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Amar ID, Franceschini G, Nero C, Pasqua I, Paris I, Orlandi A, Gori S, Fabi A, Garganese G, Scambia G, Villa P. Preventing Bone Loss in Breast Cancer Patients: Designing a Personalized Clinical Pathway in a Large-Volume Research Hospital. J Pers Med 2024; 14:371. [PMID: 38672998 PMCID: PMC11051440 DOI: 10.3390/jpm14040371] [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: 03/08/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND We assess the impact of bone health clinical management in breast cancer (BC) patients receiving adjuvant endocrine therapy and design a personalized clinical pathway to reduce bone loss in an Italian research hospital. METHODS The primary endpoint was to assess (through the process improvement organizational method) the clinical pathway that post-surgical BC patients prescribed with endocrine therapy undergo to prevent bone loss. The secondary endpoint was to design a personalized clinical pathway for a prompt implementation of guidelines, to assess and possibly prescribe antiresorptive therapy. RESULTS During the first year of the execution of the new Diagnostic Therapeutic Assistance Pathway, a 60% increase in Dual-Energy X-ray Absorptiometry evaluations within 30 days and a 39.5% increase in antiresorptive therapy prescription within 90 days (since the prescription of endocrine therapy) were shown, thus increasing patients' compliance. CONCLUSION Case managers and bone health specialists in this context can improve patients' adherence to therapies and bone health, helping physicians to expand their collaboration.
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Affiliation(s)
- Inbal Dona Amar
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Gianluca Franceschini
- Onco-Plastic Surgery Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Camilla Nero
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Ilaria Pasqua
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Ida Paris
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Armando Orlandi
- Medical Oncology Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Stefania Gori
- Medical Oncology Unit, Department of Oncology, IRCCS Sacro Cuore “Don Calabria”, 37024 Negrar, Italy;
- Rete Oncologica Pazienti Italia (ROPI), 20121 Milan, Italy
- Associazione Italiana di Oncologia Medica (AIOM), 20133 Milan, Italy
| | - Alessandra Fabi
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Associazione Italiana di Oncologia Medica (AIOM), 20133 Milan, Italy
| | - Giorgia Garganese
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Paola Villa
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.N.); (I.P.); (I.P.); (G.G.); (G.S.); (P.V.)
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Visconti G, Bianchi A, Di Leone A, Franceschini G, Masetti R, Salgarello M. The Ultrasound Evolution of Lateral Thoracic Perforator Flaps Design and Harvest for Partial and Total Breast Reconstruction. Aesthetic Plast Surg 2024; 48:894-904. [PMID: 36517641 DOI: 10.1007/s00266-022-03208-8] [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: 08/07/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The lateral thoracic area is a known source for perforator flaps for partial breast reconstruction. In this paper, we report our experience in designing and harvesting lateral thoracic perforator flaps for partial and total breast reconstruction with the introduction of the "propuller" concept. PATIENTS AND METHODS Between September 2013 and August 2021, 95 flaps were performed for immediate, partial and total breast reconstruction. On a total of 95 flaps, 30 (19 thoracodorsal artery perforator(TDAP) flaps, 10 lateral intercostal artery perforator(LICAP) flaps and 1 lateral thoracic artery perforator(LTAP) flap) were harvested in the traditional fashion (control group) and 65 (57 LICAP, 2 LTAP and 6 TDAP flaps) according to the propeller concept (study group). All cases were preoperatively planned with Color-Coded Duplex Ultrasound. RESULTS No flap losses were experienced in both groups. The mean operative time was 156 minutes (range 118-234) for the control group and 75 minutes (range 53-125) for the study group (p < 0.0001). A significantly higher number of LICAP flaps were chosen in the study group compared to control group. None of the patients had donor site complications. Patients' and Surgeons' satisfaction was high to very high. CONCLUSION The ultrasound preoperative planning led to the development of an easier and safer method of local perforator flap harvesting, that we named as propuller design. Its novelty lies in that perforator intraoperative selection and fully skeletonization are not needed and a more efficient flap movement (propeller plus advancement) which transfers more tissue into the new breast can be achieved safely, faster and easier.
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Affiliation(s)
- Giuseppe Visconti
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy.
| | - Alessandro Bianchi
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy
| | - Alba Di Leone
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy
- Dipartimento Salute Della Donna, Bambino e Sanità Pubblica, UOC Chirurgia Senologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gianluca Franceschini
- Dipartimento Salute Della Donna, Bambino e Sanità Pubblica, UOC Chirurgia Senologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Masetti
- Dipartimento Salute Della Donna, Bambino e Sanità Pubblica, UOC Chirurgia Senologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marzia Salgarello
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy
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Scardina L, Masetti R, Franceschini G. Conserving surgery in inflammatory breast cancer after neoadjuvant chemotherapy in patients with clinical complete response: the ConSIBreC randomized controlled trial. Front Oncol 2024; 14:1372633. [PMID: 38463227 PMCID: PMC10921562 DOI: 10.3389/fonc.2024.1372633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
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Franceschini G, Masetti R. Inflammatory breast cancer: is conservative surgery possible? Minerva Surg 2024; 79:1-3. [PMID: 37817477 DOI: 10.23736/s2724-5691.23.09980-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
- Gianluca Franceschini
- Breast Unit, Department of Woman and Child's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy -
| | - Riccardo Masetti
- Breast Unit, Department of Woman and Child's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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Franceschini G, Talevi G, Maso S, Comparcini D, Porfiri M, Cicolini G, Simonetti V. Home-care educational interventions to prevent complications in patients with Ventricular Assist Devices: a systematic review. Ann Ig 2024; 36:41-59. [PMID: 37885355 DOI: 10.7416/ai.2023.2582] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background The implantation of ventricular assist devices is the only effective alternative to cardiac transplantation in patients with chronic heart failure, in terms of survival and quality of life. However, their implantation can lead to physical and psychological complications, potentially preventable, especially in the long term, through patients' education. This research aimed to summarize the current best evidence on educational strategies towards patients after implantation of ventricular assist devices, in home-care setting, to reduce the major related complications, namely driveline infections, gastrointestinal bleeding and psychological complications. Study Design Systematic review. Methods Title and abstract selection, full-text screening, study quality assessment, and data extraction followed the PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. The search was conducted through consultation of databases such as Medline, Scopus, EMBASE, and Web of Science, during the period from March 2022 to December 2022, in relation to English-language articles, from search strings processing and inclusion and exclusion criteria. Results Of the 1,231 items identified, 9 were selected because consistent with the inclusion criteria. The most effective educational interventions toward patients with ventricular assist devices were identified, delivered by multidisciplinary teams coordinated by a professional expert in management of ventricular assist devices, and regularly conducted. In particular, gastrointestinal bleeding and driveline infections could be prevented and reduced by complex, multimodal educational interventions, including telephone and app interventions. Educational strategies based on verbal instructions, hands-on demonstrations, innovative technologies, and active involvement of families/caregivers were particularly effective in preventing psychological complications. Conclusions Investing time and resources in educating patients with ventricular assist devices is mandatory, given the significant impact of educational outcomes on complications' reduction. Moreover, educational interventions geared towards patient's psychological well-being, brings positive outcomes on patient's compliance too, resulting in promising clinical outcomes. However, more in-depth research is needed, to support professionals in developing effective educational plans for such fragile and complex patients.
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Affiliation(s)
- G Franceschini
- Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - G Talevi
- Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - S Maso
- Azienda ULSS3 Serenissima, Venezia, Italy
| | - D Comparcini
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - M Porfiri
- Department of Management, Università Politecnica delle Marche, Ancona, Italy
| | - G Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - V Simonetti
- LUM University "Giuseppe Degennaro", Casamassima, Bari, Italy
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D'Angelo A, Scardina L, Palma S, Cicero SL, Maresca A, Caprini F, Biondi E, Franco A, Terribile D, Franceschini G, Belli P, Manfredi R. Magnetic seed versus skin tattoo localization of non-palpable breast lesions: a single institution cohort study. Eur Radiol 2024; 34:149-154. [PMID: 37526666 DOI: 10.1007/s00330-023-10008-4] [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: 03/31/2023] [Revised: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE The objective of this retrospective study was to investigate the accuracy and feasibility of magnetic seed compared to skin tattoo in preoperative localization of impalpable breast lesions in terms of accuracy of placement, re-excision and positive margins rates, and breast/surgical specimen volume ratio. METHODS We retrospectively analyzed 77 patients who underwent breast conservative surgery in our center from November 2020 to November 2021, with previous localization with skin tattoo or magnetic seed. RESULTS Thirty-seven magnetic seeds were placed in 36 patients (48.6%) and 40 skin tattoos were performed in the remaining cases (51.4%). The seeds were placed correctly at the two-view mammogram acquired after the insertion in 97.6% (36/37) of cases. With both methods, 100% of the index lesions were completely removed and found in the surgical specimen. The reported re-excision rate was 0% for both groups. A significant difference was observed in the volume of breast parenchyma removed between the two groups, inferior in the seed group (p = 0.046), especially in case of voluminous breasts (p = 0.003) and small lesions (dimension < 8 mm, p = 0.019). CONCLUSIONS Magnetic seed is a non-radioactive localization technique, feasible to place, recommended in case of non-palpable breast lesions, saving the breast parenchyma removed compared with skin tattoo, without reducing the accuracy. CLINICAL RELEVANCE STATEMENT Our findings contribute to the current evidence on preoperative localization techniques for non-palpable breast lesions, highlighting the efficacy of magnetic seed localization for deep and small lesions. KEY POINTS • Magnetic seed is a non-radioactive technique for the preoperative localization of non-palpable breast lesions studied in comparison with skin tattoo. • Magnetic seed is feasible to place in terms of post-placement migration and distance from the target lesion. • Magnetic seed is recommended in case of non-palpable breast lesions, saving the breast parenchyma removed without reducing the accuracy.
