1
|
Lockley M, Stoneham S, Shamash J, Pashankar F, Frazier L. Re: 'Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? An international multicenter analysis'. Eur J Cancer 2021; 152:255-256. [PMID: 34099362 DOI: 10.1016/j.ejca.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Michelle Lockley
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, UK; Department of Gynaecological Oncology, Cancer Services, University College London Hospital, London, UK.
| | - Sara Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom, UK
| | | | | | - Lindsay Frazier
- Dana Farber/Boston Childrens Cancer and Blood Disorders Center, Boston, MA, USA
| |
Collapse
|
2
|
Mangili G, Giorda G, Ferrandina G, Cormio G, Cassani C, Savarese A, Danese S, Carnelli M, Vasta FM, Perrone AM, Scarfone G, Pignata S, Legge F, Raspagliesi F, Taccagni G, Candiani M, Bogani G, Mascilini F, Bergamini A. Surveillance alone in stage I malignant ovarian germ cell tumors: a MITO (Multicenter Italian Trials in Ovarian cancer) prospective observational study. Int J Gynecol Cancer 2021; 31:1242-1247. [PMID: 34035080 DOI: 10.1136/ijgc-2021-002575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the oncological outcome of stage I malignant ovarian germ cell tumors patients included in the MITO-9 study to identify those who might be recommended routine surveillance alone after complete surgical staging. METHODS MITO-9 was a prospective observational study analyzing data collected between January 2013 and December 2019. Three groups were identified: group A included 13 patients stage IA dysgerminoma and IAG1 immature teratoma; group B included 29 patients with stage IB-C dysgerminomas, IA-C G2-G3 immature teratomas and stage IA mixed malignant ovarian germ cell tumors and yolk sac tumors; and group C included five patients (two patients with stage IC1 and one patient with stage IC2 yolk sac tumors and two patients with mixed-stage IC2 malignant ovarian germ cell tumors). RESULTS A total of 47 patients with stage I conservatively treated malignant ovarian germ cell tumors were analyzed. Two patients in group B were excluded from the routine surveillance alone group due to positive surgical restaging. Therefore, a total of 45 patients were included in the study. Median follow-up was 46.2 months (range; 6-83). In total, 14 of 45 patients (31.1%) received chemotherapy, while 31 (68.9%%) underwent surveillance alone. One patient in group A, with stage IA dysgerminoma had a relapse, successfully managed with conservative surgery and chemotherapy. None of the patients in group B and C relapsed. All patients were alive at completion of the study. Overall, among 31 patients (68.9%) who underwent surveillance alone, only one patient relapsed but was treated successfully. CONCLUSIONS Our data showed that close surveillance alone could be an alternative option to avoid adjuvant chemotherapy in properly staged IB-C dysgerminomas, IA-IC G2-G3 immature teratomas, and IA mixed malignant ovarian germ cell tumors with yolk sac tumor component.
