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Squarcia Neri G, Pezone G, Cavaliere A, Lo Schiavo Elia R, Sorotos M, D’Andrea F, Schonauer F. Snip conjunctivoplasty associated with methylene blue staining for treatment of postoperative conjunctival chemosis. Case Reports Plast Surg Hand Surg 2024; 11:2306984. [PMID: 38283641 PMCID: PMC10812848 DOI: 10.1080/23320885.2024.2306984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/13/2024] [Indexed: 01/30/2024]
Abstract
Conjunctival chemosis usually undergoes spontaneous resolution; sometimes, it requires treatment. We present the case of a 43 years-old female patient who developed bilateral conjunctival chemosis following upper and lower blepharoplasty. Two months after the operation, patient underwent bilateral snip conjunctivoplasty with methylene blue demarcation of the chemotic conjunctiva.
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Affiliation(s)
| | - G. Pezone
- Unit of Plastic Surgery, University “Federico II,”Naples, Italy
| | - A. Cavaliere
- Unit of Plastic Surgery, University “Federico II,”Naples, Italy
| | | | - M. Sorotos
- Unit of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant’Andrea Hospital, Rome, Italy
| | - F. D’Andrea
- Unit of Plastic Surgery, University “Federico II,”Naples, Italy
| | - F. Schonauer
- Unit of Plastic Surgery, University “Federico II,”Naples, Italy
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Militello AM, Orsi G, Cavaliere A, Niger M, Avallone A, Salvatore L, Tortora G, Rapposelli IG, Giordano G, Noventa S, Giommoni E, Bozzarelli S, Macchini M, Peretti U, Procaccio L, Puccini A, Cascinu S, Montagna C, Milella M, Reni M. Clinical outcomes and response to chemotherapy in a cohort of pancreatic cancer patients with germline variants of unknown significance (VUS) in BRCA1 and BRCA2 genes. Cancer Chemother Pharmacol 2023; 92:501-510. [PMID: 37725113 DOI: 10.1007/s00280-023-04585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The clinical outcome and the efficacy of chemotherapy in pancreatic cancer patients with BRCA1/2 Variants of Unknown Significance (VUS) is unknown. We explored the effects of chemotherapy with or without Platinum in non metastatic and metastatic pancreatic cancer patients with BRCA1/2 VUS. METHODS A retrospective analysis of non-metastatic or metastatic pancreatic cancer patients with gBRCA1/2 VUS treated in 13 Italian centers between November 2015 and December 2020 was performed. All patients were assessed for toxicity and RECIST 1.1 response. Metastatic patients were evaluated for survival outcome. RESULTS 30 pancreatic cancer patients with gBRCA1/2 VUS were considered: 20 were M+ and 10 were non-M+. Pl-CT was recommended to 16 patients: 10 M+ (6 FOLFIRINOX and 4 PAXG) and 6 non-M+ (3 FOLFIRINOX and 3 PAXG); 11 patients received Nabpaclitaxel-Gemcitabine (AG; 8 M+) and 3 patients (2 M+) were treated with Gemcitabine (G). The RECIST 1.1 response rate was 27% for AG and 44% for Pl-CT (22% for (m) FOLFIRINOX and 71% PAXG). 1 year Progression-Free Survival was 37.5% for patients treated with AG and 33% in the Pl-CT subgroup. Median Overall Survival (OS) was 23.5 months for patients treated with AG and 14 months for the Pl-CT subgroup. 1 Year and 2 Year OS were numerically better for AG (1 Year OS: 75% vs 60% and 2 Year OS: 50% and 20% in AG and Pl-CT subgroups, respectively) as well. CONCLUSIONS Pl-CT does not seem to be associated with a better outcome compared to AG chemotherapy in PDAC patients with BRCA 1/2 VUS.
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Affiliation(s)
- Anna Maria Militello
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Cavaliere
- Department of Oncology, University of Torino, Candiolo, Italy
- Candiolo Cancer Institute, FPO - IRCCS Candiolo, Candiolo, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy
| | - Antonio Avallone
- Biologia Cellulare e Bioterapie, Istituto Nazionale per lo Studio e la Cura dei Tumori ''Fondazione Giovanni Pascale'' - IRCCS, Naples, Italy
| | - Lisa Salvatore
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ''Dino Amadori'', Meldola, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Silvia Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elisa Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marina Macchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Alberto Puccini
- University of Genoa, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Montagna
- Department of Radiation Oncology and Genomic Instability and Cancer Genetics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy.
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.
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Cavaliere A, D'Andrea F, Schonauer F. Letter to the Editor: A new laser level App to improve nipple-areola complex symmetry in breast surgery. J Plast Reconstr Aesthet Surg 2023; 86:33-34. [PMID: 37672808 DOI: 10.1016/j.bjps.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/13/2023] [Indexed: 09/08/2023]
Affiliation(s)
- A Cavaliere
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5, Napoli, Naples 80131, Italy.
| | - F D'Andrea
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5, Napoli, Naples 80131, Italy
| | - F Schonauer
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5, Napoli, Naples 80131, Italy
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Milella M, Orsi G, Palloni A, Salvatore L, Procaccio L, Noventa S, Bozzarelli S, Garajova I, Vasile E, Giordano G, Macchini M, Cavaliere A, Gaule M, Lonardi S, Di Marco M, Tortora G, Sperduti I, Reni M. 1307P Real-world impact of olaparib use in advanced pancreatic cancer (PC) patients (pts) harboring germline BRCA1/2 (gBRCA) mutations. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sirico D, Basso A, Sabatino J, Reffo E, Cavaliere A, Biffanti R, Cerutti A, Castaldi B, Zulian F, Da Dalt L, Di Salvo G. P154 EVOLUTION OF ECHOCARDIOGRAPHIC AND CARDIAC MRI ABNORMALITIES DURING FOLLOW–UP IN PATIENTS WITH PREVIOUS MIS–C DIAGNOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Cardiovascular manifestations in the acute phase of MIS–C are frequent. However, there is lacking evidence regarding late cardiological follow–up of this cohort of patients. The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS–C, assessed by standard echocardiography (TTE), speckle tracking echocardiography (STE), and cardiac MRI (CMR).
Materials and Methods
32 consecutive patients with confirmed MIS–C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected for all patients. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis.
Results
Mean age was 8.25±4years (range 1.3–17.7). Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease–like symptoms, and 5 (15.6%) needed ICU admission. All patients showed an hyperinflammatory state. Tn–I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Median time to STE evaluation was 7 days and to CMR 18 days since fever onset. Mean LVEF at baseline was 58.8±10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (–17.4±4%). Coronary dilation was observed in 9 (28,1%) patients. On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Median time to T1 and T2 evaluation was respectively 48.5 and 207 days. Follow–up data showed statistically significant improvement in left ventricular systolic function compared to acute phase. LVEF improved rapidly at T1 (62.5 ± 7.5 vs. 58.8±10.6%, p value 0.044) with only three patients (10%) below ≤ 55% at T1 and one patient (4%) at T2. LV GLS remained impaired at T1 (–17.2 ± 2.7 vs.–17.4 ± 4, p value 0.71), and significantly improved at T2 (–19±2.6% vs. –17.4±4%, p value 0.009). LV GLS was impaired (>–18%) in 53% of patients at baseline and T1, while only 13% showed LV GLS reduction at T2. CMR, performed 6 months after diagnosis, showed LGE persistence in 33.4% of cases.
Conclusions
Even though, early cardiac involvement significantly improves during follow–up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS–C patients.
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Affiliation(s)
- D Sirico
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - A Basso
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - J Sabatino
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - E Reffo
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | | | - R Biffanti
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - A Cerutti
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - B Castaldi
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - F Zulian
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - L Da Dalt
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
| | - G Di Salvo
- AZIENDA OSPEDALE UNIVERSITÀ PADOVA, PADOVA
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Albanese M, Marrone G, Paolino A, Di Lauro M, Di Daniele F, Chiaramonte C, D'Agostini C, Romani A, Cavaliere A, Guerriero C, Magrini A, Mercuri NB, Di Daniele N, Noce A. Effects of Ultramicronized Palmitoylethanolamide (um-PEA) in COVID-19 Early Stages: A Case–Control Study. Pharmaceuticals (Basel) 2022; 15:ph15020253. [PMID: 35215365 PMCID: PMC8878249 DOI: 10.3390/ph15020253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/15/2022] Open
Abstract
Ultramicronized palmitoylethanolamide (um-PEA), a compound with antioxidant, anti-inflammatory and neuroprotective properties, appears to be a potential adjuvant treatment for early stages of Coronavirus disease 2019 (COVID-19). In our study, we enrolled 90 patients with confirmed diagnosis of COVID-19 that were randomized into two groups, homogeneous for age, gender and BMI. The first group received oral supplementation based on um-PEA at a dose of 1800 mg/day for a total of 28 days; the second group was the control group (R.S. 73.20). At baseline (T0) and after 28 days of um-PEA treatment (T1), we monitored: routine laboratory parameters, inflammatory and oxidative stress (OS) biomarkers, lymphocytes subpopulation and COVID-19 serological response. At T1, the um-PEA-treated group presented a significant reduction in inflammation compared to the control group (CRP p = 0.007; IL-6 p = 0.0001; neutrophils to lymphocytes ratio p = 0.044). At T1, the controls showed a significant increase in OS compared to the treated group (FORT p = 0.05). At T1, the um-PEA group exhibited a significant decrease in D-dimer levels (p = 0.0001) and higher levels of IgG against SARS-CoV-2 (p = 0.0001) compared to the controls. Our data demonstrated, in a randomized clinical trial, the beneficial effects of um-PEA in both asymptomatic and mild-symptomatic patients related to reductions in inflammatory state, OS and coagulative cascade alterations.
