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Palassini E, Baldi GG, Sulfaro S, Barisella M, Bianchi G, Campanacci D, Fiore M, Gambarotti M, Gennaro M, Morosi C, Navarria F, Palmerini E, Sangalli C, Sbaraglia M, Trama A, Asaftei S, Badalamenti G, Bertulli R, Bertuzzi AF, Biagini R, Bonadonna A, Brunello A, Callegaro D, Cananzi F, Cianchetti M, Collini P, Comandini D, Curcio A, D'Ambrosio L, De Pas T, Dei Tos AP, Ferraresi V, Ferrari A, Franchi A, Frezza AM, Fumagalli E, Ghilli M, Greto D, Grignani G, Guida M, Ibrahim T, Krengli M, Luksch R, Marrari A, Mastore M, Merlini A, Milano GM, Navarria P, Pantaleo MA, Parafioriti A, Pellegrini I, Pennacchioli E, Rastrelli M, Setola E, Tafuto S, Turano S, Valeri S, Vincenzi B, Vitolo V, Ivanescu A, Paloschi F, Casali PG, Gronchi A, Stacchiotti S. Clinical recommendations for treatment of localized angiosarcoma: A consensus paper by the Italian Sarcoma Group. Cancer Treat Rev 2024; 126:102722. [PMID: 38604052 DOI: 10.1016/j.ctrv.2024.102722] [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: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
Angiosarcoma (AS) represents a rare and aggressive vascular sarcoma, posing distinct challenges in clinical management compared to other sarcomas. While the current European Society of Medical Oncology (ESMO) clinical practice guidelines for sarcoma treatment are applicable to AS, its unique aggressiveness and diverse tumor presentations necessitate dedicated and detailed clinical recommendations, which are currently lacking. Notably, considerations regarding surgical extent, radiation therapy (RT), and neoadjuvant/adjuvant chemotherapy vary significantly in localized disease, depending on each different site of onset. Indeed, AS are one of the sarcoma types most sensitive to cytotoxic chemotherapy. Despite this, uncertainties persist regarding optimal management across different clinical presentations, highlighting the need for further investigation through clinical trials. The Italian Sarcoma Group (ISG) organized a consensus meeting on April 1st, 2023, in Castel San Pietro, Italy, bringing together Italian sarcoma experts from several disciplines and patient representatives from "Sofia nel Cuore Onlus" and the ISG patient advocacy working group. The objective was to develop specific clinical recommendations for managing localized AS within the existing framework of sarcoma clinical practice guidelines, accounting for potential practice variations among ISG institutions. The aim was to try to standardize and harmonize clinical practices, or at least highlight the open questions in the local management of the disease, to define the best evidence-based practice for the optimal approach of localized AS and generate the recommendations presented herein.
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Affiliation(s)
- Elena Palassini
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | | | | | - Marta Barisella
- Department of Pathology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giuseppe Bianchi
- Department of Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Domenico Campanacci
- Department of Surgery, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Marco Fiore
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Gambarotti
- Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Gennaro
- Department of Surgery, Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Federico Navarria
- Department of Radiation Oncology, IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Pordenone, Italy
| | - Emanuela Palmerini
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Sangalli
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marta Sbaraglia
- Department of Pathology, Università di Padova, Padova, Italy
| | - Annalisa Trama
- Department of Edidemiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sebastian Asaftei
- Department of Pediatric Oncology, Ospedale Infantile Regina Margherita , Torino
| | - Giuseppe Badalamenti
- Department of Medical Oncology, Azienda Universitaria Policlinico Giaccone, Palermo, Italy
| | - Rossella Bertulli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alexia Francesca Bertuzzi
- Department of Medical Oncology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Roberto Biagini
- Department of Oncological Orthopedics, IRCCS Istituto Nazionale Tumori Regina Elena - Istituti Fisioterapici Ospitalieri, Roma, Italy
| | - Angela Bonadonna
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Pordenone, Italy
| | - Antonella Brunello
- Department of Medical Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Dario Callegaro
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ferdinando Cananzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Cancer Center, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Danila Comandini
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Annalisa Curcio
- Department of Surgery, Ospedale Morgagni e Pierantoni, Forlì, Italy
| | - Lorenzo D'Ambrosio
- Department of Medical Oncology, Ospedale S. Luigi, Orbassano, Torino, Italy
| | - Tommaso De Pas
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS Istituto Nazionale Tumori Regina Elena - Istituti Fisioterapici Ospitalieri, Roma, Italy
| | - Andrea Ferrari
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Franchi
- Department of Pathology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Anna Maria Frezza
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elena Fumagalli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Matteo Ghilli
- Breast Centre, Department of Oncology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniela Greto
- Department of Radiation Therapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giovanni Grignani
- Department of Medical Oncology, Azienda Ospedaliera Univerisitaria Città della Salute e della Scienza, Torino, Italy
| | - Michele Guida
- Department of Medical Oncology, IRCCS Istituto Tumori di Bari Giovanni Paolo II, Bari, Italy
| | - Toni Ibrahim
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Krengli
- Department of Radiation Therapy, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Roberto Luksch
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Marrari
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alessandra Merlini
- Department of Medical Oncology, Ospedale S. Luigi, Orbassano, Torino, Italy
| | | | - Piera Navarria
- Department of Radiation Therapy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Maria Abbondanza Pantaleo
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna', University of Bologna, Bologna, Italy
| | | | - Ilaria Pellegrini
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marco Rastrelli
- Department of Surgical Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), Università di Padova, Padova, Italy
| | - Elisabetta Setola
- Department of Medical Oncology, Istituto Europeo Oncologia, Milano, Italy
| | - Salvatore Tafuto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori G. Pascale, Napoli, Italy
| | - Salvatore Turano
- Department of Medical Oncology, Azienda Ospedaliera S.S. Annunziata, Cosenza, Italy
| | - Sergio Valeri
- Department of Surgery, Università Campus Bio-Medico, Roma, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - Viviana Vitolo
- Department of Radiation Therapy, Centro Nazionale di Adroterapia Oncologica, Fondazione CNAO, Pavia, Italy
| | | | | | - Paolo Giovanni Casali
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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D’Ambrosio L, Fumagalli E, De Pas TM, Nannini M, Bertuzzi A, Carpano S, Boglione A, Buonadonna A, Comandini D, Gasperoni S, Vincenzi B, Brunello A, Badalamenti G, Maccaroni E, Baldi GG, Merlini A, Mogavero A, Ligorio F, Pennacchioli E, Conforti F, Manessi G, Aliberti S, Tolomeo F, Fiore M, Sbaraglia M, Dei Tos AP, Stacchiotti S, Pantaleo MA, Gronchi A, Grignani G. Guideline-Based Follow-Up Outcomes in Patients With Gastrointestinal Stromal Tumor With Low Risk of Recurrence: A Report From the Italian Sarcoma Group. JAMA Netw Open 2023; 6:e2341522. [PMID: 37930700 PMCID: PMC10628737 DOI: 10.1001/jamanetworkopen.2023.41522] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 06/13/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Importance Gastrointestinal stromal tumor (GIST) follow-up is recommended by international guidelines, but data on the role of follow-up in patients with low relapse risk are missing. For these patients, the potential benefit of anticipating recurrence detection should be weighed against psychological burden and radiologic examination loads in terms of costs and radiation exposure. Objective To evaluate the outcomes of guideline-based follow-up in low-risk GIST. Design, Setting, and Participants This multi-institutional retrospective cohort study involving Italian Sarcoma Group reference institutions evaluated patients with GIST who underwent surgery between January 2001 and June 2019. Median follow-up time was 69.2 months. Data analysis was performed from December 15, 2022, to March 20, 2023. Patients with GIST at low risk according to Armed Forces Institute of Pathology criteria were included provided adequate clinical information was available: primary site, size, mitotic index, surgical margins, and 2 or more years of follow-up. Exposures All patients underwent follow-up according to European Society for Medical Oncology (ESMO) guidelines. Main Outcomes and Measures The primary outcome was the number of tests needed to identify a relapse according to ESMO guidelines follow-up plan. Secondary outcomes included relapse rate, relapse timing, disease-free survival (DFS), overall survival (OS), GIST-specific survival (GIST-SS), postrelapse OS, secondary tumor rates, and theoretical ionizing radiation exposure. An exploratory end point, new follow-up schedule proposal for patients with low-risk GIST according to the observed results, was also assessed. Results A total of 737 patients (377 men [51.2%]; median age at diagnosis, 63 [range, 18-86] years) with low-risk GIST were included. Estimated 5-year survival rates were 95.5% for DFS, 99.8% for GIST-SS, and 96.1% for OS. Estimated 10-year survival rates were 93.4% for DFS, 98.1% for GIST-SS, and 91.0% for OS. Forty-two patients (5.7%) experienced disease relapse during follow-up (9 local, 31 distant, 2 both), of which 9 were detected after 10 or more years. This translated into approximately 1 relapse detected for every 170 computed tomography scans performed, with a median radiation exposure of 80 (IQR, 32-112) mSv per patient. Nongastric primary tumor (hazard ratio [HR], 2.09; 95% CI, 1.14-3.83; P = .02), and KIT mutation (HR, 2.77; 95% CI, 1.05-7.27; P = .04) were associated with a higher risk of relapse. Second tumors affected 187 of 737 patients (25%), of which 56 were detected during follow-up and represented the primary cause of death in these patients. Conclusions and Relevance In this cohort study on patients affected by low-risk GISTs, the risk of relapse was low despite a follow-up across 10 or more years. These data suggest the need to revise follow-up schedules to reduce the anxiety, costs, and radiation exposure of currently recommended follow-up strategy.
