Giovanna Gagliardi

Giovanna Gagliardi

Affiliated to Research
Visiting address: M1:01 Anna Steckséns väg 41, 17176 Stockholm
Postal address: K7 Onkologi-Patologi, K7 Forskning Tedgren, 171 77 Stockholm
Part of:

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

  • *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]
    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 [2]
    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 [3]
    1) Onjukka E, Mercke C, Björgvinsson E, …*Gagliardi G*/, et al/
    /Modeling of Xerostomia After Radiotherapy for Head and Neck Cancer: A
    Registry Study/ [4]
    Frontiers in Oncology 10, 2020, DOI: 10.3389/fonc.2020.01647 [5]
    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./ [6]
    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./ [7]
    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./ [8]
    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/
    [9]
    1) /2012:20, Report from SSM’s scientific council on ionizing radiation
    within oncology, 2011, 2012:20/
    http://www.stralsakerhetsmyndigheten.se/Publikationer/Rapport/Stralskydd/2012/201220/
    1) /2014:03 Report from SSM’s scientific council on ionizing radiation
    within oncology, 2012/
    http://www.stralsakerhetsmyndigheten.se/Publikationer/Rapport/Stralskydd/2014/201451/
    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 [10] (published 2015)
    [1] https://doi.org/10.3389/fonc.2022.917961
    [2] https://doi.org/10.1016/j.ijrobp.2021.08.032
    [3] https://dx.doi.org/10.1016%2Fj.ijrobp.2020.06.055
    [4] https://www.researchgate.net/publication/343661895_Modeling_of_Xerostomia_After_Radiotherapy_for_Head_and_Neck_Cancer_A_Registry_Study
    [5] https://www.researchgate.net/deref/http%3A%2F%2Fdx.doi.org%2F10.3389%2Ffonc.2020.01647
    [6] https://www.ncbi.nlm.nih.gov/pubmed/27732122
    [7] http://www.ncbi.nlm.nih.gov/pubmed/25727681
    [8] http://www.ncbi.nlm.nih.gov/pubmed/23484825
    [9] http://www.stralsakerhetsmyndigheten.se/Publikationer/Rapport/Stralskydd/2011/201125/
    [10] https://ec.europa.eu/energy/sites/ener/files/documents/RP182web.pdf%20ISSN%202315-2826

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