Objectives
Radiomic involves testing the associations of a large number of quantitative imaging features with clinical characteristics. Our aim was to extract a radiomic signature from axial ...T2-weighted (T2-W) magnetic resonance imaging (MRI) of the whole prostate able to predict oncological and radiological scores in prostate cancer (PCa).
Methods
This study included 65 patients with localized PCa treated with radiotherapy (RT) between 2014 and 2018. For each patient, the T2-W MRI images were normalized with the histogram intensity scale standardization method. Features were extracted with the IBEX software. The association of each radiomic feature with risk class, T-stage, Gleason score (GS), extracapsular extension (ECE) score, and Prostate Imaging Reporting and Data System (PI-RADS v2) score was assessed by univariate and multivariate analysis.
Results
Forty-nine out of 65 patients were eligible. Among the 1702 features extracted, 3 to 6 features with the highest predictive power were selected for each outcome. This analysis showed that texture features were the most predictive for GS, PI-RADS v2 score, and risk class; intensity features were highly associated with T-stage, ECE score, and risk class, with areas under the receiver operating characteristic curve (ROC AUC) ranging from 0.74 to 0.94.
Conclusions
MRI-based radiomics is a promising tool for prediction of PCa characteristics. Although a significant association was found between the selected features and all the mentioned clinical/radiological scores, further validations on larger cohorts are needed before these findings can be applied in the clinical practice.
Key Points
• A radiomic model was used to classify PCa aggressiveness.
• Radiomic analysis was performed on T2-W magnetic resonance images of the whole prostate gland.
• The most predictive features belong to the texture (57%) and intensity (43%) domains.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Bioprinting is an interdisciplinary study field, where additive manufacturing is combined with tissue engineering and material sciences. The ever-increasing need for personalized medicine fueled ...interest in the possibility of using this technique to reproduce biological tissues, allowing bioprinting to establish itself as one of the most promising approach in biomedical research. Producing bioconstructs that resemble living tissues is a very complex and multi-step procedure. Given the complexity of the processes involved, the literature still lacks robust solutions for monitoring the bioprinted construct quality, especially in situ and in-line. Here, a novel non-destructive approach for monitoring the geometries of bioprinted constructs based on infrared (IR) imaging is proposed. Besides the intuitive use of IR information to gain insight on the temperature signature, we propose IR video imaging as a viable solution to overcome traditional problems of visible-range imaging for geometry reconstruction with transparent bioinks, especially when precise information on the last printed layer only is required. The results obtained show a significant new direction for in-line monitoring of bioprinting processes.
As part of the AIRC IG-13218 (NCT01913717), we analyzed data from patients with low- and intermediate-risk prostate cancer treated with extreme hypofractionated radiotherapy (RT) and simultaneous ...boost to the intraprostatic lesion. The aim of the study is to identify clinically meaningful information through the analysis of validated questionnaires testing gastrointestinal (GI) and genitourinary (GU) RT-related toxicity and their impact on quality of life (QoL). At the end of RT treatment, clinical assessment and prostate-specific antigen (PSA) measurements were performed every 3 months for at least 2 years and GI and GU toxicities were evaluated contextually. QoL of enrolled patients was assessed by International Prostate Symptoms score (IPSS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 (EORTC QLQ-C30), EORTC QLQ prostate specific (QLQ-PR25), and sexual activity by International Index of Erectile Function (IIEF-5). Patients’ score changes were calculated at the end of RT, at one month after RT and at 12 and 24 months. Sixty-five prospectively enrolled patients were analyzed. Extensive analysis of different QoL assessments showed that patients’ tolerance was satisfactory across all the considered time points, with no statistically significant change of QoL from baseline compared to that before RT. Overall survival and biochemical progression-free survival at 2-years were of 98% and 97%, respectively. Despite the toxicity of extreme hypofractionation was low and tumor control was encouraging, a longer follow-up is necessary to confirm our findings. The increasing dose to the dominant intraprostatic lesion does not worsen the RT toxicity and consequently does not affect patients’ QoL, thus questioning the possibility of an even more escalated treatment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To compare the contouring of organs at risk (OAR) between a clinical specialist radiation therapist (CSRT) and radiation oncologists (ROs) with different levels of expertise (senior-SRO, junior-JRO, ...fellow-FRO).