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Affiliation(s)
- Maria Albanese
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giulia Marrone
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Agostino Paolino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Manuela Di Lauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Di Daniele
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
- UOSD of Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Carlo Chiaramonte
- Department of Statistics, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cartesio D'Agostini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory of Clinical Microbiology, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Annalisa Romani
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), DiSIA, University of Florence, Sesto Fiorentino, 50019 Florence, Italy
| | | | - Cristina Guerriero
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Andrea Magrini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | - Nicola Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
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Cavaliere A, Vivian LM, Puricelli F, Reffo E, Di Salvo G. Predictive factors of outcome in patients with Tetralogy of Fallot (TOF) after pulmonary valve replacement: preliminary data of our Centre experience (2010-2020). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
TOF patients undergo multiple surgical procedures during their life. The improvement in surgical techniques and patient’s clinical management led to longer life expectancy, creating an adult TOF population that experiences specific adverse events, such as atrial/ventricular arrythmias, heart failure and sudden cardiac death. In selected patients, pulmonary valve replacement (PVR) is mandatory to reduce right ventricular (RV) volume; therefore, careful patients’ selection but also correct timing of PVR are crucial.
Purpose
Current guidelines are based on pre-PVR threshold values of indexed RV end-diastolic volume (RVEDVi) calculated with cardiac magnetic resonance (CMR), to achieve normalization of RV size after valve implantation, but recent studies demonstrated that post-PVR RV dilatation is not so tightly connected with adverse clinical outcomes. Therefore, our aim is to identify new possible predictive factors of post-PVR outcome to provide tailored PVR on the correct cohort of patients, at the correct time.
Methods: The inclusion criteria of this retrospective and partially prospective cohort study were
i) repaired TOF; ii) available CMR data pre- and post-PVR; iii) PVR performed between 2010 and 2020; iv) clinical and ECG available pre- and post-PVR; v) complete echocardiographic examination pre- and post-PVR. Multivariate analysis was applied. Primary outcomes were considered death, resuscitated death, atrial/ventricular arrhythmias. NYHA class was considered to evaluate patients’ clinical status. CMR Late Gadolinium Enhancement (LGE) score was calculated pre- and post-PVR.
Results
22 patients were selected (12 males, median age ± SD 28,25 ± 11,2 years). After PVR, the only primary outcome observed was sustained ventricular tachycardia in 4 patients. Multivariate analysis showed that patients with later PVR, lower Fractional Area Change (FAC) at pre-PVR echocardiogram and higher LGE score post-PVR (LGE > 3) showed higher post-PVR RVEDVi. On the contrary, patients with class I NYHA post-PVR showed lower RVEDVi.
Conclusion
Our study demonstrates that lower age at PVR and careful patient’s selection, guided by echocardiographic and CMR findings, lead to greater benefit in terms of good volumetric recovery of the RV and better performance status post-PVR (NYHA class I) in TOF patients after PVR.
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Affiliation(s)
- A Cavaliere
- University of Padua, DIDAS - Neuroradiology , Padova, Italy
| | | | - F Puricelli
- University of Padua, Department of Women"s and Children"s Health, Pediatric Cardiology, Padova, Italy
| | - E Reffo
- University of Padua, Department of Women"s and Children"s Health, Pediatric Cardiology, Padova, Italy
| | - G Di Salvo
- University of Padua, Department of Women"s and Children"s Health, Pediatric Cardiology, Padova, Italy
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Sirico D, Basso A, Sabatino J, Reffo E, Cavaliere A, Biffanti R, Cerutti A, Castaldi B, Zulian F, Da Dalt L, Di Salvo G. OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1066-1074. [PMID: 35639926 PMCID: PMC9384104 DOI: 10.1093/ehjci/jeac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Aims Methods and results Conclusion
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Affiliation(s)
- D Sirico
- Corresponding author. Tel: +39 3388121632, E-mail:
| | - A Basso
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - J Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - E Reffo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - A Cavaliere
- Institute of Radiology, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - R Biffanti
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - A Cerutti
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - B Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - F Zulian
- Pediatric Rheumatology Unit, Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - L Da Dalt
- Pediatric Emergency Unit, Department for Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - G Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
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Orsi G, Di Marco M, Cavaliere A, Niger M, Bozzarelli S, Giordano G, Noventa S, Rapposelli IG, Garajova I, Tortora G, Rodriquenz MG, Bittoni A, Penzo E, De Lorenzo S, Peretti U, Paratore C, Bernardini I, Mosconi S, Spallanzani A, Macchini M, Tamburini E, Bencardino K, Giommoni E, Scartozzi M, Forti L, Valente MM, Militello AM, Cascinu S, Milella M, Reni M. Chemotherapy toxicity and activity in patients with pancreatic ductal adenocarcinoma and germline BRCA1-2 pathogenic variants (gBRCA1-2pv): a multicenter survey. ESMO Open 2021; 6:100238. [PMID: 34392104 PMCID: PMC8371213 DOI: 10.1016/j.esmoop.2021.100238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Germline BRCA1-2 pathogenic variants (gBRCA1-2pv)-related pancreatic ductal adenocarcinoma (PDAC) showed increased sensitivity to DNA cross-linking agents. This study aimed at exploring safety profile, dose intensity, and activity of different chemotherapy regimens in this setting. PATIENTS AND METHODS gBRCA1-2pv PDAC patients of any age and clinical tumor stage who completed a first course of chemotherapy were eligible. A descriptive analysis of chemotherapy toxicity, dose intensity, response, and survival outcomes was performed. RESULTS A total of 85 gBRCA1-2pv PDAC patients treated in 21 Italian centers between December 2008 and March 2021were enrolled. Seventy-four patients were assessable for toxicity and dose intensity, 83 for outcome. Dose intensity was as follows: nab-paclitaxel 72%, gemcitabine 76% (AG); cisplatin 75%, nab-paclitaxel 73%, capecitabine 73%, and gemcitabine 65% (PAXG); fluorouracil 35%, irinotecan 58%, and oxaliplatin 64% (FOLFIRINOX). When compared with the literature, grade 3-4 neutropenia, thrombocytopenia, and diarrhea were increased with PAXG, and unmodified with AG and FOLFIRINOX. RECIST responses were numerically higher with the three- (81%) or four-drug (73%) platinum-containing regimens that outperformed AG (41%) and oxaliplatin-based doublets (56%). Carbohydrate antigen 19.9 (CA19.9) reduction >89% at nadir was reported in two-third of metastatic patients treated with triplets and quadruplets, as opposed to 33% and 45% of patients receiving oxaliplatin-based doublets or AG, respectively. All patients receiving AG experienced disease progression, with a median progression-free survival (mPFS) of 6.4 months, while patients treated with platinum-containing triplets or quadruplets had an mPFS >10.8 months. Albeit still immature, data on overall survival seemed to parallel those on PFS. CONCLUSIONS Our data, as opposed to figures expected from the literature, highlighted that platinum-based regimens provoked an increased toxicity on proliferating cells, when dose intensity was maintained, or an as-expected toxicity, when dose intensity was reduced, while no change in toxicity and dose intensity was evident with AG. Furthermore, an apparently improved outcome of platinum-based triplets or quadruplets over other regimens was observed.
