative
access type Accesso libero

Radiological evaluation of ex novo high grade glioma: velocity of diametric expansion and acceleration time study

Pubblicato online: 03 Dec 2020
Pagine: 26 - 34

Astratto

AbstractBackground

One of the greatest neuro-oncological concern remains the lack of knowledge about the etiopathogenesis and physiopathology of gliomas. Several studies reported a strict correlation between radiological features and biological behaviour of gliomas; in this way the velocity of diametric expansion (VDE) correlate with lower grade glioma aggressiveness. However, there are no the same strong evidences for high grade gliomas (HGG) because of the lack of several preoperative MRI.

Patients and methods

We describe a series of 4 patients affected by HGG followed from 2014 to January 2019. Two patients are male and two female; two had a pathological diagnosis of glioblastoma (GBM), one of anaplastic astrocytoma (AA) and one had a neuroradiological diagnosis of GBM. The VDE and the acceleration time (AT) was calculated for fluid attenuated inversion recovery (FLAIR) volume and for the enhancing nodule (EN). Every patients underwent sequential MRI study along a mean period of 413 days.

Results

Mean VDE evaluated on FLAIR volume was 39.91 mm/year. Mean percentage ratio between peak values and mean value of acceleration was 282.7%. Median appearance time of EN after first MRI scan was 432 days. Mean VDE was 45.02 mm/year. Mean percentage ratio between peak values and mean value of acceleration was 257.52%.

Conclusions

To our knowledge, this is the first report on VDE and acceleration growth in HGG confirming their strong aggressiveness. In a case in which we need to repeat an MRI, time between consecutive scans should be reduced to a maximum of 15–20 days and surgery should be executed as soon as possible.

Key words

  • acceleration time
  • glioblastoma
  • anaplastic astrocytoma
  • high grade glioma
  • radiological growth
  • velocity of diametric expansion
access type Accesso libero

Tumoral volume measured preoperatively by magnetic resonance imaging is related to survival in endometrial cancer

Pubblicato online: 12 Jan 2021
Pagine: 35 - 41

Astratto

AbstractBackground

The aim of the study was to determine if the endometrial tumor volume (TV) measured by magnetic resonance imaging (MRI-TV) is associated with survival in endometrial cancer and lymph nodes metastases (LN+).

Patients and methods

We evaluated the MRI imaging and records of 341 women with endometrial cancer and preoperative MRI from 2008 to 2018. The MRI-TV was calculated using the ellipsoid formula measuring three perpendicular tumor diameters. Tumor myometrial invasion was also analyzed.

Results

Higher MRI-TV was associated with age ≥ 65y, non-endometrioid tumors, grade-3, deep-myometrial invasion, LN+ and advanced FIGO stage. There were 37 patients with LN+ (8.8%). Non-endometrioid tumors, deep-myometrial invasion, grade-3 and MRI-TV ≥ 10 cm3 were the factors associated with LN+. Using a receiver operating characteristic [ROC] curve, the MRI-TV cut-off for survival was 10 cm3 (area under curve [AUC] = 0.70; 95% CI: 0.61–0.73). 5 years disease-free (DFS) and overall survival (OS) was significantly lower in MRI-TV ≥ 10 cm3 (69.3% vs. 84.5%, and 75.4% vs. 96.1%, respectively). MRI-TV was considered an independent factor of DFS (HR: 2.20, 95% CI: 1.09–4.45, p = 0.029) and OS (HR: 3.88, 95% CI: 1.34–11.24, p = 0.012) in multivariate analysis.

Conclusions

MRI-TV was associated with LN+, and MRI-TV ≥ 10 cm3 was an independent prognostic factor of lower DFS and OS. The MRI-TV can be auxiliary information to plan the surgery strategy and predict the adjuvant treatment in women with endometrial cancer.

Key words

  • tumoral volume
  • magnetic resonance image
  • endometrial cancer
  • recurrence
  • survival
access type Accesso libero

Trends in population-based cancer survival in Slovenia

Pubblicato online: 21 Jan 2021
Pagine: 42 - 49

Astratto

AbstractBackground

The aim of our study was to describe the survival of Slovenian cancer patients diagnosed in the last twenty years. An insight is given into the improvement made in different cancer types, population groups and prognostic factors.

Materials and methods

The principal data source was the population-based Slovenian Cancer Registry. The survival analysis included patients diagnosed with cancer in twenty years period from 1997 to 2016, which has been divided into four consecutive five-year periods. In addition, the analysis was stratified by cancer type, gender, age and stage. The survival was estimated using net survival calculated by the Pohar-Perme method and the complete approach has been applied.

Results

The survival of Slovenian cancer patients has been increasing over time. During the 20 years observed, five-year net survival increased by 11 percentage points. Significantly higher growth was observed in men. Age and stage at diagnosis are still crucial for the survival of cancer patients. Five-year net survival is lowest in those over 75 years of age at diagnosis but has also improved by seven percentage points over the past 20 years. The five-year net survival of patients in the localized stage increased by ten percentage points over the 20 years under observation. Survival of patients in the distant stage has not been improving. In both sexes, survival for melanoma, colorectal and lung cancers have increased significantly over the last 20 years. Progress has also been made in the two most common gender specific cancers: breast cancer in women and prostate cancer in men. Still, the significant progress in prostate cancer is probably mostly due to lead-time bias as during the study period, Slovenia used indiscriminate PSA testing, which probably artificially prolonged survival.