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Affiliation(s)
- Anna D'Angelo
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy.
| | - Lorenzo Scardina
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Simone Palma
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Stefano Lo Cicero
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Alessandro Maresca
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Flavia Caprini
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Ersilia Biondi
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Franco
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniela Terribile
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Paolo Belli
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
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Rella R, Conti M, Borghetti A, Belli P, Morciano F, Rossati C, Caneva A, Di Leone A, Franceschini G, Gori E, Fornasa F, Tommasini O, Romanucci G. Atypical ductal hyperplasia on vacuum-assisted breast biopsy: a scoring system to predict the risk of upgrade to malignancy. Radiol Med 2024; 129:38-47. [PMID: 37874442 PMCID: PMC10808485 DOI: 10.1007/s11547-023-01740-4] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023]
Abstract
RATIONALE AND OBJECTIVES Our multicentric study analysed clinical, radiologic and pathologic features in patients with atypical ductal hyperplasia (ADH) diagnosed with vacuum-assisted biopsy (VAB), to identify factors associated with the risk of upgrade, to develop a scoring system to support decision making. MATERIALS AND METHODS Patients with ADH on VAB under stereotactic/tomosynthesis guidance (2012-2022) were eligible. Inclusion criteria were availability of surgical histopathological examination of the entire lesion or radiologic follow-up (FUP) ≥ 24 months. VAB results were compared with surgical pathological results or with imaging FUP evolution to assess upgrade. A backward stepwise linear regression was used to identify predictors of upgrade. The discriminatory power of the model was calculated through the area under the receiver operating curve (ROC-AUC); the Hosmer-Lemeshow test was used to assess model calibration. The points system was developed based on the selected risk factors, and the probability of upgrade associated with each point total was determined. RESULTS 112 ADH lesions were included: 91 (91/112, 81.3%) underwent surgical excision with 20 diagnosis of malignancy, while 21 (21/112, 18.7%) underwent imaging FUP with one interval change (mean FUP time 48 months). Overall upgrade rate was 18.7% (21/112). Age, menopausal status, concurrent breast cancer, BIRADS classification and number of foci of ADH were identified as risk factors for upgrade. Our model showed an AUC = 0.85 (95% CI 0.76-0.94). The points system showed that the risk of upgrade is < 2% when the total score is ≤ 1. CONCLUSION Our scoring system seemed a promising easy-to-use decision support tool for management of ADH, decreasing unnecessary surgeries, reducing patients' overtreatment and healthcare costs.
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Affiliation(s)
- Rossella Rella
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122, Rome, Italy
| | - Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Claudia Rossati
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142, Verona, Italy
| | - Andrea Caneva
- Divisione di Patologia, ULSS9 Scaligera, Ospedale G. Fracastoro, San Bonifacio, 37047, Verona, Italy
| | - Alba Di Leone
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Elisabetta Gori
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Francesca Fornasa
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142, Verona, Italy
| | - Oscar Tommasini
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122, Rome, Italy
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142, Verona, Italy
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Abstract
The safety profile of hormone replacement therapy (HRT) on breast is still controversial. Tibolone is an option of treatment for climacteric syndrome of postmenopausal women. Its risk profile on breast is debated. This is an updated narrative review focusing on the impact of tibolone on breast. Particularly, we will report data from major preclinical and clinical studies regarding the effects of the use of this compound on breast tissue and breast density. Moreover, we will analyze and discuss the most relevant findings of the principal studies evaluating the relationship between tibolone and breast cancer risk. Our purpose is making all clinicians who are particularly involved in women's health more aware of the effects of this compound on breast and, thus, more experienced in the management of menopausal symptoms with this drug. According to the available literature, tibolone seems to be characterized by an interesting safety profile on breast tissue.
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Affiliation(s)
- Stefano Lello
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Anna Capozzi
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Giovanni Scambia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Centre, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
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Franceschini G. Editorial: Methods in breast cancer. Front Oncol 2023; 13:1304941. [PMID: 38023139 PMCID: PMC10668017 DOI: 10.3389/fonc.2023.1304941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
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Franceschini G. Use of Oxidized Regenerated Cellulose in Patients with Lung Cancer: A Biomaterial to Handle with Caution! Mol Imaging Radionucl Ther 2023; 32:255-256. [PMID: 37870403 PMCID: PMC10600556 DOI: 10.4274/mirt.galenos.2023.06641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/03/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Gianluca Franceschini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Women, Children and Public Health Sciences, Rome, Italy
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Affiliation(s)
- Gianluca Franceschini
- From the Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Franceschini G. Commentary: A lymph node mediastinal foreign body reaction mimicking nodal metastasis: a case series. Front Med (Lausanne) 2023; 10:1259819. [PMID: 37822470 PMCID: PMC10562627 DOI: 10.3389/fmed.2023.1259819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Gianluca Franceschini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Woman and Child Health and Public Health, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Franco A, Di Leone A, Conti M, Fabi A, Carbognin L, Terribile AD, Belli P, Orlandi A, Sanchez MA, Moschella F, Mason EJ, Cimino G, De Filippis A, Marazzi F, Paris I, Visconti G, Barone Adesi L, Scardina L, D’Archi S, Salgarello M, Giannarelli D, Masetti R, Franceschini G. An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy. J Pers Med 2023; 13:1280. [PMID: 37623530 PMCID: PMC10455579 DOI: 10.3390/jpm13081280] [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: 06/29/2023] [Revised: 08/05/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons' expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. METHODS Patients (stage I-III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed. RESULTS A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896-8.724 was predictive for BCS, 8.725-9.375 for OPS, and 9.376-14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5-14.7%; p = 0.010), a better locoregional disease-free survival (98.8-88.9%; p < 0.001) and a better overall survival (96.1-86.5%; p = 0.017), and a better satisfaction with breasts (39.8-27.5%; p = 0.017) and physical wellbeing (93.5-73.6%; p = 0.001). CONCLUSION A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.
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Affiliation(s)
- Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Marco Conti
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Luisa Carbognin
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Andreina Daniela Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Paolo Belli
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Martin Alejandro Sanchez
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Francesca Moschella
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Elena Jane Mason
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Giovanni Cimino
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Alessandra De Filippis
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Fabio Marazzi
- Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Giuseppe Visconti
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Liliana Barone Adesi
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Sabatino D’Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Marzia Salgarello
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
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Franceschini G, Scardina L, Masetti R. Precision surgery for breast cancer: current trends and future perspectives. Updates Surg 2023:10.1007/s13304-023-01569-6. [PMID: 37341904 DOI: 10.1007/s13304-023-01569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Gianluca Franceschini
- Breast Unit-Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Lorenzo Scardina
- Breast Unit-Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Riccardo Masetti
- Breast Unit-Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, 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Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, 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Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana 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O, Mateo-Sierra O, Azzis O, Ojewuyi O, Habeeb O, Idowu O, Elebute O, Agboola O, Ladipo-Ajayi O, Oyinloye O, Adebola O, Ekor O, Ogundoyin O, Salamanca O, Vergara-Fernandez O, Wafi O, Aladawi O, Bahassan OM, Tammo Ö, Ozkan OF, Williams OM, Salami O, Akinajo O, Sakhov O, Gallo O, Sole OM, Milella O, Alser O, Bettar OA, Alomar O, Osman OS, Aisuodionoe-Shadrach O, Basnayake O, Bozbiyik O, Hodges O, Ojo O, Yanık Ö, Mutlu ÖPZ, Kazan O, Calavia P, García PR, Urriza PV, Lopez PR, Christidis P, Dorovinis P, Kokoropoulos P, Mourmouris P, Papatheodorou P, Garg PK, Patel P, Vassiliu P, Campennì P, De Nardi P, Bernante P, Ubiali P, Baroffio P, Pizzini P, Sapienza P, Myrelid P, Chatzikomnitsa P, Tsiantoula P, Gada P, Avella P, Cianci P, Romero P, Méndez PS, Pazmiño PAF, Coughlin P, Kirchweger P, Pessaux P, Maguire PJ, Petrone P, Cullis P, Köglberger P, Marriott P, Nankivell P, Santos-Costa P, Martins PN, Panahi P, Botelho P, Teixeira P, Escobar P, Vázquez PJG, Gribnev P, Nolte P, Agbonrofo P, Bobak P, Choong P, Elbe P, Hutchinson P, Labib P, Paal P, Pockney P, Reemst P, Szatmary P, Vaughan-Shaw PG, Alexander P, Pucher P, Stather P, Foessleitner P, Winnand P, Zehnder P, Kruse P, Matos PAW, Lapolla P, Cicerchia PM, Solli P, Di Lascio P, Zarif P, Champagne PO, Anoldo P, Bertoglio P, Fransvea P, Familiari P, Lombardi PM, Stogowski PT, Bruzzaniti P, Tripathi P, D'sa P, Salunke P, Shah PA, Punjabi PPP, Christodoulou P, Hamdan Q, Tawalbeh R, Gadelkareem R, Awad R, Callcut R, Clegg R, Choron R, Payne R, Gefen R, Costea R, Drasovean R, Mirica RM, Ravindra R, Fajardo RT, Nunes RL, Aspide R, Lombardi R, Vidya R, Elboraei R, Saaid R, Ghodke R, Gupta R, Sharma RD, Lunevicius R, Kalayarasan R, Mohan R, Singh R, Sivaprakasam R, Seenivasagam RK, Rajendram R, Radulescu RB, Goicea R, Seshadri RA, Sarı R, Nataraja R, Aslam R, Abdelemam R, Shrestha R, Bharathan R, Pellini R, Guevara R, Agarwal R, Vissapragada R, Alharmi RA, Sayyed R, Browning R, Critchley R, Mallick R, Alarabi R, Beron RI, Függer R, 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Ciniero V, Tonini V, Silvestri V, Vijay V, Dewan V, Lohsiriwat V, Thuduvage V, Mousafeiris V, Dragisic V, Sasireka V, Santric V, Kusuma VRM, Kolli VS, Alonso V, De Simone V, Picotti V, Martínez VM, Panduro-Correa V, Kakotkin V, Angulo VP, Turrado-Rodriguez V, Krishnamoorthy V, Ban VS, Shah V, Maiola V, Giordano V, La Vaccara V, Lizzi V, Papagni V, Schiavone V, Satchithanantham V, Garcia-Virto V, Jimenez V, Kumar V, Shelat V, Bhat V, Sodhai V, Graziadei V, Kutuzov V, Stoyanov V, Oktseloglou V, Flis V, Elhassan WAF, Yang W, Soon WC, Tashkandi W, Al-Khyatt W, Mabood W, Bijou W, Wijenayake W, D W, Krawczyk W, Atkins W, Bolton W, White W, Ceelen W, Vagena X, Gozal Y, Baba YI, Subramani Y, Jansen Y, Mittal Y, Kara Y, Zwain Y, Noureldin Y, Alawneh Y, Aydin Y, Lam YH, Tang Y, Lim Y, Dean Y, Tanas Y, Su YX, Fujimoto Y, Altinel Y, Frolova Y, Oshodi Y, Fadel ZT, Zahid Z, Elahi Z, Djama Z, Zaheen Z, Jawad Z, Demetrashvili Z, Gebremeskel Z, Gudisa Z, Alyami Z, Garoufalia Z, Li Z, Zimak Z, Radin Z, Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Di Leone A, Franco A, Zotta F, Scardina L, Sicignano M, Di Guglielmo E, Castagnetta V, Magno S, Terribile D, Sanchez AM, Franceschini G, Masetti R. Local Treatment of Triple-Negative Breast Cancer: Is Mastectomy Superior to Breast-Conserving Surgery? J Pers Med 2023; 13:jpm13050865. [PMID: 37241035 DOI: 10.3390/jpm13050865] [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: 04/01/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). TNBC accounts for about 15% of breast cancers and has a poorer prognosis as compared with other subtypes of breast cancer. The more rapid onset of this cancer and its aggressiveness have often convinced breast surgeons that mastectomy could provide better oncological results. However, there is no relevant clinical trial that has assessed differences between breast-conserving surgery (BCS) and mastectomy (M) in these patients. This population-based study aimed to investigate the distinct outcomes between conservative treatment and M in a case series of 289 patients with TNBC treated over a 9-year period. This monocentric study retrospectively evaluated patients with TNBC who underwent upfront surgery at Fondazione Policlinico Agostino Gemelli IRCCS, in Rome, between 1 January 2013 and 31 December 2021. First, the patients were divided in two groups according to the surgical treatment received: BCS vs. M. Then, the patients were stratified into four risk subclasses based on combined T and N pathological staging (T1N0, T1N+, T2-4N0 and T2-4N+). The primary endpoint of the study was to evaluate locoregional disease-free survival (LR-DFS), distant disease-free survival (DDFS) and overall survival (OS) in the different subclasses. We analyzed 289 patients that underwent either breast-conserving surgery (247/289, 85.5%) or mastectomy (42/289, 14.5%). After a median follow-up of 43.2 months (49.7, 22.2-74.3), 28 patients (9.6%) developed a locoregional recurrence, 27 patients (9.0%) showed systemic recurrence and 19 patients (6.5%) died. No significant differences due to type of surgical treatment were observed in the different risk subclasses in terms of locoregional disease-free survival, distant disease-free survival and overall survival. With the limits of a retrospective, single-center study, our data seem to indicate similar efficacy in terms of locoregional control, distant metastasis and overall survival with the use of upfront breast-conserving surgery as compared with radical surgery in the treatment of TNBC. Therefore, TNBC should not be considered to be a contraindication for breast conservation.
