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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Coccolini F, Lippolis PV, Gelmini R, Deraco M, Biacchi D, Aulicino M, Vaira M, De Franciscis S, D'Acapito F, Carboni F, Milone E, Donini A, Fugazzola P, Faviana P, Sorrentino L, Pizzolato E, Cenzi C, Del Bianco P, Sommariva A. Prognostic value of specific KRAS mutations in patients with colorectal peritoneal metastases. ESMO Open 2024; 9:102976. [PMID: 38613907 PMCID: PMC11033065 DOI: 10.1016/j.esmoop.2024.102976] [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: 12/20/2023] [Revised: 02/17/2024] [Accepted: 02/29/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND There is little evidence on KRAS mutational profiles in colorectal cancer (CRC) peritoneal metastases (PM). This study aims to determine the prevalence of specific KRAS mutations and their prognostic value in a homogeneous cohort of patients with isolated CRC PM treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. MATERIALS AND METHODS Data were collected from 13 Italian centers, gathered in a collaborative group of the Italian Society of Surgical Oncology. KRAS mutation subtypes have been correlated with clinical and pathological characteristics and survival [overall survival (OS), local (peritoneal) disease-free survival (LDFS) and disease-free survival (DFS)]. RESULTS KRAS mutations occurred in 172 patients (47.5%) out of the 362 analyzed. Two different prognostic groups of KRAS mutation subtypes were identified: KRASMUT1 (G12R, G13A, G13C, G13V, Q61H, K117N, A146V), median OS > 120 months and KRASMUT2 (G12A, G12C, G12D, G12S, G12V, G13D, A59E, A59V, A146T), OS: 31.2 months. KRASMUT2 mutations mainly occurred in the P-loop region (P < 0.001) with decreased guanosine triphosphate (GTP) hydrolysis activity (P < 0.001) and were more frequently related to size (P < 0.001) and polarity change (P < 0.001) of the substituted amino acid (AA). When KRASMUT1 and KRASMUT2 were combined with other known prognostic factors (peritoneal cancer index, completeness of cytoreduction score, grading, signet ring cell, N status) in multivariate analysis, KRASMUT1 showed a similar survival rate to KRASWT patients, whereas KRASMUT2 was independently associated with poorer prognosis (hazard ratios: OS 2.1, P < 0.001; DFS 1.9, P < 0.001; LDFS 2.5, P < 0.0001). CONCLUSIONS In patients with CRC PM, different KRAS mutation subgroups can be determined according to specific codon substitution, with some mutations (KRASMUT1) that could have a similar prognosis to wild-type patients. These findings should be further investigated in larger series.
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Affiliation(s)
- M Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - D Baratti
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - P Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery 'Pietro Valdoni', Sapienza University of Rome, Rome
| | - A Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, Rome
| | - M Robella
- Surgical Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin
| | - C Sassaroli
- Integrated Medical Surgical Research in Peritoneal Surface Malignancy, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Pascale IRCCS, Naples
| | - M Framarini
- General and Oncologic Department of Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì
| | - M Valle
- Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, Rome
| | - A Macrì
- Peritoneal and Retroperitonel Surgical Unit-University Hospital 'G. Martino' Messina
| | - L Graziosi
- General and Emergency Surgery Department, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia
| | - F Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena; General Emergency and Trauma Surgery, Pisa University Hospital, Pisa
| | - P V Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa
| | - R Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia
| | - M Deraco
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - D Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery 'Pietro Valdoni', Sapienza University of Rome, Rome
| | - M Aulicino
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, Rome
| | - M Vaira
- Surgical Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin
| | - S De Franciscis
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Pascale IRCCS, Naples
| | - F D'Acapito
- General and Oncologic Department of Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì
| | - F Carboni
- Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, Rome
| | - E Milone
- Peritoneal and Retroperitonel Surgical Unit-University Hospital 'G. Martino' Messina
| | - A Donini
- General and Emergency Surgery Department, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia
| | - P Fugazzola
- General surgery, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - P Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa
| | - L Sorrentino
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia
| | - E Pizzolato
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - C Cenzi
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - P Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - A Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua.
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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Coccolini F, Lippolis PV, Gelmini R, Deraco M, Biacchi D, Santullo F, Vaira M, Di Lauro K, D'Acapito F, Carboni F, Milone E, Donini A, Fugazzola P, Faviana P, Sorrentino L, Pizzolato E, Cenzi C, Del Bianco P, Sommariva A. ASO Visual Abstract: Is Systemic Chemotherapy Useful in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Metastases? A Propensity-Score Analysis. Ann Surg Oncol 2024; 31:2017-2018. [PMID: 37907699 DOI: 10.1245/s10434-023-14494-0] [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: 11/02/2023]
Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery"Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Andrea Di Giorgio
- Unit of Peritoneum and Retroperitoneum, Fondazione PoliclinicoUniversitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela Robella
- Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Cinzia Sassaroli
- Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale" IRCCS, Naples, Italy
| | - Massimo Framarini
- General and Oncologic Department of Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, Rome, Italy
| | - Antonio Macrì
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Luigina Graziosi
- General and Emergency Surgery Department, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
- General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Piero Vincenzo Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery"Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Francesco Santullo
- Unit of Peritoneum and Retroperitoneum, Fondazione PoliclinicoUniversitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Vaira
- Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Fabrizio D'Acapito
- General and Oncologic Department of Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Carboni
- Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, Rome, Italy
| | - Erica Milone
- University Hospital "G. Martino", Messina, Italy
| | - Annibale Donini
- General and Emergency Surgery Department, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Paola Fugazzola
- General surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pinuccia Faviana
- Pathological Anatomy III, Laboratory Medicine Department, Hospital University Pisa (AOUP), Pisa, Italy
| | - Lorena Sorrentino
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Pizzolato
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Carola Cenzi
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Coccolini F, Lippolis PV, Gelmini R, Deraco M, Biacchi D, Santullo F, Vaira M, Di Lauro K, D'Acapito F, Carboni F, Milone E, Donini A, Fugazzola P, Faviana P, Sorrentino L, Pizzolato E, Cenzi C, Del Bianco P, Sommariva A. Is Systemic Chemotherapy Useful in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Metastases? A Propensity-Score Analysis. Ann Surg Oncol 2024; 31:594-604. [PMID: 37831280 DOI: 10.1245/s10434-023-14417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Multimodal treatment of colorectal (CRC) peritoneal metastases (PM) includes systemic chemotherapy (SC) and surgical cytoreduction (CRS), eventually with hyperthermic intraperitoneal chemotherapy (HIPEC), in select patients. Considering lack of clear guidelines, this study was designed to analyze the role of chemotherapy and its timing in patients treated with CRS-HIPEC. METHODS Data from 13 Italian centers with PM expertise were collected by a collaborative group of the Italian Society of Surgical Oncology (SICO). Clinicopathological variables, SC use, and timing of administration were correlated with overall survival (OS), disease-free survival (DFS), and local (peritoneal) DFS (LDFS) after propensity-score (PS) weighting to reduce confounding factors. RESULTS A total of 367 patients treated with CRS-HIPEC were included in the propensity-score weighting. Of the total patients, 19.9% did not receive chemotherapy within 6 months of surgery, 32.4% received chemotherapy before surgery (pregroup), 28.9% after (post), and 18.8% received both pre- and post-CRS-HIPEC treatment (peri). SC was preferentially administered to younger (p = 0.02) and node-positive (p = 0.010) patients. Preoperative SC is associated with increased rate of major complications (26.9 vs. 11.3%, p = 0.0009). After PS weighting, there were no differences in OS, DFS, or LDFS (p = 0.56, 0.50, and 0.17) between chemotherapy-treated and untreated patients. Considering SC timing, the post CRS-HIPEC group had a longer DFS and LDFS than the pre-group (median DFS 15.4 vs. 9.8 m, p = 0.003; median LDFS 26.3 vs. 15.8 m, p = 0.026). CONCLUSIONS In patients with CRC-PM treated with CRS-HIPEC, systemic chemotherapy was not associated with overall survival benefit. The adjuvant schedule was related to prolonged disease-free intervals. Additional, randomized studies are required to clarify the role and timing of systemic chemotherapy in this patient subset.
