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Macchia G, Pezzulla D, Cilla S, Buwenge M, Romano C, Ferro M, Boccardi M, Ferioli M, Bonome P, Lancellotta V, Tagliaferri L, Ferrandina G, Gambacorta MA, Morganti AG, Deodato F. Stereotactic Body Reirradiation in Gynaecological Cancer: Outcomes and Toxicities from a Single Institution Experience. Clin Oncol (R Coll Radiol) 2023; 35:682-693. [PMID: 37558548 DOI: 10.1016/j.clon.2023.07.011] [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: 01/18/2023] [Revised: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
AIMS To report toxicity profile, outcomes and quality of life (QoL) data in patients with recurrent gynaecological cancer who underwent stereotactic body radiotherapy (SBRT) retreatment. MATERIALS AND METHODS Data from patients' folders were retrospectively extracted, focusing on the primary neoplasm, previous systemic therapies and previous radiotherapy. Concerning SBRT, the total dose (five daily fractions) was delivered with a linear accelerator using intensity-modulated radiotherapy techniques. Acute and late toxicities were assessed by the CTCAE 4.03 scale. QoL was evaluated according to the Cancer Linear Analogue Scale [CLAS1 (fatigue), CLAS2 (energy level), CLAS3 (daily activities)]. RESULTS Between December 2005 and August 2021, 23 patients (median age 71 years, range 48-80) with 27 lesions were treated. Most patients had endometrial (34.8%), ovarian (26.1%) and cervical cancer (26.1%) as the primary tumour. The most common SBRT schedules in five fractions were 30 Gy (33.3%), 35 Gy (29.6%) and 40 Gy (29.6%). The median follow-up was 32 months (range 3-128). There were no patients reporting acute or late toxicities higher than grade 2, except for a bone fracture. One- and 2-year local control was 77.9% and 70.8%, respectively. One- and 2-year overall survival was 82.6% and 75.1%, respectively. The overall response rate was 96.0%. Regarding QoL, no statistically significant difference was identified between the baseline and follow-up values: the median CLAS1, CLAS2 and CLAS3 scores for each category were 6 (range 4-10) at baseline and 6 (range 3-10) 1 month after SBRT. CONCLUSIONS This preliminary experience suggests that SBRT retreatment for recurrent gynaecological cancer is a highly feasible and safe treatment with limited side-effects and no short-term QoL impairment.
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Affiliation(s)
- G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - D Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - S Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - C Romano
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - P Bonome
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - V Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Roma, Italy
| | - L Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Roma, Italy
| | - G Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - M A Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Roma, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - F Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
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Rosati A, Vargiu V, Certelli C, Arcieri M, Vizza E, Legge F, Cosentino F, Ferrandina G, Fanfani F, Scambia G, Corrado G. Is the sarcomatous component (homologous vs heterologous) the prognostic "driving force" in early-stage uterine carcinosarcomas? A retrospective multicenter study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04594-5. [PMID: 36773091 PMCID: PMC10356890 DOI: 10.1007/s00432-023-04594-5] [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: 11/07/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Uterine carcinosarcomas (UCSs) are aggressive biphasic malignancies, with a carcinomatous/epithelial component and a sarcomatous/mesenchymal counterpart. The aim of this study was to evaluate the impact of the sarcomatous component (homologous vs heterologous) on the overall survival (OS) and progression-free survival (PFS). METHODS This is a multicenter observational retrospective study conducted in patients with stage I and II UCSs. RESULTS Ninety-five women with histological diagnosis of early-stage UCSs were retrieved: 60 (63.2%) had tumors with homologous sarcomatous components, and 35 (36.8%) with heterologous. At univariate analysis, a stromal invasion ≥ 50%, the presence of clear cell, serous or undifferentiated carcinomatous component, the heterologous sarcomatous component and FIGO stage IB and II were shown to be variables with a statistically significant negative impact on PFS. Similarly, a depth of invasion ≥ 50%, the heterologous sarcomatous component and FIGO stage IB and II were statistically negative prognostic factors also concerning OS. At multivariate analysis, only the heterologous sarcomatous component was confirmed to be a statistically significant negative prognostic factor both on PFS (HR 2.362, 95% CI 1.207-4.623, p value = 0.012) and on OS (HR 1.950, 95% CI 1.032-3.684, p = 0.040). CONCLUSION Carcinomatous and sarcomatous components both played a role in tumor progression and patients' survival. However, only the sarcomatous component retained a statistical significance at the multivariable model suggesting its preeminent prognostic role in early-stage UCSs.
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Affiliation(s)
- A Rosati
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - V Vargiu
- Department of Gynecologic Oncology, Gemelli Molise, Campobasso, Italy
| | - C Certelli
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - M Arcieri
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - E Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - F Legge
- Gynecologic Oncology Unit, Dept. Obstetrics/Gynecology "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - F Cosentino
- Department of Gynecologic Oncology, Gemelli Molise, Campobasso, Italy.,Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio" Università degli studi del Molise, Campobasso, Italy
| | - G Ferrandina
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italia
| | - F Fanfani
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italia
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italia
| | - G Corrado
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.
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3
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Marchetti C, Fagotti A, Cassani C, Incorvaia L, Perri M, Sassu C, Camnasio C, Giudice E, Minucci A, Arbustini E, Vertechy L, Salutari V, Distefano M, Boccia S, Musacchio L, Ferrandina G, Russo A, Scambia G, Lorusso D. 42P Efficacy of maintenance with PARPi in advanced ovarian cancer according to the location of BRCA mutation. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100822] [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: 02/27/2023] Open
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4
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Musacchio L, Palluzzi E, Lauria R, Di Napoli M, Corrado G, Bergamini A, Salutari V, Marchetti C, Angioli R, Cassani C, Gori S, Palaia I, Savarese A, Raspagliesi F, Mosconi A, Zafarana E, De Angelis C, Ferrandina G, Scambia G, Lorusso D. 52P Real-world data of niraparib in platinum sensitive relapsed ovarian cancer: A multicenter experience of the MITO group. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100832] [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: 02/27/2023] Open
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5
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Panza G, Autorino R, Cusumano D, Boldrini L, Gui B, Russo L, Votta C, Dinapoli N, Ferrandina G, Nardangeli A, Campitelli M, Macchia G, Valentini V, Gambacorta M. PO-1343 Radiomic model to predict 2ysOS in Cervical Cancer patients underwent neoadjuvant chemoradiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03307-2] [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: 10/18/2022]
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Federico A, Anchora LP, Scambia G, Ferrandina G. ASO Author Reflections: Role of Adjuvant Surgery in Locally Advanced Cervical Cancer: An Unresolved Issue. Ann Surg Oncol 2022; 29:4815-4816. [DOI: 10.1245/s10434-022-11620-2] [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] [Received: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022]
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7
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Ciccarone F, Biscione A, Lorusso D, Zannoni GF, Cina A, Ferrandina G, Scambia G, Testa AC. Diagnosis of uterine leiomyosarcoma 5 years after magnetic-resonance-guided high-intensity focused ultrasound treatment of fibroid. Ultrasound Obstet Gynecol 2022; 59:125-126. [PMID: 34532904 DOI: 10.1002/uog.24775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- F Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Biscione
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - D Lorusso
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G F Zannoni
- Unità Operativa di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Cina
- Dipartimento di Scienze Radiologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Ferrandina
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Pedone Anchora L, Bizzarri N, Gallotta V, Chiantera V, Fanfani F, Fagotti A, Cosentino F, Vizzielli G, Carbone V, Ferrandina G, Scambia G. Impact of surgeon learning curve in minimally invasive radical hysterectomy on early stage cervical cancer patient survival. Facts Views Vis Obgyn 2021; 13:231-239. [PMID: 34555877 PMCID: PMC8823276 DOI: 10.52054/fvvo.13.3.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Recently, it has been sustained that only surgeons skilled in minimally invasive radical hysterectomy (MI-RH) could provide valuable oncological outcomes in early-stage cervical cancer. Still, literature lacks data correlating surgeon experience with patient survival rate. Objective To investigate the impact of surgeon training patient survival rate following MI-RH for early stage cervical cancer. Methods This was a retrospective study of 243 early-stage cervical cancer treated with MI-RH. Multiple regression analyses were undertaken to investigate the impact of the surgeons learning curve, according to the number of MI-RH, on patients prognosis. Results A steady trend of reduction in disease recurrence risk is associated with increased surgeon experience. The peak of the learning curve was shown at the 19th MI-RH (hazard ratio of disease-free survival: 0.321; 95%CI: 0.140-0.737; p= 0.007). The 3 years disease-free survival that a surgeon could provide to patients is significantly lower at the beginning of his/her learning path comparing to what he/she could guarantee once adequate experience had been achieved (75.4% and 91.6% respectively, p=0.005). Surgeon experience appears to be an independent prognostic factor. Conclusion The experience that a surgeon can achieve practicing in MI-RH significantly influences oncological outcomes of early-stage cervical cancer patients. Future studies comparing minimally invasive and open surgery should take this into account. It would be advisable that the scientific community precisely establishes the minimum training required in the field of MI-RH for early-stage cervical cancer.