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Affiliation(s)
- G Orsi
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Di Marco
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola - Malpighi University Hospital, Bologna, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - G Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - S Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - I G Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST, Meldola, Italy
| | - I Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - A Bittoni
- Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Ancona, Italy
| | - E Penzo
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - S De Lorenzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - U Peretti
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Paratore
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - I Bernardini
- Medical Oncology Unit, Ospedale Ramazzini, Carpi (MO), Italy
| | - S Mosconi
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - M Macchini
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Tamburini
- Medical Oncology and Palliative Care Department, Azienda Ospedaliera Cardinale G. Panico, Tricase-Lecce, Italy
| | - K Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - M Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - L Forti
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - M M Valente
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A M Militello
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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10
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Melisi D, Cavaliere A, Gobbo S, Fasoli G, Allegrini V, Simionato F, Gaule M, Casalino S, Pesoni C, Zecchetto C, Merz V, Mambrini A, Barbi E, Girelli R, Giardino A, Frigerio I, Scalamogna R, Avitabile A, Castellani S, Milella M, Butturini G. Role of next-generation genomic sequencing in targeted agents repositioning for pancreaticoduodenal cancer patients. Pancreatology 2021; 21:S1424-3903(21)00143-5. [PMID: 33896692 DOI: 10.1016/j.pan.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreaticoduodenal cancer (PDC) is a group of malignant tumors arising in the ampullary region, which lack approved targeted therapies for their treatment. METHODS This retrospective, observational study is based on Secondary Data Use (SDU) previously collected during a multicenter collaboration, which were subsequently entered into a predefined database and analyzed. FoundationOne CDx or Liquid, a next-generation DNA sequencing (NGS) service, was used to identify genomic alterations of patients who failed standard treatments. Detected alterations were described according to ESMO Scale of Clinical Actionability for molecular Targets (ESCAT). RESULTS NGS analysis was performed in 68 patients affected by PDC. At least one alteration ranking tier I, II, III, or IV according to ESCAT classification was detected in 8, 1, 9, and 12 patients respectively (44.1%). Ten of them (33.3%) received a matched therapy. Patients with ESCAT tier I to IV were generally younger than the overall population (median = 54, range = 26-71 years), had an EGOG performance status score = 0 (83.3%), and an uncommon histological or clinical presentation. The most common mutations with clinical evidence of actionability (ESCAT tier I-III) involved genes of the RAF (10.3%), BRCA (5.9%) or FGFR pathways (5.9%). We present the activity of the RAF kinases inhibitor sorafenib in patients with RAF-mutated advanced PDC. CONCLUSIONS In advanced PDC, NGS is a feasible and valuable method for enabling precision oncology. This genomic profiling method might be considered after standard treatments failure, especially in young patients maintaining a good performance status, in order to detect potentially actionable mutations and offer molecularly targeted therapeutic approaches.
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Affiliation(s)
- Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy.
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Stefano Gobbo
- Patological Anatomy Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Giulia Fasoli
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy
| | - Valentina Allegrini
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Francesca Simionato
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Camilla Pesoni
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Andrea Mambrini
- Medical Oncology Unit, Azienda USL Toscana Nord Ovest, Carrara, Massa Carrara, Italy
| | - Emilio Barbi
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Roberto Girelli
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Alessandro Giardino
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Isabella Frigerio
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | | | | | | | - Michele Milella
- Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Giovanni Butturini
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
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11
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Merz V, Gaule M, Zecchetto C, Cavaliere A, Casalino S, Pesoni C, Contarelli S, Sabbadini F, Bertolini M, Mangiameli D, Milella M, Fedele V, Melisi D. Targeting KRAS: The Elephant in the Room of Epithelial Cancers. Front Oncol 2021; 11:638360. [PMID: 33777798 PMCID: PMC7991835 DOI: 10.3389/fonc.2021.638360] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
Mutations of the proto-oncogene KRAS are the most frequent gain-of-function alterations found in cancer. KRAS is mutated in about 30% of all human tumors, but it could reach more than 90% in certain cancer types such as pancreatic adenocarcinoma. Although historically considered to be undruggable, a particular KRAS mutation, the G12C variant, has recently emerged as an actionable alteration especially in non-small cell lung cancer (NSCLC). KRASG12C and pan-KRAS inhibitors are being tested in clinical trials and have recently shown promising activity. Due to the difficulties in direct targeting of KRAS, other approaches are being explored. The inhibition of target upstream activators or downstream effectors of KRAS pathway has shown to be moderately effective given the evidence of emerging mechanisms of resistance. Various synthetic lethal partners of KRAS have recently being identified and the inhibition of some of those might prove to be successful in the future. The study of escape mechanisms to KRAS inhibition could support the utility of combination strategies in overcoming intrinsic and adaptive resistance and enhancing clinical benefit of KRASG12C inhibitors. Considering the role of the microenvironment in influencing tumor initiation and promotion, the immune tumor niche of KRAS mutant tumors has been deeply explored and characterized for its unique immunosuppressive skewing. However, a number of aspects remains to be fully understood, and modulating this tumor niche might revert the immunoresistance of KRAS mutant tumors. Synergistic associations of KRASG12C and immune checkpoint inhibitors are being tested.
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Camilla Pesoni
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Fabio Sabbadini
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Monica Bertolini
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Domenico Mangiameli
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
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12
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Peretti U, Cavaliere A, Niger M, Tortora G, Di Marco MC, Rodriquenz MG, Centonze F, Rapposelli IG, Giordano G, De Vita F, Stuppia L, Avallone A, Ratti M, Paratore C, Forti LG, Orsi G, Valente MM, Gaule M, Macchini M, Carrera P, Calzavara S, Simbolo M, Melisi D, De Braud F, Salvatore L, De Lorenzo S, Chiarazzo C, Falconi M, Cascinu S, Milella M, Reni M. Germinal BRCA1-2 pathogenic variants (gBRCA1-2pv) and pancreatic cancer: epidemiology of an Italian patient cohort. ESMO Open 2021; 6:100032. [PMID: 33399070 PMCID: PMC7807989 DOI: 10.1016/j.esmoop.2020.100032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Germline BRCA1-2 pathogenic variants (gBRCApv) increase the risk of pancreatic cancer and predict for response to platinating agents and poly(ADP-ribose) polymerase inhibitors. Data on worldwide gBRCApv incidence among pancreatic ductal adenocarcinoma (PDAC) patients are sparse and describe a remarkable geographic heterogeneity. The aim of this study is to analyze the epidemiology of gBRCApv in Italian patients. MATERIALS AND METHODS Patients of any age with pancreatic adenocarcinoma, screened within 3 months from diagnosis for gBRCApv in Italian oncologic centers systematically performing tests without any selection. For the purposes of our analysis, breast, ovarian, pancreas, and prostate cancer in a patient's family history was considered as potentially BRCA-associated. Patients or disease characteristics were examined using the χ2 test or Fisher's exact test for qualitative variables and the Student's t-test or Mann-Whitney test for continuous variables, as appropriate. RESULTS Between June 2015 and May 2020, 939 patients were tested by 14 Italian centers; 492 (52%) males, median age 62 years (range 28-87), 569 (61%) metastatic, 273 (29%) with a family history of potentially BRCA-associated cancers. gBRCA1-2pv were found in 76 patients (8.1%; 9.1% in metastatic; 6.4% in non-metastatic). The gBRCA2/gBRCA1 ratio was 5.4 : 1. Patients with gBRCApv were younger compared with wild-type (59 versus 62 years, P = 0.01). The gBRCApv rate was 17.1% among patients <40 years old, 10.4% among patients 41-50 years old, 9.2% among patients 51-60 years old, 6.7% among patients aged 61-70 years, and 6.2% among patients >70 years old (none out of 94 patients >73 years old). gBRCApv frequency in 845 patients <74 years old was 9%. Patients with/without a family history of potentially BRCA-associated tumors had 14%/6% mutations. CONCLUSION Based on our findings of a gBRCApv incidence higher than expected in a real-life series of Italian patients with incident PDAC, we recommend screening all PDAC patients <74 years old, regardless of family history and stage, due to the therapeutic implications and cancer risk prevention in patients' relatives.
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Affiliation(s)
- U Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Tortora
- Department of Medicine, Section of Medical Oncology, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - M C Di Marco
- Medical Oncology Division, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy; Medical Oncology Division, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M G Rodriquenz
- Oncology Unit, foundation IRCCS Casa Sollievo della sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - F Centonze
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - I G Rapposelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Giordano
- Department of Medical Oncology, Policlinico Riuniti, Azienda Ospedaliero Universitarià, Foggia, Italy
| | - F De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, 'Luigi Vanvitelli' University of Campania, Naples, Italy
| | - L Stuppia
- Medical Genetics, Department of Psychological, Health and Territorial Sciences Center for Advanced Sciences and Technology G. d'Annunzio University Chieti-Pescara Italy, Chieti, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori- IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Ratti
- Department of Oncology, Medical Department, ASST di Cremona, Ospedale di Cremona, Cremona, Italy
| | - C Paratore
- Chiara Paratore, University of Turin, Ordine Mauriziano Hospital, Largo Filippo Turati, Turin, Italy
| | - L G Forti
- SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy
| | - G Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M M Valente
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M Gaule
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Macchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - P Carrera
- Clinical Genomics - Molecular Genetics Service, Genomics for Diagnosis of Human Diseases, San Raffaele Hospital, Milan, Italy
| | - S Calzavara
- Clinical Genomics - Molecular Genetics Service, Genomics for Diagnosis of Human Diseases, San Raffaele Hospital, Milan, Italy
| | - M Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - D Melisi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - F De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - L Salvatore
- Department of Medicine, Section of Medical Oncology, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - S De Lorenzo
- Medical Oncology Division, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C Chiarazzo
- Oncology Unit, foundation IRCCS Casa Sollievo della sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - M Falconi
- Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy; Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy.