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Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Dept. of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela Robella
- Surgical Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Cinzia Sassaroli
- Abdominal Oncology Department, Fondazione Giovanni Pascale, IRCCS, Naples, Italy
| | - Massimo Framarini
- General and Oncologic Department of Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, Rome, Italy
| | - Antonio Macrì
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Luigina Graziosi
- General and Emergency Surgery Department, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
- General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Piero Vincenzo Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Unit, Dept. of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Vaira
- Surgical Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Fabrizio D'Acapito
- General and Oncologic Department of Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Carboni
- Peritoneal Tumours Unit, IRCCS, Regina Elena Cancer Institute, Rome, Italy
| | - Erica Milone
- University Hospital "G. Martino", Messina, Italy
| | - Annibale Donini
- General and Emergency Surgery Department, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Paola Fugazzola
- General surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pinuccia Faviana
- Pathological Anatomy III, Laboratory Medicine Department, Hospital University Pisa (AOUP), Pisa, Italy
| | - Lorena Sorrentino
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Pizzolato
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Carola Cenzi
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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Zumstein L, Tuninetti V, Vaira M, Siatis D, Palermo F, Petracchini M, Scotto G, Turinetto M, Piva R, Pasini B, Valabrega G. Lynch syndrome-associated endometrial cancer patient with a rare novel germline likely pathogenic variant of MSH2 gene: A case report. Gynecol Oncol Rep 2023; 48:101220. [PMID: 37434947 PMCID: PMC10331303 DOI: 10.1016/j.gore.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 06/04/2023] [Indexed: 07/13/2023] Open
Abstract
The Lynch syndrome (LS) is an autosomal dominant condition usually characterized by germline pathogenic variants in DNA mismatch repair (MMR) genes. Despite the guidelines now available, determining the pathogenicity of rare variants remains challenging, as the clinical significance of a genetic variant could be uncertain, but it may represent a disease-associated variation in the aforementioned genes. In this case report we will describe the case of a 47 years-old female affected by endometrial cancer (EC) with an extremely rare germline heterozygous variant in the MSH2 gene (c.562G > T p. (Glu188Ter), exon 3) that is likely pathogenic, and a family history consistent with LS.
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Affiliation(s)
- L. Zumstein
- Department of Oncology, University of Turin, Turin, Italy
| | - V. Tuninetti
- Department of Oncology, University of Turin, Medical Oncology, Ordine Mauriziano Hospital
| | - M. Vaira
- Department of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - D. Siatis
- Department of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - F. Palermo
- Department of Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - M. Petracchini
- Department of Radiology, Umberto I Mauriziano Hospital, Turin, Italy
| | - G. Scotto
- Department of Oncology, University of Turin, Turin, Italy
| | - M. Turinetto
- Department of Oncology, University of Turin, Turin, Italy
| | - R. Piva
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy
- Città Della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - B. Pasini
- Medical Genetics Unit at the AOU Città della Salute e della Scienza di Torino, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - G. Valabrega
- Department of Oncology, University of Turin, Medical Oncology, Ordine Mauriziano Hospital
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5
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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Fugazzola P, Lippolis PV, Gelmini R, Biacchi D, Kasamura S, Deraco M, Cenzi C, Del Bianco P, Vaira M, Sommariva A. External validation of COMPASS and BIOSCOPE prognostic scores in colorectal peritoneal metastases treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Eur J Surg Oncol 2023; 49:604-610. [PMID: 38432873 DOI: 10.1016/j.ejso.2022.10.007] [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: 04/22/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The selection of patients undergoing cytoreductive- surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. BIOSCOPE and COMPASS are prognostic scores designed to stratify survival into four classes according to clinical and pathological features. The purpose of this study is to analyze the prognostic role of these scores using a large cohort of patients as an external reference. METHODS Overall survival analysis was performed using Log-Rank and Kaplan-Meier curves for each score. The probability of survival at 12, 36, and 60 months was tested using receiver operating characteristic (ROC) curves to determine sensitivity and specificity. RESULTS From the validation cohort of 437 patients, the analysis included 410 patients in the COMPASS group and 364 patients in the BIOSCOPE group (100% data completeness). We observed a different patient distribution between classes (high-risk for BIOSCOPE compared to COMPASS, p = 0.0001). Nevertheless, both COMPASS and BIOSCOPE effectively stratified overall survival (Log-Rank, p = 0.0001 in both cases), with a lack of discrimination between COMPASS classes II and III (p = n.s.). COMPASS at 12 m and BIOSCOPE at 60 m showed the best performance in terms of survival prediction (AUC of 0.82 and 0.81). The specificity of the two tests is good (median 81.3%), whereas sensibility is quite low (median 64.2%). CONCLUSION Following external validation in a large population of patients with CRC-PM who are eligible for surgery, the COMPASS and BIOSCOPE scores exhibit high inter-test variability but effectively stratify cancer-related mortality risk. While the quality of the scores is similar, BIOSCOPE shows better inter-tier differentiation, suggesting that tumor molecular classification could improve test discrimination capability. More powerful stratification scores with the inclusion of novel predictors are needed.
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Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Dept. of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela Robella
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - Cinzia Sassaroli
- Integrated Medical Surgical Research of Peritoneal Neoplasm - Abdominal Oncology Department, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy
| | - Massimo Framarini
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Mario Valle
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Antonio Macrì
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Luigina Graziosi
- University of Perugia, General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Paola Fugazzola
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Piero Vincenzo Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Shigeki Kasamura
- Peritoneal Surface Malignancy Unit, Dept. of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Unit, Dept. of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carola Cenzi
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marco Vaira
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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6
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Di Giorgio A, Macrì A, Ferracci F, Robella M, Visaloco M, De Manzoni G, Sammartino P, Sommariva A, Biacchi D, Roviello F, Pastorino R, Pires Marafon D, Rotolo S, Casella F, Vaira M. 10 Years of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15041125. [PMID: 36831468 PMCID: PMC9954579 DOI: 10.3390/cancers15041125] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel intraperitoneal drug delivery method of low-dose chemotherapy as a pressurized aerosol in patients affected by peritoneal cancer of primary or secondary origin. We performed a systematic review and meta-analysis with the aim of assessing the feasibility, safety, and efficacy of PIPAC. METHODS A systematic literature search was performed using Medline and Web of Science databases from 1 January 2011, to inception, to 31 December 2021. Data were independently extracted by two authors. The Newcastle-Ottawa Scale was used to assess the quality and risk of bias of studies. Meta-analysis was performed for pathological response, radiological response, PCI variation along treatment, and for patients undergoing three or more PIPAC. Pooled analyses were performed using the Freeman-Tukey double arcsine transformation, and 95% CIs were calculated using Clopper-Pearson exact CIs in all instances. RESULTS A total of 414 papers on PIPAC were identified, and 53 studies considering 4719 PIPAC procedure in 1990 patients were included for analysis. The non-access rate or inability to perform PIPAC pooled rate was 4% of the procedures performed. The overall proportion of patients who completed 3 or more cycles of PIPAC was 39%. Severe toxicities considering CTCAE 3-4 were 4% (0% to 38.5%). In total, 50 studies evaluated deaths within the first 30 postoperative days. In the included 1936 patients were registered 26 deaths (1.3%). The pooled analysis of all the studies reporting a pathological response was 68% (95% CI 0.61-0.73), with an acceptable heterogeneity (I2 28.41%, p = 0.09). In total, 10 papers reported data regarding the radiological response, with high heterogeneity and a weighted means of 15% (0% to 77.8%). PCI variation along PIPAC cycles were reported in 14 studies. PCI diminished, increased, or remained stable in eight, one and five studies, respectively, with high heterogeneity at pooled analysis. Regarding survival, there was high heterogeneity. The 12-month estimated survival from first PIPAC for colorectal cancer, gastric cancer, gynecological cancer and hepatobiliary/pancreatic cancer were, respectively, 53%, 25%, 59% and 37%. CONCLUSIONS PIPAC may be a useful treatment option for selected patients with PM, with acceptable grade 3 and 4 toxicity and promising survival benefit. Meta-analysis showed high heterogeneity of data among up-to-date available studies. In a subset analysis per primary tumor origin, pathological tumor regression was documented in 68% of the studies with acceptable heterogeneity. Pathological regression seems, therefore, a reliable outcome for PIPAC activity and a potential surrogate endpoint of treatment response. We recommend uniform selection criteria for patients entering a PIPAC program and highlight the urgent need to standardize items for PIPAC reports and datasets.