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Casà C, Macchia G, Ferioli M, Lancellotta V, Boccardi M, Cerrotta A, Tortoreto F, Ippolito E, Laliscia C, Huscher A, Di Muzio J, Morganti A, Lazzari R, Ferrandina G, Tagliaferri L. PH-0445 Preliminary results of the Italian Retrospective Study on adjuvant radiotherapy for vulvar cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07336-9] [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: 10/20/2022]
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10
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Macchia G, Ferrandina G, Patarnello S, Autorino R, Masciocchi C, Pisapia V, Calvani C, Iacomini C, Cesario A, Gui B, Rufini V, Boldrini L, Scambia G, Valentini V. OC-0059 Multidisciplinary Tumor Board Smart Virtual Assistant in Locally Advanced Cervical Carcinoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ferrandina G, Gallotta V, Federico A, Fanfani F, Ercoli A, Chiantera V, Cosentino F, Turco LC, Legge F, Anchora LP, Bizzarri N, Moroni R, Macchia G, Valentini V, Scambia G. Minimally Invasive Approaches in Locally Advanced Cervical Cancer Patients Undergoing Radical Surgery After Chemoradiotherapy: A Propensity Score Analysis. Ann Surg Oncol 2020; 28:3616-3626. [PMID: 33165720 PMCID: PMC8184543 DOI: 10.1245/s10434-020-09302-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022]
Abstract
Purpose Chemoradiation (CT/RT) followed by radical surgery (RS) may play a role in locally advanced cervical cancer (LACC) patients with suboptimal response to CT/RT or in low-income countries with limited access to radiotherapy. Our aim is to evaluate oncological and surgical outcomes of minimally invasive radical surgery (MI-RS) compared with open radical surgery (O-RS). Patients and Methods Data for stage IB2–IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed. Results Beginning with 686 patients, propensity score matching resulted in 462 cases (231 per group), balanced for FIGO stage, lymph node status, histotype, tumor grade, and clinical response to CT/RT. The 5-year disease-free survival (DFS) was 73.7% in the O-RS patients and 73.0% in the MI-RS patients (HR 1.034, 95% CI 0.708–1.512, p = 0.861). The 5-year locoregional recurrence rate was 12.5% (O-RS) versus 15.2% (MI-RS) (HR 1.174, 95% CI 0.656–2.104, p = 0.588). The 5-year disease-specific survival (DSS) was 80.4% in O-RS patients and 85.3% in the MI-RS group (HR 0.731, 95% CI 0.438–1.220, p = 0.228). Estimated blood loss was lower in the MI-RS group (p < 0.001), as was length of hospital stay (p < 0.001). Early postoperative complications occurred in 77 patients (33.3%) in the O-RS group versus 88 patients (38.1%) in the MI-RS group (p = 0.331). Fifty-six (24.2%) patients experienced late postoperative complications in the O-RS group, versus 61 patients (26.4%) in the MI-RS group (p = 0.668). Conclusion MI-RS and O-RS are associated with similar rates of recurrence and death in LACC patients managed by surgery after CT/RT. No difference in early or late complications was reported. Electronic supplementary material The online version of this article (10.1245/s10434-020-09302-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Gallotta
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A Federico
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Ercoli
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - F Cosentino
- Gynecologic Oncology, Gemelli Molise, Campobasso, Italy
| | - L C Turco
- Gynecology and Breast Care Unit, Mater Olbia Hospital, Olbia, Italy
| | - F Legge
- Gynecologic Oncology Unit, Department Obstetrics/Gynecology "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - L Pedone Anchora
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - N Bizzarri
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - R Moroni
- Direzione Scientifica, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - G Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - V Valentini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Macchia G, Cerrotta A, Deodato F, Pappalardi B, Re A, Santoni R, Campitelli M, Scambia G, Valentini V, Aristei C, Ferrandina G. PO-1116: Cervical cancer patterns of care in italy: a radiation oncology survey of mito and airo gyn groups. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Lorusso D, Marchetti C, Conte C, Giudice E, Bolomini G, Vertechy L, Ceni V, Ditto A, Ferrandina G, Raspagliesi F, Scambia G, Fagotti A. Bevacizumab as maintenance treatment in BRCA mutated patients with advanced ovarian cancer: A large, retrospective, multicenter case-control study. Gynecol Oncol 2020; 159:95-100. [PMID: 32703631 DOI: 10.1016/j.ygyno.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the correlation between BRCA mutational status and response to bevacizumab in a large advanced ovarian cancer (AOC) series. METHODS This is a multicenter, retrospective case-control study including upfront AOC treated between January 2015 and June 2019. The main inclusion criteria were: having received three weekly carboplatin-paclitaxel as first-line treatment, with or without Bevacizumab maintenance, knowledge of the BRCA mutational status. RESULTS Overall, 441 patients were included; 183 (41.5%) patients received bevacizumab (Cases), and 258 (58.5%) did not receive it (Controls). The BRCA mutated patients (BRCAmut) were 58 (39%) in the Cases group and 90 (34.9%) in the Controls group (p = .77). Patients who received bevacizumab had a significant 4-months increase in median progression free survival (mPFS: 21 vs. 17 months, p = .033). Concerning BRCAmut patients, no differences were shown between those who received bevacizumab or not in terms of mPFS (24 vs. 22 months, p = .3). Conversely, in BRCA wild-type (BRCAwt) population bevacizumab administration significantly prolonged mPFS (20 vs 15 months, p = .019). At multivariate analysis, independent factors of prolonged PFS were BRCA status (OR = 0.60), having received PDS (OR = 0.69), and complete cytoreduction (OR = 0.50), but not the bevacizumab administration (OR = 0.83, p = .22). CONCLUSIONS No evidence of oncological benefit in terms of PFS and OS related to bevacizumab maintenance therapy was found in BRCAmut patients. Differently, BRCAwt patients seem to benefit from antiangiogenic treatment in terms of mPFS.