On ten planning computed tomography (CT) image sets of patients undergoing breast radiotherapy (RT), the observers independently contoured the contralateral breast, heart, left anterior descending artery (LAD), oesophagus, kidney, liver, spinal cord, stomach and trachea. The CSRT was instructed by the JRO e SRO. The inter-observer variability of contoured volumes was measured using the Dice similarity coefficient (DSC) (threshold of ≥ 0.7 for good concordance) and the centre of mass distance (CMD). The analysis of variance (ANOVA) was performed and a
-value < 0.01 was considered statistically significant.
Good overlaps (DSC > 0.7) were obtained for all OARs, except for LAD (DSC = 0.34 ± 0.17, mean ± standard deviation) and oesophagus (DSC = 0.66 ± 0.06, mean ± SD). The mean CMD < 1 cm was achieved for all the OARs, but spinal cord (CMD = 1.22 cm). By pairing the observers, mean DSC > 0.7 and mean CMD < 1 cm were achieved in all cases. The best overlaps were seen for the pairs JRO-CSRT(DSC = 0.82; CMD = 0.49 cm) and SRO-JRO (DSC = 0.80; CMD = 0.51 cm).
Overall, good concordance was found for all the observers. Despite the short training in contouring, CSRT obtained good concordance with his tutor (JRO). Great variability was seen in contouring the LAD, due to its difficult visualization and identification of CT scans without contrast.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
•Immunological implications combining immunotherapy and RT was explored in advanced NSCLC.•SBRT may help to modify the tumor microenvironment and sensitize immune system in advanced NSCLC.•Liver ...metastases strongly correlate with worse survival and response to treatments.
Presence of liver metastases correlates with worse survival and response to any treatments. This may be due to the microenvironment of liver which leads tumor to escape from Immune System. Stereotactic Body Radiation Therapy may help to sensitize Immune System and to improve the immunotherapy effect. Interest is being directed toward combining Immune-Checkpoint Inhibitors with radiotherapy to improve response to immunotherapy. However, the mechanisms by which radiation induces anti-tumor T-cells remain unclear. Preclinical studies founded radiotherapy enhances antitumor immune responses, increasing tumor antigen release, and inducing T-cell infiltration. Radiotherapy is under investigation for its ability to enhance responses to immunotherapy. Nevertheless, how to optimally deliver combination therapy regarding dose-fractionation and timing of radiotherapy is unknown. The aim of this review is to explore the role of Stereotactic Body Radiation Therapy in metastatic non-small cell lung cancer, focusing on patients with liver metastases, and the possible immunological implications combining immunotherapy and radiotherapy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•Between 30% and 47% of PCa patients are at risk of intraprostatic recurrence.•ADT, the standard of care, represents a serious burden in terms of QoL.•Purpose of this ESTRO ACROP project is to ...collect experts’ opinion on salvage SBRT.•Low consensus was achieved, highlighting the need for further investigations.•The present Delphi consensus may serve as a practical guidance for salvage SBRT.
Between 30% and 47% of patients treated with definitive radiotherapy (RT) for prostate cancer are at risk of intraprostatic recurrence during follow-up. Re-irradiation with stereotactic body RT (SBRT) is emerging as a feasible and safe therapeutic option. However, no consensus or guidelines exist on this topic. The purpose of this ESTRO ACROP project is to investigate expert opinion on salvage SBRT for intraprostatic relapse after RT.
A 40-item questionnaire on salvage SBRT was prepared by an internal committee and reviewed by a panel of leading radiation oncologists plus a urologist expert in prostate cancer. Following the procedure of a Delphi consensus, 3 rounds of questionnaires were sent to selected experts on prostate re-irradiation.
Among the 33 contacted experts, 18 (54.5%) agreed to participate. At the end of the final round, participants were able to find consensus on 14 out of 40 questions (35% overall) and major agreement on 13 questions (32.5% overall). Specifically, the consensus was reached regarding some selection criteria (no age limit, ECOG 0–1, satisfactory urinary flow), diagnostic procedures (exclusion of metastatic disease, SBRT target defined on the MRI) and therapeutic approach (no need for concomitant ADT, consideration of the first RT dose, validity of Phoenix criteria for salvage SBRT failure).