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Affiliation(s)
- Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy
| | - Antonio Macrì
- U.O.C.—P.S.G. con O.B.I. Azienda Ospedaliera Universitaria “G. Martino”—Messina, 98125 Messina, Italy
| | - Federica Ferracci
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy
- Correspondence: or ; Tel.: +39-0630157255
| | - Manuela Robella
- Candiolo Cancer Institute, FPO—IRCCS, Candiolo, 10060 Torino, Italy
| | - Mario Visaloco
- U.O.C.—P.S.G. con O.B.I. Azienda Ospedaliera Universitaria “G. Martino”—Messina, 98125 Messina, Italy
| | | | - Paolo Sammartino
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Antonio Sommariva
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Daniele Biacchi
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Franco Roviello
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
| | - Roberta Pastorino
- Sezione di Igiene, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Roma, Italy
| | - Denise Pires Marafon
- Sezione di Igiene, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Stefano Rotolo
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Francesco Casella
- Upper GI Surgery Division, University of Verona, 37129 Verona, Italy
| | - Marco Vaira
- Candiolo Cancer Institute, FPO—IRCCS, Candiolo, 10060 Torino, Italy
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7
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Vaira M, Robella M, Guaglio M, Berchialla P, Sommariva A, Valle M, Pasqual EM, Roviello F, Framarini M, Fiorentini G, Sammartino P, Ilari Civit A, Di Giorgio A, Ansaloni L, Deraco M. Diagnostic and Therapeutic Algorithm for Appendiceal Tumors and Pseudomyxoma Peritonei: A Consensus of the Peritoneal Malignancies Oncoteam of the Italian Society of Surgical Oncology (SICO). Cancers (Basel) 2023; 15:cancers15030728. [PMID: 36765686 PMCID: PMC9913318 DOI: 10.3390/cancers15030728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 01/26/2023] Open
Abstract
Aim: Pseudomyxoma peritonei (PMP) is an uncommon pathology, and its rarity causes a lack of scientific evidence, precluding the design of a prospective trial. A diagnostic and therapeutic algorithm (DTA) is necessary in order to standardize the disease treatment while balancing optimal patient management and the correct use of resources. The Consensus of the Italian Society of Surgical Oncology (SICO) Oncoteam aims at defining a diagnostic and therapeutic pathway for PMP and appendiceal primary tumors applicable in Italian healthcare. Method: The consensus panel included 10 delegated representatives of oncological referral centers for Peritoneal Surface Malignancies (PSM) affiliated to the SICO PSM Oncoteam. A list of statements regarding the DTA of patients with PMP was prepared according to recommendations based on the review of the literature and expert opinion. Results: A consensus was obtained on 33 of the 34 statements linked to the DTA; two flowcharts regarding the management of primary appendiceal cancer and peritoneal disease were approved. Conclusion: Currently, consensus has been reached on pathological classification, preoperative evaluation, cytoreductive surgery technical detail, and systemic treatment; some controversies still exist regarding the exclusion criteria for HIPEC treatment. A shared Italian model of DTA is an essential tool to ensure the appropriateness and equity of treatment for these patients.
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Affiliation(s)
- Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO—IRCCS, 10060 Candiolo, Italy
- Correspondence: authors: (M.V.); (M.R.)
| | - Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO—IRCCS, 10060 Candiolo, Italy
- Correspondence: authors: (M.V.); (M.R.)
| | - Marcello Guaglio
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale Tumori IRCCS Milano, 20133 Milano, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology and Public Health (C-BEPH), University of Torino, 10124 Torino, Italy
| | - Antonio Sommariva
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, t, 35100 Padova, Italy
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Enrico Maria Pasqual
- AOUD Center Advanced Surgical Oncology, DAME University of Udine, 33100 Udine, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Massimo Framarini
- Surgery and Advanced Oncological Therapy Unit, Ospedale “GB.Morgagni-L.Pierantoni”—AUSL Forlì, 47122 Forlì, Italy
| | - Giammaria Fiorentini
- Italian Network of International Clinical Hyperthermia Society Coordinator, 48121 Ravenna, Italy
| | - Paolo Sammartino
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Alba Ilari Civit
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO—IRCCS, 10060 Candiolo, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy
| | - Luca Ansaloni
- Unit of General Surgery, San Matteo Hospital, 27100 Pavia, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale Tumori IRCCS Milano, 20133 Milano, Italy
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8
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Robella M, Tonello M, Berchialla P, Sciannameo V, Ilari Civit AM, Sommariva A, Sassaroli C, Di Giorgio A, Gelmini R, Ghirardi V, Roviello F, Carboni F, Lippolis PV, Kusamura S, Vaira M. Enhanced Recovery after Surgery (ERAS) Program for Patients with Peritoneal Surface Malignancies Undergoing Cytoreductive Surgery with or without HIPEC: A Systematic Review and a Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030570. [PMID: 36765534 PMCID: PMC9913706 DOI: 10.3390/cancers15030570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
Enhanced recovery after surgery (ERAS) program refers to a multimodal intervention to reduce the length of stay and postoperative complications; it has been effective in different kinds of major surgery including colorectal, gynaecologic and gastric cancer surgery. Its impact in terms of safety and efficacy in the treatment of peritoneal surface malignancies is still unclear. A systematic review and a meta-analysis were conducted to evaluate the effect of ERAS after cytoreductive surgery with or without HIPEC for peritoneal metastases. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane Database were searched from January 2010 and December 2021. Single and double-cohort studies about ERAS application in the treatment of peritoneal cancer were considered. Outcomes included the postoperative length of stay (LOS), postoperative morbidity and mortality rates and the early readmission rate. Twenty-four studies involving 5131 patients were considered, 7 about ERAS in cytoreductive surgery (CRS) + HIPEC and 17 about cytoreductive alone; the case histories of two Italian referral centers in the management of peritoneal cancer were included. ERAS adoption reduced the LOS (-3.17, 95% CrI -4.68 to -1.69 in CRS + HIPEC and -1.65, 95% CrI -2.32 to -1.06 in CRS alone in the meta-analysis including 6 and 17 studies respectively. Non negligible lower postoperative morbidity was also in the meta-analysis including the case histories of two Italian referral centers. Implementation of an ERAS protocol may reduce LOS, postoperative complications after CRS with or without HIPEC compared to conventional recovery.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, 10060 Torino, Italy
- Correspondence: ; Tel.: +39-338-382-4104
| | - Marco Tonello
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Paola Berchialla
- Center for Biostatistics, Epidemiology and Public Health (C-BEPH), Deptartment of Clinical and Biological Sciences, University of Torino, 10124 Torino, Italy
| | - Veronica Sciannameo
- Center for Biostatistics, Epidemiology and Public Health (C-BEPH), Deptartment of Clinical and Biological Sciences, University of Torino, 10124 Torino, Italy
| | | | - Antonio Sommariva
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Cinzia Sassaroli
- Abdominal Oncology Department, Fondazione Giovanni Pascale, IRCCS, 80131 Naples, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Roberta Gelmini
- SC Chirurgia Generale d’Urgenza ed Oncologica, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Valentina Ghirardi
- UOC Ovarian Carcinoma Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Fabio Carboni
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | - Shigeki Kusamura
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale Tumori IRCCS Milano, 20133 Milano, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, 10060 Torino, Italy
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9