Collapse
Affiliation(s)
- Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Giorgio Giorda
- Centro di Riferimento Oncologico di Aviano, IRCCS Aviano, Aviano, Italy
| | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli, Roma, Italy.,Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, University of Bari, Bari, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Saverio Danese
- Deparment of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Carnelli
- Unit of Gynecology and Obstetrics, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna Myriam Perrone
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Giovanna Scarfone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Mangiagalli Center, Milano, Italy
| | - Sandro Pignata
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale", Naples, Italy
| | - Francesco Legge
- Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
| | | | | | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy.,Università Vita Salute San Raffaele, Milano, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Floriana Mascilini
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| |
Collapse
|
3
|
Bergamini A, Sarwar N, Ferrandina G, Scarfone G, Short D, Aguiar X, Camnasio C, Kaur B, Savage PM, Cormio G, Lim A, Pignata S, Mangili G, Seckl MJ. Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis. Eur J Cancer 2020; 137:136-143. [PMID: 32763784 DOI: 10.1016/j.ejca.2020.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The role of surveillance after surgery for stage IA-C grade 2 (G2) or grade 3 (G3) immature teratomas (ITs) is controversial with many guidelines advocating adjuvant chemotherapy. Here, we investigate the safety of surveillance in stage IA-C G1-3 ITs. METHODS Clinicopathological data were analysed on postpubertal patients with stage I pure ITs in Multicenter Italian Trials in Ovarian Cancer centres and at Charing Cross Hospital, UK, between January 1985 and January 2018. RESULTS Of 108 stage I patients, 66 (61.1%), 3 (2.8%) and 39 (36.1%) were International Federation of Gynecology and Obstetrics IA, IB, IC, respectively, with 31 (28.7%), 41 (38%) and 36 (33.3%) having grade 1 (G1), 2 and 3 disease, respectively. After surgery, 27 patients (25%) had adjuvant chemotherapy and 81 (75%) surveillance. There was no significant increase in the risk of malignant (G2-3 IT) relapse (9/81 vs 2/27; p = 0.72) or in disease-free survival (DFS) or overall survival in the surveillance vs chemotherapy groups. The median time to relapse was 17.8 months (range: 3-47) with no significant difference between surveillance or chemotherapy groups. The median follow-up was 64.3 months (Interquartile range (IQR) 22.2-101.7). Chemotherapy induced cures in all except for one patient who did not follow the surveillance protocol due to pregnancy and died of disease. Univariate and multivariate analyses revealed that only tumour grade (hazard ratio [HR] = 3.11; p = 0.02) and complete surgical staging (HR = 0.2; p = 0.01) were independent prognostic factors for decreased DFS. CONCLUSION The present study suggests that in the adult setting careful surveillance appears to be an acceptable alternative to adjuvant chemotherapy for stage IA-C ITs of any grade, properly staged and with negative postoperative tumour markers.
Collapse
Affiliation(s)
- Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | - Naveed Sarwar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dee Short
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Xianne Aguiar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Cristina Camnasio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Baljeet Kaur
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Philip M Savage
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, UK
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" Bari & Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Adrian Lim
- Department of Imaging, Charing Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138, Naples, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael J Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK.
| |
Collapse
|
4
|
Newton C, Murali K, Ahmad A, Hockings H, Graham R, Liberale V, Sarker SJ, Ledermann J, Berney DM, Shamash J, Banerjee S, Stoneham S, Lockley M. A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice. Eur J Cancer 2019; 113:19-27. [PMID: 30954883 PMCID: PMC6522056 DOI: 10.1016/j.ejca.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 03/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone. AIM The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years. METHODS Multicentre cohort study was carried out in four large UK cancer centres over 12 years. RESULTS One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10-7). Neoadjuvant/adjuvant chemotherapy reduced future relapse/progression in dysgerminoma (n = 37, chemo:0% vs. no chemo:20%), yolk sac tumour (n = 23, 26.3% vs.75%) and mixed germ cell tumour (n = 32, 40%vs.70%) but not in IT (n = 42, 33% vs.15%). Additionally, we observed no radiological responses to chemotherapy in ITs, pathological IT grade did not predict EFS (univariate hazard ratio 0.82, 95% confidence interval: 0.57-1.19, P = 0.94) and there were no deaths in this subtype. CONCLUSION Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
Collapse
Affiliation(s)
- C Newton
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK; University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - K Murali
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - A Ahmad
- The Wolfson Institute, CRUK Barts Cancer Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK; Cancer Intelligence, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - H Hockings
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - R Graham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - V Liberale
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - S-J Sarker
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Research Department of Medical Education, UCL Medical School, Royal Free Campus, Hampstead, London NW3 2PR, UK
| | - J Ledermann
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - D M Berney
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - J Shamash
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - S Banerjee
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - S Stoneham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - M Lockley
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| |
Collapse
|
5
|
Mangili G, Sigismondi C, Lorusso D, Cormio G, Candiani M, Scarfone G, Mascilini F, Gadducci A, Mosconi AM, Scollo P, Cassani C, Pignata S, Ferrandina G. The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study. Ann Oncol 2017; 28:333-338. [PMID: 27803008 DOI: 10.1093/annonc/mdw563] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated. Patients and methods Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed. Results Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively. Conclusions This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.