Conclusions

The survival of Slovenian cancer patients has been increasing over time, which gives us a basis and an incentive for future improvements. To monitor the effectiveness of managing the cancer epidemic, the cancer burden needs to be monitored also in the future, using quality data and scientifically justified methodological approaches. In this process a well organised population-based cancer registries should play a key role.

Key words

  • cancer burden
  • cancer survival
  • time trend
  • Slovenian
  • Cancer Registry
access type Accesso libero

Completely resected stage III melanoma controversy - 15 years of national tertiary centre experience

Pubblicato online: 08 Oct 2020
Pagine: 50 - 56

Astratto

AbstractBackground

Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients’ treatment from Slovenian national CM register to leading international clinical guidelines.

Patients and methods

Since 2000, all Slovenian CM patients with primary tumour ≥ TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests.

Results

Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280).

Conclusions

Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III.

Key words

  • cutaneous melanoma
  • sentinel node biopsy
  • completion lymph node dissection
  • overall survival
access type Accesso libero

Surgical resection of synchronous liver metastases in gastric cancer patients. A propensity score-matched study

Pubblicato online: 10 Nov 2020
Pagine: 57 - 65

Astratto

AbstractBackground

The aim of the study was to determine the value of synchronous liver resection in patients with oligo-metastatic gastric cancer and the prognostic factors in these patients.

Patients and methods

We compared the results of 21 gastric patients with liver metastases and synchronous liver resection (LMR) to 21 propensity score-matched patients with gastric cancer and liver metastases in whom liver resection was not performed (LM0) and to a propensity score-matched control group of 21 patients without liver metastases and stage III and IV resectable gastric cancer (CG).

Results

The overall 5-year survival of LMR, LM0 and CG were 14.3%, 0%, and 19%, respectively (p = 0.002). Five-year survival was 47.5% for well-differentiated tumour compared to 0% in patients with moderate or poor tumour differentiation (p = 0.006). In addition, patients with R0 resection and TNM stage N0–1 had a significantly better survival compared to patients with TNM N stage N2–3 (5-year survival: 60% for N0–1 vs. 7.7% for N2–3; p = 0.007).

Conclusions

The results presented in the study support synchronous liver resections in gastric patients and provide additional criteria for patient selection.

Key words

  • gastric cancer
  • liver metastases
  • synchronous resection
  • propensity score
access type Accesso libero

Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: a preferential benefit for squamous cell carcinoma

Pubblicato online: 03 Dec 2020
Pagine: 66 - 76

Astratto

AbstractBackground

The beneficial effect of postoperative radiotherapy (PORT) on completely resected pathological IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) has been a subject of interest with controversy. The aim of the study was to distinguish the clinical efficacy of PORT on lung adenocarcinoma (LADC) and lung squamous cell carcinoma (LSCC) among pIIIA-N2 NSCLC.

Patients and methods

Between October 2010 and September 2016, 288 consecutive patients with completely resected pIIIA-N2 NSCLC at Beijing Chest Hospital were retrospectively analyzed, which consisted of 194 cases of LADC and 85 cases of LSCC. There were 42 (21.6%) patients treated with PORT in LADC cases and 19 (22.3%) patients treated with PORT in LSCC cases. The 5-year overall survival (OS), loco-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The prognostic factors were determined using Cox’s regression model.

Results

Among 194 cases of LADC, the 1-, 3-, and 5-year OS in the PORT group were 95.2%, 61.9% and 40.0%, respectively, while in the non-PORT group were 90.1%, 63.3% and 45.0% (p = 0.948). The use of postoperative chemotherapy (POCT) and smoking index ≥ 400 were both prognostic factors of 5-year rates of OS, LRFS and DMFS. On the other hand, among 85 cases of LSCC, the 1-, 3-, and 5-year OS in the PORT group were 94.7%, 63.2% and 63.2%, respectively, whereas in the non-PORT group were 86.4%, 48.5% and 37.1% (p = 0.026). In this group, only the use of PORT was a favorable prognostic factor for 5-year OS, LRFS and DMFS.

Conclusions

Due to clinicopathological differences among completely resected pIIIA-N2 NSCLC, PORT may not be suitable to all patients. Our study distinguishes pIIIA-N2 LSCC from LADC by their positive responses to PORT.

Key words

  • lung squamous cell carcinoma
  • lung adenocarcinoma
  • pIIIA-N2
  • postoperative radiotherapy
access type Accesso libero

Radiotherapy-associated angiosarcoma in the breast reconstructed by autologous free-flap and treated with electrochemotherapy

Pubblicato online: 29 Dec 2020
Pagine: 77 - 81

Astratto

AbstractBackground

Radiotherapy-associated angiosarcoma (RAA) of the breast is a rare complication of radiotherapy, which is often difficult to identify and has poor prognosis. It usually presents as violaceous skin, erythema or rapidly growing palpable firm mass that can be confused with other benign skin lesions.

Patients and methods

After reviewing the literature, we found only four cases with RAA after mastectomy and autologous breast reconstruction. The presented case is the first that was treated by electrochemotherapy. The patient presented with secondary angiosarcoma of the breast five years after mastectomy, immediate breast reconstruction with deep inferior epigastric artery perforator free flap and adjuvant radiotherapy.

Results

Electrochemotherapy was feasible, safe and effective in treatment of radiation induced sarcoma. Most of the treated lesions in several consecutive electrochemotherapy sessions responded with complete response, but multiple recurrences occurred in non-treated areas.