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Cardi M, Pocard M, Dico RL, Fiorentini G, Valle M, Gelmini R, Vaira M, Pasqual EM, Asero S, Baiocchi G, Di Giorgio A, Spagnoli A, Di Marzo F, Sollazzo B, D'Ermo G, Biacchi D, Iafrate F, Sammartino P. Selected Patients With Peritoneal Metastases From Breast Cancer May Benefit From Cytoreductive Surgery: The Results of a Multicenter Survey. Front Oncol 2022; 12:822550. [PMID: 35646687 PMCID: PMC9132044 DOI: 10.3389/fonc.2022.822550] [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: 11/25/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Even though breast cancer is the most frequent extra-abdominal tumor causing peritoneal metastases, clear clinical guidelines are lacking. Our aim is to establish whether cytoreductive surgery (CRS) could be considered in selected patients with peritoneal metastases from breast cancer (PMBC) to manage abdominal spread and allow patients to resume or complete other medical treatments. Methods We considered patients with PMBC treated in 10 referral centers from January 2002 to May 2019. Clinical data included primary cancer characteristics (age, histology, and TNM) and data on metastatic disease (interval between primary BC and PM, molecular subtype, other metastases, and peritoneal spread). Overall survival (OS) was estimated using the Kaplan–Meier method. Univariate and multivariable data for OS were analyzed using the Cox proportional hazards model. Results Of the 49 women with PMBC, 20 were treated with curative aim (CRS with or without HIPEC) and 29 were treated with non-curative procedures. The 10-year OS rate was 27%. Patients treated with curative intent had a better OS than patients treated with non-curative procedures (89.2% vs. 6% at 36 months, p < 0.001). Risk factors significantly influencing survival were age at primary BC, interval between BC and PM diagnosis, extra-peritoneal metastases, and molecular subtype. Conclusions The improved outcome in selected cases after a multidisciplinary approach including surgery should lead researchers to regard PMBC patients with greater attention despite their scarce epidemiological impact. Our collective efforts give new information, suggest room for improvement, and point to further research for a hitherto poorly studied aspect of metastatic BC.
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Affiliation(s)
- Maurizio Cardi
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Marc Pocard
- University of Paris, Unité Mixte de Recherche (UMR) 1275 CArcinose et pathologies du Péritoine (CAP) Paris Tech Carcinomatosis Peritoneum Paris Technology, Digestive and Hepato-Biliary Surgery Department, Pitié Salpetrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rea Lo Dico
- University of Paris, Unité Mixte de Recherche (UMR) 1275 CArcinose et pathologies du Péritoine (CAP) Paris Tech Lariboisière Carcinomatosis Peritoneum Paris Technology, Digestive and Oncological Surgery Department, Saint Louis Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gianmaria Fiorentini
- Department of Oncology, Azienda Ospedaliera (AO) Ospedali Marche Nord, Pesaro, Italy
| | - Mario Valle
- Peritoneal Tumors Unit, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Roberta Gelmini
- Department of Surgery, General and Oncologic Surgery Unit, Azienda Ospedaliera Universitaria (AOU) Modena, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
| | - Marco Vaira
- Surgical Oncology Unit, Istituto Tumori di Candiolo, Turin, Italy
| | - Enrico Maria Pasqual
- Advanced Oncologic Surgery Unit, Dipartimento Area Medica (DAME) University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) Udine, Italy
| | - Salvatore Asero
- Department of Oncology, Surgical Oncology Unit, Azienda Ospedaliera di Rilievo e di Alta Specializzazione Garibaldi, Catania, Italy
| | - Gianluca Baiocchi
- Clinical and Experimental Sciences Department, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Cremona, Italy
| | - Andrea Di Giorgio
- Surgery of Peritoneum and Retroperitoneum Unit, Istituti Ricerca e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alessandra Spagnoli
- Public Health and Infectious Diseases Department, Statistics Unit, Sapienza University of Rome, San Donato, Italy
| | - Francesco Di Marzo
- General Surgery Department, Ospedale Valtiberina, Unità Sanitaria Locale (USL) Toscana Sud-Est, Sansepolcro, Italy
| | - Bianca Sollazzo
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - Franco Iafrate
- Department of Radiology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Paolo Sammartino
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
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10
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Robella M, Hubner M, Sgarbura O, Reymond M, Khomiakov V, di Giorgio A, Bhatt A, Bakrin N, Willaert W, Alyami M, Teixeira H, Kaprin A, Ferracci F, De Meeus G, Berchialla P, Vaira M, Villeneuve L, Cortés-Guiral D, Nowacki M, So J, Abba J, Afifi A, Mortensen MB, Brandl A, Ceelen W, Coget J, Courvoiser T, de Hingh IH, Delhorme JB, Dumont F, Escayola C, Eveno C, Ezanno AC, Gagnière J, Galindo J, Glatz T, Glehen O, Jäger T, Kepenekian V, Kothonidis K, Lehmann K, Lynch C, Mehta S, Moldovan B, Nissan A, Orry D, Pérez GO, Paquette B, Paskonis M, Piso P, Pocard M, Rau B, Singh S, Somashekhar S, Soravia C, Taibi A, Torkington J, Vizzielli G. Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study. Eur J Surg Oncol 2022; 48:2212-2217. [DOI: 10.1016/j.ejso.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/04/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
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11
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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Coccolini F, Lippolis PV, Gelmini R, Deraco M, Biacchi D, Santullo F, Vaira M, Di Lauro K, D'Acapito F, Carboni F, Giuffrè G, Donini A, Fugazzola P, Faviana P, Sorrentino L, Scapinello A, Del Bianco P, Sommariva A. Correction: Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Ann Surg Oncol 2022; 29:5265. [PMID: 35381942 DOI: 10.1245/s10434-022-11707-w] [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: 11/18/2022]
Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela Robella
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cinzia Sassaroli
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale" IRCCS, Naples, Italy
| | - Massimo Framarini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Mario Valle
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Antonio Macrì
- Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Messina, Italy
| | - Luigina Graziosi
- General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.,General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Piero Vincenzo Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Vaira
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Fabrizio D'Acapito
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Carboni
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Giuseppe Giuffrè
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Section of Pathology, University of Messina, Messina, Italy
| | - Annibale Donini
- General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Paola Fugazzola
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Pinuccia Faviana
- Pathological Anatomy III, Laboratory Medicine Department, Hospital University Pisa (AOUP), Pisa, Italy
| | - Lorena Sorrentino
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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12
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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Coccolini F, Lippolis PV, Gelmini R, Deraco M, Biacchi D, Santullo F, Vaira M, Di Lauro K, D'Acapito F, Carboni F, Giuffrè G, Donini A, Fugazzola P, Faviana P, Sorrentino L, Scapinello A, Del Bianco P, Sommariva A. ASO Visual Abstract: Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2022. [PMID: 35359171 DOI: 10.1245/s10434-021-11149-w] [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: 11/18/2022]
Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela Robella
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cinzia Sassaroli
- Colorectal Surgical Oncology, Abdominal Oncology Department, "Fondazione Giovanni Pascale" IRCCS - Naples, Naples, Italy
| | - Massimo Framarini
- General and Oncologic Surgery, Morgagni -Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Mario Valle
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Antonio Macrì
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Luigina Graziosi
- General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.,General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Piero Vincenzo Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Vaira
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Fabrizio D'Acapito
- General and Oncologic Surgery, Morgagni -Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Carboni
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Giuseppe Giuffrè
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Annibale Donini
- General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Paola Fugazzola
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Pinuccia Faviana
- Pathological Anatomy III, Laboratory Medicine Department, Hospital University Pisa (AOUP), Pisa, Italy
| | - Lorena Sorrentino
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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13
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Sammartino P, Vaira M. Preface of the Special Issue: "Peritoneal Surface Malignancies (PSM): The SICO (Italian Society of Surgical Oncology) PSM-Oncoteam Experience, Result Analysis, and Studies' Purpose". Cancers (Basel) 2021; 13:cancers13246387. [PMID: 34945006 PMCID: PMC8699735 DOI: 10.3390/cancers13246387] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Over the past 40 years, strategies to treat neoplastic spread into the peritoneal space have benefitted from a gradually evolving approach, thanks mainly to studies conducted by the charismatic leader in this medical field Professor Paul Sugarbaker, Washington DC [...].