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Affiliation(s)
- D Lorusso
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Marchetti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Conte
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Bolomini
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Vertechy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - V Ceni
- Department of Obstetrics and Gynecology of Parma, Parma, Italy
| | - A Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Raspagliesi
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - A Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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Gallotta V, Bruno M, Conte C, Giudice MT, Davià F, Moro F, Zannoni GF, Fagotti A, De Bonis M, Capoluongo E, Scambia G, Ferrandina G. Salvage lymphadenectomy in recurrent ovarian cancer patients: Analysis of clinical outcome and BRCA1/2 gene mutational status. Eur J Surg Oncol 2020; 46:1327-1333. [PMID: 32085925 DOI: 10.1016/j.ejso.2020.01.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/26/2019] [Revised: 12/28/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study is aimed to analyze the clinical outcome of recurrent ovarian cancer patients bearing isolated lymph-node recurrence (ILNR) who underwent salvage lymphadenectomy (SL). The prognostic role of clinicopathological variables and the mutational status of BRCA1/2 have also been investigated. METHODS This retrospective, single-institutional study included women with platinum-sensitive lymph node recurrence underwent to SL between June 2008 and June 2018. Univariate and multivariate analysis was performed to evaluate the impact of clinical parameters, and BRCA1/2 mutational status on post salvage lymphadenectomy progression-free survival (PSL-PFS). RESULTS As of June 2019, the median follow-up after SL was 30 months, and the relapse has been documented in 48 (56.5%) patients. In the whole series, the median PSL-PFS was 21 months, and the 3-year PSL-PFS was 36.7%. The median PSL-PFS, according to patients with ILNR (N = 71) versus patients with lymph-nodes and other sites of disease (N = 14), was 27 months versus 12 months, respectively. Univariate analysis of variables conditioning PSL-PFS showed that platinum-free interval (PFI) ≥12 months, normal Ca125 serum levels, and number of metastatic lymph-nodes ≤3 played a statistically significant favorable role. In multivariate analysis, PFI duration ≥12 months and the number of metastatic lymph nodes ≤3 were shown to keep their favorable, independent prognostic value on PSL-PFS. CONCLUSIONS In the context of SL, the patients with long PFI and low metastatic lymph node numbers at ILNR diagnosis have the best outcome. The BRCA mutational status seems not associated with clinical variables and PSL-PFS, differently from other sites of disease in ROC patients.
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Affiliation(s)
- V Gallotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy.
| | - M Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - C Conte
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy
| | - M T Giudice
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - F Davià
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - F Moro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy
| | - G F Zannoni
- Università Cattolica Del Sacro Cuore, Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Gineco-patologia e Patologia Mammaria, Roma, Italy
| | - A Fagotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - M De Bonis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Polo Scienze per Immagini, di Laboratorio e Infettivologiche, Roma, Italy
| | - E Capoluongo
- Università Federico II-CEINGE, Biotecnologie Avanzate, Napoli, Italy
| | - G Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - G Ferrandina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
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15
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Lorusso D, Ferrandina G, Colombo N, Pignata S, Pietragalla A, Sonetto C, Pisano C, Lapresa MT, Savarese A, Tagliaferri P, Lombardi D, Cinieri S, Breda E, Sabatucci I, Sabbatini R, Conte C, Cecere SC, Maltese G, Scambia G. Carboplatin-paclitaxel compared to Carboplatin-Paclitaxel-Bevacizumab in advanced or recurrent endometrial cancer: MITO END-2 - A randomized phase II trial. Gynecol Oncol 2019; 155:406-412. [PMID: 31677820 DOI: 10.1016/j.ygyno.2019.10.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 08/14/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Increased Vascular Endothelial Growth Factor Receptor (VEGF) expression in endometrial cancer (EC) is associated with a poor prognosis. Preliminary clinical data reported Bevacizumab effectiveness in EC both as single agent and in combination with chemotherapy. METHODS In a phase II trial, patients with advanced (FIGO stage III-IV) or recurrent EC were randomized to receive Carboplatin-Paclitaxel standard dose for 6-8 cycles vs Carboplatin-Paclitaxel and Bevacizumab 15 mg/kg in combination with chemotherapy and maintenance until disease progression or unacceptable toxicity. The primary endpoint was progression free survival (PFS). RESULTS 108 patients were randomized; PFS (10.5 vs 13.7 months, HR 0.84 p = 0.43), overall response rate (ORR 53.1% vs 74.4%) and overall survival (OS) (29.7 vs 40.0 months, HR 0.71 p = 0.24) resulted in a non-significant increase in Bevacizumab treated patients. The PFS increase became significant when an exploratory analysis with the Breslow test was used. Moreover, patients treated with Bevacizumab experienced a significant increase in 6-month disease control rate (70.4% vs 90.7%). Cardiovascular events were more frequent in the experimental arm ("de novo" grade ≥2 hypertension 21% vs 0% and grade ≥2 thromboembolic events 11% vs 2% in the Bevacizumab vs standard treatment arm, respectively). CONCLUSIONS Bevacizumab combined with chemotherapy in the treatment of advanced/recurrent EC failed to demonstrate a significant increase in PFS in the MITO END-2 trial. Nevertheless, these preliminary data suggests some effectiveness of the antiangiogenic agent which merits further exploration in a larger population with a better molecular characterization.