Conclusions

Patients with breast cancer after skin-sparing mastectomy and immediate breast reconstruction, who receive radiotherapy, need regular long-term follow up and low threshold for biopsy of any suspicious lesions is mandatory. Electrochemotherapy proved as one of feasible modalities of treatment for RAA.

Key words

  • radiation-associated angiosarcoma
  • breast reconstruction
  • breast cancer
  • electrochemotherapy
  • radiotherapy
access type Accesso libero

Clinical and volumetric predictors of local control after robotic stereotactic radiosurgery for cerebral metastases: active systemic disease may affect local control in the brain

Pubblicato online: 10 Nov 2020
Pagine: 82 - 87

Astratto

AbstractBackground

The aim of the study was to assess the association between physical and biological dose normalized to volume of the metastatic tumor as well as clinical factors with local control in patients with brain metastases who underwent robotic stereotactic radiosurgery.

Patients and methods

A cohort of 69 patients consecutively treated with robotic radiosurgery between 2011 and 2016 was analyzed. The patients were treated with either single fraction radiosurgery or hypofractionated regimens. Biologically effective dose (BED) was calculated assuming alpha/beta value = 10 and both physical dose and BED were normalized to the tumor volume to allow dose-volume effect evaluation. Moreover, clinical and treatment-related variables were evaluated to asses association with local control.

Results

A total of 133 tumors were irradiated and their volumes ranged between 0.001 and 46.99 cm3. Presence of extracranial progression was associated with worse local control whereas higher total dose, BED10 > 59 Gy and single metastasis predicted statistically significantly better local outcome. BED10/cm3 > 36 Gy, and BED2 > 60 Gy negatively affected local control in univariate analysis. In multivariate analysis performed on all these variables, presence of a single metastasis, BED10 > 59 Gy and extracranial progression retained their significance. Excluding a priori the BED2/ cm3 parameter resulted with a Cox model confirming significance of all remaining variables.

Conclusions

Hypofractionated treatment schemes have similar efficiency to single fraction treatment in terms of local control and the effect depends on BED irrespective of fractionation schedule. Effective control of extracranial sites of the disease is associated with higher probability of local control in the brain which in turn is consistently lower in patients with multiple lesions.

Key words

  • brain metastases
  • radiosurgery
  • radiobiology
  • local control
access type Accesso libero

Prospective evaluation of probabilistic dose-escalated IMRT in prostate cancer

Pubblicato online: 22 Dec 2020
Pagine: 88 - 96

Astratto

AbstractBackground

Cure- and toxicity rates after intensity-modulated radiotherapy (IMRT) of prostate cancer are dose-and volume dependent. We prospectively studied the potential for organ at risk (OAR) sparing and compensation of tumor movement with the coverage probability (CovP) concept.

Patients and methods

Twenty-eight prostate cancer patients (median age 70) with localized disease (cT1c–2c, N0, M0) and intermediate risk features (prostate-specific antigen [PSA] < 20, Gleason score ≤ 7b) were treated in a prospective study with the CovP concept. Planning-CTs were performed on three subsequent days to capture form changes and movement of prostate and OARs. The clinical target volume (CTV) prostate and the OARs (bladder and rectum) were contoured in each CT. The union of CTV1–3 was encompassed by an isotropic margin of 7 mm to define the internal target volume (ITV). Dose prescription/escalation depended on coverage of all CTVs within the ITV. IMRT was given in 39 fractions to 78 Gy using the Monte-Carlo algorithm. Short-term androgen deprivation was recommended and given in 78.6% of patients.

Results

Long-term toxicity was evaluated in 26/28 patients after a median follow-up of 7.1 years. At last follow-up, late bladder toxicity (Radiation Therapy Oncology Group, RTOG) G1 was observed in 14.3% of patients and late rectal toxicities (RTOG) of G1 (7.1%) and of G2 (3.6%) were observed. No higher graded toxicity occurred. After 7.1 years, biochemical control (biochemically no evidence of disease, bNED) was 95.5%, prostate cancer-specific survival and the distant metastasis-free survival after 7.1 years were 100% each.

Conclusions

CovP-based IMRT was feasible in a clinical study. Dose escalation with the CovP concept was associated by a low rate of toxicity and a high efficacy regarding local and distant control.

Key words

  • probabilistic planned IMRT
  • coverage probability concept
  • prostate cancer
  • IMRT
  • dose escalation
access type Accesso libero

Effect of the oral intake of astaxanthin on semen parameters in patients with oligo-astheno-teratozoospermia: a randomized double-blind placebo-controlled trial

Pubblicato online: 23 Oct 2020
Pagine: 97 - 105

Astratto

AbstractBackground

Higher concentrations of seminal reactive oxygen species may be related to male infertility. Astaxanthin with high antioxidant activity can have an impact on the prevention and treatment of various health conditions, including cancer. However, efficacy studies on astaxanthin in patients with oligospermia with/without astheno- or teratozoospermia (O±A±T) have not yet been reported. Our aim was to evaluate the effect of the oral intake of astaxanthin on semen parameters.

Patients and methods

In a randomized double-blind trial, 80 men with O±A±T were allocated to intervention with 16 mg astaxanthin orally daily or placebo. At baseline and after three months basic semen parameters, sperm deoxyribonucleic acid (DNA) fragmentation and mitochondrial membrane potential (MMP) of spermatozoa and serum follicle-stimulating hormone (FSH) value were measured.