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Affiliation(s)
- Alba Di Leone
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Zotta
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Scardina
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Margherita Sicignano
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Guglielmo
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Virginia Castagnetta
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Magno
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Terribile
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Filippone A, Rossi C, Rossi MM, Di Micco A, Maggiore C, Forcina L, Natale M, Costantini L, Merendino N, Di Leone A, Franceschini G, Masetti R, Magno S. Endocrine Disruptors in Food, Estrobolome and Breast Cancer. J Clin Med 2023; 12:jcm12093158. [PMID: 37176599 PMCID: PMC10178963 DOI: 10.3390/jcm12093158] [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: 03/09/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The microbiota is now recognized as one of the major players in human health and diseases, including cancer. Regarding breast cancer (BC), a clear link between microbiota and oncogenesis still needs to be confirmed. Yet, part of the bacterial gene mass inside the gut, constituting the so called "estrobolome", influences sexual hormonal balance and, since the increased exposure to estrogens is associated with an increased risk, may impact on the onset, progression, and treatment of hormonal dependent cancers (which account for more than 70% of all BCs). The hormonal dependent BCs are also affected by environmental and dietary endocrine disruptors and phytoestrogens which interact with microbiota in a bidirectional way: on the one side disruptors can alter the composition and functions of the estrobolome, ad on the other the gut microbiota influences the metabolism of endocrine active food components. This review highlights the current evidence about the complex interplay between endocrine disruptors, phytoestrogens, microbiome, and BC, within the frames of a new "oncobiotic" perspective.
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Affiliation(s)
- Alessio Filippone
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Cristina Rossi
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Maddalena Rossi
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Annalisa Di Micco
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Claudia Maggiore
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luana Forcina
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Natale
- Breast Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Lara Costantini
- Department of Ecological and Biological Sciences (DEB), Tuscia University, Largo dell'Università snc, 01100 Viterbo, Italy
| | - Nicolò Merendino
- Department of Ecological and Biological Sciences (DEB), Tuscia University, Largo dell'Università snc, 01100 Viterbo, Italy
| | - Alba Di Leone
- Breast Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Breast Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Women's Health Department, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Masetti
- Breast Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Women's Health Department, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefano Magno
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Franco A, Di Leone A, Fabi A, Belli P, Carbognin L, Gambaro E, Marazzi F, Mason EJ, Mulè A, Orlandi A, Palazzo A, Paris I, Rossi A, Scardina L, Terribile DA, Tiberi G, Giannarelli D, Scambia G, Masetti R, Franceschini G. Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting. Cancers (Basel) 2023; 15:cancers15092450. [PMID: 37173916 PMCID: PMC10177504 DOI: 10.3390/cancers15092450] [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: 03/23/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1. improve survival rates, and 2. de-escalation of surgery. This de-escalation has allowed the introduction of conservative breast surgery (CBS). We evaluate the possibility of submitting cT4 patients to CBS instead of radical breast surgery (RBS) by assessing the risk of locoregional disease-free survival, (LR-DFS) distant disease-free survival (DDFS), and overall survival (OS). METHODS This monocentric, retrospective study evaluated cT4 patients submitted to NA and surgery between January 2014 and July 2021. The study population included patients undergoing CBS or RBS without immediate reconstruction. Survival curves were obtained using the Kaplan-Meyer method and compared using a Log Rank test. RESULTS At a follow-up of 43.7 months, LR-DFS was 70% and 75.9%, respectively, in CBS and RBS (p = 0.420). DDFS was 67.8% and 29.7%, respectively, (p = 0.122). OS was 69.8% and 59.8%, respectively, (p = 0.311). CONCLUSIONS In patients with major or complete response to NA, CBS can be considered a safe alternative to RBS in the treatment of cT4a-d stage. In patients with poor response to NA, RBS remained the best surgical choice.
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Affiliation(s)
- Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alessandra Fabi
- Precision Medicine Senology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Paolo Belli
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Luisa Carbognin
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Elisabetta Gambaro
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Fabio Marazzi
- Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Elena Jane Mason
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Antonino Mulè
- Anatomic Pathology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Antonella Palazzo
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alessandro Rossi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", 00135 Roma, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Daniela Andreina Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Giordana Tiberi
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Giovanni Scambia
- Gynecological Oncology Unit, Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
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Franceschini G, Leone AD, D'Archi S, Masetti R. Decision-making and technical skills to prevent local recurrence after mastectomy for pure ductal carcinoma in situ. J Cancer Res Ther 2023; 19:842-843. [PMID: 34213501 DOI: 10.4103/jcrt.jcrt_1881_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gianluca Franceschini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Woman and Child Health and Public Health, Multidisciplinary Breast Unit; Rome, Italy
| | - Alba Di Leone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Woman and Child Health and Public Health, Multidisciplinary Breast Unit; Rome, Italy
| | - Sabatino D'Archi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Woman and Child Health and Public Health, Multidisciplinary Breast Unit; Rome, Italy
| | - Riccardo Masetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Woman and Child Health and Public Health, Multidisciplinary Breast Unit; Rome, Italy
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Scardina L, Di Leone A, Biondi E, Carnassale B, Zotta F, Murando F, Franco A, Terribile D, Masetti R, Franceschini G. P199 Management and Outcomes of Very Young Women (≤35 Years) with Breast Cancer treated in a single Institution. Breast 2023. [DOI: 10.1016/s0960-9776(23)00317-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: 03/15/2023] Open
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21
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Rella R, Conti M, Bufi E, Trombadori CML, Di Leone A, Terribile D, Masetti R, Zagaria L, Mulè A, Morciano F, Franceschini G, Belli P. Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes. Cancers (Basel) 2023; 15:cancers15072046. [PMID: 37046707 PMCID: PMC10093210 DOI: 10.3390/cancers15072046] [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: 02/26/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: To help to refine the accuracy of sentinel lymph node biopsy (SLNB) in breast cancer (BC) patients with biopsy-proven nodal disease prior to neoadjuvant chemotherapy (NACT), a method of marking the biopsy-proven positive LN at diagnosis to enable its removal during surgery was proposed. The aim of this study was to evaluate the accuracy of the Radio-Guided Occult Lesion Localization (ROLL) technique of biopsy-proven metastatic LN in nodal staging after NACT among node-positive BC patients. (2) Methods: Patients with invasive BC and biopsy-proven axillary metastases receiving NACT were enrolled. A clip marker was placed on the sampled LN (clipped lymph node, CLN) before NACT. Before surgery, the ROLL procedure (radioactive tracer injection into CLN under ultrasound guidance) was performed, and the CLN was surgically resected. The correspondence between the CLNs and SLNs was evaluated. The pathologic findings of the CLNs and SLN(s) were compared with remaining axillary nodes at ALND to determine false negative rates (FNRs). (3) Results: Seventy-two patients were analyzed. Surgery successfully identified the CLN in 70/72 procedures (97.2%). For 60/72 patients who underwent ALND, the FNRs dropped from 19.35% for SLNB to 3.13% for CLN biopsy. (4) Conclusions: The ROLL procedure got CLNs is accurate in axillary nodal staging after NACT in node-positive BC patients at diagnosis.
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Affiliation(s)
- Rossella Rella
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Charlotte Marguerite Lucille Trombadori
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alba Di Leone
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Daniela Terribile
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Masetti
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Luca Zagaria
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonino Mulè
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
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Scardina L, Magno S, Di Leone A, Franco A, Biondi E, Carnassale B, Martullo A, Gambaro E, Martin AS, Moschella F, D'Archi S, Masetti R, Franceschini G. Upfront surgery or neoadjuvant chemotherapy in young women with breast cancer: results of a retrospective cohort study. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.310] [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: 02/23/2023]
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Li J, Zhang D, Liu Z, Wang Y, Li X, Wang Z, Liang G, Yuan X, Li Y, Komorowski AL, Rozen WM, Orlandi A, Takabe K, Franceschini G, Jerusalem G, Wang X. The combined effect and mechanism of antiangiogenic drugs and PD-L1 inhibitor on cell apoptosis in triple negative breast cancer. Ann Transl Med 2023; 11:83. [PMID: 36819490 PMCID: PMC9929791 DOI: 10.21037/atm-22-6446] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
Background Breast cancer is the most common cancer worldwide, and triple-negative breast cancer (TNBC) has the worst prognosis. Standard systemic treatment includes chemotherapy and immunotherapy. Poly ADP-ribose polymerase (PARP) inhibitors are considered in breast cancer (BRCA) susceptibility genes mutated tumors. The role of antiangiogenic drugs is controversial. Immunotherapy with immune checkpoint inhibitor is now a standard of care for TNBC in the US, but its use in combination with anlotinib, an inhibitor of angiogenesis, on TNBC cells was never investigated. Methods We tested the effects of anlotinib and programmed cell death-ligand 1 (PD-L1) inhibitor on the proliferation, apoptosis, migration, and invasion of MDA-MB-468 and BT-549 TNBC cells through 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assays, cell apoptosis assay, wound healing and transwell matrix assays, and verified whether the combination of the two drugs had synergistic effect. Western blotting was used to detect the effect of anlotinib and PD-L1 inhibitor on the protein expression levels of PI3K, p-PI3K, AKT, p-AKT, Bcl-xl in MDA-MB-468 and BT-549 cells. The effects of anlotinib, PD-L1 inhibitor and the combination of the two drugs on the transplanted tumor of TNBC mice were tested by animal experiments. Results Anlotinib and PD-L1 inhibitor inhibited the proliferation and promote cell apoptosis of MDA-MB-468 and BT-549 cells, and the combination demonstrated the synergetic effect. Anlotinib and PD-L1 inhibitor inhibited cell migration and invasion, and the effect was strongest in the combination group. Both anlotinib and PD-L1 inhibitor reduced the expression of p-PI3K, p-AKT and Bcl-xl proteins in cells and the effects were the strongest in the combination group. Both anlotinib and PD-L1 inhibitor inhibited the growth of transplanted tumors in mice, and the combined group demonstrated the strongest growth suppression. Conclusions Anlotinib and PD-L1 inhibitor can inhibit cell proliferation, migration, and invasion of TNBC and promote cell apoptosis, and the two drugs show combined anti-tumor effects in vivo and in vitro. The combination of anlotinib and PD-L1 inhibitor may promote apoptosis of TNBC cells through PI3K/AKT/Bcl-xl signaling pathways, which might offer potential clinical treatment roles for these.