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Affiliation(s)
- D Lorusso
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - G Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Woman, Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - N Colombo
- Gynecologic Oncology Program, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of medicine and surgery, University of Milan-Bicocca, Milan, Italy
| | - S Pignata
- Department of Oncology, Fondazione Pascale National Cancer Institute, Naples, Italy
| | - A Pietragalla
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Sonetto
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - C Pisano
- Department of Oncology, Fondazione Pascale National Cancer Institute, Naples, Italy
| | - M T Lapresa
- Gynecologic Oncology Program, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Savarese
- Department of Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - P Tagliaferri
- Department of Oncology, Magna Grecia University, Catanzaro, Italy
| | - D Lombardi
- Department of Oncology, CRO, Aviano, Italy
| | - S Cinieri
- Department of Oncology, Di Summa-Perrino Hospital, Brindisi, Italy
| | - E Breda
- Department of Oncology, Fatebenefratelli Hospital, Rome, Italy
| | - I Sabatucci
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - R Sabbatini
- Department of Oncology, University of Modena and Reggio Emilia, Italy
| | - C Conte
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S C Cecere
- Department of Oncology, Fondazione Pascale National Cancer Institute, Naples, Italy
| | - G Maltese
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Woman, Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
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Piccirillo MC, Scambia G, Bologna A, Signoriello S, Vergote I, Baumann K, Lorusso D, Murgia V, Sorio R, Ferrandina G, Sacco C, Cormio G, Breda E, Cinieri S, Natale D, Mangili G, Pisano C, Cecere SC, Di Napoli M, Salutari V, Raspagliesi F, Arenare L, Bergamini A, Bryce J, Daniele G, Gallo C, Pignata S, Perrone F. Quality-of-life analysis of the MITO-8, MaNGO, BGOG-Ov1, AGO-Ovar2.16, ENGOT-Ov1, GCIG study comparing platinum-based versus non-platinum-based chemotherapy in patients with partially platinum-sensitive recurrent ovarian cancer. Ann Oncol 2019; 29:1189-1194. [PMID: 29462248 DOI: 10.1093/annonc/mdy062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background MITO-8 showed that prolonging platinum-free interval by introducing non-platinum-based chemotherapy (NPBC) does not improve prognosis of patients with partially platinum-sensitive recurrent ovarian cancer. Quality of life (QoL) was a secondary outcome. Patients and methods Ovarian cancer patients recurring or progressing 6-12 months after previous platinum-based chemotherapy (PBC) were randomized to receive PBC or NPBC as first treatment. QoL was assessed at baseline, third and sixth cycles, with the EORTC C-30 and OV-28 questionnaires. Mean changes and best response were analysed. Progression-free survival, response rate, and toxicity are also reported for proper interpretation of data. All analyses were based on intention-to-treat. Results Out of the 215 patients, 151 (70.2%) completed baseline questionnaire, balanced between the arms; thereafter, missing rate was higher in the NPBC arm. At mean change analysis, C30 scores were prevalently worse in the NPBC than PBC arm, statistical significance being attained for emotional functioning, global health status/QoL, fatigue, and dyspnoea (effect sizes ranging from 0.30 to 0.51). Conversely, as for OV28 scale, the other chemotherapy side-effects item was significantly worse with PBC at three and six cycles, with a larger effect size (0.70 and 0.54, respectively). At best response analysis, improvement of emotional functioning and pain and worsening of peripheral neuropathy and other chemotherapy side-effects were significantly more frequent in the PBC arm. Progression-free survival (median 9 versus 5 months, P = 0.001) and objective response rate (51.6% versus 19.4%, P = 0.0001) were significantly better with PBC. Allergy, blood cell count, alopecia, nausea, musculoskeletal, and neurological side-effects were more frequent and severe with PBC; hand-foot skin reaction, rash/desquamation, mucositis, and vascular events were more frequent with NPBC. Conclusion MITO-8 QoL analysis shows that deterioration of some functioning and symptom scales is lower with PBC, with improvement of emotional functioning and pain, despite worsening of toxicity-related items. ClinicalTrials.gov NCT00657878.
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Affiliation(s)
- M C Piccirillo
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - G Scambia
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma
| | - A Bologna
- Medical Oncology Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Reggio Emilia
| | - S Signoriello
- Medical Statistics, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - I Vergote
- University Hospital Leuven, Leuven; Leuven Cancer Institute, Leuven, Belgium
| | - K Baumann
- UKGM Gynecology, Frauenklinik, Marburg, Germany
| | - D Lorusso
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma; Gynaecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano
| | - V Murgia
- Medical Oncology, Ospedale S. Chiara, Trento
| | - R Sorio
- Medical Oncology C, Centro di Riferimento Oncologico, Aviano, PN
| | - G Ferrandina
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma; Gynaecologic Oncology, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso
| | - C Sacco
- Oncology Department, AO S. Maria della Misericordia, Udine
| | - G Cormio
- Università di Bari, Bari; Ginecoloy Oncology, Istituto Oncologico "Giovanni Paolo II", Bari
| | - E Breda
- Medical Oncology, Ospedale S.Giovanni Calibita Fatebenefratelli, Roma
| | - S Cinieri
- Medical Oncology, Ospedale Antonio Perrino, Brindisi
| | - D Natale
- Medical Oncology, Ospedale San Massimo, Penne, PE
| | - G Mangili
- Obstertic and Gynaecologic Department, Ospedale San Raffaele, Milano
| | - C Pisano
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy
| | - S C Cecere
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy
| | - M Di Napoli
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy
| | - V Salutari
- Department of Protection of Women's Health, Rising Life, Child and Adolescent, Università Cattolica del Sacro Cuore, Roma
| | | | - L Arenare
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - A Bergamini
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli; Obstertic and Gynaecologic Department, Ospedale San Raffaele, Milano
| | - J Bryce
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - G Daniele
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
| | - C Gallo
- Medical Statistics, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - S Pignata
- Uro-Gynaecologic Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli, Italy.
| | - F Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS - Fondazione G.Pascale, Napoli
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Paris I, Accetta C, Carbognin L, Di Giorgio D, Magno S, Terribile D, Franceschini G, Sanchez M, Ferrandina G, Pasciuto T, Fulvi A, Scambia G, Masetti R. Abstract P1-11-03: Impact of scalp cooling device (SCD) in preventing alopecia in women undergoing chemotherapy for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-11-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background.
Alopecia (A) is a common and emotionally traumatic adverse effect for breast cancer (BC) patients (pts) undergoing chemotherapy (CT). Food and Drug Administration (FDA) cleared the DigniCap® SCD, for patients with breast cancer in 2015. This device was designed to reduce hair loss during chemotherapy. However, the impact of SCD in pts undergoing anthracycline and taxane-based sequential regimen is not entirely established. Thus, the aim of this analysis was to prospectively explore the role of SCD in a cohort of pts including also this regimen.
Methods.
From February 2016 to June 2018 patients with early/locally advanced breast cancer treated with neoadjuvant/adjuvant CT including anthracycline, taxane or both in sequential regimen were enrolled. The estimate of hair-loss was evaluated by photographs of the head using the Dean scale during and one month after the end of chemotherapy. Alopecia was graduated according to Dean scale: G0 = no A; G1 < 25% A; G2 = 25–50% A; G3 = 50–75% A; G4 > 75%. A score of 0-2 (≤ 50% hair loss) was defined as treatment success. Tolerability was defined as the percentage of patients who completed all chemotherapy cycles using the SCD. All patients received the Patient Symptoms Survey (self-reported). A database for individual data and information was appropriately fulfilled. Descriptive statistics was adopted.
Results.
Overall 121 pts were enrolled; 118 pts were evaluable for efficacy of Dignicap® SCD. Median age was 44 years (range: 24-74 years). CT regimens included docetaxel/cyclophosphamide (37 pts), epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2 iv) three weekly followed by 12 courses of paclitaxel (80 mg/m2 iv weekly) (84 pts). Alopecia all grade was showed in 52.5% (n=62): G1 in 35 pts (29.6%)and G2 in 23 pts (19.5%). No hair loss in 42 pts (35.6 %). Treatment success was seen in 103 pts (87.3%). Toxicity included grade 1/2 headache in 56 pts (47.4%), cervical discomfort in 36 pts (30.5%), pain of skin in one pts (8.5%). Discontinuation of SCD was seen in 28 pts (23.7%) primarily for headache G3 (4 pts – 3.4%), hair loss G3 in 15 pts (12.7%), discomfort in 8 pts (6.8%), use of head cover in one pt (0.8%).
Conclusions.
This prospective observational study suggests that SCD is effective in preventing A in a relevant number of patients (87.3%), undergoing also anthracyclines followed by taxanes regimen in sequential schedule.
Citation Format: Paris I, Accetta C, Carbognin L, Di Giorgio D, Magno S, Terribile D, Franceschini G, Sanchez M, Ferrandina G, Pasciuto T, Fulvi A, Scambia G, Masetti R. Impact of scalp cooling device (SCD) in preventing alopecia in women undergoing chemotherapy for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-03.