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Affiliation(s)
- Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Pietro Valdoni Department of Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
| | - Marco Vaira
- Surgical Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy;
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14
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Tonello M, Baratti D, Sammartino P, Di Giorgio A, Robella M, Sassaroli C, Framarini M, Valle M, Macrì A, Graziosi L, Coccolini F, Lippolis PV, Roberta G, Deraco M, Biacchi D, Santullo F, Vaira M, Di Lauro K, D'Acapito F, Carboni F, Giuffrè G, Donini A, Fugazzola P, Faviana P, Lorena S, Scapinello A, Del Bianco P, Sommariva A. Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Ann Surg Oncol 2021; 29:3405-3417. [PMID: 34783946 DOI: 10.1245/s10434-021-11045-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) leads to prolonged survival for selected patients with colorectal (CRC) peritoneal metastases (PM). This study aimed to analyze the prognostic role of micro-satellite (MS) status and RAS/RAF mutations for patients treated with CRS. METHODS Data were collected from 13 Italian centers with PM expertise within a collaborative group of the Italian Society of Surgical Oncology. Clinical and pathologic variables and KRAS/NRAS/BRAF mutational and MS status were correlated with overall survival (OS) and disease-free survival (DFS). RESULTS The study enrolled 437 patients treated with CRS-HIPEC. The median OS was 42.3 months [95% confidence interval (CI), 33.4-51.2 months], and the median DFS was 13.6 months (95% CI, 12.3-14.9 months). The local (peritoneal) DFS was 20.5 months (95% CI, 16.4-24.6 months). In addition to the known clinical factors, KRAS mutations (p = 0.005), BRAF mutations (p = 0.01), and MS status (p = 0.04) were related to survival. The KRAS- and BRAF-mutated patients had a shorter survival than the wild-type (WT) patients (5-year OS, 29.4% and 26.8% vs 51.5%, respectively). The patients with micro-satellite instability (MSI) had a longer survival than the patients with micro-satellite stability (MSS) (5-year OS, 58.3% vs 36.7%). The MSI/WT patients had the best prognosis. The MSS/WT and MSI/mutated patients had similar survivals, whereas the MSS/mutated patients showed the worst prognosis (5-year OS, 70.6%, 48.1%, 23.4%; p = 0.0001). In the multivariable analysis, OS was related to the Peritoneal Cancer Index [hazard ratio (HR), 1.05 per point], completeness of cytoreduction (CC) score (HR, 2.8), N status (HR, 1.6), signet-ring (HR, 2.4), MSI/WT (HR, 0.5), and MSS/WT-MSI/mutation (HR, 0.4). Similar results were obtained for DFS. CONCLUSION For patients affected by CRC-PM who are eligible for CRS, clinical and pathologic criteria need to be integrated with molecular features (KRAS/BRAF mutation). Micro-satellite status should be strongly considered because MSI confers a survival advantage over MSS, even for mutated patients.
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Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela Robella
- Surgical Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Cinzia Sassaroli
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale" IRCCS, Naples, Italy
| | - Massimo Framarini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Mario Valle
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Antonio Macrì
- Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Messina, Italy
| | - Luigina Graziosi
- General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Federico Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.,General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Piero Vincenzo Lippolis
- General and Peritoneal Surgery, Department of Surgery, Hospital University Pisa (AOUP), Pisa, Italy
| | - Gelmini Roberta
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Vaira
- Surgical Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Fabrizio D'Acapito
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Carboni
- Peritoneal Malignancies Unit, INT "Regina Elena", Rome, Italy
| | - Giuseppe Giuffrè
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Section of Pathology, University of Messina, Messina, Italy
| | - Annibale Donini
- General and Emergency Surgery Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Paola Fugazzola
- General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Pinuccia Faviana
- Pathological Anatomy III, Laboratory Medicine Department, Hospital University Pisa (AOUP), Pisa, Italy
| | - Sorrentino Lorena
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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15
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Marano L, Marrelli D, Sammartino P, Biacchi D, Graziosi L, Marino E, Coccolini F, Fugazzola P, Valle M, Federici O, Baratti D, Deraco M, Di Giorgio A, Macrì A, Pasqual EM, Framarini M, Vaira M, Roviello F. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer with Synchronous Peritoneal Metastases: Multicenter Study of 'Italian Peritoneal Surface Malignancies Oncoteam-S.I.C.O.'. Ann Surg Oncol 2021; 28:9060-9070. [PMID: 34057569 PMCID: PMC8590997 DOI: 10.1245/s10434-021-10157-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 02/16/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
Background The development of multimodality treatment, including cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC), has led to promising results in selected patients with peritoneal disease of gastric origin. The aim of this study was to investigate the short- and long-term outcomes of CRS/HIPEC in the treatment of synchronous peritoneal metastasis in gastric cancer. Methods The Italian Peritoneal Surface Malignancies Oncoteam—S.I.C.O. retrospective registry included patients with synchronous peritoneal malignancy from gastric cancer submitted to gastrectomy with CRS and HIPEC between 2005 and 2018 from 11 high-volume, specialized centers. Results A total of 91 patients with a median age of 58 years (range 26–75) were enrolled. The median overall survival (OS) time for the whole group of patients was 20.2 months (95% confidence interval [CI] 11.8–28.5] and the median recurrence-free survival (RFS) was 7.3 months (95% CI 4–10.6). The completeness of cytoreduction score (CCS) of 0 and Peritoneal Cancer Index (PCI) score of ≤ 6 groups showed a significantly better long-term survival (median OS 40.7 and 44.3 months, respectively) compared with the incomplete resected groups (median OS 10.7 months, p = 0.003) and PCI score of > 6 group (median OS 13.4 months, p = 0.005). A significant difference was observed in the survival rate according to neoadjuvant treatment (untreated patients: 10.7 months, 95% CI 5.1–16.2; treated patients: 35.3 months, 95% CI 2.8–67.8; p = 0.022). Conclusions In referral centers, CRS and HIPEC after neoadjuvant treatment significantly improved survival in selected patients. Patients with a PCI score ≤ 6, complete cytoreduction, negative nodal involvements, and negative cytology had encouraging results, showing a clinically meaningful survival.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Luigina Graziosi
- General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - Elisabetta Marino
- General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.,General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Mario Valle
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Orietta Federici
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Peritoneal Surface Malignancies Unit, Milan, Italy
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Peritoneal Surface Malignancies Unit, Milan, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Macrì
- Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, Messina University Medical School Hospital, Messina, Italy
| | - Enrico Maria Pasqual
- Department of Medical Area, University of Udine, Santa Maria della Misericordia University Hospital Udine, Udine, Italy
| | | | - Marco Vaira
- Candiolo Cancer Institute, Unit of Surgical Oncology, FPO-IRCCS, Candiolo, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
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16
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Robella M, Berchialla P, Borsano A, Cinquegrana A, Ilari Civit A, De Simone M, Vaira M. Study Protocol: Phase I Dose Escalation Study of Oxaliplatin, Cisplatin and Doxorubicin Applied as PIPAC in Patients with Peritoneal Metastases. Int J Environ Res Public Health 2021; 18:ijerph18115656. [PMID: 34070561 PMCID: PMC8197803 DOI: 10.3390/ijerph18115656] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 01/06/2023]
Abstract
Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is a novel laparoscopic intraperitoneal chemotherapy approach offered in selected patients affected by non-resectable peritoneal carcinomatosis. Drugs doses currently established for nebulization are very low: oxaliplatin (OXA) 120 mg/sm, cisplatin (CDDP) 10.5 mg/sm and doxorubicin (DXR) 2.1 mg/sm. A model-based approach for dose-escalation design in a single PIPAC procedure and subsequent dose escalation steps is planned. The starting dose of oxaliplatin is 100 mg/sm with a maximum estimated dose of 300 mg/sm; an escalation with overdose and under-dose control (for probability of toxicity less than 16% in case of under-dosing and probability of toxicity greater than 33% in case of overdosing) will be further applied. Cisplatin is used in association with doxorubicin: A two-dimensional dose-finding design is applied on the basis of the estimated dose limiting toxicity (DLT) at all combinations. The starting doses are 15 mg/sm for cisplatin and 3 mg/sm for doxorubicin. Safety is assessed according to Common Terminology Criteria for Adverse Events (CTCAE version 4.03). Secondary endpoints include radiological response according to Response Evaluation Criteria in Solid Tumor (version 1.1) and pharmacokinetic analyses. This phase I study can provide the scientific basis to maximize the optimal dose of cisplatin, doxorubicin and oxaliplatin applied as PIPAC.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia—IRCCS, 10060 Candiolo, Italy; (A.B.); (A.C.); (A.I.C.); (M.D.S.); (M.V.)
- Correspondence:
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy;
| | - Alice Borsano
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia—IRCCS, 10060 Candiolo, Italy; (A.B.); (A.C.); (A.I.C.); (M.D.S.); (M.V.)
| | - Armando Cinquegrana
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia—IRCCS, 10060 Candiolo, Italy; (A.B.); (A.C.); (A.I.C.); (M.D.S.); (M.V.)
| | - Alba Ilari Civit
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia—IRCCS, 10060 Candiolo, Italy; (A.B.); (A.C.); (A.I.C.); (M.D.S.); (M.V.)
| | - Michele De Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia—IRCCS, 10060 Candiolo, Italy; (A.B.); (A.C.); (A.I.C.); (M.D.S.); (M.V.)
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia—IRCCS, 10060 Candiolo, Italy; (A.B.); (A.C.); (A.I.C.); (M.D.S.); (M.V.)
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17
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Sommariva A, Ansaloni L, Baiocchi GL, Cascinu S, Cirocchi R, Coccolini F, Deraco M, Fiorentini G, Gelmini R, Di Giorgio A, Lippolis PV, Pasqual EM, Sassaroli C, Macrì A, Sammartino P, Scaringi S, Valle M, Vaira M. Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology. Eur J Surg Oncol 2020; 47:164-171. [PMID: 33028502 DOI: 10.1016/j.ejso.2020.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/22/2020] [Revised: 09/04/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
AIM the surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. METHOD a panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Onco-team of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. RESULTS two different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. CONCLUSION a shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.
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Affiliation(s)
- Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Stefano Cascinu
- Department of Medical Oncology Vita-Salute, San Raffaele University IRCCS, Milan, Italy
| | - Roberto Cirocchi
- General Surgery and Clinical Anatomy, University of Perugia, Perugia, Italy
| | | | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Gianmaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro, Italy
| | - Roberta Gelmini
- General and Oncological Surgery Unit, AOU of Modena University of Modena and Reggio Emilia, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | | | - Enrico Maria Pasqual
- Advanced Surgical Oncology Unit, Department Area Medica, University of Udine, Italy
| | - Cinzia Sassaroli
- Abdominal Oncology Department, Fondazione Giovanni Pascale, IRCCS, Naples, Italy
| | - Antonio Macrì
- Department of Human Pathology, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Italy
| | - Paolo Sammartino
- Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy
| | - Stefano Scaringi
- Digestive Surgery Unit - IBD Unit, Careggi University Hospital, Florence, Italy
| | - Mario Valle
- Surgical Oncology Peritoneum and Abdomen Pathologies, National Cancer Institute "Regina Elena" Rome, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, Turin, Italy
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18
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D'Ambrosio C, Erriquez J, Arigoni M, Capellero S, Mittica G, Ghisoni E, Borella F, Katsaros D, Privitera S, Ribotta M, Maldi E, Nardo GD, Berrino E, Venesio T, Ponzone R, Vaira M, Hall D, Jimenez-Linan M, Paterson A, Valabrega G, Calogero R, Brenton J, Di Renzo M, Olivero M. Abstract 1677: Assays of conventional chemotherapeutics and targeted drugs for ovarian cancer using patient derived models. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Patients with advanced ovarian cancers have experienced little improvement in overall survival with standard treatments. We used patient derived models to accelerate the discovery of treatment options. We developed a platform of Patient Derived Xenografts (PDX), by implanting and propagating patient's tumor samples collected at surgery in severely immunocompromised mice. From each PDX line we derived short term cultures of PDX Derived Tumor Cells (PDTCs). We envisioned that the weakness of PDXs and PDTCs, i.e. lack of human stromal and immune cells, might be instrumental to link tumor biomarkers to treatments. We have successfully propagated 49 PDX lines from metastatic EOC, which were fully characterized as far as histology, immunohistochemistry of epithelial and tissue specific markers and presence of TP53 and BRCA1/2 mutations. On PDTCs cultures we first assessed sensitivity to Carboplatin, currently used as first-line drug in ovarian cancer treatment. Of PDX lines derived from naïve metastatic HGS-EOC copy number variations and whole exome sequencing analyses were carried out, in order to identify putative and actionable cancer genes. Thus, on PDTCs we assayed also approved or experimental targeted drugs as monotherapy or in combinations. In one PDX line we identified a possibly loss-of-function mutation (W624R) of the PIK3R1 gene (encoding the p85alpha regulatory subunit of PI3K) with an allele frequency of 0.9, which could result in activation of the PI3K pathway. Several PI3K inhibitors were assayed on PDTCs of this PDX line harboring the PIK3R1W624R. Buparlisib (a Pan Class I PI3Ki) showed the ability to block proliferation of the PDTCs and the growth of the relevant PDXs in vivo.