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Affiliation(s)
- Lorenzo D’Ambrosio
- Department of Medical Oncology, University of Turin, Turin, Italy
- San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Elena Fumagalli
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Tommaso Martino De Pas
- Medical Oncology Division, Cliniche Humanitas Gavazzeni, Bergamo, Italy
- Previously at Unit of Sarcomas and Thymomas, European Institute of Oncology, Milan, Italy
| | - Margherita Nannini
- Oncology Unit. Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Alexia Bertuzzi
- Medical Oncology, Humanitas Cancer Center, Rozzano (MI), Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Angela Buonadonna
- Sarcoma and gastrointestinal tumors Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Danila Comandini
- Medical Oncology 1, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Silvia Gasperoni
- Clinical Oncology Unit, Oncology Department and Robotic Surgery, AOU Careggi, Florence, Italy
| | - Bruno Vincenzi
- Medical Oncology, Università Campus Bio-Medico, Rome, Italy
| | | | - Giuseppe Badalamenti
- Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Elena Maccaroni
- Department of Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | | | - Alessandra Merlini
- Department of Medical Oncology, University of Turin, Turin, Italy
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Andrea Mogavero
- Department of Medical Oncology, University of Turin, Turin, Italy
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Francesca Ligorio
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Fabio Conforti
- Medical Oncology Division, Cliniche Humanitas Gavazzeni, Bergamo, Italy
- Previously at Unit of Sarcomas and Thymomas, European Institute of Oncology, Milan, Italy
| | - Giulia Manessi
- Department of Medical Oncology, University of Turin, Turin, Italy
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Sandra Aliberti
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Francesco Tolomeo
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Marco Fiore
- Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marta Sbaraglia
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | | | | | - Maria Abbondanza Pantaleo
- Oncology Unit. Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giovanni Grignani
- Sarcoma Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
- Medical Oncology 2, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Catalano F, Cremante M, Dalmasso B, Pirrone C, Lagodin D’Amato A, Grassi M, Comandini D. Molecular Tailored Therapeutic Options for Advanced Gastrointestinal Stromal Tumors (GISTs): Current Practice and Future Perspectives. Cancers (Basel) 2023; 15:cancers15072074. [PMID: 37046734 PMCID: PMC10093725 DOI: 10.3390/cancers15072074] [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] [Received: 02/20/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are one of the most common mesenchymal tumors characterized by different molecular alterations that lead to specific clinical presentations and behaviors. In the last twenty years, thanks to the discovery of these mutations, several new treatment options have emerged. This review provides an extensive overview of GISTs’ molecular pathways and their respective tailored therapeutic strategies. Furthermore, current treatment strategies under investigation and future perspectives are analyzed and discussed.
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Affiliation(s)
- Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Malvina Cremante
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Bruna Dalmasso
- Genetica dei Tumori Rari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Massimiliano Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence:
| | - Danila Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Cremante M, Catalano F, Comandini D, Mascherini M, Zaottini F, Picasso R, Spina B, Guadagno A, Grassi M. 56P Pembrolizumab in advanced mesenchymal tumors: A prospective monocentric study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101093] [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: 04/05/2023] Open
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Cremante M, Pastorino A, Ponzano M, Grassi M, Martelli V, Puccini A, Catalano F, Murianni V, Iaia ML, Puglisi S, Gandini A, Fornarini G, Caprioni F, Andretta V, Pessino A, Comandini D, Sciallero MS, Mammoliti S, Sormani MP, Sobrero A. Reliability of patient-reported toxicities during adjuvant chemotherapy. Eur J Cancer 2023; 182:115-121. [PMID: 36758476 DOI: 10.1016/j.ejca.2023.01.005] [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: 11/23/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are validated tools to assess the impact of efficacy and toxicities of cancer treatments on patients' health status. Because of the demonstrated little reliability of humans in reporting memories of painful experiences, this work explores the reliability of cancer patients in reporting chemotherapy-related toxicities. AIM This study aims to evaluate the concordance between toxicities experienced by the patients during chemotherapy and toxicities reported to the doctor at the end of the cycles. METHODS Questionnaires concerning chemotherapy-related toxicities were administered on days 2, 5, 8, 11, 14, and 17 of each chemo cycle and at the end of the same cycle to patients undergoing adjuvant chemotherapy. The co-primary end-points were Lins's concordance correlation coefficient (CCC) and mean difference between real-time and retrospective toxicity assessments. RESULTS In total, 7182 toxicity assessments were collected from 1096 questionnaires. Concordance was observed between the retrospective evaluations and the toxicity assessments at early (day 2), peak (maximum toxicity), late (day 14 or 17), and mean real-time evaluations for each chemotherapy cycle (CCC for mean ranging from 0.52 to 0.77). No systematic discrepancy was found between real-time and retrospective evaluations, except for peak, which was systematically underestimated retrospectively. CONCLUSIONS Toxicities reported by the patients to the doctor at the end of each chemotherapy cycle reflect what they actually experienced without any substantial distortion. This result is very relevant both for the clinical implications in daily patients' management and in the light of the current growing impact on digital monitoring of PROs.