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Affiliation(s)
- I Paris
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - C Accetta
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - L Carbognin
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - D Di Giorgio
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - S Magno
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - D Terribile
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Franceschini
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - M Sanchez
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - T Pasciuto
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - A Fulvi
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - R Masetti
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Multidisciplinary Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore., Roma, Italy; Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Testa AC, Moro F, Pasciuto T, Moruzzi MC, Di Legge A, Fuoco G, Autorino R, Collarino A, Gui B, Zannoni GF, Gambacorta A, Miccò M, Rufini V, Scambia G, Ferrandina G. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. Ultrasound Obstet Gynecol 2018; 52:110-118. [PMID: 29119649 DOI: 10.1002/uog.18953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. METHODS Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. RESULTS Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. CONCLUSIONS Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A C Testa
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Pasciuto
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M C Moruzzi
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Legge
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Fuoco
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Autorino
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - A Collarino
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Gui
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - G F Zannoni
- Department of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Gambacorta
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - M Miccò
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - V Rufini
- Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ferrandina
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Health Science and Medicine, University of Molise, Campobasso, Italy
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Ludovisi M, Moruzzi MC, Ferrandina G, Scambia G, Testa AC. Ultrasound appearance of breast cancer metastatic to uterine leiomyoma. Ultrasound Obstet Gynecol 2018; 51:839-840. [PMID: 28925535 DOI: 10.1002/uog.18903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Affiliation(s)
- M Ludovisi
- Department of Women and Child Health, Women Health Area, Division of Gynecologic Oncology, Fondazione Policlinico Gemelli Università Cattolica del Sacro Cuore, Rome, Italy
| | - M C Moruzzi
- Department of Women and Child Health, Women Health Area, Division of Gynecologic Oncology, Fondazione Policlinico Gemelli Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ferrandina
- Department of Women and Child Health, Women Health Area, Division of Gynecologic Oncology, Fondazione Policlinico Gemelli Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Department of Women and Child Health, Women Health Area, Division of Gynecologic Oncology, Fondazione Policlinico Gemelli Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Department of Women and Child Health, Women Health Area, Division of Gynecologic Oncology, Fondazione Policlinico Gemelli Università Cattolica del Sacro Cuore, Rome, Italy
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Autorino R, Nardangeli A, Campitelli M, Gui B, Rodolfino E, Foti E, Mascillini F, Ferrandina G, Gambacorta M. EP-1523: Testing the efficacy of trimodal therapy in locally advanced cervical cancer: a phase II study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31832-2] [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]
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Bergamini A, Ferrandina G, Candiani M, Cormio G, Giorda G, Lauria R, Perrone AM, Scarfone G, Breda E, Savarese A, Frigerio L, Gadducci A, Mascilini F, Maneschi F, Cassani C, Marchetti C, Cecere SC, Biglia N, De Giorgi U, Raspagliesi F, Lorusso D, Mangili G. Laparoscopic surgery in the treatment of stage I adult granulosa cells tumors of the ovary: Results from the MITO-9 study. Eur J Surg Oncol 2018; 44:766-770. [PMID: 29576462 DOI: 10.1016/j.ejso.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/05/2017] [Revised: 02/16/2018] [Accepted: 03/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Surgery represents the mainstay of treatment of stage I adult type granulosa cell tumors of the ovary (AGCTs). Because of the rarity and indolent course of the disease, no prospective trials are available. Open surgery has long been considered the traditional approach; oncological safety of laparoscopy is only supported by small series or case reports. The aim of this study was to compare the oncological outcomes between laparoscopic and open surgery in stage I AGCTs treated within the MITO (Multicenter Italian Trials in Ovarian cancer) Group. METHODS Data from patients with stage I AGCTs were retrospectively collected. Clinicopathological features were evaluated for association with relapse and death. Survival curves were calculated using the Kaplan-Meier method and compared with the log-rank test. The role of clinicopathological variables as prognostic factors for survival was evaluated using Cox's regression model. RESULTS 223 patients were identified. Stage 1A, 1B and 1C were 61.5%, 1.3% and 29.6% respectively. 7.6% were apparently stage I. Surgical approach was laparoscopic for 93 patients (41.7%) and open for 130 (58.3%). 5-years DFS was 84% and 82%, 10-years DFS was 68% and 64% for the laparoscopic and open-group (p = 0.6).5-years OS was 100% and 99%, 10 years OS was 98% and 97% for the laparoscopic and open-surgery group (p = 0.8). At multivariate analyses stage IC, incomplete staging, site of primary surgery retained significant prognostic value. CONCLUSION The present study suggests that surgical route does not affect the oncological safety of patients with stage I AGCTs, with comparable outcomes between laparoscopic and open approach.
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Affiliation(s)
- A Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari, Italy; Gynecologic Oncology Unit, IRCCS National Cancer Institute "Giovanni Paolo II" Bari, Italy
| | - G Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - R Lauria
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - A M Perrone
- Department of Gynecology Oncology, Institute of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Breda
- Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - A Savarese
- Division of Medical Oncology 1, Regina Elena Cancer Institute, Rome, Italy
| | - L Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - A Gadducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mascilini
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - F Maneschi
- Gynecology and Obstetric Unit, AO San Giovanni Addolorata, Rome, Italy
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - C Marchetti
- Department of Gynecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - S C Cecere
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - N Biglia
- Obstetrics and Gynaecology Unit, Umberto I Hospital, Department of Surgical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - D Lorusso
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - G Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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Mangili G, Sigismondi C, Lorusso D, Cormio G, Candiani M, Scarfone G, Mascilini F, Gadducci A, Mosconi AM, Scollo P, Cassani C, Pignata S, Ferrandina G. The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study. Ann Oncol 2017; 28:333-338. [PMID: 27803008 DOI: 10.1093/annonc/mdw563] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated. Patients and methods Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed. Results Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively. Conclusions This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.