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Affiliation(s)
- Jing Li
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Dianbao Zhang
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Zhiwei Liu
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Yukun Wang
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Xinyang Li
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Ziming Wang
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Gaofeng Liang
- Medical College, Henan University of Science and Technology, Luoyang, China
| | - Xiang Yuan
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Yuanpei Li
- Department of Biochemistry and Molecular Medicine, UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | | | - Warren Matthew Rozen
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston Victoria, Australia
| | - Armando Orlandi
- Comprehensive Cancer Center, Unit of Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kazuaki Takabe
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences The State University of New York, Bufflo, NY, USA;,Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Bufflo, NY, USA
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Guy Jerusalem
- Medica l Oncology Department, CHU Liège and Liège University, Liege, Belgium
| | - Xinshuai Wang
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
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Garufi G, Carbognin L, Sperduti I, Miglietta F, Dieci MV, Mazzeo R, Orlandi A, Gerratana L, Palazzo A, Fabi A, Paris I, Franco A, Franceschini G, Fiorio E, Pilotto S, Guarneri V, Puglisi F, Conte P, Milella M, Scambia G, Tortora G, Bria E. Development of a nomogram for predicting pathological complete response in luminal breast cancer patients following neoadjuvant chemotherapy. Ther Adv Med Oncol 2023; 15:17588359221138657. [PMID: 36936199 PMCID: PMC10017935 DOI: 10.1177/17588359221138657] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/27/2022] [Indexed: 03/17/2023] Open
Abstract
Background Given the low chance of response to neoadjuvant chemotherapy (NACT) in luminal breast cancer (LBC), the identification of predictive factors of pathological complete response (pCR) represents a challenge. A multicenter retrospective analysis was performed to develop and validate a predictive nomogram for pCR, based on pre-treatment clinicopathological features. Methods Clinicopathological data from stage I-III LBC patients undergone NACT and surgery were retrospectively collected. Descriptive statistics was adopted. A multivariate model was used to identify independent predictors of pCR. The obtained log-odds ratios (ORs) were adopted to derive weighting factors for the predictive nomogram. The receiver operating characteristic analysis was applied to determine the nomogram accuracy. The model was internally and externally validated. Results In the training set, data from 539 patients were gathered: pCR rate was 11.3% [95% confidence interval (CI): 8.6-13.9] (luminal A-like: 5.3%, 95% CI: 1.5-9.1, and luminal B-like: 13.1%, 95% CI: 9.8-13.4). The optimal Ki67 cutoff to predict pCR was 44% (area under the curve (AUC): 0.69; p < 0.001). Clinical stage I-II (OR: 3.67, 95% CI: 1.75-7.71, p = 0.001), Ki67 ⩾44% (OR: 3.00, 95% CI: 1.59-5.65, p = 0.001), and progesterone receptor (PR) <1% (OR: 2.49, 95% CI: 1.15-5.38, p = 0.019) were independent predictors of pCR, with high replication rates at internal validation (100%, 98%, and 87%, respectively). According to the nomogram, the probability of pCR ranged from 3.4% for clinical stage III, PR > 1%, and Ki67 <44% to 53.3% for clinical stage I-II, PR < 1%, and Ki67 ⩾44% (accuracy: AUC, 0.73; p < 0.0001). In the validation set (248 patients), the predictive performance of the model was confirmed (AUC: 0.7; p < 0.0001). Conclusion The combination of commonly available clinicopathological pre-NACT factors allows to develop a nomogram which appears to reliably predict pCR in LBC.
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Affiliation(s)
| | | | | | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Roberta Mazzeo
- Oncologia Medica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy University of Udine, Italy
| | - Armando Orlandi
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Lorenzo Gerratana
- Oncologia Medica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy University of Udine, Italy
| | - Antonella Palazzo
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Alessandra Fabi
- Unit of Precision Medicine in Senology, Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Franco
- Breast Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Franceschini
- Breast Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Fiorio
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Fabio Puglisi
- Oncologia Medica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy University of Udine, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Franceschini G, Orlandi A. Racial and ethnic disparities in breast cancer survival: critical appraisal of the data emerging from the randomized TAILORx. Ann Transl Med 2022; 10:1294. [PMID: 36618783 PMCID: PMC9816834 DOI: 10.21037/atm-2022-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Gianluca Franceschini
- Multidisciplinary Breast Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Armando Orlandi
- Multidisciplinary Breast Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Scardina L, Di Leone A, Magno S, Franco A, Biondi E, Sanchez AM, D’Archi S, Gentile D, Fabi A, Masetti R, Franceschini G. Paget’s disease of the breast: Our 20 years’ experience. Front Oncol 2022; 12:995442. [DOI: 10.3389/fonc.2022.995442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
IntroductionPaget’s disease (PD) represents 1%–3% of all breast cancers and mostly occurs in postmenopausal women. Multiple studies have confirmed that breast-conserving surgery (BCS) followed by radiotherapy is a safe option for patients with in situ or invasive PD, ensuring local control and survival rates similar to those achieved with mastectomy.Materials and methodsWe retrospectively analyzed 115 patients affected by PD treated in our institution between January 2000 and May 2021. Median age at diagnosis was 60 years and median follow-up was 82 months; 69 patients were treated with BCS and 46 were treated with modified radical mastectomy or skin-sparing mastectomy.ResultsAt histological examination, 59 patients (59/115, 51.0%) had an underlying invasive carcinoma; in 11 patients (11/115, 9.0%), only PD was found. In 45 patients (45/115, 40.0%), only noninvasive cancer was found. Nine patients (9/115, 7.8%) developed a local recurrence, 7 patients (7/115, 6.0%) are alive with distant metastasis, and 10 patients (10/115, 8.6%) died.DiscussionIn our series, no statistically significant differences were shown between PD alone, PD associated with in situ cancer, and PD with invasive cancer, regardless of the surgical procedure. BCS followed by radiotherapy appears to be an effective and safe option for patients with PD.ConclusionPD is a rare form of breast cancer and, in half of the cases, is associated with an invasive carcinoma. Separating our sample into three subgroups based on tumor histology, there were no significant differences in terms of LC, DFS, and OS rate in patients treated with different types of surgery. This study presents some limitations due to its retrospective nature and being confined to a single institution.
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27
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Pavese F, Capoluongo ED, Muratore M, Minucci A, Santonocito C, Fuso P, Concolino P, Di Stasio E, Carbognin L, Tiberi G, Garganese G, Corrado G, Di Leone A, Generali D, Fragomeni SM, D’Angelo T, Franceschini G, Masetti R, Fabi A, Mulè A, Santoro A, Belli P, Tortora G, Scambia G, Paris I. BRCA Mutation Status in Triple-Negative Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: A Pivotal Role for Treatment Decision-Making. Cancers (Basel) 2022; 14:cancers14194571. [PMID: 36230495 PMCID: PMC9559391 DOI: 10.3390/cancers14194571] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is characterized by earlier recurrence and shorter survival compared with other types of breast cancer. Moreover, approximately 15 to 25% of all TNBC patients harbor germline BRCA (gBRCA) 1/2 mutations, which confer a more aggressive phenotype. However, TNBC seems to be particularly sensitive to chemotherapy, the so-called ‘triple negative paradox’. Therefore, Neoadjuvant chemotherapy (NACT) is currently considered the preferred approach for early-stage TNBC. BRCA status has also been studied as a predictive biomarker of response to platinum compounds. Although several randomized trials investigated the addition of carboplatin to standard NACT in early-stage TNBC, the role of BRCA status remains unclear. In this retrospective analysis, we evaluated data from 136 consecutive patients with Stage I-III TNBC who received standard NACT with or without the addition of carboplatin, in order to define clinical features and outcomes in BRCA 1/2 mutation carriers and non-carrier controls. Between January 2013 and February 2021, 67 (51.3%) out of 136 patients received a standard anthracyclines/taxane regimen and 69 (50.7%) patients received a platinum-containing chemotherapy regimen. Deleterious germline BRCA1 or BRCA2 mutations were identified in 39 (28.7%) patients. Overall, patients with deleterious gBRCA1/2 mutation have significantly higher pCR rate than non-carrier patients (23 [59%] of 39 vs. 33 [34%] of 97; p = 0.008). The benefit of harboring a gBRCA mutation was confirmed only in the subset of patients who received a platinum-based NACT (17 [65.4%] of 26 vs. 13 [30.2%] of 43; p = 0.005) while no differences were found in the platinum-free subgroup. Patients who achieved pCR after NACT had significantly better EFS (OR 4.5; 95% CI 1.9–10.7; p = 0.001) and OS (OR 3.3; 95% CI 1.3–8.9; p = 0.01) than patients who did not, regardless of BRCA1/2 mutation status and type of NACT received. Our results based on real-world evidence show that TNBC patients with the gBRCA1/2 mutation who received platinum-based NACT have a higher pCR rate than non-carrier patients, supporting the use of this chemotherapy regimen in this patient population. Long-term follow-up analyses are needed to further define the role of gBRCA mutation status on clinical outcomes in patients with early-TNBC.