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Affiliation(s)
- Malvina Cremante
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alessandro Pastorino
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Massimiliano Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Valentino Martelli
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alberto Puccini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Veronica Murianni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria L Iaia
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Annalice Gandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Francesco Caprioni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Valeria Andretta
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Annamaria Pessino
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Danila Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria S Sciallero
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Serafina Mammoliti
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maria P Sormani
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
| | - Alberto Sobrero
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
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Campora M, Paudice M, Gambella A, Comandini D, Parente P, Sbaraglia M, Dei Tos AP, Grillo F, Mastracci L. Counting mitoses in gastrointestinal stromal tumours (GISTs): variable practices in the real-world setting and their clinical implications. Virchows Arch 2023; 482:589-594. [PMID: 36416965 PMCID: PMC10033612 DOI: 10.1007/s00428-022-03454-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/03/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Mitotic count (MC) is an important prognostic indicator in gastrointestinal stromal tumours (GISTs). Though MC evaluation was initially proposed in 50 HPFs, recent international guidelines recommend that MC be performed on 5 mm2 because HPFs may have different areas depending on the ocular field number (FN) of the utilized light microscope. Performing MC on different areas leads to a non-standardized evaluation and erroneous risk stratification. The aim of the study was to audit real-life MC practices with special emphasis on possible risk stratification errors. A survey was administered to Italian pathologists to evaluate the following: method used for MC (5 mm2 versus 50 HPF); FN of the light microscope; prognostic scheme for risk stratification. Based on the results of the survey, 100 GISTs (25/risk class using Miettinen prognostic scheme) were retrieved and MC performed using 5 mm2 versus the corresponding mm2 area sizes of 50 HPFs with variable FNs (18, 20, 22). The survey demonstrated that the majority of pathologists (64.5%) use 50 HPFs with various FNs leading to excessive area size. The most frequently used prognostic scheme is that by Miettinen. Using this prognostic scheme and counting mitoses in 5 mm2 versus 50 HPFs with FNs 18, 20 and 22, a change in risk class was identified ranging from 10 to 41%, depending on FN. In conclusion, this study demonstrates that MC is still frequently performed on 50 HPF, with area sizes exceeding the specified 5 mm2 by far.
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Affiliation(s)
| | - Michele Paudice
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, 16132, Genoa, Italy
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | | | - Danila Comandini
- Oncology Unit, Department of Oncology and Haematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Parente
- Fondazione IRCCS Casa Sollievo della Sofferenza, Pathology Unit, San Giovanni Rotondo (FG), Italy
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine (DIMED), University of Padua School of Medicine, Padua, Italy
| | - Federica Grillo
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, 16132, Genoa, Italy
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Luca Mastracci
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, 16132, Genoa, Italy.
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
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7
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Comandini D, Catalano F, Grassi M, Pesola G, Bertulli R, Guadagno A, Spina B, Mascherini M, De Cian F, Pistoia F, Rebuzzi SE. Outstanding Response in a Patient With ROS1-Rearranged Inflammatory Myofibroblastic Tumor of Soft Tissues Treated With Crizotinib: Case Report. Front Oncol 2021; 11:658327. [PMID: 34211840 PMCID: PMC8239351 DOI: 10.3389/fonc.2021.658327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a very rare subtype of sarcoma, which frequently harbor chromosomal rearrangements, including anaplastic lymphoma kinase (ALK) rearrangements (almost 50% of the IMTs) and other kinase fusions such as ROS1. ROS1 fusions are present in about 10% of IMT, almost half of the ALK-negative IMT patients. Apart from radical surgery for resectable tumors, there is no standard-of-care therapy for advanced IMTs. Nonetheless, the use of tyrosine kinase inhibitors has shown promising efficacy in IMT patients with targetable genomic alterations. We report the case of a 24-year-old patient with chemotherapy-refractory metastatic IMT harboring ROS1 kinase fusion, who experienced a significant clinical and pathological response to crizotinib. This clinical case highlights the need to assess all patients with unresectable IMTs for chromosomal abnormalities and gene mutations and address them to targeted agents as well as clinical trials.
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Affiliation(s)
- Danila Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Massimiliano Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Pesola
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Rossella Bertulli
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Antonio Guadagno
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Bruno Spina
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Franco De Cian
- Surgical Clinic Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Federico Pistoia
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
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8
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Merlo G, Cozzani E, Comandini D, Trave I, Centurioni MG, Franchelli S, Zena M, Vellone VG, Biatta CM, Parodi A. Neoadjuvant imatinib as treatment preceding surgery for vulvar dermatofibrosarcoma protuberans. Dermatol Ther 2021; 34:e14860. [PMID: 33559311 DOI: 10.1111/dth.14860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Giulia Merlo
- Di.S.Sal. Section of Dermatology, University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Emanuele Cozzani
- Di.S.Sal. Section of Dermatology, University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Danila Comandini
- Unit of Medical Oncology, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Ilaria Trave
- Di.S.Sal. Section of Dermatology, University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Maria G Centurioni
- Unit of Obstetrics and Gynecology, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Simonetta Franchelli
- Unit of Breast Cancer Surgery, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Monica Zena
- Department of Surgical and Diagnostic Integrated Sciences, D.I.S.C. - University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Valerio G Vellone
- Department of Surgical and Diagnostic Integrated Sciences, D.I.S.C. - University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy.,Unit of Pathology, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Chiara M Biatta
- Department of Surgical and Diagnostic Integrated Sciences, D.I.S.C. - University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy.,Unit of Pathology, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Aurora Parodi
- Di.S.Sal. Section of Dermatology, University of Genoa, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
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9
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Grosso F, D’Ambrosio L, Zucchetti M, Ibrahim T, Tamberi S, Matteo C, Rulli E, Comandini D, Palmerini E, Baldi GG, DeCensi A, Bergaglio M, Marra D, Marchesi E, Siri G, D’Incalci M, Grignani G. Pharmacokinetics, safety, and activity of trabectedin as first‐line treatment in elderly patients who are affected by advanced sarcoma and are unfit to receive standard chemotherapy: A phase 2 study (TR1US study) from the Italian Sarcoma Group. Cancer 2020; 126:4726-4734. [DOI: 10.1002/cncr.33120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Federica Grosso
- Mesothelioma and Rare Cancer Unit Azienda Ospedaliera SS Antonio e Biagio General Hospital Alessandria Italy
| | - Lorenzo D’Ambrosio
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
- Department of Oncology University of Torino Orbassano Italy
| | - Massimo Zucchetti
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Italy
| | | | - Cristina Matteo
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Eliana Rulli
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | | | | | | | - Andrea DeCensi
- Division of Medical Oncology Unit EO Ospedali Galliera Genova Italy
| | | | - Domenico Marra
- Division of Medical Oncology Unit EO Ospedali Galliera Genova Italy
| | - Emanuela Marchesi
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
| | - Giacomo Siri
- Department of Mathematics University of Genoa Genova Italy
- E.O. Ospedali GallieraScientific Directorate Genova Italy
| | - Maurizio D’Incalci
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Giovanni Grignani
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
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10
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Comandini D, Grassi M, Prelaj A, Martelli V, Damiani A, Damiano G, Rebuzzi SE. Gastrointestinal stromal tumors and second primary malignancies: a retrospective monocentric analysis. Neoplasma 2020; 67:1416-1423. [PMID: 32657607 DOI: 10.4149/neo_2020_200301n212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/08/2020] [Indexed: 11/08/2022]
Abstract
In the post-Imatinib era, the median survival of patients diagnosed with GIST has reached almost 5 years. Prolonging GIST-specific survival, GIST patients have an increased incidence of secondary neoplasia. Data on the prognostic impact of second tumors in GIST patients are very poor with few and small retrospective analyses available in the literature. We conducted a retrospective monocentric analysis on 145 patients diagnosed with GIST between April 2001 and October 2018. Kaplan-Meier and Cox hazard methods were used for survival analysis. A total of 154 GIST patients were included and 31 patients of them (21%) were diagnosed with at least one additional malignancy. The most common second tumors associated with GIST were gastrointestinal tumors. GIST patients with additional malignancies showed to have lower size (>5 cm: 35% vs 45%; p=0.75), higher mitotic rate (>5/50 HPFs: 42% vs 29%; p=0.24), higher presence of c-KIT mutation (85% vs 69%), a lower presence of PDGFRα mutation (8% vs 17%; p=0.05) and shorter survival (mOS: 9.6 vs 15.5 years; p=0.30). In conclusion, our study did not find any significant correlation between clinicopathological characteristics and the development of a second tumor in GIST patients. Further analyses and strict follow up protocols are needed in order to early diagnose and promptly treat a second primary tumor in the GIST population.