Results

Analysis of the results of 72 patients completing the study (37 in the study group, 35 in the placebo group) did not show any statistically significant change, in the astaxanthin group no improvements in the total number of spermatozoa, concentration of spermatozoa, total motility of spermatozoa, morphology of spermatozoa, DNA fragmentation and mitochondrial membrane potential of spermatozoa or serum FSH were determined. In the placebo group, statistically significant changes in the total number and concentration of spermatozoa were determined.

Conclusions

The oral intake of astaxanthin did not affect any semen parameters in patients with O±A±T.

Key words

  • antioxidant
  • male infertility
  • oligo-astheno-teratozoospermia
  • semen quality
  • DNA fragmentation
  • cancer
access type Accesso libero

Semi-supervised planning method for breast electronic tissue compensation treatments based on breast radius and separation

Pubblicato online: 22 Dec 2020
Pagine: 106 - 115

Astratto

AbstractBackground

The aim of the study was to develop and assess a technique for the optimization of breast electronic tissue compensation (ECOMP) treatment plans based on the breast radius and separation.

Materials and methods

Ten ECOMP plans for 10 breast cancer patients delivered at our institute were collected for this work. Pre-treatment CT-simulation images were anonymized and input to a framework for estimation of the breast radius and separation for each axial slice. Optimal treatment fluence was estimated based on the breast radius and separation, and a total beam fluence map for both medial and lateral fields was generated. These maps were then imported into the Eclipse Treatment Planning System and used to calculate a dose distribution. The distribution was compared to the original treatment hand-optimized by a medical dosimetrist. An additional comparison was performed by generating plans assuming a single tissue penetration depth determined by averaging the breast radius and separation over the entire treatment volume. Comparisons between treatment plans used the dose homogeneity index (HI; lower number is better).

Results

HI was non-inferior between our algorithm (HI = 12.6) and the dosimetrist plans (HI = 9.9) (p-value > 0.05), and was superior than plans obtained using a single penetration depth (HI = 17.0) (p-value < 0.05) averaged over the 10 collected plans. Our semi-supervised algorithm takes approximately 20 seconds for treatment plan generation and runs with minimal user input, which compares favorably with the dosimetrist plans that can take up to 30 minutes of attention for full optimization.

Conclusions

This work indicates the potential clinical utility of a technique for the optimization of ECOMP breast treatments.

Key words

  • electronic compensation
  • dose homogeneity index
  • plan optimization
access type Accesso libero

Efficacy of breast shielding during head computed tomography examination

Pubblicato online: 01 Aug 2020
Pagine: 116 - 120

Astratto

AbstractBackground

Female breasts are exposed to scattered radiation regardless of not being included in the primary field during head CT. This study aimed to investigate whether the use of lead shielding is beneficial in dose reduction to the breasts during head CT.

Patients and methods

The study was performed in two different hospitals on two different CT units and included 120 patients. Half of the measurements (n = 60) was conducted without the use of lead shielding and the other half (n = 60) with the use of lead shielding of 0.5 mm equivalent thickness.

Results

Significant skin dose reduction to the breasts during head CT in both hospitals with the use of lead shielding was discovered; 81% (338.2 ± 43.7 μGy to 64.3 ± 18.8 μGy) in Hospital A and 74% (from 253.1 ± 35.1 μGy to 65.3 ± 16.9 μGy) in Hospital B.

Conclusions

Considering the assumed carcinogenic effect of low doses of radiation, high frequency of the head CT scans and the significant reduction of radiation doses to the highly radiosensitive breasts, the use of lead shielding is highly recommendable.

Key words

  • scatter radiation
  • head CT
  • lead shielding
  • breasts
  • dose reduction
15 Articoli

Review

access type Accesso libero

Artificial intelligence in musculoskeletal oncological radiology

Pubblicato online: 10 Nov 2020
Pagine: 1 - 6

Astratto

AbstractBackground

Due to the rarity of primary bone tumors, precise radiologic diagnosis often requires an experienced musculoskeletal radiologist. In order to make the diagnosis more precise and to prevent the overlooking of potentially dangerous conditions, artificial intelligence has been continuously incorporated into medical practice in recent decades. This paper reviews some of the most promising systems developed, including those for diagnosis of primary and secondary bone tumors, breast, lung and colon neoplasms.

Conclusions

Although there is still a shortage of long-term studies confirming its benefits, there is probably a considerable potential for further development of computer-based expert systems aiming at a more efficient diagnosis of bone and soft tissue tumors.

Key words

  • artificial intelligence
  • deep learning
  • tumor recognition
  • cancer imaging
  • image segmentation
access type Accesso libero

Physical activity and cancer risk. Actual knowledge and possible biological mechanisms

Pubblicato online: 12 Jan 2021
Pagine: 7 - 17

Astratto

AbstractBackground

Scientific evidence has shown that an increase in regular physical activity is associated with a decrease in the development of many types of cancer. Potential mechanisms that link physical activity to reduced cancer risk include a decrease in systemic inflammation, hyperinsulinemia, insulin-like growth factor (IGF-I), sex hormones, pro-inflammatory leptin and other obesity-related cytokines, and a significant increase in anti-inflammatory adiponectin levels. In addition, physical activity improves immune function and the composition and diversity of the gastrointestinal microbiota. Moderate physical activity is important for cancer protection, but the most significant changes in the inflammatory profile are conferred by physical activity performed at higher intensities. Thus, there is a need for further investigation into the type, intensity, and duration of physical activity for the prevention of some types of cancer and the development of effective recommendations.