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Affiliation(s)
- Francesco Pavese
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Ettore Domenico Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, 80131 Naples, Italy
- Department of Clinical Pathology and Genomics, Cannizzaro Hospital, 95126 Catania, Italy
| | - Margherita Muratore
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Angelo Minucci
- Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Concetta Santonocito
- Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paola Fuso
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paola Concolino
- Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Stasio
- Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luisa Carbognin
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giordana Tiberi
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgia Garganese
- Gynaecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giacomo Corrado
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Alba Di Leone
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniele Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Simona Maria Fragomeni
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Tatiana D’Angelo
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandra Fabi
- Unit of Precision Medicine in Breast Cancer, Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonino Mulè
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Angela Santoro
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paolo Belli
- UOC Radiologia Generale ed Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Unit of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Scambia
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Ida Paris
- Division of Oncological Gynecology, Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
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Scardina L, Di Leone A, Biondi E, Carnassale B, Sanchez AM, D’Archi S, Franco A, Moschella F, Magno S, Terribile D, Gentile D, Fabi A, D’Angelo A, Barone Adesi L, Visconti G, Salgarello M, Masetti R, Franceschini G. Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience. J Pers Med 2022; 12:jpm12091533. [PMID: 36143318 PMCID: PMC9504024 DOI: 10.3390/jpm12091533] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that offers improved esthetic results and patient quality of life. Traditionally, implants have been placed in a submuscular (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of the prosthesis has been increasingly used in order to avoid morbidities related to manipulation of the PMM. The aim of this study was to compare outcomes of SM vs. PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: In this retrospective observational study, we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our institution from January 2018 to December 2021. Conservative mastectomy was performed in 146 of the 400 patients that underwent NAC during the study period. Patients were divided into two groups based on the positioning of implants: 56 SM versus 90 PP. Results: The two cohorts were similar for age (mean age 42 and 44 years in the SM and PP group respectively) and follow-up (33 and 20 months, respectively). Mean operative time was 56 min shorter in the PP group (300 and 244 min in the SM and PP group). No significant differences were observed in overall major complication rates. Implant loss was observed in 1.78% of patients (1/56) in the SM group and 1.11% of patients (1/90) in PP group. No differences were observed between the two groups in local or regional recurrence. Conclusions: Our preliminary experience, which represents one of the largest series of patients undergoing PP-IPBR after NAC at a single institution documented in the literature, seems to confirm that PP-IPBR after NAC is a safe, reliable and effective alternative to traditional SM-IPBR with excellent esthetic and oncological outcomes; it is easy to perform, reduces operative time and minimizes complications related to manipulation of PPM. However, this promising results need to be confirmed in prospective trials with longer follow-up.
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Affiliation(s)
- Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Multidisciplinary Breast Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Correspondence: or
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Ersilia Biondi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Beatrice Carnassale
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sabatino D’Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Moschella
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Magno
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Anna D’Angelo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Liliana Barone Adesi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Visconti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Marzia Salgarello
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Franceschini G, Scardina L, Visconti G, Hayashi A, Masetti R. Editorial: Update of Current Evidences in Breast Cancer Surgery. Front Oncol 2022; 12:928467. [PMID: 35814467 PMCID: PMC9270019 DOI: 10.3389/fonc.2022.928467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gianluca Franceschini
- Center of Multidisciplinary Breast, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
| | - Lorenzo Scardina
- Center of Multidisciplinary Breast, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
- *Correspondence: Lorenzo Scardina, ;
| | - Giuseppe Visconti
- Fondazione Policlinico Universitario Agostino Gemelli Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Department of Women, Children and Public Health Sciences, Breast Unit, Rome, Italy
| | - Akitatsu Hayashi
- Department of Breast Center, Kameda Medical Center Chiba, Kamogawa, Japan
| | - Riccardo Masetti
- Center of Multidisciplinary Breast, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
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Scardina L, Moschella F, Magno S, Sanchez AM, Di Leone A, D'Archi S, Franco A, Biondi E, Carnassale B, Di Micco A, Bria E, Masetti R, Franceschini G. Mastectomy and immediate prepectoral versus submuscular breast reconstruction after neoadjuvant chemotherapy: Our early experience. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12618] [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: 11/20/2022] Open
Abstract
e12618 Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that allows to improve aesthetic results and patient quality of life. Traditionally, implants have been placed in a submuscolar (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of prosthesis is increasingly used in order to avoid morbidities related to manipulation of PMM. The aim of this study was to compare outcomes of SM vs PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: In this retrospective observational study we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our Istitution from January 2018 to December 2021. Conservative mastectomy was performed in 155 of the 400 patients that underwent NAC during the study period. Patients were divided in 2 groups based on the positioning of implants: 60 SM versus 95 PP. Results: The two cohorts were similar for age (mean age 45 and 42 years in the SM and PP group respectively) and follow‐up (32 and 21 months, respectively). Mean operative time was 55 minutes shorter in the PP group (298 and 243 minutes in the SM and PP group). No significant differences were observed in overall major complication rates. Implant loss occurred was observed in 1.6% of patients (1/60) in the SM group and 1,05% of patients (1/95) in PP group. No differences were observed among the two groups in local or regional recurrence. Conclusions: Our preliminary experience, that represents one of the largest series of PP-IPBR after NAC at a single Institution documented in the Literature, seems to confirm that PP - IPBR after NAC is a safe, reliable and effective alternative to traditional SM - IPBR with excellent aesthetic and oncological outcomes; it is easy to perfom, reduces operative time and minimizes complications related to manipolation of PPM. However this promising results need to be confirmed in prospective trials with longer follow-up.
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Affiliation(s)
- Lorenzo Scardina
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Stefano Magno
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Alba Di Leone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Sabatino D'Archi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Ersilia Biondi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Annalisa Di Micco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Emilio Bria
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Costantini M, Montella RA, Fadda MP, Tondolo V, Franceschini G, Bove S, Garganese G, Rinaldi PM. Diagnostic Challenge of Invasive Lobular Carcinoma of the Breast: What Is the News? Breast Magnetic Resonance Imaging and Emerging Role of Contrast-Enhanced Spectral Mammography. J Pers Med 2022; 12:jpm12060867. [PMID: 35743654 PMCID: PMC9224821 DOI: 10.3390/jpm12060867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Invasive lobular carcinoma is the second most common histologic form of breast cancer, representing 5% to 15% of all invasive breast cancers. Due to an insidious proliferative pattern, invasive lobular carcinoma remains clinically and radiologically elusive in many cases. Breast magnetic resonance imaging (MR) is considered the most accurate imaging modality in detecting and staging invasive lobular carcinoma and it is strongly recommended in pre-operative planning for all ILC. Contrast-enhanced spectral mammography (CESM) is a new diagnostic method that enables the accurate detection of malignant breast lesions similar to that of breast MR. CESM is also a promising breast imaging method for planning surgeries. In this study, we compare the ability of contrast-enhanced spectral mammography (CESM) with breast MR in the preoperative assessment of the extent of invasive lobular carcinoma. All patients with proven invasive lobular carcinoma treated in our breast cancer center underwent preoperative breast MRI and CESM. Images were reviewed by two dedicated breast radiologists and results were compared to the reference standard histopathology. CESM was similar and in some cases more accurate than breast MR in assessing the extent of disease in invasive lobular cancers. Further evaluation in larger prospective randomized trials is needed to validate our preliminary results.
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Affiliation(s)
- Melania Costantini
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Area Diagnostica per Immagini, 00168 Rome, Italy
| | - Rino Aldo Montella
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
- Correspondence: ; Tel.: +39-078-9189-9901
| | - Maria Paola Fadda
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
| | - Vincenzo Tondolo
- General Surgery Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy;
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze Della Salute Della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy; (S.B.); (G.G.)
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy; (S.B.); (G.G.)
- Dipartimento Scienze Della Vita e Sanità Pubblica, Sezione Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pierluigi Maria Rinaldi
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
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Gong C, Cheng Z, Yang Y, Shen J, Zhu Y, Ling L, Lin W, Yu Z, Li Z, Tan W, Zheng C, Zheng W, Zhong J, Zhang X, Zeng Y, Liu Q, Huang RS, Komorowski AL, Yang ES, Bertucci F, Ricci F, Orlandi A, Franceschini G, Takabe K, Klimberg S, Ishii N, Toss A, Tan MP, Cherian MA, Song E. A 10-miRNA risk score-based prediction model for pathological complete response to neoadjuvant chemotherapy in hormone receptor-positive breast cancer. Sci China Life Sci 2022; 65:2205-2217. [PMID: 35579777 DOI: 10.1007/s11427-022-2104-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 12/21/2022]
Abstract
Patients with hormone receptor (HR)-positive tumors breast cancer usually experience a relatively low pathological complete response (pCR) to neoadjuvant chemotherapy (NAC). Here, we derived a 10-microRNA risk score (10-miRNA RS)-based model with better performance in the prediction of pCR and validated its relation with the disease-free survival (DFS) in 755 HR-positive breast cancer patients (273, 265, and 217 in the training, internal, and external validation sets, respectively). This model, presented as a nomogram, included four parameters: the 10-miRNA RS found in our previous study, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status, and volume transfer constant (Ktrans). Favorable calibration and discrimination of 10-miRNA RS-based model with areas under the curve (AUC) of 0.865, 0.811, and 0.804 were shown in the training, internal, and external validation sets, respectively. Patients who have higher nomogram score (>92.2) with NAC treatment would have longer DFS (hazard ratio=0.57; 95%CI: 0.39-0.83; P=0.004). In summary, our data showed the 10-miRNA RS-based model could precisely identify more patients who can attain pCR to NAC, which may help clinicians formulate the personalized initial treatment strategy and consequently achieves better clinical prognosis for patients with HR-positive breast cancer.