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Affiliation(s)
- D Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - M Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - A Prelaj
- Thoracic Oncology Unit, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy
| | - V Martelli
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - A Damiani
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - G Damiano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - S Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
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11
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Astolfi A, Indio V, Nannini M, Saponara M, Schipani A, De Leo A, Altimari A, Vincenzi B, Comandini D, Grignani G, Secchiero P, Urbini M, Pantaleo MA. Targeted Deep Sequencing Uncovers Cryptic KIT Mutations in KIT/PDGFRA/SDH/RAS-P Wild-Type GIST. Front Oncol 2020; 10:504. [PMID: 32391261 PMCID: PMC7188756 DOI: 10.3389/fonc.2020.00504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/13/2019] [Accepted: 03/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Gastrointestinal stromal tumors (GIST) are known to carry oncogenic KIT or PDGFRA mutations, or less commonly SDH or NF1 gene inactivation, with very rare cases harboring mutant BRAF or RAS alleles. Approximately 10% of GISTs are devoid of any of such mutations and are characterized by very limited therapeutic opportunities and poor response to standard treatments. Methods: Twenty-six sporadic KIT/PDGFRA/SDH/RAS-pathway wild type GIST were profiled for the molecular status of genes frequently altered in GIST by a targeted next generation sequencing (NGS) approach. Molecular findings were validated by alternative amplicon-based targeted sequencing, immunohistochemistry, gene expression profiling and Sanger sequencing. Results: Three patients harboring NF1 inactivating mutations were identified and excluded from further analysis. Intriguingly, five patients carried cryptic KIT alterations, mainly represented by low-allele-fraction mutations (12–16% allele ratio). These mutations were confirmed by another targeted NGS approaches and supported by CD117 immuno-staining, gene expression profiling, Sanger sequencing, with peak signals at the level of background noise, and by the patients' clinical course assessment. Conclusion: This study indicates that ~20% patients diagnosed with a KIT/PDGFRA/SDH/RAS-pathway wild-type GIST are bona-fide carriers of pathogenic KIT mutations, thus expected to be eligible for and responsive to the various therapeutic lines of TK-inhibitors in use for KIT/PDGFRA-mutant GIST. The centralization for a second level molecular analysis of GIST samples diagnosed as wild-type for KIT and PDGFRA is once again strongly recommended.
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Affiliation(s)
- Annalisa Astolfi
- Department of Morphology, Surgery & Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Margherita Nannini
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Medical Oncology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maristella Saponara
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angela Schipani
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Antonio De Leo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Annalisa Altimari
- Laboratory of Oncologic Molecular Pathology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Danila Comandini
- Medical Oncology 1, Policlinico San Martino, University of Genova, Genova, Italy
| | - Giovanni Grignani
- Sarcoma Unit, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - Paola Secchiero
- Department of Morphology, Surgery & Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Milena Urbini
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Maria Abbondanza Pantaleo
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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12
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Abstract
Gastrointestinal stromal tumors (GISTs) are rare neoplasms, but they also represent the most common mesenchymal tumors of the gastrointestinal tract originating from the cell of Cajal. GIST incidence ranges around 1% of all gastrointestinal malignancies. Approximately 5% of all GISTs have a hereditary etiology. The remaining 95% of GISTs are considered sporadic events, with up to 75% of cases driven by a constitutional activation of the c-KIT proto-oncogene. GISTs are generally solitary lesions. Nonetheless, multiple sporadic GISTs can occur and present as synchronous or metachronous tumors, usually associated with familial GIST. Here, we report a case of primary prostate and lung tumors associated with gastric and small bowel GISTs, unrelated to any known hereditary syndrome. Also, in the case we describe, the prostatic tumor came before the GISTs, while the lung tumor occurred later in time and led to pulmonary lobectomy plus lymphoadenectomy, with a diagnosis of nonsmall cell lung cancer. With the exception of a slight difference in lymphoid infiltration, the abdominal and gastric GIST nodules shared the same proliferative MIB1 index and mitotic count. However, the genetic analysis revealed that the gastric GIST and abdominal tumors were characterized by two different c-KIT mutations. This molecular heterogeneity supported the hypothesis of two different synchronous GISTs arising from stomach and ileum. At present, the patient is disease free and has already completed the third year of adjuvant therapy with imatinib. This case supports the importance of the analysis of c-KIT mutational status to distinguish metastases from synchronous multicentric GISTs, with relevant implications in therapeutic decisions, as well as the importance of a dedicated multidisciplinary team and of a radiological follow-up after the diagnosis of a primary GIST, to discover a relapse of the GIST or, possibly, additional malignancies.
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Affiliation(s)
- Danila Comandini
- Unit of Medical Oncology, IRCCS AOU San Martino IST, Genoa, Italy
| | - Azzurra Damiani
- Unit of Medical Oncology, IRCCS AOU San Martino IST, Genoa, Italy
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13
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Origone P, Gargiulo S, Mastracci L, Ballestrero A, Battistuzzi L, Casella C, Comandini D, Cusano R, Dei Tos AP, Fiocca R, Garuti A, Ghiorzo P, Martinuzzi C, Toffolatti L, Bianchi Scarrà G. Molecular characterization of an Italian series of sporadic GISTs. Gastric Cancer 2013; 16:596-601. [PMID: 23291969 DOI: 10.1007/s10120-012-0213-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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] [Received: 06/15/2012] [Accepted: 11/04/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract. Most (80 %) contain activating mutations in the KIT receptor tyrosine kinase, roughly 10 % in platelet-derived growth factor receptor-alpha (PDGFRA). In a small subset, BRAF mutations are an alternative molecular pathway. GISTs respond well to imatinib, but low response is seen in patients with wild-type KIT or PDGFRA. Resistance has also been reported as a result of mutations in downstream effectors such as BRAF. METHODS We provide here a molecular characterization of a series of primary GISTs from Italian patients. Of 121 GIST cases diagnosed between 2000 and 2012, 83 were evaluated by PCR amplification and direct sequencing for mutations in KIT exons 8, 9, 11, 13, and 17, PDGFRA exons 12, 14, and 18, and BRAF exon 15. Eighty-one GISTs also underwent K-RAS testing. RESULTS Sixty-four GISTs were positive: 55 had mutations in KIT and 9 in PDGFRA; 16 patients were mutation negative. Three samples came from NF1 patients and were KIT- and PDGFRA negative. Overall, we identified six novel mutations in KIT (p.K550_M552delinsL, p.Q556_W557delinsG p.Q556_G575del, p.W557_V559delinsQ p.P573_R588dup, p.G592_K593dup) and one novel mutation in PDGFRA (p.D842_N848delinsVDV), thus contributing to widening the spectrum of known mutations in GIST tumors and confirming the most frequently altered regions underlying GIST development. CONCLUSIONS Among the 64 KIT- and PDGFRA-positive sporadic patients in our series, no BRAF or KRAS mutations were identified, suggesting that co-occurrence of these mutations is likely to be rare in the northwestern Italian population and not a frequent cause of primary resistance to imatinib in KIT-positive GIST patients.
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Affiliation(s)
- P Origone
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, Genoa, Italy,
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14
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Mammoliti S, Andretta V, Bennicelli E, Caprioni F, Comandini D, Fornarini G, Guglielmi A, Pessino A, Sciallero S, Sobrero AF, Mazzola G, Lambiase A, Bordignon C. Two doses of NGR-hTNF in combination with capecitabine plus oxaliplatin in colorectal cancer patients failing standard therapies. Ann Oncol 2010; 22:973-978. [PMID: 20855468 PMCID: PMC3065876 DOI: 10.1093/annonc/mdq436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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] [Indexed: 11/12/2022] Open
Abstract
Background: asparagine-glycine-arginine-human tumour necrosis factor (NGR-hTNF), an agent selectively damaging the tumour vasculature, showed a biphasic dose–response curve in preclinical models. Previous phase I trials of NGR-hTNF indicated 0.8 and 45 μg/m2 as optimal biological and maximum-tolerated dose, respectively. Patients and methods: Two sequential cohorts of 12 colorectal cancer (CRC) patients who had failed standard therapies received NGR-hTNF 0.8 or 45 μg/m2 in combination with capecitabine–oxaliplatin (XELOX). Results: Median number of prior treatment lines was 3 in the low-dose and 2 in the high-dose cohort. Overall, 21 patients had been pretreated with oxaliplatin-based regimens. No grade 3–4 NGR-hTNF-related toxicities were observed. Grade 1–2 chills were reported in 43% and 40% of cycles in the low-dose and high-dose cohorts, respectively. In the low-dose cohort, one patient achieved a partial response and five had stable disease for a median of 4.6 months. In the high-dose cohort, six patients had stable disease for a median of 3.6 months. Three-month progression-free survival (PFS) rates were 50% and 33% in the low-dose and high-dose cohort, respectively. Three patients in low-dose cohort experienced PFS longer than PFS on last prior therapy. Conclusions: Both NGR-hTNF doses were safely combined with XELOX in pretreated CRC patients. Hint of activity was apparent only with low-dose NGR-hTNF.