While awaiting the results of ongoing studies, our ESTRO ACROP Delphi consensus may serve as a practical guidance for salvage SBRT. Future research should address the existing disagreements on this promising approach.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Based on literature, intensity‐modulated radiation therapy (IMRT) provides less related toxicity compared with conventional 2D/3D‐RT with no impact on oncological outcomes for oropharyngeal cancer. ...The aim of this systematic review and meta‐analysis is to assess whether IMRT might provide similar clinical outcomes with reduced related toxicity in comparison with conventional 2D/3D RT in patients treated for clinically advanced oropharyngeal cancer (OPC). Inclusion criteria for paper selection included: squamous OPC patients, treatment performed by concomitant CRT or RT alone, four treatment performed for curative intent, and presence of clinical outcome of interest, namely, overall survival (OS) and disease‐free survival (DFS) and full paper available in English. Acute and late toxicities were retrieved together with OS and DFS. Crude relative risk estimates of relapse and death comparing 2D/3D‐RT versus IMRT were calculated from tabular data, extracting events at 2–3 years of follow‐up. Eight studies were selected. Six of them were included in the meta‐analysis considering summary relative risk. Considering both acute and late toxicities, the considered studies evidenced advantages for IMRT populations, with the 2D/3D‐RT population showing higher frequencies than the IMRT one. No statistical difference between IMRT and 2D/3D‐RT in terms of death (SRR = 0.93, 95% CI: 0.83–1.04 with no heterogeneity I2 = 0%) and relapse (SRR = 0.92, 95% CI: 0.83–1.03, with no heterogeneity I2 = 0%) was found. Results of our study suggest the improvement in the therapeutic index with IMRT with evidenced reduced toxicity without any worsening in clinical outcome when compared to 2D/3DCRT.
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CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
In the last years, the growing demand for tissues and organs led to the development of novel techniques, such as 3D bioprinting. This technique proved to be promising for both patient-specific and ...custom-made applications when using autologous cells, and for the creation of standardized models that in the future could be used for instance for high-throughput drug screening. Within this context, the formulation of bioinks that could provide reliable, reproducible, and replicable structures with good mechanical properties and high biocompatibility is a crucial challenge. In this work, the use of a thermoresponsive PEG-based formulation was investigated as a bioink, allowing its use for 4D bioprinting applications triggered by thermal changes. First, the polymer was synthesized by reversible addition-fragmentation chain transfer polymerization (RAFT), which allows for optimal control over the final properties of the polymer. Then, the printability for extrusion-based bioprinting of this formulation was assessed through in-situ imaging. Finally, the use of this polymer as bioink was tested by encapsulation of endothelial cells and evaluating cell distribution within the construct.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Tissue engineering techniques are central for the development of biomedical scaffolds, which are primarily employed in the biofabrication of various artificial human tissue and organ models. ...Bioprinting is a new technique of creating tissue constructs that can sustain cell proliferation. The development of printing techniques proceeds together with the development of the biomaterials to be printed, which is why studying the printability of these specific biomaterials must be explored. An appropriate hydrogel used as bioink should have numerous rheological, mechanical, and biological properties for producing appropriate tissue constructs. However, reaching the right trade-off between a desirable bioactivity and high printability is challenging, and despite numerous optimization studies for different materials, printing defects often occur during printing. Herein, methods are proposed to automatically identify these drifting processes in commonly used geometries and how they affected subsequent layers, as well as printing defects within each layer. Several structures were printed with standard commercial bioink as proof of concept. The constructs were analyzed using optical images from a coaxial camera. The images were then digitally processed to get geometrical data from which patterns of defectology to be monitored were derived. This automation should decrease the time in post-processing characterization of constructs and should provide a standardized tool to compare different bioinks.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aim
To evaluate the role of baseline neutrophil‐to‐lymphocyte ratio (NLR) as prognostic marker in squamous cell carcinoma of the oropharynx (OPC) treated with definitive chemoradiotherapy (CRT) in ...the era of HPV status.
Patients and methods
A retrospective analysis of 125 patients (pts) affected with locally advanced OPC was performed. Inclusion criteria were age >18 years, stage III or IV (TNM 7th ed.) and definitive CRT. Haematological marker for their independent role as prognostic biomarkers for progression‐free survival (PFS) and overall survival (OS). Logistic models were used to assess the association with downstage in TNM 8th ed.
Results
Seventy‐seven (61.6%) pts had HPV/p16 + related OPC. Therapeutic choice consisted in sequential and concurrent CRT. Median follow‐up was 50 months. A value of NLR ≥3 was associated with poorer OS. Two‐year OS was 91% and 81% in pts with NLR <3 and ≥3, respectively.
Conclusion
A baseline NLR ≥ 3 at treatment initiation represented a negative prognostic marker for OPC treated with definitive CRT. These results are in line with literature data, and prognostic value of NLR has been confirmed restaging our cohort with new TNM staging (8th ed.). Therefore, NLR could be considered a valuable biomarker for risk stratification in pts with OPC.
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CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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