Neutrinos are abundantly produced in the LHC. Flavour composition and energy reach of the neutrino flux from proton-proton collisions depend on the pseudorapidity . At large , energies can exceed the ...TeV, with a sizeable contribution of the τ flavour. A dedicated detector could intercept this intense neutrino flux in the forward direction, and measure the interaction cross section on nucleons in the unexplored energy range from a few hundred GeV to a few TeV. The high energies of neutrinos result in a larger N interaction cross section, and the detector size can be relatively small. Machine backgrounds vary rapidly while moving along and away from the beam line. Four locations were considered as hosts for a neutrino detector: the CMS quadrupole region (25 m from CMS Interaction Point (IP)), UJ53 and UJ57 (90 and 120 m from CMS IP), RR53 and RR57 (240 m from CMS IP), TI18 (480 m from ATLAS IP). The potential sites are studied on the basis of (a) expectations for neutrino interaction rates, flavour composition and energy spectrum, (b) predicted backgrounds and in situ measurements, performed with a nuclear emulsion detector and radiation monitors. TI18 emerges as the most favourable location. Already with 150 fb−1 expected in LHC Run3, a small detector in TI18 could measure, for the first time and with good precision, the high-energy N cross section for all neutrino flavours.
We discuss an experiment to investigate neutrino physics at the LHC, with emphasis on tau flavour. As described in our previous paper Beni et al (2019 J. Phys. G: Nucl. Part. Phys. 46 115008), the ...detector can be installed in the decommissioned TI18 tunnel, ≈480 m downstream the ATLAS cavern, after the first bending dipoles of the LHC arc. The detector intercepts the intense neutrino flux, generated by the LHC beams colliding in IP1, at large pseudorapidity η, where neutrino energies can exceed a TeV. This paper focuses on exploring the neutrino pseudorapity versus energy phase space available in TI18 in order to optimize the detector location and acceptance for neutrinos originating at the pp interaction point, in contrast to neutrinos from pion and kaon decays. The studies are based on the comparison of simulated pp collisions at s= 13 TeV: PYTHIA events of heavy quark (c and b) production, compared to DPMJET minimum bias events (including charm) with produced particles traced through realistic LHC optics with FLUKA. Our studies favour a configuration where the detector is positioned off the beam axis, slightly above the ideal prolongation of the LHC beam from the straight section, covering 7.4 < η < 9.2. In this configuration, the flux at high energies (0.5-1.5 TeV and beyond) is found to be dominated by neutrinos originating directly from IP1, mostly from charm decays, of which ≈50% are electron neutrinos and ≈5% are tau neutrinos. The contribution of pion and kaon decays to the muon neutrino flux is found small at those high energies. With 150 fb−1 of delivered LHC luminosity in Run 3 the experiment can record a few thousand very high energy neutrino charged current (CC) interactions and over 50 tau neutrino CC events. These events provide useful information in view of a high statistics experiment at HL-LHC. The electron and muon neutrino samples can extend the knowledge of the charm PDF to a new region of x, which is dominated by theory uncertainties. The tau neutrino sample can provide first experience on reconstruction of tau neutrino events in a very boosted regime.
•Oligometastatic sarcomas can be safely and effectively treated with SABR.•One out of 5 patients is free of progression at 2-years after SABR.•SABR can defer the need for systemic therapy with a ...median time of 19,5 months.
Stereotactic Ablative Radiotherapy (SABR) is emerging as a valid alternative to surgery in the oligometastatic setting in soft tissue sarcomas (STS), although robust data are lacking. The aim of this study is to evaluate toxicity and efficacy of SABR in oligometastatic STS.
This is a retrospective multicenter study including adult patients affected by stage IV STS, treated with SABR for a maximum of 5 cranial or extracranial metastases in up to 3 different organs. SABR was delivered with ablative purposes. Study endpoints were overall survival (OS), local control (LC), distant progression free survival (DPFS), time to polymetastatic progression (TTPP), time to new systemic therapy (TTNS) and toxicity.