Altogether these data show that Patient Derived models are invaluable tools to unveil actionable pathways for the treatment of advanced/metastatic HGS-EOC.
Citation Format: Concetta D'Ambrosio, Jessica Erriquez, Maddalena Arigoni, Sonia Capellero, Gloria Mittica, Eleonora Ghisoni, Fulvio Borella, Dionyssios Katsaros, Silvana Privitera, Marisa Ribotta, Elena Maldi, Giovanna Di Nardo, Enrico Berrino, Tiziana Venesio, Riccardo Ponzone, Marco Vaira, Douglas Hall, Mercedes Jimenez-Linan, Anna Paterson, Giorgio Valabrega, Raffaele Calogero, James Brenton, Mariaflavia Di Renzo, Martina Olivero. Assays of conventional chemotherapeutics and targeted drugs for ovarian cancer using patient derived models [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1677.
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Affiliation(s)
| | | | | | | | | | | | - Fulvio Borella
- 4Citta della Salute e della Scienza di Torino, Torino, Italy
| | | | | | - Marisa Ribotta
- 4Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Elena Maldi
- 2Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy
| | | | | | | | | | - Marco Vaira
- 2Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy
| | - Douglas Hall
- 6University of Cambridge, Cambridge, CB2 0RE, United Kingdom
| | | | - Anna Paterson
- 7Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE UK, United Kingdom
| | | | | | - James Brenton
- 7Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE UK, United Kingdom
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19
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Baiocchi GL, Gheza F, Molfino S, Arru L, Vaira M, Giacopuzzi S. Indocyanine green fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review. BMC Surg 2020; 20:158. [PMID: 32680492 PMCID: PMC7367360 DOI: 10.1186/s12893-020-00821-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background To review the available clinical data about the value of Indocyanine Green (ICG) fluorescence imaging for intraoperative detection of peritoneal carcinomatosis. Methods We conducted a systematic review, according to the PRISMA guidelines, for clinical series investigating the possible role of ICG fluorescence imaging in detecting peritoneal carcinomatosis during surgical treatment of abdominal malignancies. With the aim to analyze actual application in the daily clinical practice, papers including trials with fluorophores other than ICG, in vitro and animals series were excluded. Data on patients and cancer features, timing, dose and modality of ICG administration, sensitivity, specificity and accuracy of fluorescence diagnosis of peritoneal nodules were extracted and analyzed. Results Out of 192 screened papers, we finally retrieved 7 series reporting ICG-guided detection of peritoneal carcinomatosis. Two papers reported the same cases, thus only 6 series were analyzed, for a total of 71 patients and 353 peritoneal nodules. The investigated tumors were colorectal carcinomas in 28 cases, hepatocellular carcinoma in 16 cases, ovarian cancer in 26 cases and endometrial cancer in 1 case. In all but 4 cases, the clinical setting was an elective intervention in patients known as having peritoneal carcinomatosis. No series reported a laparoscopic procedure. Technical data of ICG management were consistent across the studies. Overall, 353 lesions were harvested and singularly evaluated. Sensitivity varied from 72.4 to 100%, specificity from 54.2 to 100%. Two series reported that planned intervention changed in 25 and 29% of patients, respectively. Conclusion Indocyanine Green based fluorescence of peritoneal carcinomatosis is a promising intraoperative tool for detection and characterization of peritoneal nodules in patients with colorectal, hepatocellular, ovarian carcinomas. Further prospective studies are needed to fix its actual diagnostic value on these and other abdominal malignancies with frequent spread to peritoneum.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. .,Oncoteam Peritoneal Surface Malignancies, SICO (Italian Society of Surgical Oncology), Brescia, Italy.
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Arru
- Centre Hospitalier de Luxembourg, Service de Chirurgie Generale, Luxemborg City, Luxembourg
| | - Marco Vaira
- Oncoteam Peritoneal Surface Malignancies, SICO (Italian Society of Surgical Oncology), Brescia, Italy.,Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Str. Prov.le 142, km. 3,95, 10060, Candiolo, TO, Italy
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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20
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Gastón M, Vaira M. Male mating success is related to body condition and stress-induced leukocyte response in an anuran with scramble competition. CAN J ZOOL 2020. [DOI: 10.1139/cjz-2019-0193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Competition among males can be a decisive factor for successful mating in anuran explosive breeders with a male-biased population sex ratio. The Yungas Red-belly Toad (Melanophryniscus rubriventris (Vellard, 1947)) is an explosive breeder where males exhibit a classic scramble competition. We studied the body size, body condition, and stress-induced leukocyte response of M. rubriventris males under natural scenarios of scramble competition. We hand-captured adult males (categorised as single, in pairs, or in mating balls) and determined their body mass and length, body condition, and their leukocyte profile. We found that males in pairs had significantly higher body mass than single males and those in mating balls. We found the highest percentage of individuals with better body condition within the paired males who showed significantly higher body condition index value than singles or those in mating balls. Amplectant males (those collected in pairs or in mating balls) had a significantly lower proportion of lymphocytes and higher neutrophil–lymphocyte ratios than singles. Amplectant males showed significantly higher proportions of neutrophils or eosinophils than singles. Our results suggest that M. rubriventris males with better body condition can be more successful in acquiring mates, although scramble competition among males can trigger a stress response.
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Affiliation(s)
- M.S. Gastón
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Canónigo Gorriti 237, Y4600 San Salvador de Jujuy, Argentina
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Canónigo Gorriti 237, Y4600 San Salvador de Jujuy, Argentina
| | - M. Vaira
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Canónigo Gorriti 237, Y4600 San Salvador de Jujuy, Argentina
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Canónigo Gorriti 237, Y4600 San Salvador de Jujuy, Argentina
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21
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D’Ambrosio C, Erriquez J, Arigoni M, Capellero S, Mittica G, Ghisoni E, Borella F, Katsaros D, Privitera S, Ribotta M, Maldi E, Di Nardo G, Berrino E, Venesio T, Ponzone R, Vaira M, Hall D, Jimenez-Linan M, Paterson AL, Calogero RA, Brenton JD, Valabrega G, Di Renzo MF, Olivero M. PIK3R1W624R Is an Actionable Mutation in High Grade Serous Ovarian Carcinoma. Cells 2020; 9:E442. [PMID: 32075097 PMCID: PMC7072782 DOI: 10.3390/cells9020442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
Identifying cancer drivers and actionable mutations is critical for precision oncology. In epithelial ovarian cancer (EOC) the majority of mutations lack biological or clinical validation. We fully characterized 43 lines of Patient-Derived Xenografts (PDXs) and performed copy number analysis and whole exome sequencing of 12 lines derived from naïve, high grade EOCs. Pyrosequencing allowed quantifying mutations in the source tumours. Drug response was assayed on PDX Derived Tumour Cells (PDTCs) and in vivo on PDXs. We identified a PIK3R1W624R variant in PDXs from a high grade serous EOC. Allele frequencies of PIK3R1W624R in all the passaged PDXs and in samples of the source tumour suggested that it was truncal and thus possibly a driver mutation. After inconclusive results in silico analyses, PDTCs and PDXs allowed the showing actionability of PIK3R1W624R and addiction of PIK3R1W624R carrying cells to inhibitors of the PI3K/AKT/mTOR pathway. It is noteworthy that PIK3R1 encodes the p85α regulatory subunit of PI3K, that is very rarely mutated in EOC. The PIK3R1W624R mutation is located in the cSH2 domain of the p85α that has never been involved in oncogenesis. These data show that patient-derived models are irreplaceable in their role of unveiling unpredicted driver and actionable variants in advanced ovarian cancer.