Collapse
Affiliation(s)
- G Mangili
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - C Sigismondi
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - D Lorusso
- Department of Gynecologic Oncology, IRCCS Foundation National Cancer Institute, Milan
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari
| | - M Candiani
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan
| | - F Mascilini
- Gynecology Oncology Unit, Foundation "PoliclinicoUniversitario A. Gemelli", Rome
| | - A Gadducci
- Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa
| | - A M Mosconi
- Azienda Ospedaliera Universitaria Perugia, Perugia
| | - P Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples
| | - G Ferrandina
- Department of Medicine and Health Science, University of Molise, Campobasso/Foundation, PoliclinicoUniversitario A. Gemelli, Rome, Italy
| |
Collapse
|
6
|
Terenziani M, Bisogno G, Boldrini R, Cecchetto G, Conte M, Boschetti L, De Pasquale MD, Biasoni D, Inserra A, Siracusa F, Basso ME, De Leonardis F, Di Pinto D, Barretta F, Spreafico F, D'Angelo P. Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study. Pediatr Blood Cancer 2017; 64. [PMID: 28449306 DOI: 10.1002/pbc.26568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/30/2016] [Accepted: 03/06/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT. METHODS Patients were treated according to their stage: surgery and surveillance for stage I; a modified bleomycin-etoposide-cisplatin (BEP) regimen for stages II (three cycles), III, and IV (three cycles) with surgery on residual disease. RESULTS Seventy-seven patients were enrolled (median age 11.8 years), 26 with dysgerminoma (Dysg), 13 with immature teratoma and elevated serum alpha-fetoprotein levels (IT + AFP), and 38 with nondysgeminoma (Non-Dysg) staged as follows: 27 stage I, 13 stage II, 32 stage III, 5 stage IV. Among evaluable patients in stage I (5-year event-free survival [EFS] 72.1% [95% CI: 56.4-92.1%]; 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescued with chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II-IV, 48 (98%) achieved complete remission after chemotherapy ± surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6-100%) and 84.5% (95% CI: 76.5-93.5%). CONCLUSIONS We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists, we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers.
Collapse
Affiliation(s)
- M Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - G Bisogno
- Pediatric Unit, University-Hospital of Padua, Padova, Italy
| | - R Boldrini
- Pathology Unit, Ospedale Pediatrico Bambino Gesù-IRCCS. Roma, Italy
| | - G Cecchetto
- Pediatric Surgery Unit, University-Hospital of Padua, Padova, Italy
| | - M Conte
- Oncology Unit, Ospedale Pediatrico G. Gaslini, Genova, Italy
| | - L Boschetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - M D De Pasquale
- Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Roma, Italy
| | - D Biasoni
- Pediatric Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - A Inserra
- Pediatric Surgery Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Roma, Italy
| | - F Siracusa
- Pediatric Surgery Department, Università of Palermo, Palermo, Italy
| | - M E Basso
- Hematology/Oncology Unit, Ospedale Infantile Regina Margherita, Torino, Italy
| | - F De Leonardis
- Division of Pediatric Hematology-Oncology, University of Bari, Italy
| | - D Di Pinto
- Pediatric Oncology Unit, Seconda Università, Napoli, Italy
| | - F Barretta
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - F Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - P D'Angelo
- Hematology/Oncology Unit, A.R.N.A.S Civico Di Cristina e Benfratelli, Palermo, Italy
| |
Collapse
|
7
|
Billmire DF, Krailo M, Rodriguez-Galindo C, Frazier AL. Reply to G. Mangili et al and C. Lhommé et al. J Clin Oncol 2014; 32:2816-7. [PMID: 25071123 DOI: 10.1200/jco.2014.56.3890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Mark Krailo
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - A Lindsay Frazier
- Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| |
Collapse
|