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Affiliation(s)
- Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ziliang Cheng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yingying Zhu
- Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Li Ling
- Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wanyi Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Zhigang Yu
- Department of Breast Surgery, the Second Affiliated Hospital, Shandong University, Jinan, 250033, China
| | - Zhihua Li
- Department of Breast Surgery, Key Laboratory of Breast Diseases, Third Hospital of Nanchang, Nanchang, 330009, China
| | - Weige Tan
- Department of Breast Surgery, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510120, China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Wenbo Zheng
- Department of Breast Surgery, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510120, China
| | - Jiajie Zhong
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xiang Zhang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yunjie Zeng
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Qiang Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - R Stephanie Huang
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Andrzej L Komorowski
- Department of Surgery, College of Medicine, University of Rzeszów, Rzeszów, 35-959, Poland
| | - Eddy S Yang
- Department of Radiation Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - François Bertucci
- Laboratoty of Predictive Oncology, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Francesco Ricci
- Department of Drug Development and Innovation(D3i), Institut Curie, Paris, 75005, France
| | - Armando Orlandi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Kazuaki Takabe
- Breast Surgery, Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Suzanne Klimberg
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Angela Toss
- Department of Oncology and Hematology, University Hospital of Modena, Modena, 41124, Italy
| | - Mona P Tan
- MammoCare: Breast Clinic and Surgery in Singapore, Singapore, 228510, Singapore
| | - Mathew A Cherian
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, 43210, USA
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Scardina L, Magno S, Franco A, Biondi E, Sanchez M, Di Leone A, D'Archi S, Carnassale B, Masetti R, Franceschini G. 123P Paget’s disease of the breast: Our 20-year experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.140] [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] Open
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34
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Marazzi F, Orlandi A, Masiello V, Zinicola T, Moschella F, Palazzo A, Chiesa S, Garufi G, Frascino V, Tagliaferri L, Franceschini G, Fabi A, Gambacorta M, Bria E, Masetti R, Tortora G, Valentini V. 191P Radiotherapy (RT) in oligoprogressive metastatic breast cancer (mBC): A retrospective analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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35
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Lello S, Capozzi A, Scardina L, Ionta L, Sorge R, Scambia G, Franceschini G. Vitamin D and Histological Features of Breast Cancer: Preliminary Data from an Observational Retrospective Italian Study. J Pers Med 2022; 12:jpm12030465. [PMID: 35330465 PMCID: PMC8951751 DOI: 10.3390/jpm12030465] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Vitamin D (vitD) may be involved in different extraskeletal conditions as well as skeletal muscle diseases. It has been hypothesized that, at least in part, a low level of vitD could contribute to facilitating cancer development. Breast cancer (BC) seems to be associated with low levels of vitD. Materials and methods: This was an observational retrospective evaluation of 87 women (mean age: 54 ± 12 years old) who underwent surgery for the treatment of BC. Our main purpose was to correlate the types of BC and the levels of vitD. Results: A positive significant correlation (R > 0.7) was found between non-invasive carcinoma in situ and 25(OH)D levels and age (R = 0.82, p < 0.05). A positive, but nonsignificant, correlation was reported between invasive ductal carcinoma and 25(OH)D and age (R = 0.45, p > 0.05). A negative but nonsignificant correlation was found between invasive lobular carcinoma and 25(OH)D and age (R = 0.24, p > 0.05). Discussion and Conclusions: We did not find a significant relationship between vitD and BC subtypes. Considering the positive significant correlation between vitD levels and age for in situ BC, although preliminary, our results seem to suggest a possible role of vitD in in situ BC. However, these findings need to be confirmed in larger studies.
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Affiliation(s)
- Stefano Lello
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.L.); (A.C.); (G.S.)
| | - Anna Capozzi
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.L.); (A.C.); (G.S.)
| | - Lorenzo Scardina
- Department of Woman and Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.I.); (G.F.)
- Correspondence:
| | - Lucia Ionta
- Department of Woman and Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.I.); (G.F.)
| | - Roberto Sorge
- Laboratory of Biometry, Department of Systems Medicine, University of Rome Tor Vergata, 00187 Rome, Italy;
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.L.); (A.C.); (G.S.)
| | - Gianluca Franceschini
- Department of Woman and Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.I.); (G.F.)
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36
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Yan M, Ouyang Q, Sun T, Niu L, Yang J, Li L, Song Y, Hao C, Chen Z, Orlandi A, Ishii N, Takabe K, Franceschini G, Ricci F, Verschraegen C, Liu Z, Zhang M, Lv H, Liu L, Yang X, Xiao H, Gao Z, Li X, Dong F, Chen X, Qiao J, Zhang G. Pyrotinib plus capecitabine for patients with human epidermal growth factor receptor 2-positive breast cancer and brain metastases (PERMEATE): a multicentre, single-arm, two-cohort, phase 2 trial. Lancet Oncol 2022; 23:353-361. [PMID: 35085506 DOI: 10.1016/s1470-2045(21)00716-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Min Yan
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
| | - Quchang Ouyang
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Tao Sun
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Limin Niu
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jin Yang
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Li
- Department of Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuhua Song
- Breast Cancer Centre, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunfang Hao
- Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Zhanhong Chen
- Department of Breast Cancer Internal Medicine, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - Armando Orlandi
- Unit of Medical Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kazuaki Takabe
- Division of Breast Surgery, Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA
| | - Gianluca Franceschini
- Multidisciplinary Breast Centre, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | | | | | - Zhenzhen Liu
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Mengwei Zhang
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Huimin Lv
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Liping Liu
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaohong Yang
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Huawu Xiao
- Department of Breast Medicine, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhichao Gao
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Xiaorui Li
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Fangyuan Dong
- Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Xiuchun Chen
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jianghua Qiao
- Henan Breast Cancer Centre, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Guifang Zhang
- Department of Medical Oncology, Xinxiang Central Hospital, Xinxiang, China
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37
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Franceschini G, Mason EJ, Di Leone A, Scardina L, Masetti R. Multidisciplinary management of mammary Paget's disease: recommendations to optimize oncological and aesthetic outcomes. Ann Ital Chir 2022; 93:481-482. [PMID: 36196555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We read with interest the article of Francesca Maria Plutino entitled "A peculiar case of Paget's disease of the breast" and would like to make some considerations about this particular topic 1. Mammary Paget's Disease (MPD) or Paget's disease of the breast is an uncommon pathology which accounts for less than 5% of breast cancers 1-3. MPD occurs with alterations of the nipple-areolar complex (NAC) such as redness, eczema, bleeding ulceration and usually itching 1-3. In the era of personalized care, a careful multidisciplinary management is mandatory to optimize the results and minimize the risk of overtreatment 4; an adequate knowledge of the MPD, surgical skills and use of appropriate adjuvant therapies allow to reduce the risk of local recurrence and improve the aesthetic outcomes and patient's quality of life; however, a successful work can be more easily achieved thanks to the repetitive performance of some standardized tasks, such as 5: - an accurate radiological preoperative assessment with mammography and ultrasonography is important to identify associated glandular lesions; an underlying breast carcinoma (in situ and/or invasive) may be present up to about 80% to 90% of MPD although often without an evident breast mass or mammographic abnormality (2,5); therefore, all patients with MPD should also perform a magnetic resonance imaging to detect possible underlying occult breast carcinoma and define the true extent of disease 5,6; - a pathological diagnosis should be early established by nipple scrape cytology when a MPD is clinically suspected; full-thickness punch or wedge biopsy of the NAC may be necessary to accurately diagnose MPD; the histological examination must detect malignant intraepithelial carcinoma cells, also known as "Paget cells", in the epidermis of the NAC 2,3; a needle biopsy is also required for any suspicious glandular lesion identified by imaging and associated with MPD 5; - a multidisciplinary "Surgery Board" is mandatory to select the more adequate local treatment for the patient: breast-conserving surgery (BCS) followed by radiotherapy (RT) is the optimal local treatment when a NAC resection and wide local excision of any underlying cancer allows to achieve tumour-free margins and appropriate aesthetic outcomes 4,5,7; the oncoplastic techniques with the remodelling of breast tissue and placement of clips within the excision cavity as a landmark to guide adjuvant RT should always be used in BCS in order to optimize oncological and cosmetic results 5,8,9,10. Instead, skin-sparing mastectomy with immediate breast reconstruction is indicated for MPD associated to multicentric or extensive carcinoma, inadequate margins after BCS, contraindications to adjuvant RT and patient preference 5,8. Staging and surgical treatment of the axilla in MPD is based on the possible presence of underlying cancer; sentinel lymph node biopsy (SLB) is not necessary when BCS is used to treat pure MPD or MPD associate with ductal carcinoma in situ; SLB must be performed when MPD is associated with underlying invasive cancer and treated with breast-conserving surgery; SLB is always recommended when a mastectomy is performed in order to avoid complete axillary lymph node dissection in case an invasive component is revealed at final pathology of the gland (mastectomy precludes subsequent use of SLB) 5,7,8; - a multidisciplinary "Tumor Board" is crucial to choose the adjuvant treatment; whole breast radiation should be always performed after BCS and a radiation boost should be considered for the site of the resected NAC and any associated resected cancer site 2,4,5; adjuvant systemic therapies in patients with MPD should be based on biological features and the stage of the underlying cancer; no data are available to support the use of endocrine therapy in the MPD without an associated DCIS or invasive carcinoma 5. In conclusion, a dedicated multidisciplinary pathway with meticulous repetitive performance of some specific tasks could help to perform a successful work while optimizing oncological and aesthetic outcomes in patients with MPD.
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Scardina L, DI Leone A, Sanchez AM, D'Archi S, Biondi E, Franco A, Mason EJ, Magno S, Terribile D, Barone-Adesi L, Visconti G, Salgarello M, Masetti R, Franceschini G. Nipple sparing mastectomy with prepectoral immediate prosthetic reconstruction without acellular dermal matrices: a single center experience. Minerva Surg 2021; 76:498-505. [PMID: 34935320 DOI: 10.23736/s2724-5691.21.08998-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that allows to improve aesthetic results and patient quality of life. Traditionally, implant for reconstruction have been placed in a submuscolar (SM) plane, beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of prosthesis is increasingly used in order to avoid morbidities related to manipulation of PMM. The aim of the present study was to report our experience with 209 NSMs and IPBR using a prepectoral approach and polyurethane-coated implant without acellular dermal matrices (ADMs). METHODS A retrospective review of breast cancer patients who underwent NSM followed by PP - IPBR from January 2018 to April 2021 was performed. Data were recorded in order to evaluate operative details, major complications and oncological outcomes. Aesthetic results and patient quality of life were measured by a specific "QOL assessment PRO" survey. RESULTS Two hundred and nine patients (269 breasts) with PP - IPBR after NSM were included. Mean age was 47 (25-73) years and median follow-up was 14 (1-40) months. A simultaneous contralateral implant-based mammoplasty of symmetrization after unilateral NSM was carried out in six of 149 (4%) patients. Implant loss was observed in three of 209 patient (1.44%); two of 209 (0.96%) patients developed a full-thickness NAC necrosis that required excision. During follow-up one local relapse (0.48%) and two regional nodes recurrences (0,96%) was observed. Patient satisfaction, assessed using a personalized QOL Assessment PRO survey, in term of aesthetic results, chronic pain, shoulder dysfunction, sports activity, sexual and relationship life and skin sensibility, was excellent. CONCLUSIONS Our experience shows that PP-IPBR using polyurethane-coated implant after NSM is a safe, reliable and effective alternative to traditional IPBR with excellent aesthetic outcomes and high patient quality of life; it is easy to perform, minimizes complications related to manipulation of PPM and reduces operative time while resulting also in a cost-effective technique.
