Giovanna Gagliardi - KI

Giovanna Gagliardi

Affiliated to research

Email:
giovanna.gagliardi.1@ki.se
Organisation:

About me

I am a physicist from Italy, specialized in Medical Physics. I moved to Sweden in 1988.

I am associate professor at Stockholm University since 2008, where I also got my PhD in 1998 (Thesis title: Modelling heart and lung complication data in radiation therapy of the breast).

I am currently employed as Head of the Section of Radiotherapy Physics and Engineering at Karolinska University Hospital. The section is part of the Medical Radiation Physics and Nuclear Medicine Unit.  The group comprises about 40 people; they are medical physicists and engineers providing medical radiation physics and Hardware/Software competence to the Radiotherapy Medical Unit and to the Gammaknife department at Karolinska University Hospital, to the Skandion proton center in Uppsala and to St Erik Oftalmologic Hospital (St Erik Ögon Sjukhus) in Stockholm.

My position as Head of department started in 2010. Earlier I was employed for several years as Medical Physicist at Karolinska Hospital.

My tasks as head of department focus on management of clinic, research and education within the discipline. This includes identification and delineation of research and development lines relevant to the clinical activity and at the same time within the research and development frame of Karolinska University Hospital.

 

My scientific production has lead to 42 articles in peer-reviewed journals, three reports for SSM (Swedish Radiation Safety Authority), one report for the European Union, 1 book chapter.

 By August 2022 I had 5826 citations and an h-index of 28 (Scopus)

I am member of the radiotherapy R&D group at Karolinska/KI

I am member of the Swedish Society of Radiation Oncology since 2021

I am member of the ESTRO Physics Leadership group since 2021

I have acted as opponent of 2 PhD theses, in the Netherlands and in Denmark, respectively, and been part of the examination Committee of 4 PhD theses.

I have been a member of the Scientific Council on ionizing radiation within Oncology for the Swedish Radiation Safety Agency (2010-2012)

I have been a member of the ESTRO board - European SocieTy for Radiotherapy and Oncology (2003-2006)

I lecture at graduate and post-graduate courses within curricula for medical physicists, radiation therapists and oncologists at international academic sites. I have been part of the Faculty of the ESTRO course on Advanced Radiotherapy Modalities and of the Royal Marsden course in Medical Physics.  I have been invited lecturer up to now in 20 national and European conferences, and at 25 national and international courses.

I have been the organizer of several European courses and have been the scientific chair, i.e- chair of the scientific program committee, for two ESTRO conferences (European SocieTy for Radiotherapy and Oncology) in 2003 and 2006 respectively.

 

Relevant issues for the board of research

1.To strengthen the research profile of radiation therapy within KI, also according to the Cancer Comprehensive Center strategy plan 

2.To facilitate the integration and implementation of basic research and development of radiation therapy in the clinic, with special focus to Medical Radiation Physics

3. To reinforce the dialogue and the interaction between clinic, education and research from the Medical Physics Science perspective

Research description

Modelling of radiation therapy side effects

I have been involved in several projects within modelling radiotherapy side effects, a field where I have actively worked since the early period of modern 3D conformal therapy.

Cardiac and lung complication after radiation therapy of the breast have been the core of my studies, which have followed the changes and the implications for the field introduced by the technologic evolution in radiation therapy during almost three decades. The research has contributed to the identification of constraints, i.e. numbers which drive the optimization of treatment plans for heart and lung to be used in the clinical practice. The analysis have been performed initially on literature studies and later on on large patient groups, which was necessary for severe and late complications. The studies have been performed in collaborations, one of them was the EU project RACE, together with UK, Denmark and Italy.  I have also been involved in several studies modelling lung complications after Stereotactic Body RadioTherapy (SBRT) and actively worked on the modelling of normal tissue complications following prostate radiotherapy in collaboration with italian centers.

I am currently part of a study which investigates the normal tissue complication following Head and Neck radiation therapy, based on real life data collected from a large cohort of patients. Predictive models of Xerostomia, identification of organs at risk for swallowing dysfunction, re-irradiations issues are the main goals of the research project which is entirely conducted within Karolinska University Hospital and KI (dr Eva Onjukka is the project PI).

During the years I have organized the scientific program of several courses on normal tissue complication modeling issues and have lectured on this subject, mostly in international conferences and courses.

Radiotherapy in the treatment of Oesophageal cancer

Radiotherapy plays a major role in oesophagus cancer treatment, either with curative or palliative intent. A collaboration with Clintec on this subject has started, where high definition radiotherapy data for different studies and analysis is provided.