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Affiliation(s)
- S Mammoliti
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - V Andretta
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - E Bennicelli
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - F Caprioni
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - D Comandini
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - G Fornarini
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - A Guglielmi
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - A Pessino
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - S Sciallero
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | - A F Sobrero
- Medical Oncology Unit, Ospedale San Martino, Genoa
| | | | | | - C Bordignon
- Clinical Development, MolMed, Milan; Hematology, Università Vita-Salute San Raffaele, Milan, Italy.
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15
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Pessino A, Andretta V, Guglielmi A, Mammoliti S, Caprioni F, Fornarini G, Comandini D, Sciallero S, Ansaldi F, Sobrero A. 6075 A triple combination of Imatinib, Bevacizumab and Cetuximab plus modified FOLFOX-6 in advanced untreated colorectal cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71170-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: 11/16/2022] Open
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16
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Sobrero A, Pessino A, Andretta V, Bennicelli E, Fornarini G, Caprioni F, Comandini D, Orsino L, Lambiase A, Bordignon C. 6066 Phase II study of two doses of NGR-hTNF, a vascular targeting agent (VTA), combined with capecitabine/oxaliplatin (XELOX) in colorectal cancer (CRC) patients failing standard regimens. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71161-9] [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: 11/25/2022] Open
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17
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Sobrero AF, Bennicelli E, Pessino A, Guglielmi A, Mammoliti S, Caprioni F, Fornarini G, Comandini D, Sciallero S, Ansaldi F. Phase II trial of imatinib, bevacizumab and cetuximab plus modified FOLFOX-6 in advanced untreated colorectal cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15030 Background: Imatinib inhibits PDGFR interfering with pericytes, the structural support to newly formed tumor blood vessels. It may thus synergize with bevacizumab. Microenvironment and tumor targeted agents along with chemotherapy could be a promising add-on approach. Methods: cetuximab 500 mg/m2, bevacizumab 5 mg/kg and modified FOLFOX-6 were given i.v. on day 1 and repeated every 2 weeks. Imatinib 400 mg/day per os was given continuously. Due to the cost and potential toxicity of the combination, the endpoint for this phase II study was very ambitious: at least 25% of complete response (medically or surgically achieved), lasting a minimum of 12 months in advanced untreated colorectal cancer patients with clearly unresectable disease. Results: Of 26 patients (16 with 1 site of disease), 17 completed the first 4 months of treatment according to the protocol, while 9 had to discontinue one biologic drug due to side effects (5 cetuximab, 3 imatinib and 1 bevacizumab). Grade 3–4 toxicity: diarrhea 12%, neutropenia 24%, skin rash 24%, hypersensitivity reactions 16%, asthenia 8%, neuro 8%. All patients were evaluable for response. Eleven responses ( 1 CR and 10 PR), 13 SD and 2 PD were observed, corresponding to 42% RR ( 95% CI = 23–61). The minimum follow up is 12 months; median PFS is 10 months. One patient among responders underwent radiofrequency ablation and 17 patients underwent surgery: 8 R-0, 3 R-1, 5 R-2 and one exploratory laparotomy. Major post surgical complications occurred in 5/17 patients. No evidence of macroscopic disease after the entire treatment plan was obtained in 13/26 patients: 12 surgical and 1 medical CR. Seven/13 were disease free at 6 months, but only 3 were still disease free at 12 months. ERCC1, ERCC2/XDP, GSTP1,TS,EGF, COX2, CYCLIN D, FCgR polymorphisms and K-RAS mutations were evaluated on all 26 patients, but no correlations were found with clinical outcome. Conclusions: The triple combination of biologics with modified FOLFOX-6 is feasible and tolerable as initial aggressive treatment. The primary endpoint of the study was not met . In fact the activity, 42% RR, was not outstanding and the high resectability rate, 69%, is misleading in the light of the short duration of the surgically induced CR. [Table: see text]
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Affiliation(s)
- A. F. Sobrero
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - E. Bennicelli
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - A. Pessino
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - A. Guglielmi
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - S. Mammoliti
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - F. Caprioni
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - G. Fornarini
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - D. Comandini
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - S. Sciallero
- Azienda Ospedale Universita, San Martino, Genova, Italy
| | - F. Ansaldi
- Azienda Ospedale Universita, San Martino, Genova, Italy
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Pessino A, Artale S, Sciallero S, Guglielmi A, Fornarini G, Andreotti I, Mammoliti S, Comandini D, Caprioni F, Bennicelli E, Andretta V, Siena S, Sobrero A. First-line single-agent cetuximab in patients with advanced colorectal cancer. Ann Oncol 2008; 19:711-6. [DOI: 10.1093/annonc/mdm516] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Baldo S, Rivoire M, Sobrero A, Comandini D, Civalleri D, Stella M, Quaglia F, Santoni R, Malerba M, Mariani F, DeCian F. [Surgical resection of gastrointestinal stromal tumor after treatment with imatinib: clinical case]. Suppl Tumori 2005; 4:S97. [PMID: 16437930] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The stromal tumor is the most common mesenchymal tumor of the gastrointestinal tract. Surgical resection is the first-line therapy for operable lesions, however for inoperable imatinib is an effective therapy. In this setting a patient has been operated after a remarkable response to imatinib, used as both neoadjuvant and adjuvant. This approach led to a disease-free condition without toxicity and complications.
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Affiliation(s)
- S Baldo
- DICMI, Università degli Studi, Genova
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20
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Sobrero A, Caprioni F, Fornarini G, Mammoliti S, Comandini D, Baldo S, Decian F. Pemetrexed in gastric cancer. Oncology (Williston Park) 2004; 18:51-5. [PMID: 15655938] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Gastric cancer is a major clinical challenge, with poor overall prognosis and limited life expectancy for patients with advanced disease. Even with surgery and other modalities, palliation is often difficult. Improvement of response rates has evolved with the development of standard regimens and those incorporating newer chemotherapy agents, such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums (eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed [Alimta]). Ongoing trials with these regimens aim toward improving survival, as well as improving the safety profile. It is hoped that in conjunction with molecular research in the pathogenesis of gastric cancer and development of targeted therapies in this disease, these trial data might lead to the evolution of treatment strategies that could prove effective.
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Affiliation(s)
- Alberto Sobrero
- Divisione di Oncologia Medica Ospedale San Martino, Genova, Italy.