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13
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Luchini C, Paolino G, Mattiolo P, Piredda ML, Cavaliere A, Gaule M, Melisi D, Salvia R, Malleo G, Shin JI, Cargnin S, Terrazzino S, Lawlor RT, Milella M, Scarpa A. KRAS wild-type pancreatic ductal adenocarcinoma: molecular pathology and therapeutic opportunities. J Exp Clin Cancer Res 2020; 39:227. [PMID: 33115526 PMCID: PMC7594413 DOI: 10.1186/s13046-020-01732-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease, whose main molecular trait is the MAPK pathway activation due to KRAS mutation, which is present in 90% of cases.The genetic landscape of KRAS wild type PDAC can be divided into three categories. The first is represented by tumors with an activated MAPK pathway due to BRAF mutation that occur in up to 4% of cases. The second includes tumors with microsatellite instability (MSI) due to defective DNA mismatch repair (dMMR), which occurs in about 2% of cases, also featuring a high tumor mutational burden. The third category is represented by tumors with kinase fusion genes, which marks about 4% of cases. While therapeutic molecular targeting of KRAS is an unresolved challenge, KRAS-wild type PDACs have potential options for tailored treatments, including BRAF antagonists and MAPK inhibitors for the first group, immunotherapy with anti-PD-1/PD-L1 agents for the MSI/dMMR group, and kinase inhibitors for the third group.This calls for a complementation of the histological diagnosis of PDAC with a routine determination of KRAS followed by a comprehensive molecular profiling of KRAS-negative cases.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
| | - Gaetano Paolino
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
| | - Maria L Piredda
- ARC-Net Research Center, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Alessandro Cavaliere
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Marina Gaule
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Davide Melisi
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Roberto Salvia
- Department of Surgery, University of Verona, 37134, Verona, Italy
| | - Giuseppe Malleo
- Department of Surgery, University of Verona, 37134, Verona, Italy
| | - Jae Il Shin
- Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
| | - Sarah Cargnin
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100, Novara, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100, Novara, Italy
| | - Rita T Lawlor
- ARC-Net Research Center, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy.
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134, Verona, Italy
- ARC-Net Research Center, University and Hospital Trust of Verona, 37134, Verona, Italy
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14
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Simionato F, Zecchetto C, Merz V, Cavaliere A, Casalino S, Gaule M, D'Onofrio M, Malleo G, Landoni L, Esposito A, Marchegiani G, Casetti L, Tuveri M, Paiella S, Scopelliti F, Giardino A, Frigerio I, Regi P, Capelli P, Gobbo S, Gabbrielli A, Bernardoni L, Fedele V, Rossi I, Piazzola C, Giacomazzi S, Pasquato M, Gianfortone M, Milleri S, Milella M, Butturini G, Salvia R, Bassi C, Melisi D. A phase II study of liposomal irinotecan with 5-fluorouracil, leucovorin and oxaliplatin in patients with resectable pancreatic cancer: the nITRO trial. Ther Adv Med Oncol 2020; 12:1758835920947969. [PMID: 33403007 PMCID: PMC7745557 DOI: 10.1177/1758835920947969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Up-front surgery followed by postoperative chemotherapy remains the standard paradigm for the treatment of patients with resectable pancreatic cancer. However, the risk for positive surgical margins, the poor recovery after surgery that often impairs postoperative treatment, and the common metastatic relapse limit the overall clinical outcomes achieved with this strategy. Polychemotherapeutic combinations are valid options for postoperative treatment in patients with good performance status. liposomal irinotecan (Nal-IRI) is a novel nanoliposome formulation of irinotecan that accumulates in tumor-associated macrophages improving the therapeutic index of irinotecan and has been approved for the treatment of patients with metastatic pancreatic cancer after progression under gemcitabine-based therapy. Thus, it remains of the outmost urgency to investigate introduction of the most novel agents, such as nal-IRI, in perioperative approaches aimed at increasing the long-term effectiveness of surgery. Methods: The nITRO trial is a phase II, single-arm, open-label study to assess the safety and the activity of nal-IRI with fluorouracil/leucovorin (5-FU/LV) and oxaliplatin in the perioperative treatment of patients with resectable pancreatic cancer. The primary tumor must be resectable with no involvement of the major arteries and no involvement or <180° interface between tumor and vessel wall of the major veins. A total of 72 patients will be enrolled to receive a perioperative treatment of three cycles before and three cycles after surgical resection with nal-IRI 50 mg/m2, oxaliplatin 60 mg/m2, leucovorin 200 mg/m2, and 5-fluorouracil 2400 mg/m2, days 1 and 15 of a 28-day cycle. The primary objective is to improve from 40% to 55% the proportion of patients achieving R0 resection after preoperative treatment. Discussion: The nITRO trial will contribute to strengthen the clinical evidence supporting perioperative strategies in resectable pancreatic cancer patients. Moreover, this study represents a unique opportunity for translational analyses aimed to identify novel immune-related prognostic and predictive factors in this setting. Trial registration Clinicaltrial.gov: NCT03528785. Trial registration data: 1 January 2018 Protocol number: CRC 2017_01 EudraCT Number: 2017-000345-46
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Affiliation(s)
- Francesca Simionato
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Alessandro Esposito
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | | | - Luca Casetti
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Massimiliano Tuveri
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Filippo Scopelliti
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Alessandro Giardino
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Isabella Frigerio
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Paolo Regi
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Paola Capelli
- Department of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Gobbo
- Department of Pathology, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | | | - Laura Bernardoni
- Endoscopy Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Irene Rossi
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Serena Giacomazzi
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Martina Pasquato
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Morena Gianfortone
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Michele Milella
- Medical Oncology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Butturini
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Roberto Salvia
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, AOUI Verona - Policlinico "G.B. Rossi", Piazzale L.A. Scuro, 10, Verona 37134, Italy
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Tregnago D, Zuliani S, Zampiva I, Casali M, Cavaliere A, Fumagalli A, Merler S, Riva S, Rossi A, Zacchi F, Zaninotto E, Caldart A, Casalino S, Gaule M, Kadrija D, Mongillo M, Rimondini M, Del Piccolo L, Milella M, Pilotto S. 1701P Oncological patients’ perception of infection risks and level of acceptance of protective measures during SARS-CoV-2 pandemic. Ann Oncol 2020. [PMCID: PMC7506354 DOI: 10.1016/j.annonc.2020.08.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Merz V, Zecchetto C, Simionato F, Cavaliere A, Casalino S, Pavarana M, Giacopuzzi S, Bencivenga M, Tomezzoli A, Santoro R, Fedele V, Contarelli S, Rossi I, Giacomazzi S, Pasquato M, Piazzola C, Milleri S, de Manzoni G, Melisi D. A phase II trial of the FGFR inhibitor pemigatinib in patients with metastatic esophageal-gastric junction/gastric cancer trastuzumab resistant: the FiGhTeR trial. Ther Adv Med Oncol 2020; 12:1758835920937889. [PMID: 32684989 PMCID: PMC7346700 DOI: 10.1177/1758835920937889] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Prognosis of patients affected by metastatic esophageal–gastric junction (EGJ) or gastric cancer (GC) remains dismal. Trastuzumab, an anti-HER2 monoclonal antibody, is the only targeted agent approved for the first-line treatment of patients with HER2-overexpressing advanced EGJ or GC in combination with chemotherapy. However, patients invariably become resistant during this treatment. We recently identified the overexpression of fibroblast growth factor (FGF) receptor 3 (FGFR3) as a molecular mechanism responsible for trastuzumab resistance in GC models, providing the rationale for the inhibition of this receptor as a potential second-line strategy in this disease. Pemigatinib is a selective, potent, oral inhibitor of FGFR1, 2, and 3. Methods: The FiGhTeR trial is a phase II, single-arm, open-label study to assess safety and activity of the FGFR inhibitor pemigatinib as second-line treatment strategy in metastatic EGJ/GC patients progressing under trastuzumab-containing therapies. The primary endpoint is the 12-week progression-free survival rate. Plasma and tumor tissue samples will be collected for translational research analyses at baseline, during treatment, and at progression on pemigatinib. Discussion: Co-alterations in genes coding for different tyrosine-kinase receptors are emerging as relevant mechanisms of acquired resistance to anti-HER2 therapeutic strategies in GC. In particular, our group has recently identified that in GC models the overexpression of FGFR3 sustains the acquired resistance to trastuzumab. This trial aims to assess the safety, tolerability and activity of the FGFR inhibitor pemigatinib as a second-line treatment in metastatic EGJ/GC patients refractory to first-line trastuzumab-containing therapies. Furthermore, this study offers the opportunity to prospectively study mechanisms and pathways involved in trastuzumab resistance. Protocol number: CRC2017_02 EudraCT Number: 2017-004522-14
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Francesca Simionato
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Michele Pavarana
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Giacopuzzi
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Bencivenga
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Tomezzoli
- Anatomical Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Irene Rossi
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Serena Giacomazzi
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Martina Pasquato
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni de Manzoni
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology unit, Section of Medical Oncology, Department of Medicine, University of Verona, AOUI Verona - Policlinico "G.B. Rossi", Piazzale L.A. Scuro,10, Verona, 37134, Italy
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Merz V, Cavaliere A, Messina C, Salati M, Zecchetto C, Casalino S, Milella M, Caffo O, Melisi D. Multicenter Retrospective Analysis of Second-Line Therapy after Gemcitabine Plus Nab-Paclitaxel in Advanced Pancreatic Cancer Patients. Cancers (Basel) 2020; 12:E1131. [PMID: 32366019 PMCID: PMC7281137 DOI: 10.3390/cancers12051131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
Pancreatic cancer is one of the most lethal solid tumors. In many European countries gemcitabine plus nab-paclitaxel is the preferred first-line treatment. An increasing number of patients are eligible for second-line therapy, but the best regimen is still controversial. This study aimed to evaluate the efficacy of oxaliplatin-based compared to irinotecan-based therapies in this setting. 181 advanced pancreatic cancer patients consecutively treated in three centers with a second-line therapy progressed on gemcitabine plus nab-paclitaxel were retrospectively enrolled. OS and PFS were calculated using the Kaplan-Meier method and survival of the two groups was compared using the log-rank test. The median PFS and OS were respectively 3.5 (95%CI 3.2-3.8) and 8.8 months (95%CI 7.9-9.8) from second-line therapy in the overall population. The median PFS and OS were respectively 3.3 (95%CI 3.1-3.5) and 8.2 months (95%CI 7.24-9.34) with an irinotecan-based combination compared to 4.0 (95%CI 2.4-5.7) and 10.3 months (95%CI 8.62-12.02) in patients receiving an oxaliplatin-based combination. We observed a clear trend for longer survival outcomes with platinum-based doublet compared to regimens including irinotecan or nal-IRI. Head-to-head trials are still lacking. The neutrophil-to-lymphocyte ratio and the presence of liver metastases could drive physicians in tailoring the treatment strategy.
