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Stereotactic body radiation therapy in patients with spine metastases maximizes local tumor control and preserves neurologic function. A novel approach could be the use of stereotactic body radiation therapy with simultaneous integrated boost delivering modality. The aim of the present study is to report our experience in the treatment of spine metastases using a frameless radiosurgery system delivering stereotactic body radiation therapy–simultaneous integrated boost technique. The primary endpoints were the pain control and the time to local progression; the secondary ones were the overall survival and toxicity. A total of 20 patients with spine metastases and 22 metastatic sites were treated in our center with stereotactic body radiation therapy–simultaneous integrated boost between December 2007 and July 2018. Stereotactic body radiation therapy–simultaneous integrated boost treatments were delivered doses of 8 to 10 Gy in 1 fraction to isodose line of 50%. The median follow-up was 35 months (range: 12-110). The median time to local progression for all patients was not reached and the actuarial 1-, 2-, and 3-years local free progression rate was 86.36%. In 17 of 20 patients, a complete pain remission was observed and 3 of 20 patients had a partial pain remission (complete pain remission + partial pain remission: 100%). The median overall survival was 38 months (range 12-83). None of the patients experienced neither radiation adverse events (grade 1-4) nor reported pain flair reaction. None of the patients included in our series experienced vertebral compression fracture. Spine radiosurgery with stereotactic body radiation therapy–simultaneous integrated boost is safe. The use of this modality in spine metastases patients provides an excellent local control.

This study aimed to analyze the dosimetric gain of the deep-inspiration-breath-hold (DIBH) technique over the free-breathing (FB) one in left breast cancer (LBC) 3D-conformal-radiotherapy (3D-CRT), and simultaneously investigate the anatomical parameters related to heart RT-exposure. Treatment plans were generated in both DIBH and FB scenarios for 116 LBC patients monitored by the Varian RPM™ respiratory gating system for delivery of conventional or moderately hypofractionated schedules (±sequential boost). For comparison, we considered cardiac and ipsilateral lung doses and volumes. A significant reduction of cardiac and pulmonary doses using DIBH technique was achieved compared to FB plans. Larger clinical target volumes generally need longer distance between medial and lateral entrances of tangent fields at body surface, thus conditioning a worse heart RT-exposure. The DIBH technique reduces cardiac and pulmonary doses for LBC patients. Through easily detectable anatomical parameters, it is possible to predict which patients benefit most from DIBH-RT.

Palliative radiotherapy has a great role in the treatment of large tumor masses. However, treating a bulky disease could be difficult, especially in critical anatomical areas. In daily clinical practice, short course hypofractionated radiotherapy is delivered in order to control the symptomatic disease. Radiation fields generally encompass the entire tumor mass, which is homogeneously irradiated. Recent technological advances enable delivering a higher radiation dose in small areas within a large mass. This goal, previously achieved thanks to the GRID approach, is now achievable using the newest concept of LATTICE radiotherapy (LT-RT). This kind of treatment allows exploiting various radiation effects, such as bystander and abscopal effects. These events may be enhanced by the concomitant use of immunotherapy, with the latter being ever more successfully delivered in cancer patients. Moreover, a critical issue in the treatment of large masses is the inhomogeneous intratumoral distribution of well-oxygenated and hypo-oxygenated areas. It is well known that hypoxic areas are more resistant to the killing effect of radiation, hence the need to target them with higher aggressive doses. This concept introduces the “oxygen-guided radiation therapy” (OGRT), which means looking for suitable hypoxic markers to implement in PET/CT and Magnetic Resonance Imaging. Future treatment strategies are likely to involve combinations of LT-RT, OGRT, and immunotherapy. In this paper, we review the radiobiological rationale behind a potential benefit of LT-RT and OGRT, and we summarize the results reported in the few clinical trials published so far regarding these issues. Lastly, we suggest what future perspectives may emerge by combining immunotherapy with LT-RT/OGRT.

Let ff be a germ of a holomorphic self-map of C2\\mathbb {C}^2 at the origin OO tangent to the identity, and with OO as a nondicritical isolated fixed point. A parabolic curve for ff is a holomorphic ff-invariant curve, with OO on the boundary, attracted by OO under the action of ff. It has been shown by M. Abate (2001) that if the characteristic direction [v]∈P(TOC2)[v]\\in \\mathbb {P}(T_O\\mathbb {C}^2) has residual index not belonging to Q+\\mathbb {Q}^+, then there exist parabolic curves for ff tangent to [v][v]. In this paper we prove, using a different method, that the conclusion still holds just assuming that the residual index is not vanishing (at least when ff is regular along [v][v]).