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Casali PG, Fumagalli E, Messina A, Spreafico C, Comandini D, Comandone A, De Giorgi U, Frustaci S, Vinaccia V, Marré Brunenghi MC. Tumor response to imatinib mesylate in advanced GIST. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. G. Casali
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - E. Fumagalli
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - A. Messina
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - C. Spreafico
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - D. Comandini
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - A. Comandone
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - U. De Giorgi
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - S. Frustaci
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - V. Vinaccia
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
| | - M. C. Marré Brunenghi
- Istituto Nazionale Tumori, Milano, Italy; Ospedale S. Martino, Genova, Italy; Ospedale Gradenigo, Torino, Italy; Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Riferimento Oncologico, Aviano, Italy; Novartis Farma, Origgio, Varese, Italy
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Repetto L, Comandini D, Mammoliti S. Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients. Crit Rev Oncol Hematol 2001; 37:147-52. [PMID: 11166588 DOI: 10.1016/s1040-8428(00)00104-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
With ageing, function preservation and maintenance of quality of life represent a major goal in an increasing proportion of patients. Life expectancy is a function of age, comorbidity, disability and cancer type and stage. Decision-making involves a delicate balance among all these factors, evaluation of treatment related complications of the overall effects of cancer and cancer treatment on the patients' quality of life. Despite several instruments for the assessment of quality of life being validated, none have been calibrated to the special requirements of the older patients. The structured interview administered by a trained clinician represents a standard approach for geriatric research and even for clinical practice because of the frailty of the older population. The combination of this approach with the self-administered questionnaire appears the most effective way to minimise missing data in collecting information for patients unable to complete the form.
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Affiliation(s)
- L Repetto
- Divisione di Oncologia Medica 1, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy.
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Abstract
As aging is highly heterogeneous, the clinical evaluation of the older person with cancer is influenced by several factors including comorbid conditions, disabilities, tumour type and stage. Assessment of comorbidity and disability represent on evolving area of research. Results from geriatrics are now translating in clinical oncology. Instruments for measurement of comorbidity and disability have been evaluated in the older cancer patients with promising results. The use of comprehensive geriatric assessment (CGA) in the older cancer patient represents a major improvement in the oncological practice. CGA is based on standardised interviews and covers areas of physical and psychical dysfunction. Moreover, CGA allows the collections of homogeneous information among different centres and recognition of the frail elderly. A diffuse ageistic prejudice may prevent adequate evaluation and treatment of older individuals. A wide based educational effort may allow a more appropriate management of the older cancer patient.
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Affiliation(s)
- L Repetto
- Division of Medical Oncology 1, IST-National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Venturino A, Comandini D, Granetto C, Audisio RA, Castiglione F, Ross R, Repetto L. Formestane is feasible and effective in elderly breast cancer patients with comorbidity and disability. Breast Cancer Res Treat 2000; 62:217-22. [PMID: 11072786 DOI: 10.1023/a:1006490524736] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Age is a major risk factor for solid tumors, including breast cancer. The majority of elderly breast cancer patients have oestrogen-dependent tumors, thus, tamoxifen is widely administered. However, it has been noted that tamoxifen-related thrombotic events are not exceptional. Due to the increasing prevalence of comorbidity, including vascular diseases, with age, such events are more frequently observed in the aged patients. Formestane, a selective steroidal aromatase inhibitor, may represent a therapeutic option after failure with tamoxifen, or in the presence of vascular diseases contraindicating its administration. The present report provides a new clinical experience on a consecutive series of 45 elderly breast cancer women affected by moderate to severe degree of comorbidity and disability measured by a Comprehensive Geriatric Assessment (CGA) scale validated on oncological patients. Formestane was given intramuscularly at the dose of 250 mg every 2 weeks. The study included 31 patients who had metastatic disease, and 14 who received formestane as an adjuvant treatment. Median age was 74 years (range 65-93), with nine patients > 80 years. Median ECOG Performance Status (PS) was one. The more frequent comorbidities observed in our series were arthrosis-arthritis (64.4% of patients), hypertension (44.4%), vascular diseases (35.5%), CNS diseases (28.8%). Twenty percent of patients presented at least one dependency in Activities of Daily Living (ADL) and 51.2% in Instrumental Activities of Daily Living (IADL). The treatment was well tolerated - only two patients interrupted formestane because of minor adverse reaction at the injection site and generalised itching. In particular Formestane was not responsible for any worsening of pre-treatment comorbidities, especially hypertension and vascular diseases. Objective responses (OR) were observed in 11.1% of advanced patients, while the disease was stabilised in 51.8% subjects. Median duration of OR was 12 months; median overall survival was 11 months. Among patients receiving formestane as adjuvant treatment, three relapsed, with a time to failure (TTF) of 12 months. Formestane is effective and minimally toxic in an elderly breast cancer population with comorbidities and disabilities measured by CGA.
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Affiliation(s)
- A Venturino
- Oncologia Medica 1, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
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26
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Venturino A, Comandini D, Simoni C, Merlini L, Naso C, Palumbo R, Fusco V, Porcile G, Pronzato P, Rosso R, Repetto L. Is salvage chemotherapy for metastatic breast cancer always effective and well tolerated? A phase II randomized trial of vinorelbine versus 5-fluorouracil plus leucovorin versus combination of mitoxantrone, 5-fluorouracil plus leucovorin. Breast Cancer Res Treat 2000; 60:195-200. [PMID: 10930106 DOI: 10.1023/a:1006350602108] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Metastatic breast cancer remains an incurable disease and the median overall survival has not significantly improved over the past two decades. Aims of the present randomized phase II trial were to analyse activity and toxicity of chemotherapies with single agent or with combination regimens in previously treated patients with advanced breast cancer. Ninety-nine eligible patients were randomized to receive the following chemotherapies: Arm A - vinorelbine 30 mg/m2 i.v. weekly; Arm B - leucovorin 100 mg/m2 i.v. followed by 5-fluorouracil 370 mg/m2 i.v. days 1 --> 5, q 28 days; Arm C - mitoxantrone 12 mg/m2 i.v. only day 1 + leucovorin 100 mg/m2 i.v. followed by 5-fluorouracil 370 mg/m2 i.v. days 1 --> 3, q 28 days. Patients characteristics are comparable in the three groups. The median number of chemotherapy courses administered was 7, 6 and 5 in arm A, B and C, respectively. Objective responses were 24%, 30% and 21% and the median duration of responses were 2, 2.5 and 5.5 months in the arm A, B and C, respectively. Median overall survivals were 9.5, 9 and 9 months in the three arms. No difference was noted comparing the survivals of responding or non responding patients. General toxicity was not mild, with 27.5% of patients experiencing WHO grade 3-4 toxicities. Our results are similar in the three groups of patients and comparable to those reported by other authors. Chemotherapy applied to patients with second or subsequent recurrence allow objective responses in a small percentage of patients. Moreover responders have a negligible prolongation of survival.
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Affiliation(s)
- A Venturino
- Oncologia Medica 1 - Istituto Nazionale per la Ricerca sul Cancro, Genova.
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27
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Repetto L, Venturino A, Comandini D, Parodi S, Granetto C, Porcile G, Audisio RA, Rosso R. A loading dose of tamoxifen followed by a standard dose in frail older women with breast cancer is feasible and effective. J Am Geriatr Soc 2000; 48:346-8. [PMID: 10733071 DOI: 10.1111/j.1532-5415.2000.tb02666.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Badellino F, Margarino G, Mereu P, Scala M, Monteghirfo S, Comandini D, Nocentini L, Schenone F. [Diagnostic protocol of thyroid nodules used in a surgical case series (409 cases)]. MINERVA CHIR 1999; 54:755-61. [PMID: 10638148] [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: 02/15/2023]
Abstract
BACKGROUND The introduction of ultrasonography and fine needle biopsy (FNB) has changed the approach towards thyroid pathology. At the Division of Surgical Oncology of the National Institute for Cancer Research in Genoa we use a complex diagnostic system for the selection of patients affected by thyroid pathologies. Our aim is to analyze this methodology and find the best diagnostic procedure for the individual patient. METHODS Between January 1982 and June 1997, 2500 patients (pts) were found to be affected by thyroid pathologies. The diagnostic procedures for thyroid pathologies are: physical examination and anamnesis, scintigraphy, ultrasonography, fine needle biopsy, blood dosages, radiography of trachea and aesophagus; some cases require Computerized Tomography of the neck and Magnetic Nuclear Resonance. At the end of the examinations 409 pts underwent surgery; we will be evaluating the diagnostic system of these patients. RESULTS We found from our data, that the group with the highest incidence of malignant tumors is characterized by a large number of instrumental examinations. In fact, 55/73 pts underwent all the instrumental exams, and in 21.1% a malignant tumor was found. These data are interesting, but more important is that only 409 patients out of 2500 underwent surgery 16.3%. CONCLUSIONS We believe that one single instrumental examination is not enough to detect the characteristic of a thyroid nodule; the three most important examinations, scintigraphy, ultrasonography and cytology, would make it possible to select those cases which need a surgical approach. We believe that the 20% incidence in these cases can be considered good result, considering that the incidence of malignant tumors in thyroid pathologies is about 5% and that in these cases although the tumors were not malignant, they were operated on for functional or mechanical disorder.