From 10 Italian RT centers, 138 patients (202 metastases) treated between 2010 and 2022 were enrolled in the study. Treatment was generally well tolerated, no acute or late toxicity ≥ G3 was recorded. Median follow up was 42.5 months. Median OS was 39.7 months. Actuarial OS at 1 and 2 years was 91.5 % and 72.7 %. Actuarial LC at 1 and 2 years was 94.8 % and 88.0 %. Median DPFS was 9.7 months. Actuarial DPFS at 1 and 2 years was 40.8 % and 19.4 %.
SABR is a safe and effective approach for the treatment of oligometastatic sarcoma. One out of 5 patients is free of progression at 2-years.
Background
This study was designed to assess patterns of recurrence and long-term outcomes of patients undergoing surgery for localized retroperitoneal sarcoma (RPS) after neoadjuvant high dose ...long-infusion ifosfamide (HLI) and radiotherapy (RT).
Methods
Patients received three cycles of HLI (14 g/m
2
). RT was started in combination with II cycle up to a total dose of 50.4 Gy. Surgery was scheduled 4–6 weeks after the end of RT. The primary endpoint was relapse-free survival (RFS) after surgery. Secondary endpoints were overall survival (OS), crude cumulative incidence of local recurrence (CCI-LR), and distant metastases (CCI-DM). For patients who relapsed, progression-free survival (PFS) and post-relapse OS were estimated. The trial was registered with ITASARC_*II_2004_003.
Results
Between 2003 and 2010, 83 patients were recruited. At a median follow-up of 91.7 months, 42 (56%) of 75 operated patients developed LR (
n
= 27) or DM (
n
= 10) or both LR and DM (
n
= 5) relapse. Seven-year RFS was 46.6% 95% confidence interval (CI) 29.6–52.4. Thirty-two patients died. Seven-year OS rate was 63.2% (95% CI 42.7–66.0). The corresponding CCI of LR and DM were 37.4% standard error (SE) 5.5% and 20.0% (SE 12.6%), respectively. The only factor significantly associated with LR was FNCLCC grading, whereas histological subtype resulted associated with DM. At recurrence, 24 patients (57%) underwent surgery. Two-year post-relapse PFS and OS rates for patients developing LR or DM were 14.8, 41.0, 27.3, and 63.6%, respectively.
Conclusions
LR after neoadjuvant CT-RT for RPS were predominantly infield. While almost one half of relapsed patients underwent further surgery, prognosis was poor.
The National Palliative Care and Interventional Radiotherapy Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) carried out a survey whose aim was to obtain a ..."snapshot" of the real-world practice of nonmelanoma skin cancer (NMSC) treatments in Italy.
The survey was conducted on SurveyMonkey's online interface and was sent via e-mail to our society Radiation Oncologists.
Fifty-eight Italian radiation oncologists (ROs), representing 54 centers, answered the survey. Thirteen percent of the ROs declared they treat fewer than 10 NMSC lesions annually, 36% treat between 11 and 20, and 51% treat more than 20 lesions annually. Interventional radiotherapy (IRT) was offered by 25% of the ROs, and every case was reportedly discussed by a multidisciplinary team (71%). Electrons (74%), volumetric modulated arc therapy (V-MAT) (57%), three-dimensional conformal radiotherapy (3D-CRT) (43%), and IRT (26%) were the main treatment options. With external beam radiotherapy (EBRT), 46 and 53 different RT schedules were treated for curative and palliative intent, respectively; whereas for IRT, there were 21 and 7 for curative and palliative intent, respectively. The most popular EBRT curative options were 50–70.95/22–35 fractions (fx) and 50–70 Gy/16-20fx and for EBRT palliative settings, 30Gy/10fx, and 20–35Gy/5fx. For IRT, the most popular curative options were 32–50Gy/8-10fx and 30–54Gy/3-5fx, whereas 30Gy/6fz was the palliative option. Less than 10 re-RT cases were reported in one year in 42.5%, 11–20 cases in 42.5%, and >20 cases annually in 15%. Electrons (61%), VMAT (49%), and BRT (25%) were the most widely used approaches: 20–40Gy in 10fx and 20–25Gy in 5fx were the recommended fractionations.