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Affiliation(s)
- G Mangili
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - C Sigismondi
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - D Lorusso
- Department of Gynecologic Oncology, IRCCS Foundation National Cancer Institute, Milan
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari
| | - M Candiani
- Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan
| | - F Mascilini
- Gynecology Oncology Unit, Foundation "PoliclinicoUniversitario A. Gemelli", Rome
| | - A Gadducci
- Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa
| | - A M Mosconi
- Azienda Ospedaliera Universitaria Perugia, Perugia
| | - P Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples
| | - G Ferrandina
- Department of Medicine and Health Science, University of Molise, Campobasso/Foundation, PoliclinicoUniversitario A. Gemelli, Rome, Italy
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Buwenge M, Macchia G, Ferioli M, Giaccherini L, Arcelli A, Galuppi A, Cammelli S, Perrone A, De Iaco P, Boccardi M, Tagliaferri L, Ferrandina G, Deodato F, Cilla S, Frezza G, Morganti A. EP-1298: Radiotherapy in invasive vaginal carcinoma: a systematic review. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31733-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Autorino R, Campitelli M, Martino A, Nardangeli A, Mattiucci G, Frascino V, Smaniotto D, Valentini A, Ferrandina G, Gambacorta M. EP-1304: A moderate ipofractionation schedule with IMRT in preoperative locally advanced cervical cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31739-5] [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: 11/26/2022]
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Pieri M, Frakulli R, Macchia G, Farioli A, Cilla S, Deodato F, Ammendolia I, Tolento G, Cammelli S, Di Lullo L, Taffurelli M, Zamagni C, Smaniotto D, Marazzi F, Valentini V, Ferrandina G, Morganti A. Hypofractionated radiotherapy after conservative surgery in breast cancer patients: a phase I-II trial (MARA-1). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cima S, Frakulli R, Perrone A, Macchia G, Buwenge M, Cammelli S, Castellucci P, Cilla S, Deodato F, Farioli A, Ferioli M, Cellini F, Ferrandina G, Galuppi A, Gambacorta M, Salizzoni E, Valentini V, Fanti S, De Iaco P, Morganti A. Prognostic impact of primary tumor SUVmax on preoperative 18 F FDG-PET/CT in local advanced cervical cancer. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30384-2] [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: 10/20/2022]
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Mangili G, Ottolina J, Cormio G, Loizzi V, De Iaco P, Pellegrini D, Candiani M, Giorda G, Scarfone G, Cecere S, Frigerio L, Gadducci A, Marchetti C, Ferrandina G. Adjuvant chemotherapy does not improve disease-free survival in FIGO stage IC ovarian granulosa cell tumors: The MITO-9 study. Gynecol Oncol 2016; 143:276-280. [DOI: 10.1016/j.ygyno.2016.08.316] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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Piccirillo M, Scambia G, Bologna A, Vergote I, Baumann K, Raspagliesi F, Murgia V, Pisano C, Salutari V, Sorio R, Ferrandina G, Sacco C, Cormio G, Breda E, Cinieri S, Cecere S, Daniele G, Gallo C, Perrone F, Pignata S. The MITO8 phase 3 international multicenter randomized study testing the effect on survival of prolonging platinum-free interval (PFI) in patients with ovarian cancer (OC) recurring between 6 and 12 months after previous platinum based chemotherapy. A collaboration of MITO, Mango, AGO Study Group, BGOG, ENGOT, and GCIG. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw331.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fanfani F, Vizza E, Landoni F, de Iaco P, Ferrandina G, Corrado G, Gallotta V, Gambacorta MA, Fagotti A, Monterossi G, Perrone AM, Lazzari R, Colangione SP, Scambia G. Radical hysterectomy after chemoradiation in FIGO stage III cervical cancer patients versus chemoradiation and brachytherapy: Complications and 3-years survival. Eur J Surg Oncol 2016; 42:1519-25. [PMID: 27241922 DOI: 10.1016/j.ejso.2016.05.011] [Citation(s) in RCA: 22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/19/2016] [Accepted: 05/14/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To compare patterns and rates of early and late complications, and survival outcome in FIGO stage III cervical cancer patients underwent to radical hysterectomy after chemo-radiation (CT-RT) vs. chemo-radiation alone. METHODS Between May 1996 and April 2013 150 FIGO stage III cervical cancer patients were treated. We divide patients according to type of treatment: 77 were submitted to standard treatment (Group A), and 73 to completion hysterectomy after chemo-radiation (Group B). RESULTS The baseline characteristics of the 2 groups were superimposable. We observed lower intra-operative and treatment-related early urinary and gastro-intestinal complications in Group B with respect to Group A (p < 0.001). Vascular complications were registered only in Group B (p < 0.001). We found a significantly higher rate of local recurrences in the Group A than in the Group B (p < 0.002). We registered 29 deaths in the Group A and 22 in the Group B (p = 0.021). The 3-years disease-free survival rate in the Group A and in the Group B was 62.9% and 68.3%, respectively (p = 0.686), and the 3-years overall survival rate in the Group A and in the Group B was 63.2% and 67.7%, respectively (p = 0.675). CONCLUSIONS This study confirms that radical hysterectomy after CT-RT is an effective therapeutic approach for advanced cervical cancer. Further prospective and randomized studies should be performed in order to solve the question about the standard approach, and how the different pattern of complication could impact on the quality of life.
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Affiliation(s)
- F Fanfani
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy.
| | - E Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - F Landoni
- Department of Gynecology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - P de Iaco
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Ferrandina
- Department of Medicine and Health Sciences, University of Molise, Campobasso/Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - G Corrado
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - V Gallotta
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| | - M A Gambacorta
- Department of Radiotherapy, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - A Fagotti
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| | - G Monterossi
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| | - A M Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - R Lazzari
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - S P Colangione
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
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Macchia G, Cilla S, Deodato F, Nuzzo M, Ianiro A, Catani D, Valentini V, Ferrandina G, Galuppi A, Ferioli M, Cammelli S, Ronchi L, Cima S, Perrone M, De Iaco P, Romani F, Frezza G, Morganti A. EP-1313: Short course post operative IMRT on vaginal vault of endometrial tumor at low-risk of recurrence. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32563-4] [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: 10/21/2022]
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Cima S, Macchia G, Galuppi A, Nuzzo M, De Iaco P, Deodato F, Perrone A, Valli M, Richetti A, Arcelli A, Bertini F, Farioli A, Cammelli S, Bisceglie A, Pieri M, Picchi S, Zamagni A, Frezza G, Morganti A, Ferrandina G. PV-0125: Chemoradiation+surgery vs chemoradiation+BRT in advanced cervical carcinoma: a case-control study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31374-3] [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: 10/21/2022]
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Lorusso D, Scambia G, Pignata S, Sorio R, Amadio G, Lepori S, Mosconi A, Pisano C, Mangili G, Maltese G, Sabbatini R, Artioli G, Gamucci T, Di Napoli M, Capoluongo E, Ludovini V, Raspagliesi F, Ferrandina G. Prospective phase II trial of trabectedin in BRCA-mutated and/or BRCAness phenotype recurrent ovarian cancer patients: the MITO 15 trial. Ann Oncol 2015; 27:487-93. [PMID: 26681678 DOI: 10.1093/annonc/mdv608] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Current evidence suggest that trabectedin is particularly effective in cells lacking functional homologous recombination repair mechanisms. A prospective phase II trial was designed to evaluate the activity of trabectedin in the treatment of recurrent ovarian cancer patients presenting BRCA mutation and/or BRCAness phenotype. PATIENTS AND METHODS A total of 100 patients with recurrent BRCA-mutated ovarian cancer and/or BRCAness phenotype (≥2 previous responses to platinum) were treated with trabectedin 1.3 mg/mq i.v. q 3 weeks. The activity of the drug with respect to BRCA mutational status and to a series of polymorphisms [single-nucleotide polymorphisms (SNPs)] involved in DNA gene repair was analyzed. RESULTS Ninety-four were evaluable for response; in the whole population, 4 complete and 33 partial responses were registered for an overall response rate (ORR) of 39.4. In the platinum-resistant (PR) and -sensitive (PS) population, an ORR of 31.2% and 47.8%, and an overall clinical benefit of 54.2% and 73.9%, respectively, were registered. In the whole series, the median progression-free survival (PFS) was 18 weeks and the median overall survival (OS) was 72 weeks; PS patients showed a more favorable PFS and OS compared with PR patients. BRCA gene mutational status was available in 69 patients. There was no difference in ORR, PFS and OS according to BRCA 1-2 status nor any association between SNPs of genes involved in DNA repair and NER machinery and response to trabectedin was reported. CONCLUSIONS Our data prospectively confirmed that the signature of 'repeated platinum sensitivity' identifies patients highly responsive to trabectedin. In this setting, the activity of trabectedin seems comparable to what could be obtained using platinum compounds and the drug may represent a valuable alternative option in patients who present contraindication to receive platinum. EUDRACT NUMBER 2011-001298-17.