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Affiliation(s)
- F Badellino
- Divisione di Oncologia Chirurgica, Istituto Nazionale per la Ricerca sul Cancro, Genova
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Scala M, Mereu P, Comandini D, Nocentini L, Vecchio C. [Malignant phyllodes tumor with liposarcomatous differentiation. Description of a clinical case]. MINERVA CHIR 1999; 54:355-8. [PMID: 10443117] [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: 02/13/2023]
Abstract
Sarcoma of the breast are a rare group of neoplasms representing less than 5% of Soft Tissue Sarcomas (STS). Between 1980 and 1995 in the National Institute foe Cancer Research (IST) of Genoa, 2188 patients were submitted to surgery for breast cancer. Seven of them were found to be affected by sarcoma, confirmed by histologic diagnosis. All the patients were between 39 and 87 years-old. Surgical treatments were: wide excision (1 case), total mastectomy (2 cases), radical mastectomy following Halsted (4 cases). A case of a 53 year-old woman with a phyllodes tumor initially transforming in to liposarcoma is reported. The patient was submitted to surgery (total mastectomy) and nowadays is alive and free of disease after 29 months. All authors agree that the treatment for sarcoma of the breast is early and complete surgical excision of the mass. The role of chemotherapy and radiotherapy is still uncertain. Outcome is based on histologic type, degree of differentiation and tumor size.
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Affiliation(s)
- M Scala
- Divisione di Oncologia Chirurgica, Istituto per la Ricerca sul Cancro, Genova
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30
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Margarino G, Mereu P, Scala M, Comandini D, Nocentini L, Monteghirfo S. Flow chart for clinical staging of thyroid tumors. J Exp Clin Cancer Res 1998; 17:121-3. [PMID: 9646247] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- G Margarino
- Dept. of Surgical Oncology, National Cancer Institute, Genoa, Italy
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31
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Scala M, Comandini D, Mereu P, Monteghirfo S, Nocentini L, Margarino G. [Precancerous lesions of the oral cavity: review of the literature and an analysis of cases]. Acta Otorhinolaryngol Ital 1998; 18:7-10. [PMID: 9707724] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
146 patients with precancerous lesions of the oral cavity were observed in our institute between 1988 and 1995. Out of a total of 188 lesions, 110 were single and 36 were multifocal. Histologically 164 lesions were classified as keratosis, 14 as dysplasia, and 10 as lichen ruber planus. 76 patients were treated by cryosurgery, 20 received medical treatment and 3 underwent surgery. Only 47 patients eliminated such risk factors as smoking and alcohol consumption from their daily life-styles. Complete response was 99%, 20.8% and 29.8%, respectively, for cryosurgery, medical treatment and preventive measures. Only 2 patients (1.4%) developed squamous cell carcinoma of the oral cavity. Of these, 1 had had keratosis of the tongue, treated with cryosurgery, while the other had had a medically treated dysplasia of the floor of the mouth. There were 8 precancerous lesion recurrences after cryosurgery and 2 after medical treatment. After cryosurgery 18 new lesions appeared in a site other than the primary site, 4 occurred after medical treatment, 1 after surgery and 2 in patients who had eliminated tobacco and alcohol consumption. Since precancerous lesions constitute a general apparatus disease, a systemic treatment is required which can stimulate cell differentiation and/or suppress the mechanisms inducing carcinogenesis. This may prevent the occurrence of new lesions. For this reason the authors believe that the initial treatment for patients with precancerous lesions should be medical. Loco-regional therapy should be reserved for those cases which do not respond to medical treatment.
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Affiliation(s)
- M Scala
- Divisione Oncologica Chirurgica, Istituto Nationale per la Ricerca sul Cancro, Genova
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Scala M, Moresco L, Comandini D, Monteghirfo S, Tomei D. [The role of the general practitioner and dentist in the early diagnosis of preneoplastic and neoplastic lesions of the oral cavity]. Minerva Stomatol 1997; 46:133-7. [PMID: 9173222] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Early detection of oral cancer allows for a 90% 5-year survival rate. Unfortunately, nowadays 60% of these tumors are detected in advanced stages with a 5-year survival of about 20%. Therefore, early diagnosis is of the greatest importance. Both the GP and the dentist have a primary role in early diagnosis and are also responsible for informing the population regarding the risk factors in oral cancer. GPs and dentists should systematically check the oral cavity mucous membranes in heavy smokers and/or drinkers above all when over 40. Lesions become suspicious when they persist for more than two weeks after detection. The high-risk pts and suspicious lesions should undergo the following diagnostic procedures: micronucleus test, vital staining, scraping and biopsy for cytological and histological examination. The above mentioned methods will increase the early diagnosis of tumours and improve its prognosis.
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Affiliation(s)
- M Scala
- Divisione di Oncologia Chirurgica, Instituto Nazionale per la Ricerca sul Cancro, Genova
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Margarino G, Scala M, Mereu P, Comandini D, Schenone G, Galli A, Francaviglia N, Gipponi M. Combined craniofacial approach to facial tumours involving the anterior skull base. Eur J Surg Oncol 1996; 22:361-5. [PMID: 8783653 DOI: 10.1016/s0748-7983(96)90264-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors report their experience on six male patients and one female patient (age range: 58-76 years, median: 67) with facial tumours involving the anterior skull base, undergoing craniofacial resection between January 1992 and May 1994 at the Division of Surgical Oncology in the Tumor Institute, Genoa. Three patients had squamous carcinoma and adenocarcinoma of the nasal fossa; two patients had squamous carcinoma rT4NO and adenocarcinoma rT4NO1 of the maxillary sinus; one patient had squamous carcinoma of the eyelid, and another had squamous carcinoma of the internal chantus. Four patients had had previous radiotherapy, another underwent pre-operative chemoradiotherapy, and only two patients had not been treated before. A proper craniofacial tumour resection was performed in three patients; one patient had a left maxillectomy with ethmoidectomy and orbital exenteration; one patient underwent maxillectomy, resection of the medial and inferior wall of the orbit, ethmoidectomy, and orbital exenteration; one patient underwent maxillectomy, ethmoidectomy, and mucosectomy of the sphenoidal sinus, and one patient had total ethmoidectomy. As for reconstruction procedures of the anterior skull base, lyophilized dura with galeal pericranial flap was commonly used. A myocutaneous flap transposition (transverse rectus abdominis and latissimus dorsi myocutaneous flap) was used in two patients for the reconstruction of the resected tissues and bones of maxillary and orbital regions. Post-operative complications included intraoperative liquorrhea in one patient; one case of early and serious pneumocephalus; flap necrosis occurred following transposition of latissimus dorsi. Median hospital stay was 34 days. After a median follow-up of 18 months (range: 3 to 34 months) five of seven patients (71.4%) are alive and disease-free at 15, 17, 18, 30 and 34 months from surgery.