Conclusions

There is a strong evidence that physical activity of moderate to vigorous intensity protects against colon and breast cancer, and probably against cancer at all other sites.

Key words

  • physical activity
  • cancer
  • pro-inflammatory and anti-inflammatory cytokines
  • biological mechanisms

Research Article

access type Accesso libero

Clinical relevance of 18F-FDG PET/CT in the postoperative follow-up of patients with history of medullary thyroid cancer

Pubblicato online: 22 Nov 2020
Pagine: 18 - 25

Astratto

AbstractBackground

The aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC).

Patients and methods

18F-FDG PET/CT investigation was performed in 67 patients, investigated from 2010 to 2019. _ Follow up was performed from 6 to 116 months after surgery (median 16.5 months, x± SD = 29±28.9 months). Twenty five of 67 patients underwent 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy, 11 underwent somatostatin receptor scintigraphy (SRS) with 99mTc-HYNIC TOC while 11 123I-metaiodobenzylguanidine (MIBG) scintigraphy.

Results

From 67 patients, 35 (52.2%) had true positive 18F-FDG PET/CT findings (TP). Average maximal standardized uptake value (SUVmax) for all TP lesions was 5.01+3.6. In 25 (37.3%) patients findings were true negative (TN). Four (6%) patients had false positive (FP) findings while three (4.5%) were false negative (FN). Thus, sensitivity of the 18F-FDG PET/ CT was 92.11%, specificity 86.21%, positive predictive value 89.74%, negative predictive value 89.29% and accuracy 89.55%. In 27 patients (40%) 18F-FDG PET/CT finding influenced further management of the patient.

Conclusions

18F-FDG PET/CT has high accuracy in the detection of metastases/recurrences of MTC in patients after thyroidectomy as well as in evaluation and the appropriate choice of the therapy.

Key words

  • F-FDG PET/CT
  • medullary thyroid carcinoma
  • follow up
  • postoperative
access type Accesso libero

Radiological evaluation of ex novo high grade glioma: velocity of diametric expansion and acceleration time study

Pubblicato online: 03 Dec 2020
Pagine: 26 - 34

Astratto

AbstractBackground

One of the greatest neuro-oncological concern remains the lack of knowledge about the etiopathogenesis and physiopathology of gliomas. Several studies reported a strict correlation between radiological features and biological behaviour of gliomas; in this way the velocity of diametric expansion (VDE) correlate with lower grade glioma aggressiveness. However, there are no the same strong evidences for high grade gliomas (HGG) because of the lack of several preoperative MRI.

Patients and methods

We describe a series of 4 patients affected by HGG followed from 2014 to January 2019. Two patients are male and two female; two had a pathological diagnosis of glioblastoma (GBM), one of anaplastic astrocytoma (AA) and one had a neuroradiological diagnosis of GBM. The VDE and the acceleration time (AT) was calculated for fluid attenuated inversion recovery (FLAIR) volume and for the enhancing nodule (EN). Every patients underwent sequential MRI study along a mean period of 413 days.

Results

Mean VDE evaluated on FLAIR volume was 39.91 mm/year. Mean percentage ratio between peak values and mean value of acceleration was 282.7%. Median appearance time of EN after first MRI scan was 432 days. Mean VDE was 45.02 mm/year. Mean percentage ratio between peak values and mean value of acceleration was 257.52%.

Conclusions

To our knowledge, this is the first report on VDE and acceleration growth in HGG confirming their strong aggressiveness. In a case in which we need to repeat an MRI, time between consecutive scans should be reduced to a maximum of 15–20 days and surgery should be executed as soon as possible.

Key words

  • acceleration time
  • glioblastoma
  • anaplastic astrocytoma
  • high grade glioma
  • radiological growth
  • velocity of diametric expansion
access type Accesso libero

Tumoral volume measured preoperatively by magnetic resonance imaging is related to survival in endometrial cancer

Pubblicato online: 12 Jan 2021
Pagine: 35 - 41

Astratto

AbstractBackground

The aim of the study was to determine if the endometrial tumor volume (TV) measured by magnetic resonance imaging (MRI-TV) is associated with survival in endometrial cancer and lymph nodes metastases (LN+).

Patients and methods

We evaluated the MRI imaging and records of 341 women with endometrial cancer and preoperative MRI from 2008 to 2018. The MRI-TV was calculated using the ellipsoid formula measuring three perpendicular tumor diameters. Tumor myometrial invasion was also analyzed.

Results

Higher MRI-TV was associated with age ≥ 65y, non-endometrioid tumors, grade-3, deep-myometrial invasion, LN+ and advanced FIGO stage. There were 37 patients with LN+ (8.8%). Non-endometrioid tumors, deep-myometrial invasion, grade-3 and MRI-TV ≥ 10 cm3 were the factors associated with LN+. Using a receiver operating characteristic [ROC] curve, the MRI-TV cut-off for survival was 10 cm3 (area under curve [AUC] = 0.70; 95% CI: 0.61–0.73). 5 years disease-free (DFS) and overall survival (OS) was significantly lower in MRI-TV ≥ 10 cm3 (69.3% vs. 84.5%, and 75.4% vs. 96.1%, respectively). MRI-TV was considered an independent factor of DFS (HR: 2.20, 95% CI: 1.09–4.45, p = 0.029) and OS (HR: 3.88, 95% CI: 1.34–11.24, p = 0.012) in multivariate analysis.