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy; (C.M.); (O.C.)
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy; (C.M.); (O.C.)
| | - Massimiliano Salati
- Department of Medical Oncology, University Hospital of Modena, 4121 Modena, Italy;
- PhD Program Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, 4121 Modena, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
| | - Michele Milella
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy; (C.M.); (O.C.)
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
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Cavaliere A, Merz V, Casalino S, Zecchetto C, Simionato F, Salt HL, Contarelli S, Santoro R, Melisi D. Novel Biomarkers for Prediction of Response to Preoperative Systemic Therapies in Gastric Cancer. J Gastric Cancer 2019; 19:375-392. [PMID: 31897341 PMCID: PMC6928085 DOI: 10.5230/jgc.2019.19.e39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Preoperative chemo- and radiotherapeutic strategies followed by surgery are currently a standard approach for treating locally advanced gastric and esophagogastric junction cancer in Western countries. However, in a large number of cases, the tumor is extremely resistant to these treatments and the patients are exposed to unnecessary toxicity and delayed surgical therapy. The current clinical trials evaluating the combination of preoperative systemic therapies with modern targeted and immunotherapeutic agents represent a unique opportunity for identifying predictive biomarkers of response to select patients that would benefit the most from these treatments. However, it is of utmost importance that these potential biomarkers are corroborated by extensive preclinical and translational research. The aim of this review article is to present the most promising biomarkers of response to classic chemotherapeutic, anti-HER2, antiangiogenic, and immunotherapeutic agents that can be potentially useful for personalized preoperative systemic therapies in gastric cancer patients.
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Affiliation(s)
- Alessandro Cavaliere
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valeria Merz
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simona Casalino
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Simionato
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Hayley Louise Salt
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Melisi
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
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Merz V, Zecchetto C, Santoro R, Simionato F, Piro G, Sabbadini F, Cavaliere A, Casalino S, Auriemma A, Melisi D. Plasmatic CXCL8 is a marker for TGFß-activated kinase 1 (TAK1) activation which may predict resistance to nanoliposomal irinotecan (nal-IRI) in gemcitabine-refractory pancreatic cancer (PC) patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The carcinogenic and cocarcinogenic action of phenobarbital sodium was investigated in adult BALB/c mice of both sexes when administered alone at a concentration of 0.05 % in drinking water for life or after the animals had been treated with a single hydrazine sulphate dose of 5.65 mg. The results demonstrated that phenobarbital sodium is not carcinogenic in this strain of mice, but, since a single dose of hydrazine sulphate was carcinogenic, does not clarify whether it is a cocarcinogen in the lung.
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Abstract
Aims and background Granular cell tumor, usually a benign neoplasm, has been the object of many studies because of its uncertain histogenesis and based on many immunohistochemical and ultrastructural studies it has been suggested that it originates from the Schwann cell. Our recent observation that granular cell tumor is positive with PG-M1, a new anti-macrophage monoclonal antibody, led us to further investigate the immunophenotypic profile of the tumor. Study design We studied 11 granular cell tumors using a panel of 20 antibodies, 13 monoclonal and 7 polyclonal. Results The immunohistochemical study showed in all cases a constant diffuse positivity for S-100 protein, neuron-specific enolase, vimentin, KP1 and PG-M1, as well as occasional and focal positivity for alpha-1-antitrypsin, alpha-1-antichymotrypsin and lysozyme. Conclusions The immunophenotypic profile constantly observed could be the expression, on one hand, of the neuroectodermic nature of the neoplasm, proven by positivity for S-100 protein, neuron specific enolase and vimentin, and on the other could be the expression of the phagocytic activity of the tumor cell, proven by positivity for KP1 and PG-M1 antibodies and also by the presence of numerous phagolysosomes.
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Affiliation(s)
- A Cavaliere
- Institute of Pathological Anatomy and Histology, Perugia University, Italy
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Abstract
Metronidazole, which is widely used in the treatment of «Trichomonas vaginalis», «Entamoeba histolytica» and «Giardia lamblia» infections, was administered to BALB/c mice by stomach tube in an aqueous solution at a dose rate of 2 mg/day for 100 days (total 200 mg) to test its carcinogenicity. The treatment induced a significant increase in lung tumors in male mice (p < 0.001) and provoked the appearance of lymphomas in females (p < 0.001). Although there is insufficient evidence to pass judgement on the potential carcinogenicity of metronidazole in man, the results of this and other investigations reported in the literature have demonstrated that metronidazole develops carcinogenic activity in rats and mice.
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Abstract
Sprague-Dawley rats were administered low doses of metronidazole similar to those used in humans, and then subjected to a long-term follow-up. Metronidazole caused a significant rise in mammary tumors in the female rats (p < 0.001) after a mean latency period of 100.5 weeks.
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Abstract
5-Fluorouracil, a drug mainly used in the treatment of gastrointestinal tract neoplasms, was administered i.p. to BALB/c mice at the dose of 30 mg/kg body weight once a week for 50 weeks to test its carcinogenicity. The treatment induced a significant increase in lung tumor in both sexes (males, p < 0.05; females, p < 0.01) and tumors of the lymphoreticular system in female mice (p < 0.001). These results suggest that 5-fluorouracil is carcinogenic in mice.
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Affiliation(s)
- A Cavaliere
- Institute of Pathological Anatomy and Histology, 1st Chair, Perugia University, Italy
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Abstract
Aims and background Giant cell tumor of tendon sheath (GCTTS) is a common tumor occurring on the tendon sheaths of the fingers. The nature of this lesion is still controversial: some researchers consider it a reactive process arising from chronic inflammation while others regard it as a tumor of presumed synovial cell or monocytic macrophage system origin. In an effort to clarify the histogenesis we decided to further investigate the immunophenotypic profile of this tumor. Study design We studied 20 GCTTS of the fingers using a panel of 18 antibodies, 13 monoclonal and 5 polyclonal. Results The immunohistochemical investigation revealed that the mononuclear cells of this lesion can be divided into two groups. The cells of the first and more numerous group were positive for vimentin, PG-M1 and KP1 but also for muscle actin (HHF35 monoclonal antibody) and neuron-specific enolase. A second population of mononuclear cells, usually arranged around the giant cells, were positive for PG-M1, KP1, LCA and occasionally for alpha-1-antitrypsin and alpha-1-antichymotrypsin. Multinucleated giant cells were also positive for KP1, PG-M1 and LCA monoclonal antibodies. A variable but usually weak positivity for al-pha-1-antitrypsin, alpha-1-antichymotrypsin and lysozyme was also observed. Conclusions Our results suggest a synovial cell origin for GCTTS and do not support the hypothesis that it could be a neoplasm with a true histiocytic origin. The positivity of some cells for the HHF35 antibody, together with electron microscopic evidence of filament bundles with focal dense bodies, suggests that at least part of the mononuclear cells may have a myofibroblastic differentiation.
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Affiliation(s)
- A Cavaliere
- Institute of Pathological Anatomy and Histology, First Chair, Perugia University, Italy
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Abstract
A case of bilateral primary malignant lymphoma of the breast in a 30 year old woman is described. The tumors were first discovered during a self-examination of the breast at the 7th month of pregnancy. Thereafter they rapidly increased in size. The patient underwent simple bilateral mastectomy, and histological examination revealed a centroblastic/centro-cytic lymphoma. The patient is alive and well 9 months after mastectomy.