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Affiliation(s)
- D Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of Rome
| | - S Pignata
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - R Sorio
- Department of Oncology, CRO Aviano, Aviano
| | - G Amadio
- Department of Obstetrics and Gynecology, Catholic University of Rome
| | - S Lepori
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - A Mosconi
- Medical Oncology Unit, University Hospital S. Maria della Misericordia, Perugia
| | - C Pisano
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - G Mangili
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan
| | - G Maltese
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - R Sabbatini
- Department of Oncology Haematology and Respiratory Disease, AOU Policlinico di Modena, Modena
| | - G Artioli
- Medical Oncology Unit, Hospital of Mirano, Mirano
| | - T Gamucci
- Medical Oncology Unit, Hospital 'SS. Trinità', Sora
| | - M Di Napoli
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - E Capoluongo
- Department of Molecular Biology, Catholic University of Rome
| | - V Ludovini
- Molecular Biology Unit, University Hospital S. Maria della Misericordia, Perugia, Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Catholic University of Rome
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Semprucci E, Tocci P, Cianfrocca R, Sestito R, Caprara V, Veglione M, Castro VD, Spadaro F, Ferrandina G, Bagnato A, Rosanò L. Endothelin A receptor drives invadopodia function and cell motility through the β-arrestin/PDZ-RhoGEF pathway in ovarian carcinoma. Oncogene 2015; 35:3432-42. [PMID: 26522724 DOI: 10.1038/onc.2015.403] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 02/07/2023]
Abstract
The endothelin-1 (ET-1)/ET A receptor (ETAR) signalling pathway is a well-established driver of epithelial ovarian cancer (EOC) progression. One key process promoted by ET-1 is tumor cell invasion, which requires the scaffolding functions of β-arrestin-1 (β-arr1) downstream of the receptor; however, the potential role of ET-1 in inducing invadopodia, which are crucial for cellular invasion and tumor metastasis, is completely unknown. We describe here that ET-1/ETAR, through β-arr1, activates RhoA and RhoC GTPase and downstream ROCK (Rho-associated coiled coil-forming kinase) kinase activity, promoting actin-based dynamic remodelling and enhanced cell invasion. This is accomplished by the direct interaction of β-arr1 with PDZ-RhoGEF (postsynaptic density protein 95/disc-large/zonula occludens-RhoGEF). Interestingly, ETAR-mediated invasive properties are related to the regulation of invadopodia, as evaluated by colocalization of actin with cortactin, as well as with TKS5 and MT1-MMP (membrane type 1-matrix metalloproteinase) with areas of matrix degradation, and activation of cofilin pathway, which is crucial for regulating invadopodia activity. Depletion of PDZ-RhoGEF, or β-arr1, or RhoC, as well as the treatment with the dual ET-1 receptor antagonist macitentan, significantly impairs invadopodia function, MMP activity and invasion, demonstrating that β-arr1/PDZ-RhoGEF interaction mediates ETAR-driven ROCK-LIMK-cofilin pathway through the control of RhoC activity. In vivo, macitentan is able to inhibit metastatic dissemination and cofilin phosphorylation. Collectively, our data unveil a noncanonical activation of the RhoC/ROCK pathway through the β-arr1/PDZ-RhoGEF complex as a regulator of ETAR-induced motility and metastasis, establishing ET-1 axis as a novel regulator of invadopodia protrusions through the RhoC/ROCK/LIMK/cofilin pathway during the initial steps of EOC invasion.
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Affiliation(s)
- E Semprucci
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - P Tocci
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - R Cianfrocca
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - R Sestito
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - V Caprara
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - M Veglione
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - V Di Castro
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - F Spadaro
- Section of Experimental Immunotherapy, Department of Haematology, Oncology and Molecular Medicine, Istituto Superiore di Sanita', Rome, Italy
| | - G Ferrandina
- Gynecologic Oncology Unit, Catholic University of Rome, Rome, Italy
| | - A Bagnato
- Regina Elena National Cancer Institute Rome, Rome, Italy
| | - L Rosanò
- Regina Elena National Cancer Institute Rome, Rome, Italy
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Piccirillo M, Scambia G, Lorusso D, De Giorgi U, Nicoletto M, Lauria R, Mosconi A, Sacco C, Omarini C, Tagliaferri P, Ferrandina G, Cinieri S, Pisano C, Cecere S, Di Napoli M, Salutari V, Daniele G, Gallo C, Perrone F, Pignata S. MITO (Multicentre Italian Trials in Ovarian cancer) - CERV 2 trial: a randomized phase II study of carboplatin and paclitaxel +/- cetuximab, in advanced and/or recurrent cervical cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv339.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Cecere S, Daniele G, Lorusso D, Scambia G, Nicoletto M, Breda E, Colombo N, Artioli G, Daniele B, Lo Re G, Raspagliesi F, Chiappa V, Salutari V, Ferrandina G, Greggi S, Baldoni A, Piccirillo M, Fossati R, Perrone F, Pignata S. Feasibility and outcome of interval debulking surgery (IDS) after carboplatin-paclitaxel-bevacizumab (CPB): results from a subgroup of patient from the MITO-16A-MANGO OV2A phase 4 trial. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv339.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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36
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Legge F, Chiantera V, Macchia G, Fagotti A, Fanfani F, Ercoli A, Gallotta V, Morganti A, Valentini V, Scambia G, Ferrandina G. Clinical outcome of recurrent locally advanced cervical cancer (LACC) submitted to primary multimodality therapies. Gynecol Oncol 2015; 138:83-8. [DOI: 10.1016/j.ygyno.2015.04.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/27/2015] [Indexed: 01/22/2023]
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37
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Fagotti A, Vizzielli G, Fanfani F, Chiantera V, Margariti P, Gallotta V, Costantini B, Ferrandina G, Tortorella L, Scambia G. Phase III SCORPION trial (ID number: NCT01461850) in epithelial ovarian cancer patients with high tumor load receiving PDS versus NACT: An interim analysis on peri-operative outcome. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Petrillo M, Zannoni G, Martinelli E, Pedone Anchora L, Ferrandina G, Tropeano G, Fagotti A, Scambia G. The ratio between type 1 and type 2 tumor-associated macrophages predicts prognosis in patients with locally advanced cervical cancer receiving chemoradiation. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Nomura H, Hanker L, Fabbro M, Rau J, Kim Y, Arija JA, Friedlander M, Ferrandina G, Vuylsteke P, Colombo N, Malander S, Monk B, Petru E, Calvert P, Herzog T, Barrett C, Jobanputra M, Wang Q, Elser G, Du Bois A. Pazopanib Versus Placebo in Women Without Progression After First-Line Chemotherapy for Advanced Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer (Aeoc): Second Interim Overall Survival Analysis from the Ago-Ovar16 Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Lorusso D, Ferrandina G, Pignata S, Sorio R, Amadio G, Mosconi A, Pisano C, Mangili G, Masini C, Artioli G, Narducci F, Di Napoli M, Rigamonti C, Raspagliesi F, Scambia G. Trabectedin in Patients with Brca Mutated and Brcaness Phenotype Advanced Ovarian Cancer (Aoc): Phase Ii Prospective Mito-15 Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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41
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Lorusso D, Mainenti S, Ferrandina G, Scambia G. Assessment of factors that contribute to decreased quality of life in Gynecologic Oncology Group ovarian cancer trials. Expert Rev Anticancer Ther 2014; 10:987-91. [DOI: 10.1586/era.10.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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42
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Macchia G, Deodato F, Cilla S, Ferrandina G, Mariano G, Digesù C, Corrado G, Piermattei A, Valentini V, Morganti A. EP-1341: Volumetric arc radiosurgery in recurrent gynecological cancer: A preliminary report from a phase I trial. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Petrillo M, Legge F, Ferrandina G, Monterisi A, Pedone Anchora L, Scambia G. Fertility-Sparing Surgery in Ovarian Cancer Extended beyond the Ovaries: A Case Report and Review of the Literature. Gynecol Obstet Invest 2014; 77:1-5. [DOI: 10.1159/000353277] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 05/27/2013] [Indexed: 11/19/2022]
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44
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Ferrandina G, Lucidi A, De Ninno M, Carbone A, Chiantera V, Morganti AG, Macchia G. Successful treatment of a young patient with locally advanced clear cell adenocarcinoma of the uterine cervix undergoing chemoradiation followed by radical surgery. Gynecol Obstet Invest 2013; 77:64-7. [PMID: 24296792 DOI: 10.1159/000356685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/24/2013] [Indexed: 11/19/2022]
Abstract
Clear cell adenocarcinoma (CCAC) of the uterine cervix is a rare variant of cervical adenocarcinoma accounting for approximately 4-9% of this disease. Given the rarity of this pathological entity, the optimal treatment management is far from being defined. Earlier evidence suggested that the prognosis of patients bearing cervical CCAC is worse than with other histotypes, thus making the investigation of multimodal treatment strategies clinically worthwhile. Herein, we report the first case of locally advanced, large size cervical CCAC in a young woman who was triaged to concomitant chemoradiotherapy followed by radical surgery and experienced a pathologically assessed optimal response to this multimodal approach.