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Affiliation(s)
- Lorenzo Scardina
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Alba DI Leone
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alejandro M Sanchez
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabatino D'Archi
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Ersilia Biondi
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Antonio Franco
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Elena J Mason
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Stefano Magno
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Daniela Terribile
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Liliana Barone-Adesi
- Division of Plastic Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giuseppe Visconti
- Division of Plastic Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Marzia Salgarello
- Division of Plastic Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Riccardo Masetti
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Gianluca Franceschini
- Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Franceschini G, Mason EJ, Franco A, Masetti R. Surgical treatment of breast cancer. Minerva Surg 2021; 76:495-497. [PMID: 34935319 DOI: 10.23736/s2724-5691.21.09155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianluca Franceschini
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - .,Breast Unit, Department of Woman and Child Health and Public Health, Sacred Heart Catholic University, Rome, Italy -
| | - Elena J Mason
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Breast Unit, Department of Woman and Child Health and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Antonio Franco
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Breast Unit, Department of Woman and Child Health and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Riccardo Masetti
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Breast Unit, Department of Woman and Child Health and Public Health, Sacred Heart Catholic University, Rome, Italy
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Duranti S, Fabi A, Filetti M, Falcone R, Lombardi P, Daniele G, Franceschini G, Carbognin L, Palazzo A, Garganese G, Paris I, Scambia G, Pietragalla A. Breast Cancer Drug Approvals Issued by EMA: A Review of Clinical Trials. Cancers (Basel) 2021; 13:cancers13205198. [PMID: 34680350 PMCID: PMC8533780 DOI: 10.3390/cancers13205198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Considering the high incidence and mortality of breast cancer, a lot of trials evaluating new drugs for the treatment of this disease are currently ongoing. However, few drugs show a statistically and clinically significant improvement in the outcomes leading to the Competent Authority approval. In this review we analyzed the European Medicines Agency breast cancer drug indications issued between January 2015 and June 2021 and we evaluated the clinical trials results leading to the approval and their update. Abstract Breast cancer represents the first cause of cancer worldwide and the leading cause of cancer mortality for women. Therefore, new therapies are needed to improve the prognosis of women diagnosed with this disease. In this review, we summarize the new drug indications for the treatment of breast cancer approved by European Medicines Agency between January 2015 and June 2021. In particular, we analyzed the clinical trials results leading to approvals and their update (when available), according to setting (localized and locally advanced or metastatic) and clinical features (hormone receptor positive, HER2 positive, triple negative, BRCA 1/2 mutation). The aim of this paper is to describe the clinical benefit obtained with the new indications.
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Affiliation(s)
- Simona Duranti
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Correspondence: ; Tel.: +39-06-3015-8729
| | - Alessandra Fabi
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Unit of Precision Medicine in Breast Cancer, Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Rosa Falcone
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Pasquale Lombardi
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Gennaro Daniele
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Luisa Carbognin
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (I.P.)
| | - Antonella Palazzo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy;
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (I.P.)
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonella Pietragalla
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
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Fuso P, Di Salvatore M, Santonocito C, Guarino D, Autilio C, Mulè A, Arciuolo D, Rinninella A, Mignone F, Ramundo M, Di Stefano B, Orlandi A, Capoluongo E, Nicolotti N, Franceschini G, Sanchez AM, Tortora G, Scambia G, Barone C, Cassano A. Let-7a-5p, miR-100-5p, miR-101-3p, and miR-199a-3p Hyperexpression as Potential Predictive Biomarkers in Early Breast Cancer Patients. J Pers Med 2021; 11:816. [PMID: 34442460 PMCID: PMC8400663 DOI: 10.3390/jpm11080816] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of this study is to identify miRNAs able to predict the outcomes in breast cancer patients after neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS We retrospectively analyzed 24 patients receiving NAC and not reaching pathologic complete response (pCR). miRNAs were analyzed using an Illumina Next-Generation-Sequencing (NGS) system. RESULTS Event-free survival (EFS) and overall survival (OS) were significantly higher in patients with up-regulation of let-7a-5p (EFS p = 0.006; OS p = 0.0001), mirR-100-5p (EFS s p = 0.01; OS p = 0.03), miR-101-3p (EFS p = 0.05; OS p = 0.01), and miR-199a-3p (EFS p = 0.02; OS p = 0.01) in post-NAC samples, independently from breast cancer subtypes. At multivariate analysis, only let-7a-5p was significantly associated with EFS (p = 0.009) and OS (p = 0.0008). CONCLUSION Up-regulation of the above miRNAs could represent biomarkers in breast cancer.
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Affiliation(s)
- Paola Fuso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (P.F.); (A.M.); (D.A.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
| | - Mariantonietta Di Salvatore
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Concetta Santonocito
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Laboratory of Clinical Molecular Biology, Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Donatella Guarino
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Laboratory of Clinical Molecular Biology, Department of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology, Faculty of Biology and Research Institute, Universidad Complutense, Av. Sèneca, 2, 28040 Madrid, Spain;
| | - Antonino Mulè
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (P.F.); (A.M.); (D.A.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Department of Pathologic Anatomy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Damiano Arciuolo
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (P.F.); (A.M.); (D.A.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Department of Pathologic Anatomy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonina Rinninella
- Department of Science and Innovation Technology, University of Piemonte Orientale, V.le Teresa Michel 11, 15121 Alessandria, Italy; (A.R.); (F.M.)
| | - Flavio Mignone
- Department of Science and Innovation Technology, University of Piemonte Orientale, V.le Teresa Michel 11, 15121 Alessandria, Italy; (A.R.); (F.M.)
| | - Matteo Ramundo
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Brunella Di Stefano
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Armando Orlandi
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Ettore Capoluongo
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Biotecnologie Avanzate, Università Federico II-CEINGE, Corso Umberto I 40, 80138 Naples, Italy
| | - Nicola Nicolotti
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Medical Management, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gianluca Franceschini
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giampaolo Tortora
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (P.F.); (A.M.); (D.A.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
| | - Carlo Barone
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
| | - Alessandra Cassano
- Faculty of Medicine and Surgery, Università Cattolica Del Sacro Cuore, Largo F. Vito 8, 00168 Rome, Italy; (C.S.); (D.G.); (M.R.); (B.D.S.); (A.O.); (E.C.); (N.N.); (G.F.); (A.M.S.); (G.T.); (C.B.); (A.C.)
- Comprehensive Cancer Center, Medical Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Franceschini G. Breast conserving surgery using oxidized regenerated cellulose as filling biomaterial: recommendations to improve clinical outcomes. BMC Womens Health 2021; 21:281. [PMID: 34348697 PMCID: PMC8336085 DOI: 10.1186/s12905-021-01436-9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022]
Abstract
Oxidized regenerated cellulose is considered an optimal local hemostatic agent thanks to its favorable biocompatibility, absorption characteristics and ease-of-use. Recently, oxidized regenerated cellulose has also been used as a filler in breast conserving surgery with a reconstructive purpose in order to repair partial breast defects and improve aesthetic outcomes. However, some postoperative problems due to its use, such as allergic reactions, seroma, foreign-body reaction and misdiagnosis during the follow-up of breast cancer patients, have been shown. These possible surgical complications can undermine clinical outcomes and lead to delay the beginning of oncological treatments with a negative impact on patient quality of life and survival. An adequate surgical expertise and the compliance with some specific recommendations are crucial in order to minimize postoperative issues and optimise aesthetic outcomes.
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Affiliation(s)
- Gianluca Franceschini
- Multidisciplinary Breast Unit, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy. .,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
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Terribile DA, Mason EJ, Murando F, DI Leone A, Sanchez AM, Scardina L, Magno S, Franco A, D'Archi S, Natale M, Lucci Cordisco E, Masetti R, Franceschini G. Surgical management of BRCA pathogenic variant carriers with breast cancer: a recent literature review and current state of the art. Minerva Surg 2021; 76:564-574. [PMID: 34338470 DOI: 10.23736/s2724-5691.21.09009-2] [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: 11/08/2022]
Abstract
INTRODUCTION Surgical management of breast cancer patients carrying pathogenic variants (PV) on breast cancer genes (BRCA) 1 and 2 has changed throughout the last decade due to growing availability of genetic testing, and has shifted towards the diffusion of bilateral mastectomy. Today's scenario however is in further evolution because of emerging data that suggest a personalized modulation of treatment. In this work we aimed to gather recent evidence supporting a prophylactic or conservative surgical approach in order to define the state of the art in today's treatment of BRCA carriers with breast cancer. EVIDENCE ACQUISITION We reviewed the literature to identify studies providing evidence on surgical treatment in breast cancer patients with BRCA 1 and 2 PVs. We included articles comparing outcomes between patients undergoing breast conserving surgery (BCS) and mastectomy, and articles investigating contralateral risk-reducing mastectomy (CRRM), with a particular focus on recent literature. International guidelines were also reviewed. EVIDENCE SYNTHESIS Optimal surgical management of BRCA PV carriers with breast cancer remains controversial. While the introduction of routine genetic testing has initially led surgeons to favor more radical treatments, recent literature provides evidence that a conservative approach is safe and feasible in selected cases. Guidelines are heterogeneous and provide guidance without constraining the surgeon. CONCLUSIONS Patients should undergo adequate genetic and surgical counseling in order to receive the best tailored surgical treatment. Because guidelines vary in different countries and provide no definite protocol, they highlight the importance of accurate surgical planning. Clinical, familial and psychosocial factors should be taken into account when approaching a BRCA PV carrier with breast cancer, in order to guarantee the best evidence-based patient care in an era of personalized treatment.
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Affiliation(s)
- Daniela A Terribile
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena J Mason
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy -
| | - Federica Murando
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alba DI Leone
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alejandro M Sanchez
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Scardina
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Magno
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Franco
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sabatino D'Archi
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Natale
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Riccardo Masetti
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Orlandi A, D'Archi S, Garufi G, Franco A, Carnassale B, Palazzo A, Bria E, Sanchez M, DI Leone A, Terribile D, Fabi A, Tortora G, Masetti R, Franceschini G. Impact on survival of primary tumor resection in patients with metastatic breast cancer: preliminary results of a retrospective analisys. Minerva Surg 2021; 76:506-511. [PMID: 34338469 DOI: 10.23736/s2724-5691.21.09007-9] [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: 11/08/2022]
Abstract
BACKGROUND Treatment of de novo metastatic breast cancer is usually centered around systemic therapy, with local therapy (surgery and radiation therapy) largely reserved for palliation in patients with significant symptoms from primary tumour. The efficacy of locoregional treatment like surgery and/or radiotherapy is still controversial and the debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. METHODS All patients with de novo MBC undergone surgical treatment between January 2015 and January 2020 at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome were included in this study. The primary endpoint was overall survival (OS) after PT resection, the secondary endpoint was progression free survival (PFS). The survival analyses were done using Kaplan-Meier method. Patients and tumour characteristics were analyzed in an exploratory modality in order to identify prognostic factor. RESULTS 45 patients received resection of the primary breast cancer (26 mastectomy and 19 breast conserving surgery). Median age of diagnosis was 53 years old (range 25-75 years old). Median follow-up was 25.67 months. The median OS was not reached with 75% of patients alive over 2 years from PT resection. The median PFS was not reached with 64% of patients alive over 2 years from PT resection. For both PFS and OS only the triple negative (TN) immunophenotype appears to be a prognostically unfavorable factor in multivariate analysis. CONCLUSIONS In view of the low number of disease progression events and deaths, although our results are preliminary, surgical treatment of primary breast cancer in metastatic setting seems to be an option after systemic therapies in luminal and HER2 positive breast cancer. Randomized prospective trials in for each immunophenotype are necessary order to confirm this evidence.