Conclusions

MRI-TV was associated with LN+, and MRI-TV ≥ 10 cm3 was an independent prognostic factor of lower DFS and OS. The MRI-TV can be auxiliary information to plan the surgery strategy and predict the adjuvant treatment in women with endometrial cancer.

Key words

  • tumoral volume
  • magnetic resonance image
  • endometrial cancer
  • recurrence
  • survival
access type Accesso libero

Trends in population-based cancer survival in Slovenia

Pubblicato online: 21 Jan 2021
Pagine: 42 - 49

Astratto

AbstractBackground

The aim of our study was to describe the survival of Slovenian cancer patients diagnosed in the last twenty years. An insight is given into the improvement made in different cancer types, population groups and prognostic factors.

Materials and methods

The principal data source was the population-based Slovenian Cancer Registry. The survival analysis included patients diagnosed with cancer in twenty years period from 1997 to 2016, which has been divided into four consecutive five-year periods. In addition, the analysis was stratified by cancer type, gender, age and stage. The survival was estimated using net survival calculated by the Pohar-Perme method and the complete approach has been applied.

Results

The survival of Slovenian cancer patients has been increasing over time. During the 20 years observed, five-year net survival increased by 11 percentage points. Significantly higher growth was observed in men. Age and stage at diagnosis are still crucial for the survival of cancer patients. Five-year net survival is lowest in those over 75 years of age at diagnosis but has also improved by seven percentage points over the past 20 years. The five-year net survival of patients in the localized stage increased by ten percentage points over the 20 years under observation. Survival of patients in the distant stage has not been improving. In both sexes, survival for melanoma, colorectal and lung cancers have increased significantly over the last 20 years. Progress has also been made in the two most common gender specific cancers: breast cancer in women and prostate cancer in men. Still, the significant progress in prostate cancer is probably mostly due to lead-time bias as during the study period, Slovenia used indiscriminate PSA testing, which probably artificially prolonged survival.

Conclusions

The survival of Slovenian cancer patients has been increasing over time, which gives us a basis and an incentive for future improvements. To monitor the effectiveness of managing the cancer epidemic, the cancer burden needs to be monitored also in the future, using quality data and scientifically justified methodological approaches. In this process a well organised population-based cancer registries should play a key role.

Key words

  • cancer burden
  • cancer survival
  • time trend
  • Slovenian
  • Cancer Registry
access type Accesso libero

Completely resected stage III melanoma controversy - 15 years of national tertiary centre experience

Pubblicato online: 08 Oct 2020
Pagine: 50 - 56

Astratto

AbstractBackground

Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients’ treatment from Slovenian national CM register to leading international clinical guidelines.

Patients and methods

Since 2000, all Slovenian CM patients with primary tumour ≥ TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests.

Results

Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280).

Conclusions

Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III.

Key words

  • cutaneous melanoma
  • sentinel node biopsy
  • completion lymph node dissection
  • overall survival
access type Accesso libero

Surgical resection of synchronous liver metastases in gastric cancer patients. A propensity score-matched study

Pubblicato online: 10 Nov 2020
Pagine: 57 - 65

Astratto

AbstractBackground

The aim of the study was to determine the value of synchronous liver resection in patients with oligo-metastatic gastric cancer and the prognostic factors in these patients.

Patients and methods

We compared the results of 21 gastric patients with liver metastases and synchronous liver resection (LMR) to 21 propensity score-matched patients with gastric cancer and liver metastases in whom liver resection was not performed (LM0) and to a propensity score-matched control group of 21 patients without liver metastases and stage III and IV resectable gastric cancer (CG).

Results

The overall 5-year survival of LMR, LM0 and CG were 14.3%, 0%, and 19%, respectively (p = 0.002). Five-year survival was 47.5% for well-differentiated tumour compared to 0% in patients with moderate or poor tumour differentiation (p = 0.006). In addition, patients with R0 resection and TNM stage N0–1 had a significantly better survival compared to patients with TNM N stage N2–3 (5-year survival: 60% for N0–1 vs. 7.7% for N2–3; p = 0.007).

Conclusions

The results presented in the study support synchronous liver resections in gastric patients and provide additional criteria for patient selection.

Key words

  • gastric cancer
  • liver metastases
  • synchronous resection
  • propensity score
access type Accesso libero

Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: a preferential benefit for squamous cell carcinoma

Pubblicato online: 03 Dec 2020
Pagine: 66 - 76

Astratto

AbstractBackground

The beneficial effect of postoperative radiotherapy (PORT) on completely resected pathological IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) has been a subject of interest with controversy. The aim of the study was to distinguish the clinical efficacy of PORT on lung adenocarcinoma (LADC) and lung squamous cell carcinoma (LSCC) among pIIIA-N2 NSCLC.

Patients and methods

Between October 2010 and September 2016, 288 consecutive patients with completely resected pIIIA-N2 NSCLC at Beijing Chest Hospital were retrospectively analyzed, which consisted of 194 cases of LADC and 85 cases of LSCC. There were 42 (21.6%) patients treated with PORT in LADC cases and 19 (22.3%) patients treated with PORT in LSCC cases. The 5-year overall survival (OS), loco-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The prognostic factors were determined using Cox’s regression model.

