Systemic therapy augmented by radiotherapy (STAR) effect for brain metastases in a BRAF-mutated melanoma patient with prolonged survival: a case report

Agostino Cristaudo,Antonio Malorgio,Serena Medoro,Antonio Stefanelli 대한방사선종양학회 2021 Radiation Oncology Journal Vol.39 No.1

Brain metastases are common in stage IV malignant melanoma, carrying a prognosis traditionally regarded as severe, with a median survival of few months. Recently introduced systemic therapies as targeted therapy or immunotherapy have significantly improved the prognosis of metastatic melanoma. The optimal association of radiotherapy to such novel treatments has to be clarified. We report on a 43-year-old woman with 10 brain metastases. Three of them were treated with stereotactic radiosurgery (SRS) with complete response even of the untreated lesions. As the patient was BRAF-mutated, she was started on dabrafenib/trametinib. After 8 months she developed new brain metastases, which again responded to a new treatment with SRS. As after 7 months additional lesions appeared, she was treated with whole brain radiotherapy and was started on nivolumab. Twenty months after the first diagnosis of brain metastases the patient is fit without significant clinical and radiological signs of toxicity.

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

Delishaj, Durim,Ursino, Stefano,Pasqualetti, Francesco,Matteucci, Fabrizio,Cristaudo, Agostino,Soatti, Carlo Pietro,Barcellini, Amelia,Paiar, Fabiola The Korean Society for Radiation Oncology 2018 Radiation Oncology Journal Vol.36 No.1

Purpose: To investigate set-up errors, suggest the adequate planning target volume (PTV) margin and image-guided radiotherapy frequency in head and neck (H&N) cancer treated with intensity-modulated radiotherapy (IMRT) assessed by kV cone-beam computed tomography (CBCT). Methods: We analyzed 360 CBCTs in 60 patients with H&N cancer treated with IMRT. The target delineation was contoured according to ICRU62. PTVs were generated by adding a 3-5 mm margin in all directions to the respective clinical target volumes. The kV CBCT images were obtained at first three days of irradiation and weekly thereafter. The overall mean displacement, range, systematic (${\Sigma}$) and random (${\sigma}$) errors were calculated. Adequate PTV margins were calculated according to the van Herk formula ($2.5{\Sigma}+0.7r$). Results: The mean of set-up errors was less than 2 mm in any direction. The overall frequency of set-up displacements greater than 3 mm was 3.9% in medial-lateral (ML) direction, 8% in superior-inferior (SI) direction, and 15.5% in anterior-posterior (AP) direction. The range of translations shifts was 0-9 mm in ML direction, 0-5 mm in SI direction and 0-10 mm in AP direction, respectively. After systematic set-up errors correction, the adequate margin to overcome the problem of set-up errors was found to be less than 3 mm. Conclusion: Image-guided kV CBCT was effective for the evaluation of set-up accuracy in H&N cancer. The kV CBCT at first three fractions and followed-by weekly appears adequate for reducing significantly set-up errors in H&N cancer treated with IMRT technique. Finally, 3-5 mm PTV margins appear adequate and safe to overcome the problem of set-up errors.

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

Durim Delishaj, MD,Stefano Ursino,Francesco Pasqualetti,Fabrizio Matteucci,Agostino Cristaudo,Carlo Pietro Soatti,Amelia Barcellini,Fabiola Paiar 대한방사선종양학회 2018 Radiation Oncology Journal Vol.36 No.1