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Affiliation(s)
- E Bucciarelli
- Institute of Pathologic Anatomy and Histoylogy, Perugia University, Italia
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Bidviene J, Zhukovskiy N, Peritore A, Rodrigues I, Tundidor Sanz ME, Guerreiro RA, Marini C, Cereda A, Dorobantu DM, Cavalli G, Cavaliere A, Genovese D, Romeo G, Aruta P, Cucchini U, Iliceto S, Badano LP, Muraru D, Okhotin A, Privorotskaya V, De Chiara B, Musca F, Spano' F, Santambrogio G, Casadei F, Forti E, Mutignani M, Giannattasio C, Moreo A, Galrinho A, Branco L, Bravio I, Machado D, Monteiro A, Daniel P, Ferreira L, Carvalho R, Ferreira R, Tierra Rodriguez AM, Dios Diez P, Mayorga Bajo A, Fernandez Gomez MJ, Dominguez Calvo JI, Rogriguez Palomo D, Hernandez Rodriguez J, Congo K, Carvalho J, Pais J, Bras D, Picarra B, Caeiro A, Fragata J, Aguiar J, Stella S, Rosa I, Pavon AG, Ancona F, Margonato A, Colombo A, Latib A, Montorfano M, Agricola E, Casadei F, Moreo A, Ghiorghiu IA, Popescu BA, Coman IM, Ginghina CD, Enache R. Clinical Cases: See that case at least once1174An unrecognized mechanism of functional tricuspid regurgitation revealed by transthoracic three-dimensional echocardiography1175Left ventricular pseudoaneurysm after radiofrequency ablation of premature ventricular contractions1176Succesfull management of buckling of echocardiographic transesophageal probe1177An extremely rare tumor of cardiovascular system1178Pneumopericardium: a rare complication of esophageal cancer1179Left atrial dissection after myocardial infarction1180Late appearance of a ventricular septal defect after transcatheter aortic valve replacement: a rare complication1181Doppler flow velocities pattern in a trombophiliac patient with an lvad thrombosis1182An unusual cause of aortic diastolic reflux in a failed single ventricle palliation. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vecchio GM, Cavaliere A, Cartaginese F, Lucaccioni A, Lombardi T, Parenti R, Salvatorelli L, Magro G. Intraparenchymal leiomyoma of the breast: report of a case with emphasis on needle core biopsy-based diagnosis. Pathologica 2013; 105:122-127. [PMID: 24466762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE We report the clinicopathologic features of a rare case of leiomyoma of the breast parenchyma in a 36-year-old female, diagnosed preoperatively at core biopsy. A complete review of the literature on the topic is provided and differential diagnostic problems are discussed. METHODS Standard histological examination and immunohistochemical analyses using a large panel of antibodies were performed in both the core biopsy and surgical specimen. RESULTS Ultrasonography revealed a well-circumscribed tumour mass without calcifications. Histological examination of the core biopsy showed proliferation of bland-looking eosinophilic spindle cells arranged in a fascicular growth pattern. Mitoses, pleomorphism and necrosis were absent. Immunohistochemistry, revealing diffuse staining for a-smooth muscle actin, desmin and h-caldesmon, confirmed the leiomiomatous nature of neoplastic cells. Histological and immunohistochemical analyses of the surgical specimen confirmed the definitive diagnosis of leiomyoma. CONCLUSIONS The present case emphasizes that diagnosis of leiomyoma of the breast parenchyma can be confidentially rendered on needle core biopsy. We believe that correct diagnosis is primarily dependent on the awareness that this tumour can arise in this unusual site on rare occasions.
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Affiliation(s)
- G M Vecchio
- Dipartimento G. F. Ingrassia, Anatomia Patologica, Università di Catania, AOU Policlinico-Vittorio Emanuele, Catania
| | - A Cavaliere
- Istituto di Anatomia Patologica, Azienda Ospedaliera di Perugia, Perugia
| | - F Cartaginese
- Anatomia Patologica, Ospedale Città di Castello, Città di Castello
| | - A Lucaccioni
- Anatomia Patologica, Ospedale Città di Castello, Città di Castello
| | - T Lombardi
- U. O. di Senologia, Ospedale Città di Castello, Città di Castello
| | - R Parenti
- Dipartimento Scienze Biomediche, Sezione di Fisiologia, Università di Catania, Catania
| | - L Salvatorelli
- Dipartimento G. F. Ingrassia, Anatomia Patologica, Università di Catania, AOU Policlinico-Vittorio Emanuele, Catania
| | - G Magro
- Dipartimento G. F. Ingrassia, Anatomia Patologica, Università di Catania, AOU Policlinico-Vittorio Emanuele, Catania
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Greco G, Lanero TS, Torrassa S, Young R, Vassalli M, Cavaliere A, Rolandi R, Pelucchi E, Faimali M, Davenport J. Microtopography of the eye surface of the crab Carcinus maenas: an atomic force microscope study suggesting a possible antifouling potential. J R Soc Interface 2013; 10:20130122. [PMID: 23635491 DOI: 10.1098/rsif.2013.0122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Marine biofouling causes problems for technologies based on the sea, including ships, power plants and marine sensors. Several antifouling techniques have been applied to marine sensors, but most of these methodologies are environmentally unfriendly or ineffective. Bioinspiration, seeking guidance from natural solutions, is a promising approach to antifouling. Here, the eye of the green crab Carcinus maenas was regarded as a marine sensor model and its surface characterized by means of atomic force microscopy. Engineered surface micro- and nanotopography is a new mechanism found to limit biofouling, promising an effective solution with much reduced environmental impact. Besides giving a new insight into the morphology of C. maenas eye and its characterization, our study indicates that the eye surface probably has antifouling/fouling-release potential. Furthermore, the topographical features of the surface may influence the wettability properties of the structure and its interaction with organic molecules. Results indicate that the eye surface micro- and nanotopography may lead to bioinspired solutions to antifouling protection.
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Affiliation(s)
- G Greco
- BEES, University College Cork, Cooperage, Cork, Republic of Ireland.
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30
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Bennett RA, Serpelloni E, Hreinsdóttir S, Brandon MT, Buble G, Basic T, Casale G, Cavaliere A, Anzidei M, Marjonovic M, Minelli G, Molli G, Montanari A. Syn-convergent extension observed using the RETREAT GPS network, northern Apennines, Italy. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2011jb008744] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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31
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Pistilli B, Grana C, Fazio N, Cavaliere A, Ferrari M, Bodei L, Baio S, Scambia G, Paganelli G, Peccatori F. Pregnant with metastatic neuroendocrine tumour of the ovary: what now? Ecancermedicalscience 2012; 6:240. [PMID: 22331988 PMCID: PMC3273852 DOI: 10.3332/ecancer.2012.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Indexed: 12/25/2022] Open
Abstract
Neuroendocrine tumours (NET) are a heterogeneous group of neoplasms commonly occurring in the gastrointestinal tract or lungs but can occur in other regions. Primary ovarian NET account for 5% of all NET and 0.1% of all ovarian malignancies. In metastatic disease, the therapeutic goal is to extend survival and to improve quality of life. As these tumours express somatostatin receptors, somatostatin analogues are frequently used to control symptoms. Here we present a case of a pregnant woman with an ovarian NET with liver metastases and carcinoid syndrome who was treated with the somatostatin analogue, Octreotide LAR. We also summarize reported data of the use of somatostatin analogues during pregnancy.
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Affiliation(s)
- B Pistilli
- Department of Medical Oncology, Ospedale di Macerata and Fertility and Procreation in Oncology Unit, Department of Medicine, European Institute of Oncology, Milan, Italy
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32
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Aristei C, Leonardi C, Stracci F, Palumbo I, Luini A, Viale G, Cristallini E, Cavaliere A, Orecchia R. Risk factors for relapse after conservative treatment in T1–T2 breast cancer with one to three positive axillary nodes: results of an observational study. Ann Oncol 2011; 22:842-847. [DOI: 10.1093/annonc/mdq470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Daniele S, Pelliccioli GP, Daniele C, Mandich P, Montera M, Simoncelli C, Bianchi M, Cavaliere A. Von Hippel-Lindau disease in twins: clinical and molecular study. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00276.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Mosconi A, Ludovini V, Pistola L, Tofanetti FR, Mameli MG, Anastasi P, Porrozzi S, Cavaliere A, Cantelmi MG, Crino L. Mutational analysis of KRAS, BRAF, and p53 genes in borderline and malignant epithelial ovarian tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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35
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Franco G, Dente D, Leonardo C, De Nunzio C, De Cillis A, Caliolo C, Cavaliere A, Palminteri E, Carlo D. 724 TESTICULAR TUMORECTOMY: A NEW ALGORITHM. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1569-9056(10)60709-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Aristei C, Leonardi M, Stracci F, Palumbo I, Luini A, Viale G, Cavaliere A, Cristallini E, Orecchia R. 241 Loco-regional recurrence after breast conservative surgery and radiotherapy to the breast in patients with T1–2 disease and 1–3 positive axillary nodes. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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37
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Banterle A, Cavaliere A, Stranieri S. European traditional food producers and marketing capabilities: An application of the marketing management process. ACTA ACUST UNITED AC 2009. [DOI: 10.19041/apstract/2009/5-6/7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The purpose of this paper is to evaluate the marketing management capabilities of SMEs producing traditional food products, in order to analyse the market orientation of SMEs in the food industry. Following the theoretical approach of Market Orientation, our analysis is based on an assessment of the marketing management process. The methodology refers to a survey developed through a questionnaire published on the web, and a sample of 371 firms based in Belgium, Italy, Spain, the Czech Republic and Hungary was used in the analysis. Cluster analysis was applied to find the different levels of market orientation of the firms. The results revealed a certain lack of appropriate skills in marketing management in the firms of the sample, confirming the evidence found in economic literature concerning SMEs. Nevertheless, cluster analysis outlined a group of firms with good marketing capabilities and market oriented, and these represent a great part of the sample (40%). With regard to the stages of the marketing management process, the most problematic are those of planning and implementation, and control and evaluation, highlighting the difficulties SMEs encounter in carrying out coordinated marketing; which appears to be generally characterised by poor organisational capacity.