Results

Among 194 cases of LADC, the 1-, 3-, and 5-year OS in the PORT group were 95.2%, 61.9% and 40.0%, respectively, while in the non-PORT group were 90.1%, 63.3% and 45.0% (p = 0.948). The use of postoperative chemotherapy (POCT) and smoking index ≥ 400 were both prognostic factors of 5-year rates of OS, LRFS and DMFS. On the other hand, among 85 cases of LSCC, the 1-, 3-, and 5-year OS in the PORT group were 94.7%, 63.2% and 63.2%, respectively, whereas in the non-PORT group were 86.4%, 48.5% and 37.1% (p = 0.026). In this group, only the use of PORT was a favorable prognostic factor for 5-year OS, LRFS and DMFS.

Conclusions

Due to clinicopathological differences among completely resected pIIIA-N2 NSCLC, PORT may not be suitable to all patients. Our study distinguishes pIIIA-N2 LSCC from LADC by their positive responses to PORT.

Key words

  • lung squamous cell carcinoma
  • lung adenocarcinoma
  • pIIIA-N2
  • postoperative radiotherapy
access type Accesso libero

Radiotherapy-associated angiosarcoma in the breast reconstructed by autologous free-flap and treated with electrochemotherapy

Pubblicato online: 29 Dec 2020
Pagine: 77 - 81

Astratto

AbstractBackground

Radiotherapy-associated angiosarcoma (RAA) of the breast is a rare complication of radiotherapy, which is often difficult to identify and has poor prognosis. It usually presents as violaceous skin, erythema or rapidly growing palpable firm mass that can be confused with other benign skin lesions.

Patients and methods

After reviewing the literature, we found only four cases with RAA after mastectomy and autologous breast reconstruction. The presented case is the first that was treated by electrochemotherapy. The patient presented with secondary angiosarcoma of the breast five years after mastectomy, immediate breast reconstruction with deep inferior epigastric artery perforator free flap and adjuvant radiotherapy.

Results

Electrochemotherapy was feasible, safe and effective in treatment of radiation induced sarcoma. Most of the treated lesions in several consecutive electrochemotherapy sessions responded with complete response, but multiple recurrences occurred in non-treated areas.

Conclusions

Patients with breast cancer after skin-sparing mastectomy and immediate breast reconstruction, who receive radiotherapy, need regular long-term follow up and low threshold for biopsy of any suspicious lesions is mandatory. Electrochemotherapy proved as one of feasible modalities of treatment for RAA.

Key words

  • radiation-associated angiosarcoma
  • breast reconstruction
  • breast cancer
  • electrochemotherapy
  • radiotherapy
access type Accesso libero

Clinical and volumetric predictors of local control after robotic stereotactic radiosurgery for cerebral metastases: active systemic disease may affect local control in the brain

Pubblicato online: 10 Nov 2020
Pagine: 82 - 87

Astratto

AbstractBackground

The aim of the study was to assess the association between physical and biological dose normalized to volume of the metastatic tumor as well as clinical factors with local control in patients with brain metastases who underwent robotic stereotactic radiosurgery.

Patients and methods

A cohort of 69 patients consecutively treated with robotic radiosurgery between 2011 and 2016 was analyzed. The patients were treated with either single fraction radiosurgery or hypofractionated regimens. Biologically effective dose (BED) was calculated assuming alpha/beta value = 10 and both physical dose and BED were normalized to the tumor volume to allow dose-volume effect evaluation. Moreover, clinical and treatment-related variables were evaluated to asses association with local control.

Results

A total of 133 tumors were irradiated and their volumes ranged between 0.001 and 46.99 cm3. Presence of extracranial progression was associated with worse local control whereas higher total dose, BED10 > 59 Gy and single metastasis predicted statistically significantly better local outcome. BED10/cm3 > 36 Gy, and BED2 > 60 Gy negatively affected local control in univariate analysis. In multivariate analysis performed on all these variables, presence of a single metastasis, BED10 > 59 Gy and extracranial progression retained their significance. Excluding a priori the BED2/ cm3 parameter resulted with a Cox model confirming significance of all remaining variables.

Conclusions

Hypofractionated treatment schemes have similar efficiency to single fraction treatment in terms of local control and the effect depends on BED irrespective of fractionation schedule. Effective control of extracranial sites of the disease is associated with higher probability of local control in the brain which in turn is consistently lower in patients with multiple lesions.

Key words

  • brain metastases
  • radiosurgery
  • radiobiology
  • local control
access type Accesso libero

Prospective evaluation of probabilistic dose-escalated IMRT in prostate cancer

Pubblicato online: 22 Dec 2020
Pagine: 88 - 96

Astratto

AbstractBackground

Cure- and toxicity rates after intensity-modulated radiotherapy (IMRT) of prostate cancer are dose-and volume dependent. We prospectively studied the potential for organ at risk (OAR) sparing and compensation of tumor movement with the coverage probability (CovP) concept.

Patients and methods

Twenty-eight prostate cancer patients (median age 70) with localized disease (cT1c–2c, N0, M0) and intermediate risk features (prostate-specific antigen [PSA] < 20, Gleason score ≤ 7b) were treated in a prospective study with the CovP concept. Planning-CTs were performed on three subsequent days to capture form changes and movement of prostate and OARs. The clinical target volume (CTV) prostate and the OARs (bladder and rectum) were contoured in each CT. The union of CTV1–3 was encompassed by an isotropic margin of 7 mm to define the internal target volume (ITV). Dose prescription/escalation depended on coverage of all CTVs within the ITV. IMRT was given in 39 fractions to 78 Gy using the Monte-Carlo algorithm. Short-term androgen deprivation was recommended and given in 78.6% of patients.