In particular a randomized international multicenter study, the NEEDS trial (NEoadjuvant chemoradiotherapy for Esophageal squamous cell carcinoma versus Definitive chemoradiotherapy with salvage Surgery as needed), has recently started under the lead of prof Magnus Nilsson, Clintec. In this study curative chemoradiotherapy with selective surgery when needed for local tumour control will be compared to nCRT and planned surgery for all. The participation to the study of several centers from all over the world requires a robust Quality Assurance program for Radiation Therapy (QA RT) in order to ensure that the participating centers deliver the prescribed radiation doses in compliance to the clinical protocol. The QA RT program has been set up and is run by the Medical Physics group in collaboration with the Radiation Therapy medical unit.     

Imaging and motion management in high-precision radiotherapy

During the last two decades there has been increased use of high-precision radiotherapy by SBRT for the treatment of small tumours in lung and liver with ablative dose of about 7-20 Gy per fraction, compared to the conventional daily fraction of 2 Gy. The approach shift differs also when it comes to the radiobiological effect. When treating central lung tumours serious side effects, as Broncopulmonay haemorrage, can occur and have to be taken into account in treatment planning. The tumour movements, included breathing patterns, need to be followed and incorporated in the treatment planning with procedures which limit as much as possible the irradiated normal tissue volume. In a PhD project on this subject, where I act as co-supervisor, the main addressed questions are the accumulated dose to bronchi in the treatment of central lung tumors; a method to define individualized safety margins around the tumour, based on 4D_CT image series; estimation of tumor movements due to breathing, based on dynamic MR imaging.

Part of these studies are included in a PhD program, where I am co-supervisor.

 

Selected publications

  1. Nilsson M, Olafsdottir H, Alexandersson van Döbeln G., Villegas F, Gagliardi G, Hellström M, et al

Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma Versus Definitive Chemoradiotherapy With Salvage Surgery as Needed: The Study Protocol for the Randomized Controlled NEEDS Trial

Front. Oncol., 13 July 2022, https://doi.org/10.3389/fonc.2022.917961

 

  1. LO.A, Ronckers C, Aznar M.C, Avanzo M, van Dijk I, Kremer L.C.M, Gagliardi G, Howe,, R, Rancati T, Constine L.S

Breast hypoplasia and decreased lactation from radiotherapy in survivors of pediatric malignancy: A PENTEC comprehensive review

Int J Radiat Oncol Biol Phys. 2021, https://doi.org/10.1016/j.ijrobp.2021.08.032

 

  1. Cella L, Gagliardi G, Hedman M, Palma G

Injuries from Asymptomatic COVID-19 disease: new hidden toxicity risk factors in thoracic radiation therapy

Int J Radiat Oncol Biol Phys. 2020 Oct 1; 108(2): 394–396, doi: 10.1016/j.ijrobp.2020.06.055

 

  1. Onjukka E, Mercke C, Björgvinsson E, …Gagliardi G, et al

Modeling of Xerostomia After Radiotherapy for Head and Neck Cancer: A Registry Study

Frontiers in Oncology 10, 2020, DOI: 10.3389/fonc.2020.01647

 

  1. Clark C, Gagliardi G, Heijmen B, Malicki J, Thorwarth D, Verellen D, Muren LP

Adapting training for medical physicists to match future trends in radiation oncology (Editorial)

Physics and Imaging in Radiation Oncology, 11, 2019, 71-75

 

  1. Onjukka E, Fiorino C, Cicchetti A, Palorini F, Improta I, Gagliardi G et al

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

Acta Oncol 2019 Jul 12:1-8 doi: 10.1080/0284186X.2019.1635267

 

  1. Bjöhle J, Onjukka E, Rintela N, Eloranta S, Gagliardi G, Liljegren A

Post-mastectomy radiation therapy with or without implant-based reconstruction is safe in terms of clinical target volume coverage and survival - A matched cohort study.

Radiother Oncol. 2019 Feb;131:229-236. doi: 10.1016/j.radonc.2018.07.005.

 

  1. Moiseenko V, Einck J, Murphy J, Ödén J, Bjöhle J, Uzan J, Gagliardi G.

Clinical evaluation of QUANTEC guidelines to predict the risk of cardiac mortality in breast cancer patients.