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Affiliation(s)
- G Ferrandina
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
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45
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Testa AC, De Blasis I, Di Legge A, Belli P, Hohaus S, Ferrandina G. Burkitt's lymphoma of the breast metastatic to the ovary diagnosed during pregnancy. Ultrasound Obstet Gynecol 2013; 42:364-366. [PMID: 24137791 DOI: 10.1002/uog.12533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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46
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Fanfani F, Fagotti A, Gagliardi M, Ferrandina G, Monterossi G, Gallotta V, Zannoni G, Scambia G. Pre-hysterectomy cone biopsy is able to predict response in locally advanced cervical cancer patients submitted to neo-adjuvant chemoradiation. Eur J Surg Oncol 2013; 39:1025-9. [DOI: 10.1016/j.ejso.2013.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/11/2013] [Accepted: 06/06/2013] [Indexed: 01/20/2023] Open
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47
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Fagotti A, Vizzielli G, Fanfani F, Costantini B, Ferrandina G, Gallotta V, Gueli Alletti S, Tortorella L, Scambia G. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. Gynecol Oncol 2013; 131:341-6. [PMID: 23938372 DOI: 10.1016/j.ygyno.2013.08.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [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: 04/27/2013] [Revised: 07/26/2013] [Accepted: 08/02/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the prognostic impact of routinely use of staging laparoscopy (S-LPS) in patients with primary advanced epithelial ovarian cancer (AEOC). METHODS All women were submitted to S-LPS before receiving primary debulking surgery (PDS) or neoadjuvant treatment (NACT). The surgical and survival outcome were evaluated by univariate and multivariate analysis. RESULTS Among 300 consecutive patients submitted to S-LPS no complications related to the surgical procedure were registered. The laparoscopic evaluation showed that almost half of the patients (46.3%) had a high tumor load. One-hundred forty-eight (49.3%) women were considered suitable for PDS and the remaining 152 (50.7%) were submitted to NACT. The percentages of complete (residual tumor, RT=0) and optimal (RT<1cm) cytoreduction of PDS and interval debulking surgery (IDS) were 62.1% and 57.5%, 22.5% and 27.7%, respectively, p=0.07. The post-operative complications of NACT/IDS group were lower than PDS group (p=0.01). The median progression free survival in women with RT=0 at PDS was 25 months (95% CI, 15.1-34.8), which was statistically significant longer than in all other patients, irrespective of the type of treatment they received (p=0.0001). At multivariate analysis, residual disease (p=0.011) and performance status (p=0.016) maintained an independent association with the PFS. CONCLUSIONS Including S-LPS in a tertiary referral center for the management AEOC does not appear to have a negative impact in terms of survival and it may be helpful to individualize the treatment avoiding unnecessary laparotomies and surgical complications.
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Affiliation(s)
- A Fagotti
- Division of Minimally Invasive Ginecological Surgery - St. Maria Hospital - University of Perugia, Terni, Italy.
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48
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Petrillo M, Ferrandina G, Fagotti A, Vizzielli G, Margariti PA, Pedone AL, Nero C, Fanfani F, Scambia G. Timing and pattern of recurrence in ovarian cancer patients with high tumor dissemination treated with primary debulking surgery versus neoadjuvant chemotherapy. Ann Surg Oncol 2013; 20:3955-60. [PMID: 23838915 DOI: 10.1245/s10434-013-3091-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the timing and pattern of recurrence in patients with advanced ovarian cancer (AOC) receiving primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). METHODS We retrospectively evaluated a consecutive series of 175 stage IIIC-IV epithelial ovarian cancer patients, with diffuse peritoneal carcinomatosis documented at initial surgical exploration. Forty patients received complete PDS, and the remaining 135 were treated with NACT followed by IDS with absent residual tumor after surgery. RESULTS No differences were observed in the distribution of clinical pathological characteristics at the time of diagnosis between the two groups. The median follow-up was 31 months (range 9-150 months). We observed 20 (50.0%) recurrences in the PDS group compared to 103 (76.3%) in the IDS group (p = 0.001). Duration of primary platinum-free interval (PFI) was shorter in IDS compared to PDS group (13 vs. 21 months, respectively; p = 0.014). A significantly higher percentage of patients in the IDS group experienced platinum-resistant recurrences (35.9 vs. 5.0%; p = 0.006) and carcinomatosis at the time of relapse (57.3 vs. 20.0%; p = 0.0021). Finally, in women with platinum-sensitive recurrence, we observed a shorter secondary PFI in the IDS compared to PDS group (p = 0.006). CONCLUSIONS We documented a better behavior of recurrent disease in AOC patients with diffuse peritoneal carcinomatosis treated with complete PDS compared to women submitted to NACT followed by IDS with no residual tumor after surgery.
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Affiliation(s)
- M Petrillo
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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49
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Ferrandina G, Distefano M, De Vincenzo R, Salutari V, Petrillo M, Scarciglia M, Pietragalla A, Conte C, Scambia G. Paclitaxel, epirubicin, and cisplatin (TEP) regimen as neoadjuvant treatment in locally advanced cervical cancer: Long-term results. Gynecol Oncol 2013; 128:518-23. [DOI: 10.1016/j.ygyno.2012.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 11/29/2022]
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50
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Ferrandina G. I113 NEOADJUVANT RADIO-CHEMOTHERAPY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60143-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]
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