Results

Long-term toxicity was evaluated in 26/28 patients after a median follow-up of 7.1 years. At last follow-up, late bladder toxicity (Radiation Therapy Oncology Group, RTOG) G1 was observed in 14.3% of patients and late rectal toxicities (RTOG) of G1 (7.1%) and of G2 (3.6%) were observed. No higher graded toxicity occurred. After 7.1 years, biochemical control (biochemically no evidence of disease, bNED) was 95.5%, prostate cancer-specific survival and the distant metastasis-free survival after 7.1 years were 100% each.

Conclusions

CovP-based IMRT was feasible in a clinical study. Dose escalation with the CovP concept was associated by a low rate of toxicity and a high efficacy regarding local and distant control.

Key words

  • probabilistic planned IMRT
  • coverage probability concept
  • prostate cancer
  • IMRT
  • dose escalation
access type Accesso libero

Effect of the oral intake of astaxanthin on semen parameters in patients with oligo-astheno-teratozoospermia: a randomized double-blind placebo-controlled trial

Pubblicato online: 23 Oct 2020
Pagine: 97 - 105

Astratto

AbstractBackground

Higher concentrations of seminal reactive oxygen species may be related to male infertility. Astaxanthin with high antioxidant activity can have an impact on the prevention and treatment of various health conditions, including cancer. However, efficacy studies on astaxanthin in patients with oligospermia with/without astheno- or teratozoospermia (O±A±T) have not yet been reported. Our aim was to evaluate the effect of the oral intake of astaxanthin on semen parameters.

Patients and methods

In a randomized double-blind trial, 80 men with O±A±T were allocated to intervention with 16 mg astaxanthin orally daily or placebo. At baseline and after three months basic semen parameters, sperm deoxyribonucleic acid (DNA) fragmentation and mitochondrial membrane potential (MMP) of spermatozoa and serum follicle-stimulating hormone (FSH) value were measured.

Results

Analysis of the results of 72 patients completing the study (37 in the study group, 35 in the placebo group) did not show any statistically significant change, in the astaxanthin group no improvements in the total number of spermatozoa, concentration of spermatozoa, total motility of spermatozoa, morphology of spermatozoa, DNA fragmentation and mitochondrial membrane potential of spermatozoa or serum FSH were determined. In the placebo group, statistically significant changes in the total number and concentration of spermatozoa were determined.

Conclusions

The oral intake of astaxanthin did not affect any semen parameters in patients with O±A±T.

Key words

  • antioxidant
  • male infertility
  • oligo-astheno-teratozoospermia
  • semen quality
  • DNA fragmentation
  • cancer
access type Accesso libero

Semi-supervised planning method for breast electronic tissue compensation treatments based on breast radius and separation

Pubblicato online: 22 Dec 2020
Pagine: 106 - 115

Astratto

AbstractBackground

The aim of the study was to develop and assess a technique for the optimization of breast electronic tissue compensation (ECOMP) treatment plans based on the breast radius and separation.

Materials and methods

Ten ECOMP plans for 10 breast cancer patients delivered at our institute were collected for this work. Pre-treatment CT-simulation images were anonymized and input to a framework for estimation of the breast radius and separation for each axial slice. Optimal treatment fluence was estimated based on the breast radius and separation, and a total beam fluence map for both medial and lateral fields was generated. These maps were then imported into the Eclipse Treatment Planning System and used to calculate a dose distribution. The distribution was compared to the original treatment hand-optimized by a medical dosimetrist. An additional comparison was performed by generating plans assuming a single tissue penetration depth determined by averaging the breast radius and separation over the entire treatment volume. Comparisons between treatment plans used the dose homogeneity index (HI; lower number is better).

Results

HI was non-inferior between our algorithm (HI = 12.6) and the dosimetrist plans (HI = 9.9) (p-value > 0.05), and was superior than plans obtained using a single penetration depth (HI = 17.0) (p-value < 0.05) averaged over the 10 collected plans. Our semi-supervised algorithm takes approximately 20 seconds for treatment plan generation and runs with minimal user input, which compares favorably with the dosimetrist plans that can take up to 30 minutes of attention for full optimization.

Conclusions

This work indicates the potential clinical utility of a technique for the optimization of ECOMP breast treatments.

Key words

  • electronic compensation
  • dose homogeneity index
  • plan optimization
access type Accesso libero

Efficacy of breast shielding during head computed tomography examination

Pubblicato online: 01 Aug 2020
Pagine: 116 - 120

Astratto

AbstractBackground

Female breasts are exposed to scattered radiation regardless of not being included in the primary field during head CT. This study aimed to investigate whether the use of lead shielding is beneficial in dose reduction to the breasts during head CT.

Patients and methods

The study was performed in two different hospitals on two different CT units and included 120 patients. Half of the measurements (n = 60) was conducted without the use of lead shielding and the other half (n = 60) with the use of lead shielding of 0.5 mm equivalent thickness.

Results

Significant skin dose reduction to the breasts during head CT in both hospitals with the use of lead shielding was discovered; 81% (338.2 ± 43.7 μGy to 64.3 ± 18.8 μGy) in Hospital A and 74% (from 253.1 ± 35.1 μGy to 65.3 ± 16.9 μGy) in Hospital B.

Conclusions

Considering the assumed carcinogenic effect of low doses of radiation, high frequency of the head CT scans and the significant reduction of radiation doses to the highly radiosensitive breasts, the use of lead shielding is highly recommendable.

Key words

  • scatter radiation
  • head CT
  • lead shielding
  • breasts
  • dose reduction

Pianifica la tua conferenza remota con Sciendo