Purpose: To investigate set-up errors, suggest the adequate planning target volume (PTV) margin and image-guided radiotherapy frequency in head and neck (H&N) cancer treated with intensity-modulated radiotherapy (IMRT) assessed by kV cone-beam computed tomography (CBCT). Methods: We analyzed 360 CBCTs in 60 patients with H&N cancer treated with IMRT. The target delineation was contoured according to ICRU62. PTVs were generated by adding a 3–5 mm margin in all directions to the respective clinical target volumes. The kV CBCT images were obtained at first three days of irradiation and weekly thereafter. The overall mean displacement, range, systematic (Σ) and random (σ) errors were calculated. Adequate PTV margins were calculated according to the van Herk formula (2.5Σ + 0.7r). Results: The mean of set-up errors was less than 2 mm in any direction. The overall frequency of set-up displacements greater than 3 mm was 3.9% in medial-lateral (ML) direction, 8% in superior-inferior (SI) direction, and 15.5% in anterior-posterior (AP) direction. The range of translations shifts was 0–9 mm in ML direction, 0–5 mm in SI direction and 0–10 mm in AP direction, respectively. After systematic set-up errors correction, the adequate margin to overcome the problem of set-up errors was found to be less than 3 mm. Conclusion: Image-guided kV CBCT was effective for the evaluation of set-up accuracy in H&N cancer. The kV CBCT at first three fractions and followed-by weekly appears adequate for reducing significantly set-up errors in H&N cancer treated with IMRT technique. Finally, 3–5 mm PTV margins appear adequate and safe to overcome the problem of set-up errors.

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

Durim Delishaj,Stefano Ursino,Francesco Pasqualetti,Fabrizio Matteucci,Agostino Cristaudo,Carlo Pietro Soatti,Amelia Barcellini,Fabiola Paiar 대한방사선종양학회 2018 Radiation Oncology Journal Vol.36 No.1

Purpose: To investigate set-up errors, suggest the adequate planning target volume (PTV) margin and image-guided radiotherapy frequency in head and neck (H&N) cancer treated with intensity-modulated radiotherapy (IMRT) assessed by kV cone-beam computed tomography (CBCT). Methods: We analyzed 360 CBCTs in 60 patients with H&N cancer treated with IMRT. The target delineation was contoured according to ICRU62. PTVs were generated by adding a 3-5 mm margin in all directions to the respective clinical target volumes. The kV CBCT images were obtained at first three days of irradiation and weekly thereafter. The overall mean displacement, range, systematic (∑) and random (σ) errors were calculated. Adequate PTV margins were calculated according to the van Herk formula (2.5∑ + 0.7r). Results: The mean of set-up errors was less than 2 mm in any direction. The overall frequency of set-up displacements greater than 3 mm was 3.9% in medial-lateral (ML) direction, 8% in superior-inferior (SI) direction, and 15.5% in anterior-posterior (AP) direction. The range of translations shifts was 0-9 mm in ML direction, 0-5 mm in SI direction and 0-10 mm in AP direction, respectively. After systematic set-up errors correction, the adequate margin to overcome the problem of set-up errors was found to be less than 3 mm. Conclusion: Image-guided kV CBCT was effective for the evaluation of set-up accuracy in H&N cancer. The kV CBCT at first three fractions and followed-by weekly appears adequate for reducing significantly set-up errors in H&N cancer treated with IMRT technique. Finally, 3-5 mm PTV margins appear adequate and safe to overcome the problem of set-up errors.

Ribociclib-Induced Erythema Dyschromicum Perstans (Ashy Dermatosis)–Like Pigmentation in a Metastatic Breast Cancer Patient

Maria Mariano,Pietro Donati,Norma Cameli,Flavia Pigliacelli,Aldo Morrone,Antonio Cristaudo 한국유방암학회 2021 Journal of breast cancer Vol.24 No.1

Ribociclib is a selective cyclin-dependent kinase (CDK) 4/6 inhibitor that has been approved in combination with endocrine therapy for the treatment of hormone receptor-positive/human epidermal growth factor 2-negative advanced or metastatic breast cancer. The main dermatological adverse events associated with CDK 4/6 inhibitors that are described in the literature include skin rash, an increased risk of alopecia, and stomatitis. Erythema dyschromicum perstans (EDP), also known as ashy dermatosis, is characterized by acquired small and large slate-gray hyperpigmented macules with erythematous borders. There are currently no published reports of EDP-like or pigmentary changes induced by CDK 4/6 inhibitors. This report describes the first case of EDP-like pigmentation associated with ribociclib therapy.