Acta Oncol. Dec;55(12):1506-1510, 2016

 

  1. Nyholm T, Olsson C, Agrup M, Björk P, Björk-Eriksson T, Gagliardi G, et al

A national approach for automated collection of standardized and population-based radiation therapy data in Sweden

Radiother Oncol 119 344-50, 2016

 

  1. Bortfeld T, Torresin A, Fiorino C, Andreo P, Gagliardi G, Jeraj R, et al

The research versus clinical service role of medical physics.

Radiother Oncol. 114(3):285-8, 2015

 

  1. Darby SC, Ewertz M, McGale P, Bennet ..Cutter D, Gagliardi G et al:

Risk of ischemic heart disease in women after radiotherapy for breast cancer.

N Engl J Med. 368(11):987-98, 2013

 

  1. Wennberg B, Baumann P, Gagliardi G, et al

NTCP modelling of lung toxicity after SBRT comparing the universal survival curve and the linear quadratic model for fractionation correction

Acta Oncol.;50(4):518-27, 2011

 

  1. Gagliardi G, Constine L, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB

Radiation associated heart injury

Int J Radiat Oncol Biol Phys, 76, 3, S77-S85, 2010

 

  1. Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G et al

Outcome in a prospective phase II trial of medically inoperable stage I NSCLC patients treated with stereotactic body radiotherapy (SBRT).

Journal of Clinical Oncology, 2009, 27 (20):3290-96

 

  1. Taylor CW, Nisbet A, McGale P, Goldman U, Darby SC, Hall P, Gagliardi G.

Cardiac doses from Swedish breast cancer radiotherapy since the 1950’s

Radiotherapy and Oncology, 90, 127-135, 2009

 

  1. Rancati T., Wennberg B., Lind P., Svane G., Gagliardi G.    

Early clinical and radiological complications following breast cancer radiation therapy: NTCP fit with four different models

Radiotherapy and Oncology, 82: 308-316, 2007

 

  1. Lax I., Panettieri V, Wennberg B, Duch MA,  Näslund I,  Baumann P, Gagliardi G

Dose distributions in SBRT of lung tumors - Comparison between two different treatment planning algorithms and Monte-Carlo simulation including breathing motions

Acta Oncol. 45(7):978-88, 2006

 

  1. Rancati T., Fiorino C., Gagliardi G., Cattaneo G.M. et al.

Late rectal bleeding: fitting late rectal bleeding data using different NTCP models: results from an  italian multicentric study (AIROPROS0101)

Radiotherapy and Oncology, vol 7: 21- 32, 2004

 

  1. Gagliardi G., Lax I, Rutqvist LE

Partial irradiation of the heart

Seminars in Radiation Oncology, vol 11, No 3: 224 – 233, 2001

 

  1. Gagliardi G, Bjöhle J, Ottolenghi A, Lax I, Lidberg A, Erikkson F, Lind P, Rutqvist LE

Radiation pneumonitis after radiotherapy for breast cancer: analysis of the complication probability using the relative seriality model

Int. J. Rad. Onc. Biol. Phys, 46 (2): 373 - 381, 2000

 

  1. Eriksson F., Gagliardi G., Liedberg A., Lax I., Lee C., Levitt S., Lind B., Rutqvist L.E.

Long-term cardiac mortality following radiation therapy for Hodgkin’s disease: analysis with the relative seriality model.

Radiotherapy and Oncology, 55 (2): 152 – 162, 2000

 

  1. Gagliardi G, Lax I, Ottolenghi A, Rutqvist L.E

Long term cardiac mortality after radiotherapy of breast cancer - Application of the relative seriality model.

British Journal of Radiology, 69: 839-846, 1996

 

 

Reports

 

  1. 2011:25, Report from SSM’s scientific council on ionizing radiation within oncology, 2010

http://www.stralsakerhetsmyndigheten.se/Publikationer/Rapport/Stralskydd/2011/201125/

  1. 2012:20, Report from SSM’s scientific council on ionizing radiation within oncology, 2011, 2012:20

http://www.stralsakerhetsmyndigheten.se/Publikationer/Rapport/Stralskyd…

  1. 2014:03 Report from SSM’s scientific council on ionizing radiation within oncology, 2012

http://www.stralsakerhetsmyndigheten.se/Publikationer/Rapport/Stralskyd…

  1. Cardiovascular disease after radiotherapy

EU Scientific Seminar 2013 - “Radiation induced long-term health effects after medical exposure", Luxembourg

https://ec.europa.eu/energy/sites/ener/files/documents/RP182web.pdf ISSN 2315-2826 (published 2015)