The survey shows a variegated reality. A national registry with more detailed data could help in undercover its causes.
•The Italian Association of Radiotherapy and Clinical Oncology (AIRO) proposed a survey to verify the national radiotherapy practices for nonmelanoma skin cancer (NMSC).•The preferred treatment techniques were: electrons (74%) and volumetric modulated arc therapy (V-MAT) (57%).•Interventional radiotherapy (IRT) can only be offered as a therapeutic option in only 25% of Italian RT centers.•Differing RT schedules but mainly adhering to international recommendations.•Data show that the single center experience was likely to play a prevalent role.
Undifferentiated Nasopharyngeal Carcinoma (UNPC) is associated with Epstein-Barr Virus (EBV) and characterized by an abundant immune infiltrate potentially influencing the prognosis. Thus, we ...retrospectively assessed the significance of immunosuppression in the UNPC microenvironment as prognostic biomarker of treatment failure in a non-endemic area, and monitored the variation of systemic EBV-specific immunity before and after chemoradiotherapy (CRT). DNA and RNA were extracted from diagnostic biopsies obtained by tumor and adjacent mucosa from 63 consecutive EBV+ UNPC patients who underwent radical CRT. Among these patients 11 relapsed within 2 years. The expression of the EBV-derived UNPC-specific BARF1 gene and several immune-related genes was monitored through quantitative RT-PCR and methylation-specific PCR analyses. Peripheral T cell responses against EBV and BARF1 were measured in 14 patients (7 relapses) through IFN-γ ELISPOT assay. We found significantly higher expression levels of BARF1, CD8, IFN-γ, IDO, PD-L1, and PD-1 in UNPC samples compared to healthy tissues. CD8 expression was significantly reduced in both tumor and healthy tissues in UNPC patients who relapsed within two years. We observed a hypomethylated FOXP3 intron 1 exclusively in relapsed UNPC patients. Finally, we noticed a significant decrease in EBV- and BARF1-specific T-cells after CRT only in relapsing patients. Our data suggest that a high level of immunosuppression (low CD8, hypomethylated FoxP3) in UNPC microenvironment may predict treatment failure and may allow an early identification of patients who could benefit from the addition of immune modulating strategies to improve first line CRT.
To apply the German Hodgkin Study Group (GHSG) risk model in patients with recurrent/refractory Hodgkin lymphoma receiving involved-field radiotherapy after autologous stem cell transplantation.
The ...study consisted in the retrospective analysis of 30 consecutive patients with recurrent/refractory Hodgkin lymphoma who received involved-field radiotherapy after autologous stem cell transplantation. Our policy was of adding involved-field radiotherapy for patients with positive PET scan before autologous stem cell transplantation (23 out of 30 patients, 77%), and/or irradiating sites of bulky disease at relapse (11 out of 30 patients, 37%). Patients were stratified into four risk groups according to the presence of the five clinical risk factors identified by the GHSG; (1) stage IV disease; (2) time to relapse≤3 months; (3) ECOG-PS≥1; (4) bulk≥5cm; and (5) inadequate response to salvage chemotherapy.
The median interval from autologous stem cell transplantation to involved-field radiotherapy was 3 months (range, 1–7 months), and the median involved-field radiotherapy dose was 35Gy (range, 12–40Gy). At a median follow-up of 35 months (range, 1–132 months), the 2-year progression-free survival in the entire series was 60%. When examining the four different GHSG risk groups, the progression-free survival rate at 2 years was 86%, 83%, 50%, and 36% for patients with score=0, score=1, score=2, and score=3 to 5, respectively (P=0,01). Among the 12 patients havingat leastthree risk factors who underwent thoracic involved-field radiotherapy, three (25%) developed pneumonitis.