To evaluate if topical support therapy during static-intensity modulated radiotherapy (sIMRT) course is able to equal the characteristic minimum risk for radiation proctitis of Image-guided volumetric modulated arc therapy (IG-VMAT) treatment among localized prostate cancer patients. Rectal toxicity data of the above patients were retrospectively collected throughout three different clinical periods at our Radiotherapy Deparment: from October 2011 to December 2012, prostate cancer patients were treated with sIMRT and in advance supported by means of daily topical corticosteroids; from January 2013 to November 2016, topical corticosteroids were replaced by daily hyaluronic acid enemas; from December 2016 to May 2018 eligible patients were treated with newly introduced IG-VMAT supported by only on-demand topical corticosteroids. Among 359 eligible patients, IG-VMAT was proven generally more effective than sIMRT supported by topical medications in terms of proctitis reduction, although without clinical and practical relevance. Topical medications might have a role in radiation proctitis prevention.

To evaluate the impact of sarcopenia in muscle invasive bladder cancer (MIBC) elderly patients submitted to curative radiotherapy. Patients received radiotherapy between 2013 and 2018, and the skeletal muscle index was calculated to classify them as sarcopenic or non-sarcopenic. Primary endpoints were overall survival (OS), cancer specific survival (CSS), 90-day mortality and toxicity. A total of 28 patients with a median age of 85 years met our inclusion criteria and 8 of them were sarcopenic. With a median prescribed dose of 61 Gy and a median follow-up of 24.5 months, OS rates in the sarcopenic and non-sarcopenic groups were 100% and 84.4% at 3 months, 57.1% and 56.6% at 12 months, 38.1% and 50.3% at 24 months and 38.1% and 33.5% at 48 months, respectively; the CSS rates were 100% and 94.1% at 3 months and 68.6% and 88.2% at 12, 24 and 48 months, respectively. The actuarial 90-day mortality rate was 17.9% for the whole cohort, and 20% and 12.5% for the non-sarcopenic and sarcopenic groups, respectively. The radio-induced toxicity was similar in both groups. Sarcopenia cannot be considered a negative prognostic factor for MIBC elderly patients treated with external beam radiotherapy. Irradiation is therefore a feasible and effective choice for these patients, especially if unfit for surgery.

Let F be a germ of holomorphic diffeomorphism of C² fixing O and such that dFₒ has eigenvalues 1 and $e^{i\\theta}$ with $|e^{i\\theta } |$ = 1 and $e^{i\\theta}$ ≠ 1. Introducing suitable normal forms for F we define an invariant, v(F) ≥ 2, and a generic condition, that of being dynamically separating. In the case F is dynamically separating, we prove that there exist v(F)-1 parabolic curves for F at O tangent to the eigenspace of 1.

In a desired environmental protection system, groundwater may not be excluded. In addition to the problem of over-exploitation, in total disagreement with the concept of sustainable development, another not negligible issue concerns the groundwater contamination. Mainly, this aspect is due to intensive agricultural activities or industrialized areas. In literature, several papers have dealt with transport problem, especially for inverse problems in which the release history or the source location are identified. The innovative aim of the paper is to develop a data-driven model that is able to analyze multiple scenarios, even strongly non-linear, in order to solve forward and inverse transport problems, preserving the reliability of the results and reducing the uncertainty. Furthermore, this tool has the characteristic of providing extremely fast responses, essential to identify remediation strategies immediately. The advantages produced by the model were compared with literature studies. In this regard, a feedforward artificial neural network, which has been trained to handle different cases, represents the data-driven model. Firstly, to identify the concentration of the pollutant at specific observation points in the study area (forward problem); secondly, to deal with inverse problems identifying the release history at known source location; then, in case of one contaminant source, identifying the release history and, at the same time, the location of the source in a specific sub-domain of the investigated area. At last, the observation error is investigated and estimated. The results are satisfactorily achieved, highlighting the capability of the ANN to deal with multiple scenarios by approximating nonlinear functions without the physical point of view that describes the phenomenon, providing reliable results, with very low computational burden and uncertainty.

Let F be a germ of holomorphic diffeomorphism of [inline-graphic xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"02i\" /] fixing O and such that dF O has eigenvalues 1 and e iθ with | e iθ | = 1 and e iθ ≠ 1. Introducing suitable normal forms for F we define an invariant, v ( F ) ≥ 2, and a generic condition, that of being dynamically separating . In the case F is dynamically separating, we prove that there exist v ( F )-1 parabolic curves for F at O tangent to the eigenspace of 1.

Let F be a germ of holomorphic diffeomorphism of C2 fixing 0 and such that dF^sub 0^ has eigenvalues 1 and |e^sup i[theta]^| with |e^sup i[theta]^| = 1 and e^sup i[theta]^ [not =] 1. Introducing suitable normal forms for F we define an invariant, v(F) > or = 2, and a generic condition, that of being dynamically separating. In the case F is dynamically separating, we prove that there exist v(F) - 1 parabolic curves for F at 0 tangent to the eigenspace of 1. [PUBLICATION ABSTRACT]