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Affiliation(s)
- G Margarino
- Division of Surgical Oncology, Instituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Cafiero F, Gipponi M, Peressini A, Queirolo P, Bertoglio S, Comandini D, Percivale P, Sertoli MR, Badellino F. Radiation-associated angiosarcoma: diagnostic and therapeutic implications--two case reports and a review of the literature. Cancer 1996; 77:2496-502. [PMID: 8640698 DOI: 10.1002/(sici)1097-0142(19960615)77:12<2496::aid-cncr12>3.0.co;2-n] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Angiosarcoma (AS) accounts for 1 to 2% of all soft tissue sarcoma. Both primary and secondary AS may occur, the latter being reported in the upper extremity with lymphedema after extended radical mastectomy for breast cancer (postmastectomy AS) or following radiotherapy of the breast, the thoracic wall, or other sites (radiation-associated AS). The authors report two cases of cutaneous radiation-associated AS and review literature regarding treatment planning and follow-up data to define the most appropriate therapy for cutaneous and noncutaneous radiation-associated AS. METHODS The clinical records of two patients with radiation-associated AS were analyzed and previously reported cases were reviewed. RESULTS Case 1: a female age 67 years developed cutaneous AS in the residual breast 27 months after breast-conserving therapy and conventional external beam radiotherapy (EBR). She underwent chemotherapy followed by simple mastectomy and chemotherapy with the same regimen but developed early recurrence that was treated with hyperthermia and EBR, wide excision, and second-line chemotherapy. She died 30 months after primary diagnosis of AS with multiple metastases. Case 2: a male age 59 years developed cutaneous AS in the left groin, 10 years after conservative surgery and EBR for a penile carcinoma. Early recurrence following wide excision was treated with chemotherapy, re-excision, and immunochemotherapy but the patient died 24 months after the primary diagnosis of cutaneous AS with local progression and distant metastases. CONCLUSIONS The prognosis of radiation-associated AS is dismal, due mostly to its poor differentiation and frequent diagnostic delay. Simple mastectomy is advised for patients with cutaneous AS after breast-conserving surgery with wide tumor-free margins. If primary surgery fails, survival is seriously compromised because adjuvant or palliative treatments are not effective.
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Affiliation(s)
- F Cafiero
- Dipartimento di Oncologia Clinica e Sperimentale, School of Medicine, Genoa, Italy
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35
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Cafiero F, Gipponi M, Peressini A, Queirolo P, Bertoglio S, Comandini D, Percivale P, Sertoli MR, Badellino F. Radiation-associated angiosarcoma: Diagnostic and therapeutic implications—Two case reports and a review of the literature. Cancer 1996. [DOI: 10.1002/(sici)1097-0142(19960615)77:12%3c2496::aid-cncr12%3e3.0.co;2-n] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Margarino G, Schenone G, Scala M, Mereu P, Comandini D, Corvo R, Scolaro T, Badellino F. [Early stages of laryngeal cancer (I-II stage) and therapeutic options: case report and review of literature]. Acta Otorhinolaryngol Ital 1996; 16:40-6. [PMID: 8984839] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Between 1987 and 1993, 36 patients with early squamous cell carcinoma of the larynx (I-II stage) were treated with radiotherapy, at the National Institute for Cancer Research of Genoa; 25 patients were stage I (5 T1N0 of supraglottic larynx, 15 T1aN0 and 5 T1bN0 of glottic larynx) and 11 patients stage II (7 T2N0 of supraglottic larynx and 4 T2N0 of glottic larynx); there were 32 males (89%) and 4 females (11%), ages ranging from 34 to 83 years (mean age 61 years). The radiotherapy was performed utilizing the X-ray of a 6 MV linear accelerator, with a daily conventional fractionation and a dose of 66-70 Gy/33-35 fr./7 weeks, with co-axial latero-lateral beams including cervical lymph-nodes, except for T1N0 glottic cancer. The median follow-up was 51 months (range 8-84 months). The local control rate of all the patients was 80.5% at 51 months. According to the stage and tumor subsite, it was 80% for stage I a-b of the glottic site, 60% for the stage I of supraglottic site, 91% for stage II of supraglottic and glottic site. Only 6 patients (18%) underwent the salvage surgery and in all the patients the illness was under control. The overall survival rate was 83.3% at 51 months (4 patients died of a second tumor (11%) and 2 from heart disease (5.5%)). The only complication we observed was a glottic edema. The analysis of our results demonstrates that radiotherapy seems to be more appropriate in the T1a-b glottic cancer. These results are in agreement with those obtained by other studies. On the contrary, the results obtained with radiotherapy, in the T2N0 glottic cancer, are not satisfactory, with regard to local control, as those obtained with surgery, but offers best functional results. In most T2N0 tumors, after the failure of radiotherapy, a reconstructive laryngectomy is still possible. We also obtained good results with the supraglottic lesions. The small number of cases we treated does not allow us to achieve final conclusions and other studies are necessary to confirm our results.
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Affiliation(s)
- G Margarino
- Divisione Oncologia Chirurgica, Istituto Nazionale per la Ricerca sul Cancro, Genova
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Mereu P, Scala M, Schenone F, Schenone G, Comandini D, Gipponi M, Margarino G. [Non-toxic nodular goiter: treatment and follow-up]. Acta Otorhinolaryngol Ital 1995; 15:301-4. [PMID: 8928662] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Between 1982 and 1993, 224 patients (196 females and 28 males) with benign lesion of the thyroid underwent surgery. This group included: 1) 210 pts with p multinodular goiter or solitary nodule with normal serum levels of T3, T4, FT3, FT4, TSH (Thyroid stimulating hormone; 2) 14 pts with a hyper-functioning goiter; 3) 12 pts with recurrent nodules following surgery which had been carried out in another hospital. In this study only those pts with solid cold (hypofunctioning) nodules which had not been treated previously were evaluated. The minimal follow-up was 18 months. It consisted of serologic studies (86 cases), ultrasonography (70 cases) and ultrasonography and scintigraphy (5 cases). We performed isthmusectomy in 2 cases, total lobectomy in 42 cases and subtotal thyroidectomy in 42 cases. Out of the 86 pts evaluated, 70 (81.3%) were treated with post-surgical hormone suppressive therapy (Levothyroxin 100 gamma daily). The endogenous thyroid stimulating hormone (TSH) was suppressed in 50 cases (71%), while 20 pts (28.5%) remained within the norm. Thyroid ultrasonography demonstrated recurrent nodules in 14 out of the 86 evaluated (16.2%). All these pts received thyroxine therapy. Among the 50 pts who had been treated with an adequate dose of thyroid hormone, 5 had recurrences (10%), as compared to 3 out of the 20 cases (15%) who had been administered thyroxine dosage not high enough to suppress THS and to 6 pts out of the 16 (33.5%) who had not been administered thyroid hormone. One out of the 20 pts (5%) who had undergone total lobectomy and post-surgical suppressive hormone therapy developed recurrence as compared to 6 out of the 24 pts (25%) who had under gone lobectomy and had been administered a hormone dosage which was not high enough to suppress TSH. Four out of the cases (13.3%) who had under gone subtotal thyroidectomy and post-surgical suppressive hormone therapy had recurrence as compared to 3 out of the 12 (25%) who had undergone subtotal thyroidectomy without TSH suppression. We conclude that treatment with thyroid hormone decreases the risk of benign recurrences only when undergone a long thyroxine therapy in doses high enough to suppress endogenous TSH.
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Affiliation(s)
- P Mereu
- Divisione Oncologia Chirurgica, Istituto Nazionale per la Ricerca sul Cancro, Genova
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Scala M, Mereu P, Schenone G, Comandini D, Margarino G. [Lipoma of the tongue. A clinical case report]. Minerva Stomatol 1992; 41:215-8. [PMID: 1461244] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lipoma is a benign tumor of the adipose tissue. It is a common neoplasm but very rarely involves the tongue. Only 0.3% of all tumors involving the tongue are lipomas. A case of lipoma originating in the tongue is described. The tumor was removed and did not recur one year after excision.
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Affiliation(s)
- M Scala
- Divisione di Oncologia Chirurgica, Istituto Nazionale per la Ricerca sul Cancro, Genova
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