The adoption of the GHSG risk model at the time of recurrence/progression is a useful prognostic tool to select patients with Hodgkin lymphoma for consolidative involved-field radiotherapy after autologous stem cell transplantation.
L'objectif de notre étude était d'appliquer le modèle de risque du German Hodgkin Study Group (GHSG) chez les patients atteints d’un lymphome de Hodgkin récidivant ou réfractaire traité par une irradiation de type « involved field » après une greffe autologue.
Il s'agissait d'une analyse rétrospective des dossiers de 30 patients consécutifs atteints de lymphome de Hodgkin récidivant ou réfractaire traité après une irradiation de type « involved field » après une greffe autologue. Notre politique consistait à ajouter la radiothérapie de type « involved field » en cas de positivité de la TEP avant la greffe autologue (23/30 patients, 77%) et/ou de maladie volumineuse au moment de la rechute (11/30 patients, 37%). Les patients ont été stratifiés en quatre groupes à risque en fonction de la présence des cinq facteurs de risque clinique identifiés par le GHSG: (1) maladie de stade IV, (2) délai de rechute ≤3 mois, (3) indice de performance selon l’Eastern Cooperative Oncology Group≥1, (4) volume≥5cm en diamètre et (5) une réponse insuffisante à la chimiothérapie de sauvetage.
L’intervalle médian entre la greffe autologue et la radiothérapie était de 3 mois (extrêmes: 1–7 mois) et la dose médiane d’irradiation était de 35Gy (12–40Gy). Après un suivi médian de 35 mois (1–132 mois), la probabilité de survie sans progression à 2 ans de l’ensemble de la série était de 60%. Lors de l’examen des quatre groupes de risque, elle était à 2 ans était de 86%, 83%, 50% et 36% pour les patients respectivement avec score de 0, 1, 2 et 3 à 5, (p=0,01). Parmi les 12 patients qui avaientau moins trois facteurs de risque et qui ont reçu une radiothérapie thoracique, trois (25%) ont souffert d’une pneumopathie.
Le modèle de risque du GHSG au moment de la récidive/progression est un outil pronostique utile pour sélectionner les patients atteints de lymphome de Hodgkin pour une radiothérapie de type « involved field » de consolidation après une greffe autologue.
A 25-year-old female with high-grade spindle cell sarcoma of the thyroid persistent after thyroidectomy performed at another hospital was referred to our institute. Chemotherapy followed by surgery ...with intraoperative radiotherapy and postoperative intensity-modulated radiotherapy were planned within the sarcoma board. Chemotherapy was discontinued after two cycles because of local disease progression and surgery with intraoperative radiotherapy, was anticipated. The treatment was completed with postoperative radiotherapy. After 36 months off-therapy, the patient was free of disease without significant late effects. Thyroid sarcomas are very rare and there is no consensus on their clinical management. Hence, case reports are useful to share treatment options. In this patient case, the histotype and the high-grade disease required a combined therapy program, managed in a multidisciplinary setting.
Une femme de 25 ans atteinte d’un sarcome de haut grade à cellules fusiformes de la thyroïde persistant après une thyroïdectomie effectuée dans un autre hôpital a été référée à notre institut. Une chimiothérapie suivie d’une intervention chirurgicale et d’une radiothérapie peropératoire et une radiothérapie conformationnelle avec modulation d’intensité ont été planifiées par le club des sarcomes. La chimiothérapie a été arrêtée après deux cycles en raison de l’extension locale de la maladie, puis la chirurgie et la radiothérapie peropératoire ont été anticipées. Le traitement a été complété par la radiothérapie postopératoire. Après 36 mois sans traitement la patiente était guérie sans séquelle tardive significative. Les sarcomes thyroïdiens sont très rares et il n’y a pas de consensus sur leur prise en charge clinique. Par conséquent, les études de cas sont utiles pour partager les options de traitement. Dans ce cas clinique, le type histologique et le haut grade ont nécessité un programme thérapeutique multidisciplinaire.
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