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Cavaliere A, Ermito S, Mammaro A, Dinatale A, Accardi MC, Pappalardo EM, Recupero S. Ultrasound Scanning in Fetal Renal Pelvis Dilatation: not only Hydronephrosis. J Prenat Med 2009; 3:60-61. [PMID: 22439049 PMCID: PMC3279112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pelvic dilatation is the alteration of the urinary tractmost frequently detected by maternal-fetalultra-sound. Hydronephrosis is not a diagnosis; it is an imagefinding. The diagnosis is the cause that produces it. Since pelvic dilatation is relatively frequent in thenormal fetus, and the definition and diagnosis of hy-dronephrosis are difficult, once it is detected, adequate follow-up is required. Therefore, it is important for the urologist and obstetrician to understanddifferential diagnosis and clinical implications in order to offer an accurate counselling to the parents.
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Affiliation(s)
- Alessandro Cavaliere
- Department of Prenatal Diagnosis, Fetal Maternal Medical Centre "ARTEMISIA", Rome Italy
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Pedata R, Palermo M, Maiello M, Esposito N, Ermito S, Dinatale A, Carrara S, Cavaliere A. Fetal lung lesions diagnosis: the crucial role of ultrasonography. J Prenat Med 2009; 3:49-52. [PMID: 22439045 PMCID: PMC3279113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fetal lung lesions may cause significant effects of mass and may evolve into a non-immune hydrops and lead to the death of the fetus or the child. Treatment options for these severely affected infants are constantly evolving. The widespread use of ultrasound in prenatal diagnosis, in tertiary center like ours, allows us to identify the fetus, including lung lesions more 'small. Prenatal diagnosis and possible therapeutic intervention in the immediate prenatal or postnatal period has significantly changed the quality of life and the survival of fetuses and infants, especially those who were completely asymptomatic at birth.Object of our interest is the pulmonary sequestration and congenital pulmonary malformation is the second in order of frequency, with an incidence between 0.15% and 6.4% of cases.
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Affiliation(s)
- Rosa Pedata
- Dipartimento di Scienze Ginecologiche,Ostetriche e della Riproduzione. Seconda Università degli Studi di Napoli
| | - Mariarosaria Palermo
- Dipartimento di Scienze Ginecologiche,Ostetriche e della Riproduzione. Seconda Università degli Studi di Napoli
| | - Monica Maiello
- Dipartimento di Scienze Ginecologiche,Ostetriche e della Riproduzione. Seconda Università degli Studi di Napoli
| | - Nunzia Esposito
- Dipartimento di Scienze Ginecologiche,Ostetriche e della Riproduzione. Seconda Università degli Studi di Napoli
| | - Santina Ermito
- Unità Operativa di Ginecologia e Ostetricia, Policlinico Universitario “ G. Martino”, Messina, Italy
| | - Angela Dinatale
- Unità Operativa di Ginecologia e Ostetricia, Policlinico Universitario “ G. Martino”, Messina, Italy
| | - Sabina Carrara
- Department of Gynecology & Obstetrics, Sapienza University of Rome, Rome, Italy
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40
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De Paola N, Ermito S, Nahom A, Dinatale A, Pappalardo EM, Carrara S, Cavaliere A, Brizzi C. Prenatal diagnosis of left isomerism with normal heart: a case report. J Prenat Med 2009; 3:37-38. [PMID: 22439041 PMCID: PMC3279108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Left isomerism, also called polysplenia, is a laterality disturbance associated with with paired leftsidedness viscera and multiple small spleens. Left isomerism, heart congenital abnormalities and gastrointestinal malformation are strongly associated. METHODS We present a case of prenatal diagnosis of left isomerism in a fetus with a structurally normal heart. CONCLUSION Left isomerism syndrone may coesist with a structurally normal heart. If prenatal left isomerism is suspected, even in presence of a normal heart, is mandatory to esclude sign of gastrointestinal abnormalities, as late poly hy dramnios, and cardiac rhytm disturbance during the pregnancy and neonatal age.
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Affiliation(s)
- Nico De Paola
- Division of Pediatric Cardiology - Hospital S. Pietro Fatebenefratelli, Rome, Italy
| | - Santina Ermito
- Operative Unit of Obstetrics and Gynecology, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Antonella Nahom
- Neonatal Surgery Unit, Department of Neonatology, “Bambino Gesù” Children Hospital, Rome, Italy
| | - Angela Dinatale
- Operative Unit of Obstetrics and Gynecology, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Elisa Maria Pappalardo
- Department of Gynecology and Obstetrics, ARNAS, Garibaldi Nesima Hospital, Catania, Italy
| | - Sabina Carrara
- Department of Gynecology & Obstetrics, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cavaliere
- Department of Prenatal Diagnosis, Artemisia Fetal Maternal Medical Centre, Rome Italy
| | - Cristiana Brizzi
- Department of Prenatal Diagnosis, Artemisia Fetal Maternal Medical Centre, Rome Italy
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41
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Cavaliere A, Dinatale A, Cardinale G, Ermito S, La Galia T, Circosta B, Imbruglia L, Rapisarda G. A prenatally diagnosed case of sirenomelia with dextrocardia and omphalocele. J Prenat Med 2009; 3:42-43. [PMID: 22439043 PMCID: PMC3279106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Sirenomelia (Mermaid syndrome) is a rare anomaly of caudal region of the body, presented with fusion of the lower limbs. Genito-urinary, gastro-intestinal, neural tube and vertebral anomalies are found in most cases. METHODS We present a case of sirenomelia diagnosed in the first tri-mester, associated with dextrocardia, and omphalocele CONCLUSION First trimester diagnosis of sirenomielia is possible and early diagnosis gives the parents the option of early pregnancy termination.
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Affiliation(s)
- Alessandro Cavaliere
- Department of Prenatal Diagnosis, Fetal Maternal Medical Centre "Artemisia", Rome, Italy
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42
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Ludovini V, Bellezza G, Pistola L, Bianconi F, Di Carlo L, Sidoni A, Semeraro A, Del Sordo R, Tofanetti F, Mameli M, Daddi G, Cavaliere A, Tonato M, Crinò L. High coexpression of both insulin-like growth factor receptor-1 (IGFR-1) and epidermal growth factor receptor (EGFR) is associated with shorter disease-free survival in resected non-small-cell lung cancer patients. Ann Oncol 2009; 20:842-9. [DOI: 10.1093/annonc/mdn727] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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43
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Cavaliere A, Colella R, Puxeddu E, Gambelunghe G, Falorni A, Stracci F, d'Ajello M, Avenia N, De Feo P. A useful ultrasound score to select thyroid nodules requiring fine needle aspiration in an iodine-deficient area. J Endocrinol Invest 2009; 32:440-4. [PMID: 19494709 DOI: 10.1007/bf03346483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The high prevalence of thyroid nodules in iodine-deficient areas is a practical problem because of the large number of patients requiring fine needle aspiration (FNA) to detect malignant nodules. AIM To obtain an ultrasound (US) score for predicting malignant nodules and reduce the number of unnecessary and expensive FNA. SUBJECT AND METHOD All nodules observed from September 2001 to March 2006 were evaluated by US: echostructure, echogenicity, halo, microcalcifications and ratio between antero-posterior and transversal diameters (AP/TR). Two thousand six hundred and forty-two consecutive patients underwent US-guided FNA for a total of 3645 nodules. RESULTS Logistic regression analysis showed a potent predictive role for solitary nodules and absence/ incomplete halo (p=0.000). A significant predictive role for microcalcifications and AP/TR ratio was also observed. A 10-point score was constructed using the standardized regression coefficient. Nodules with US score <or=2.4, those between 2.5-5.4 and >or=5.5 had a frequency of malignancy of 0.4, 1.1 and 5.6% (p<0.001), respectively. Nodules with >or=5.5 US score were characterized by a 66% sensitivity and a 76% specificity compared to the diagnostic values of single parameters which were either sensitive or specific. CONCLUSIONS According to our data, we suggest FNA for nodules reaching a >5.4 US score, whereas a clinical judgement should be used for the intermediate category nodules. When the score is lower than 2.5 we do not recommend FNA. The practical use of this US score can help reduce unnecessary and expensive FNA in iodine-deficient areas.