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Affiliation(s)
- Armando Orlandi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy -
| | - Sabatino D'Archi
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Garufi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Franco
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Beatrice Carnassale
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Palazzo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martin Sanchez
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alba DI Leone
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Terribile
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Fabi
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Masetti
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Breast Center Unit, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Bove S, Fragomeni SM, Romito A, DI Giorgio D, Rinaldi P, Pagliara D, Verri D, Romito I, Paris I, Tagliaferri L, Marazzi F, Visconti G, Franceschini G, Masetti R, Garganese G. Techniques for sentinel node biopsy in breast cancer. Minerva Surg 2021; 76:550-563. [PMID: 34338468 DOI: 10.23736/s2724-5691.21.09002-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically non suspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction. EVIDENCE ACQUISITION The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon's confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time. EVIDENCE SYNTHESIS The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD. CONCLUSIONS This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.
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Affiliation(s)
- Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Simona M Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy -
| | | | - Pierluigi Rinaldi
- Radiology and Interventional Radiology Unit, Mater Olbia Hospital, Olbia, Italy.,Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pagliara
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Debora Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ilaria Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ida Paris
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Visconti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Chirurgia Plastica, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Riccardo Masetti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Franceschini G, Mason EJ, Orlandi A, D'Archi S, Sanchez AM, Masetti R. How will artificial intelligence impact breast cancer research efficiency? Expert Rev Anticancer Ther 2021; 21:1067-1070. [PMID: 34214007 DOI: 10.1080/14737140.2021.1951240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elena Jane Mason
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Armando Orlandi
- Division of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sabatino D'Archi
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Masetti
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Bufi E, Piacentini M, Belli P, Conti M, Ciriello G, Franceschini G, Giuliani M, Terribile D, Valente I, Manfredi R. Is subareolar intraoperative biopsy still necessary to predict nipple involvement? Eur Rev Med Pharmacol Sci 2021; 25:661-668. [PMID: 33577020 DOI: 10.26355/eurrev_202101_24627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To predict the occult tumor involvement of nipple-areola complex (NAC) using preoperative MR imaging and to investigate whether the intraoperative histopathological examination of the subareolar tissue is still necessary. PATIENTS AND METHODS Out of 712 patients submitted to nipple-sparing mastectomy (NSM) between 2014 and 2019, we selected 188 patients who underwent preoperative breast MRI. Breast MRI and intraoperative histopathological examination of the subareolar tissue were performed to predict NAC involvement at permanent pathology. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. RESULTS Forty-three patients (22.9%) had tumor involvement of the NAC. At univariate analysis, non-mass enhancement type (p = 0.009), multifocality/multicentricity (p = 0.002), median tumor size (p < 0.001), median tumor-NAC distance measured by MRI (p < 0.001), tumor-NAC distance ≤ 10 mm (p < 0.001) and tumor-NAC distance ≤ 20 mm (p < 0.001), and lymphovascular invasion (p = 0.001) were significantly correlated with NAC involvement. At multivariate analysis, only tumor-NAC distance ≤ 10 mm retained statistical significance. The sensitivity and specificity of MRI tumor-NAC distance ≤ 10 mm were 79.1% and 97.2% and those of intraoperative pathologic assessment were 74,4% and 100%, respectively. CONCLUSIONS Tumor-NAC distance is the only reliable MRI characteristic that can predict NAC involvement in breast cancer patients. Although several cut-offs showed promising performances, intraoperative pathologic assessment is still mandatory.
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Affiliation(s)
- E Bufi
- UOC Radiologia Diagnostica ed Interventistica Generale, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
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Barberi V, Pietragalla A, Franceschini G, Marazzi F, Paris I, Cognetti F, Masetti R, Scambia G, Fabi A. Oligometastatic Breast Cancer: How to Manage It? J Pers Med 2021; 11:532. [PMID: 34207648 PMCID: PMC8227505 DOI: 10.3390/jpm11060532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most frequent cancer among women and represents the second leading cause of cancer-specific death. A subset of patients with metastatic breast cancer (MBC) presents limited disease, termed 'oligometastatic' breast cancer (OMBC). The oligometastatic disease can be managed with different treatment strategies to achieve long-term remission and eventually cure. Several approaches are possible to cure the oligometastatic disease: locoregional treatments of the primary tumor and of all the metastatic sites, such as surgery and radiotherapy; systemic treatment, including target-therapy or immunotherapy, according to the biological status of the primary tumor and/or of the metastases; or the combination of these approaches. Encouraging results involve local ablative options, but these trials are limited by being retrospective and affected by selection bias. Systemic therapy, e.g., the use of CDK4/6 inhibitors for hormone receptor-positive (HR+)/HER-2 negative BC, leads to an increase of progression-free survival (PFS) and overall survival (OS) in all the subgroups, with favorable toxicity. Regardless of the lack of substantial data, this subset of patients could be treated with curative intent; the appropriate candidates could be mostly young women, for whom a multidisciplinary aggressive approach appears suitable. We provide a global perspective on the current treatment paradigms of OMBC.
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Affiliation(s)
- Vittoria Barberi
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy; (V.B.); (F.C.)
| | - Antonella Pietragalla
- Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.P.); (G.S.)
| | - Gianluca Franceschini
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.F.); (R.M.)
| | - Fabio Marazzi
- UOC Radiotherapy, Department of Imaging Diagnostic, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Cognetti
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy; (V.B.); (F.C.)
| | - Riccardo Masetti
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.F.); (R.M.)
| | - Giovanni Scambia
- Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.P.); (G.S.)
| | - Alessandra Fabi
- Unit of Precision Medicine in Breast Cancer, Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Zhu A, Yuan P, Hu N, Li M, Wang W, Wang X, Yue J, Wang J, Luo Y, Ma F, Zhang P, Li Q, Xu B, Cao S, Lippi G, Naito Y, Osman MA, Marta GN, Franceschini G, Orlandi A. Phase II study of apatinib in combination with oral vinorelbine in heavily pretreated HER2-negative metastatic breast cancer and clinical implications of monitoring ctDNA. Cancer Biol Med 2021; 18:j.issn.2095-3941.2020.0418. [PMID: 34037346 PMCID: PMC8330536 DOI: 10.20892/j.issn.2095-3941.2020.0418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Apatinib is an oral TKI targeting VEGFR-2. Single-agent apatinib treatment has been shown to produce an objective response in patients with pretreated mBC. Oral vinorelbine also holds promise as a treatment of choice in patients with mBC. This study aimed to investigate the efficacy and safety of the oral vinorelbine-apatinib combination in patients with pretreated mBC. In addition, we detected gene variants in ctDNA to explore the therapeutic implications. METHODS This study enrolled patients with HER2-negative mBC who were pretreated with anthracycline/taxanes. Patients were treated with apatinib at 500 mg/425 mg daily plus oral vinorelbine 60 mg/m2 on days 1, 8, and 15 of every cycle (3 weeks). The primary endpoint was PFS. The secondary endpoints were ORR, CBR, OS, and safety. Patients eligible for ctDNA detection were evaluated before and during treatment. RESULTS Forty patients were enrolled. The median PFS was 5.2 months (95% CI, 3.4-7.0 months), and the median OS was 17.4 months (95% CI, 8.0-27.0 months). The ORR was 17.1% (6/35), and the CBR was 45.7% (16/35). The most common AEs included gastrointestinal reaction, myelosuppression, and hypertension. In 20 patients, ctDNA was detected at baseline and during treatment. A significant difference was found in PFS for undetected vs. detected baseline ctDNA (13.9 months vs. 3.6 months, P = 0.018). CONCLUSIONS All-oral therapy with apatinib plus vinorelbine displayed objective efficacy in patients with heavily pretreated HER2-negative mBC, with acceptable and manageable toxicity profiles. Patients with no gene variant detected and lower variant allele frequencies in ctDNA at baseline showed longer PFS.
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Affiliation(s)
- Anjie Zhu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Peng Yuan
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Nanlin Hu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Mingzhou Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenmiao Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xue Wang
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jian Yue
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shanbo Cao
- AcornMed Biotechnology Co., Ltd., Beijing 101102, China
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona 37100, Italy
| | - Yoichi Naito
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan
| | - Mohammed A. Osman
- Clinical Oncology, General Organization for Teaching Hospitals, Cairo 11435, Egypt
| | - Gustavo N. Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo 01308-050, Brazil
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00176, Italy
| | - Armando Orlandi
- Unit of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma 00176, Italy
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Costantini M, Montella RA, Fadda MP, Garganese G, Di Leone A, Sanchez AM, Franceschini G, Rinaldi PM. Axillary Nodal Metastases from Carcinoma of Unknown Primary (CUPAx): Role of Contrast-Enhanced Spectral Mammography (CESM) in Detecting Occult Breast Cancer. J Pers Med 2021; 11:jpm11060465. [PMID: 34070278 PMCID: PMC8225076 DOI: 10.3390/jpm11060465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
Axillary lymph node metastases of occult breast cancer (CUPAx) is an unusual condition that represents both a diagnostic and therapeutic challenge. The first steps in the diagnostic work-up of patients with CUPAx are the histological analysis of the lymph node metastasis and the execution of basic breast diagnostic imaging (mammography and ultrasound). In the case of occult breast cancer, breast Magnetic Resonance (MR) must be performed. Breast MR identifies a suspicious lesion in many patients and second-look ultrasound detects a corresponding ultrasound alteration in about half of cases, allowing the performance of a US-guided biopsy. In the case of an MR-only lesion, MR-guided biopsy is mandatory. We present a case of CUPAx in which contrast-enhanced spectral mammography (CESM) is used to help the detection of occult breast cancer and to guide stereotactic vacuum breast biopsy (VABB). CESM is a new breast imaging technique that is proving to have good performance in breast cancer detection and that is showing potential in the identification of occult breast cancer in a CUPAx setting. The use of an innovative and personalized breast imaging approach in breast cancer patients improves diagnostic possibilities and promises to become the focus in decision strategies.
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Affiliation(s)
- Melania Costantini
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
- Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Rino Aldo Montella
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
- Correspondence: ; Tel.: +39-0789-1899901
| | - Maria Paola Fadda
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), 07026 Olbia, Italy;
- Dipartimento Scienze della Vita e Sanità Pubblica, Sezione Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Alba Di Leone
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (A.D.L.); (A.M.S.); (G.F.)
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (A.D.L.); (A.M.S.); (G.F.)
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (A.D.L.); (A.M.S.); (G.F.)
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Pierluigi Maria Rinaldi
- Radiology Unit, Mater Olbia Hospital (Qatar Foundation Endowment and Policlinico Universitario Agostino Gemelli IRCCS Foundation), 07026 Olbia, Italy; (M.C.); (M.P.F.); (P.M.R.)
- Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
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