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Bogani G, Ditto A, Leone Roberti Maggiore U, Scaffa C, Mosca L, Chiappa V, Martinelli F, Lorusso D, Raspagliesi F. Neoadjuvant chemotherapy followed by interval debulking surgery for unresectable stage IVB Serous endometrial cancer. TUMORI JOURNAL 2018; 105:92-97. [DOI: 10.1177/0300891618784785] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To test the safety and effectiveness of neoadjuvant chemotherapy followed by interval debulking surgery in unresectable stage IVB serous endometrial cancer. Methods: Data of consecutive stage IVB serous endometrial cancer are reviewed. Patients undergoing neoadjuvant chemotherapy plus interval debulking surgery were propensity matched with patients undergoing primary surgery followed by adjuvant treatment. Results: Thirty-four patients were diagnosed with a stage IVB endometrial cancer. Fifteen (44.1%) patients had neoadjuvant chemotherapy followed by interval debulking surgery; while 19 (55.8%) patients had primary cytoreduction. Among this latter group, 15 (78.9%) patients were selected, using a propensity-matched algorithm. Results of propensity-matching baseline characteristics of patients included were similar between groups. Patients having neoadjuvant chemotherapy plus interval debulking surgery had shorter length of hospital stay (4 [1.40] vs 6 [2.5] days; p=0.011) compared with patients in the control group. Moreover, patients in the neoadjuvant chemotherapy group experienced a trend toward shorter operative time (127 [62] vs 177.6 [84.5] minutes; p=0.072) and lower transfusion rate than patients in the control group (6.6% vs 33.3%; p=0.067). Cytoreduction rate was similar between groups (p=0.962). No difference in postoperative morbidity was recorded. Median disease-free survival was 12.0 vs 15.3 months in the experimental vs control group (p=0.663; log-rank test). Median overall survival was 16.7 vs 18.0 months in the experimental vs control group (p=0.349; log-rank test). Conclusions: Neoadjuvant chemotherapy might be a valuable treatment modality for patients with unresectable stage IVB serous endometrial cancer. Innovative treatments are warranted in this cluster of patients.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | | | - Cono Scaffa
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Lavinia Mosca
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Domenica Lorusso
- Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
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Value and best way for detection of Sentinel lymph node in early stage endometrial cancer: Selective lymphadenectomy algorithm. Eur J Obstet Gynecol Reprod Biol 2018; 225:35-39. [PMID: 29660577 DOI: 10.1016/j.ejogrb.2018.03.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The cornerstone of treatment for endometrial carcinoma is total abdominal hysterectomy and bilateral salpingo-oophoprectomy. Pelvic lymphadenectomy, with or without para-aortic lymphadenectomy, plays an important role in the surgical staging of endometrial carcinoma, and provides more accurate prognostic information. AIMS We aimed to evaluate the value and techniques for SLN mapping in early stage endometrial cancer with low risk for lymph node metastasis and whether selective or systematic lymphadenectomy is needed according to the results of proposed algorithm. METHOD Between June 2016 and June 2017, 120 patients with early stage endometrial cancer with low risk for nodal metastasis underwent surgical staging. Patients were classified equally according to SLN mapping technique used for injecting the methylene blue dye. Group A included hysteroscopic guided methylene blue injection, Group B included transcervical injection, Group C included subserosal uterine injection and Group D included combined transcervical and subserosal injection. Blue lymph nodes and enlarged suspicious whether stained or non stained ones were dissected for frozen section evaluation done then bilateral pelvic node dissection was done and tissues were sent for pathological examination. RESULTS Clinical and pathological SLN detection were more with hysteroscopic technique than others and pathological detection was lower than clinical detection in all techniques. Metastatic disease was more common in nodes with suspicious appearance. About 10% of negative suspicious and mapped nodes were associated with positive other nodes for metastasis. CONCLUSION SLN in endometrial cancer has a role in staging of endometrial cancer with best technique for detection, hysteroscopic guided blue dye injection. SLN can be used in patients with low risk for lymph node metastasis for selective lymphadenectomy. Blue dye labelling using methylene blue dye is good in low resource countries as it is cheap. We recommended the following algorithm for surgical staging in early endometrial cancer with better results than using SLN alone. Stage I type 1, grade 1,2 endometrial cancer should undergo surgical staging with initial evaluation of the peritoneum which if affected, it is stage III with no need for lymphadenectomy. Then, dissection of the blue and suspicious nodes which if any is positive on frozen section, selective same side pelvic and paraaortic nodal dissection should be done. If they are negative, no need for lymphadenectomy. This approach can help patients to avoid the side effects associated with a complete lymphadenectomy. The higher rate of detection using this algorithm is related to combining the suspicions nodes with the stained ones.
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Gasparri ML, Bardhi E, Ruscito I, Papadia A, Farooqi AA, Marchetti C, Bogani G, Ceccacci I, Mueller MD, Benedetti Panici P. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track? Geburtshilfe Frauenheilkd 2017. [PMID: 29093603 DOI: 10.1055/s-0043-118907]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy.,Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
| | - Erlisa Bardhi
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Ilary Ruscito
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
| | - Ammad Ahmad Farooqi
- Laboratory for Translational Oncology and Personalized Medicine, Rashid Latif Medical College, Lahore, Pakistan
| | - Claudia Marchetti
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Irene Ceccacci
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
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Gasparri ML, Bardhi E, Ruscito I, Papadia A, Farooqi AA, Marchetti C, Bogani G, Ceccacci I, Mueller MD, Benedetti Panici P. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track? Geburtshilfe Frauenheilkd 2017. [PMID: 29093603 DOI: 10.1055/s-0043-118907] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy.,Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
| | - Erlisa Bardhi
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Ilary Ruscito
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
| | - Ammad Ahmad Farooqi
- Laboratory for Translational Oncology and Personalized Medicine, Rashid Latif Medical College, Lahore, Pakistan
| | - Claudia Marchetti
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Irene Ceccacci
- Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
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Gasparri ML, Bardhi E, Ruscito I, Papadia A, Farooqi AA, Marchetti C, Bogani G, Ceccacci I, Mueller MD, Benedetti Panici P. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track? Geburtshilfe Frauenheilkd 2017; 77:1095-1103. [PMID: 29093603 PMCID: PMC5658232 DOI: 10.1055/s-0043-118907] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/02/2017] [Accepted: 08/25/2017] [Indexed: 01/15/2023] Open
Abstract
The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
| | - Erlisa Bardhi
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Ilary Ruscito
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
| | - Ammad Ahmad Farooqi
- Laboratory for Translational Oncology and Personalized Medicine, Rashid Latif Medical College, Lahore, Pakistan
| | - Claudia Marchetti
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Irene Ceccacci
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
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Slomovitz BM, Coleman RL. Reply to G. Bogani et al. J Clin Oncol 2015; 33:3516. [DOI: 10.1200/jco.2015.62.5632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bogani G, Ditto A, Martinelli F, Signorelli M, Perotto S, Lorusso D, Raspagliesi F. A critical assessment on the role of sentinel node mapping in endometrial cancer. J Gynecol Oncol 2015; 26:252-4. [PMID: 26508591 PMCID: PMC4620360 DOI: 10.3802/jgo.2015.26.4.252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Stefania Perotto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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