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Affiliation(s)
- A Cavaliere
- Institute of Pathological Anatomy, Perugia University, Perugia, Italy
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44
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Cacciatore A, Rapiti S, Carrara S, Cavaliere A, Ermito S, Dinatale A, Imbruglia L, Recupero S, La Galia T, Pappalardo EM, Accardi MC. Obstetric management in Rh alloimmunizated pregnancy. J Prenat Med 2009; 3:25-7. [PMID: 22439037 PMCID: PMC3279102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Rh alloimmunization occurs when maternal immune system is sensitized to D(Rh) erythrocyte surface antigens.The most common causes of maternal Rh alloimmunisation are blood transfusion and antepartum or intrapartum fetomaternal hemorrhage (abdominal trauma, abortion, ectopic pregnancy, invasive obstetric procedures, placental abruption, external cephalic version).The risk of alloimmunization is affected by several factors, including the degree of fetomaternal hemorrhage and maternal immune respons.Although the introduction of anti D prophylaxis reduced dramatically the rate of alloimmunization in susceptible women, his prevention is not universal and about 0.3% of susceptible women still become Rh D alloimmunized.The aim of this article is to review the management of the Rh alloimmunizated pregnant.
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Affiliation(s)
- Alessandra Cacciatore
- Department of Gynecology and Obstetrics, Università - Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico", Catania, Italy
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45
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Pappalardo EM, Militello M, Rapisarda G, Imbruglia L, Recupero S, Ermito S, Dinatale A, Carrara S, Cavaliere A. Fetal intracranial cysts: prenatal diagnosis and outcome. J Prenat Med 2009; 3:28-30. [PMID: 22439038 PMCID: PMC3279101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Intracranial cysts are central nervous system malformations involving different brain regions, and commonly diagnosed during prenatal period by ultrasound scan (US). A malformative cyst is a nontumoral fluid-filled collection exerting a mass effect on the brain parenchyma and/or on the ventricles, regardless of its location within subarachnoid spaces, brain or ventricles, and of the nature of its limiting membrane, which is always unknown prenatally. Although a large number of case reports have been published, many uncertainties remain concerning their epidemiology, pathogenesis, and outcome. Most of these lesions, if not associated with other fetal anomalies, are benign in nature, remain clinically silent, do not evolve or even frequently regress spontaneously and do not impair physiologic neurodevelopment. The normality of the adjacent brain is the major argument in favour of a malformative lesion. The correct diagnosis is of crucial importance to exclude the presence of other rare lesions (e.g. cystic neoplasms or intracranial hemorrhage) that could negatively affect neurodevelopmental outcome of the child. To establish a correct prognosis all efforts must aim to precisely interpret the US images accurately analyzing the brain anatomy.
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Affiliation(s)
- Elisa Maria Pappalardo
- Department of Gynecology and Obstetrics, ARNAS, Garibaldi Nesima Hospital, Catania, Italy
| | - Mariapia Militello
- Azienda Ospedaliero-Universitaria, Policlinico “G. Rodolico”, Catania, Italy Clinic of Obstetrics and Gynecology
| | - Giusi Rapisarda
- Department of Gynecology and Obstetrics, ARNAS, Garibaldi Nesima Hospital, Catania, Italy
| | - Laura Imbruglia
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Stefania Recupero
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Santina Ermito
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Angela Dinatale
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Sabina Carrara
- Department of Gynecology & Obstetrics, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cavaliere
- Department of Prenatal Diagnosis, Fetal Maternal Medical Centre “Artemisia”, Rome Italy
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Ermito S, Dinatale A, Carrara S, Cavaliere A, Imbruglia L, Recupero S. Prenatal diagnosis of limb abnormalities: role of fetal ultrasonography. J Prenat Med 2009; 3:18-22. [PMID: 22439035 PMCID: PMC3279100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fetal ultrasonografy is the most important tool to provide prenatal diagnosis of fetal anomalies. The detection of limb abnormalities may be a complex problem if the correct diagnostic approch is not established. A careful description of the abnormality using the rigth nomenclature is the first step. Looking for other associated abnormalities is the threshold to suspect chromosomal abnormalities or single gene disorder. According to the patogenic point of view, limb abnormalities may be the result of malformation, deformation, or disruption. The prenatal diagnosis and the management of limb abnormalities involve a multidisciplinary team of ostetrician, radiologist/sonologist, clinical geneticist, neonatologist, and orthopedic surgeons to provide the parents with the information regarding etiology of the disorder, prognosis, option related to the pregnancy and recurrence risk for future pregnancies.The aim of this review is to describe the importance of detailed fetal ultrasonography in prenatal diagnosis of limb abnormalities.
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Affiliation(s)
- Santina Ermito
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Angela Dinatale
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Sabina Carrara
- Department of Gynecology & Obstetrics, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cavaliere
- Department of Prenatal Diagnosis Fetal Maternal Medical Centre “Artemisia”, Rome Italy
| | - Laura Imbruglia
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Stefania Recupero
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
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Accardi MC, Lo Magno E, Ermito S, Dinatale A, Cacciatore A, Cavaliere A, Rossetti D. Echotomography of craniosynostosis: review of literature. J Prenat Med 2009; 3:31-33. [PMID: 22439039 PMCID: PMC3279099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ultrasound examination of the foetal cranium can diagnose fetal cranial defects and abnormal skull shape and it's aim is to detect in prenatal age most various abnormalities of the skull, brain and foetal face. The changes of each of these components frequently determine the growth of the other two.The abnormalities of the foetal head frequently appear and can associate serious pathological sceneries of high foetal and perinatal morbidity and mortality.Anomalies of the head have been observed using ultrasound study during the early second trimester. To establish diagnosis and long term prognosis is particularly important and helpful correct detection of the nature of the malformation.
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Affiliation(s)
- Manuela Chiara Accardi
- Department of Gynecology and Obstetrics, Università - Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico", Catania, Italy
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48
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Aristei C, Palumbo I, Cucciarelli F, Cavalli A, Tarducci R, Raymondi C, Perrucci E, Cavaliere A, Latini P, Rulli A. Partial breast irradiation with interstitial high-dose-rate brachytherapy in early breast cancer: Results of a phase II prospective study. Eur J Surg Oncol 2009; 35:144-50. [DOI: 10.1016/j.ejso.2008.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/22/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022] Open
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49
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Cavaliere A, Ermito S, Dinatale A, Pedata R. Management of molar pregnancy. J Prenat Med 2009; 3:15-17. [PMID: 22439034 PMCID: PMC3279094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gestational Trophoblastic Disease (GTD) originates from placental tissue and is among the rare human tumors that can be cured even in the presence of widespread metastases. GTD include a spectrum of interrelated tumors including complete and partial hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor, that have different propensities for local invasion and spread. Although most GTD develop after a mole, they can follow any antecedent pregnancy.Transvaginal ultrasound, routinary dosage of beta-hCG and current approaches to chemotherapy, let most women with malignant gestational trophoblastic disease to be cured and their reproductive function preserved.
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Affiliation(s)
| | - Santina Ermito
- Operative Unit of Obstetrics and Gynecology, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Angela Dinatale
- Operative Unit of Obstetrics and Gynecology, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Rosa Pedata
- Department of Gynecology, Obstetrics and Reproductive Sciences, Second University of Naples, Naples, Italy
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50
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Mammaro A, Carrara S, Cavaliere A, Ermito S, Dinatale A, Pappalardo EM, Militello M, Pedata R. Hypertensive disorders of pregnancy. J Prenat Med 2009; 3:1-5. [PMID: 22439030 PMCID: PMC3279097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension, and 4) gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy) (1). This terminology is preferred over the older but widely used term pregnancy-induced hypertension (PIH) because it is more precise.
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Affiliation(s)
- Alessia Mammaro
- Department of Gynecology & Obstetrics, Policlinico Tor Vergata Rome, Italy
| | - Sabina Carrara
- Department of Gynecology & Obstetrics, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cavaliere
- Department of Prenatal Diagnosis, Fetal Maternal Medical Centre “Artemisia”, Rome, Italy
| | - Santina Ermito
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Angela Dinatale
- Operative Unit of Gynecology and Obstetrics, Policlinico Universitario “G. Martino”, Messina, Italy
| | - Elisa Maria Pappalardo
- Department of Gynecology and Obstetrics, ARNAS, Garibaldi Nesima Hospital, Catania, Italy
| | - Mariapia Militello
- Clinic of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria, Policlinico “G. Rodolico”, Catania, Italy
| | - Rosa Pedata
- Department of Obstetric, Gynecological and Reproductive Sciences, Second University of Naples, Naples, Italy
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