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Affiliation(s)
- Concetta D’Ambrosio
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
- Department of Oncology, University of Torino, Candiolo, 10060 Torino, Italy
| | - Jessica Erriquez
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Maddalena Arigoni
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (M.A.); (R.A.C.)
| | - Sonia Capellero
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
- Department of Oncology, University of Torino, Candiolo, 10060 Torino, Italy
| | - Gloria Mittica
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Eleonora Ghisoni
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Fulvio Borella
- Città della Salute e della Scienza, 10126 Torino, Italy; (F.B.); (D.K.); (S.P.); (M.R.)
| | - Dionyssios Katsaros
- Città della Salute e della Scienza, 10126 Torino, Italy; (F.B.); (D.K.); (S.P.); (M.R.)
| | - Silvana Privitera
- Città della Salute e della Scienza, 10126 Torino, Italy; (F.B.); (D.K.); (S.P.); (M.R.)
| | - Marisa Ribotta
- Città della Salute e della Scienza, 10126 Torino, Italy; (F.B.); (D.K.); (S.P.); (M.R.)
| | - Elena Maldi
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Giovanna Di Nardo
- Department of Life Sciences and Systems Biology, University of Torino, 10125 Torino, Italy;
| | - Enrico Berrino
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Tiziana Venesio
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Riccardo Ponzone
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Marco Vaira
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
| | - Douglas Hall
- University of Cambridge, Cambridge CB2 0XZ, UK; (D.H.); (M.J.-L.); (A.L.P.); (J.D.B.)
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
| | | | - Anna L. Paterson
- University of Cambridge, Cambridge CB2 0XZ, UK; (D.H.); (M.J.-L.); (A.L.P.); (J.D.B.)
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
| | - Raffaele A. Calogero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (M.A.); (R.A.C.)
| | - James D. Brenton
- University of Cambridge, Cambridge CB2 0XZ, UK; (D.H.); (M.J.-L.); (A.L.P.); (J.D.B.)
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
| | - Giorgio Valabrega
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
- Department of Oncology, University of Torino, Candiolo, 10060 Torino, Italy
| | - Maria Flavia Di Renzo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
- Department of Oncology, University of Torino, Candiolo, 10060 Torino, Italy
| | - Martina Olivero
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Torino, Italy; (C.D.); (J.E.); (S.C.); (G.M.); (E.G.); (E.M.); (E.B.); (T.V.); (R.P.); (M.V.); (G.V.); (M.O.)
- Department of Oncology, University of Torino, Candiolo, 10060 Torino, Italy
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Macrì A, Arcoraci V, Belgrano V, Caldana M, Carbonari L, Cioppa T, De Cian F, De Manzoni G, De Simone M, Giardina C, Muffatti F, Orsenigo E, Robella M, Roviello F, Saladino E, Sammartino P, Vaira M. Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy used as treatment of colo-rectal carcinomatosis: a multicentric study. Updates Surg 2019; 72:163-170. [PMID: 31729630 DOI: 10.1007/s13304-019-00691-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/31/2019] [Indexed: 01/26/2023]
Abstract
The aim of this study is to assess the morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colo-rectal carcinomatosis. A retrospective multi-institutional study from seven Italian Centers was performed. One hundred and seventy-two patients, submitted to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) to treat carcinomatosis of colorectal origin, were recorded. Postoperative morbidity was evaluated in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Post-operative mortality was evaluated as patients' death within 60 days from surgical procedures. Predictors of morbidity were evaluated with univariate and multivariate analyses. Post-operative morbidity occurred in 83 patients (48.3%): grades 1-2 in 29 cases (16.9%), and grades 3-4 in 54 (31.4%). Mortality occurred in four cases (2.3%). Number of anastomoses (OR 1.45; 95% CI 1.05-2.00; p = 0.024), number of blood transfusions (OR 1.31; 95% CI 1.11-1.54; p = 0.001) and chemotherapy regimen [Oxaliplatin (OX): OR 2.87; 95% CI 1.22-6.75; p = 0.015] remained, in multivariate analysis, in a statistically significant correlation with overall morbidity. The only variable that was proven to have statistically significant correlation with 3-4 morbidity was the number of blood transfusions (OR 1.25; 95% CI 1.07-1.46; p = 0.005). Morbidity and mortality do not preclude the use of CRS plus HIPEC in the treatment of peritoneal carcinomatosis of colorectal origin.
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Affiliation(s)
- Antonio Macrì
- Department of Human Pathology, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Valerio Belgrano
- Department of Surgery, University of Genoa, Largo R. Benzi, 16132, Genoa, Italy
| | - Marina Caldana
- 1st Department of General Surgery, University of Verona, P.le A. Stefani, 37126, Verona, Italy
| | - Ludovica Carbonari
- Department of Surgery "Pietro Valdoni", Cytoreductive Surgery and Intraabdominal Chemotherapy Unit, University "Sapienza" of Rome, V.le del Policlinico, 00161, Rome, Italy
| | - Tommaso Cioppa
- Department of Medicine, Surgery and Neuroscience, University of Siena, Strada delle Scotte, 53100, Siena, Italy
| | - Franco De Cian
- Department of Surgery, University of Genoa, Largo R. Benzi, 16132, Genoa, Italy
| | - Giovanni De Manzoni
- 1st Department of General Surgery, University of Verona, P.le A. Stefani, 37126, Verona, Italy
| | - Michele De Simone
- Department of Surgical Oncology, Candiolo Cancer Insitute, SP 142, 10060, Candiolo, Torino, Italy
| | - Claudia Giardina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Francesca Muffatti
- Department of Surgery, San Raffaele Scientific Institute, Via Olgettina, 20132, Milan, Italy
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Via Olgettina, 20132, Milan, Italy
| | - Manuela Robella
- Department of Surgical Oncology, Candiolo Cancer Insitute, SP 142, 10060, Candiolo, Torino, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, University of Siena, Strada delle Scotte, 53100, Siena, Italy
| | | | - Paolo Sammartino
- Department of Surgery "Pietro Valdoni", Cytoreductive Surgery and Intraabdominal Chemotherapy Unit, University "Sapienza" of Rome, V.le del Policlinico, 00161, Rome, Italy
| | - Marco Vaira
- Department of Surgical Oncology, Candiolo Cancer Insitute, SP 142, 10060, Candiolo, Torino, Italy
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Biacchi D, Accarpio F, Ansaloni L, Macrì A, Ciardi A, Federici O, Spagnoli A, Cavaliere D, Vaira M, Sapienza P, Sammartino P. Upfront debulking surgery versus interval debulking surgery for advanced tubo-ovarian high-grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC. J Surg Oncol 2019; 120:1208-1219. [PMID: 31531879 DOI: 10.1002/jso.25703] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Whether patients with advanced tubo-ovarian high-grade serous cancer (HGSC) fare better after upfront debulking surgery (UDS) or neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) remains controversial. METHODS We studied patients with HGSC who underwent UDS or NACT-IDS between July 2000 and December 2015, with peritonectomy procedures combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Clinical reports were included peritoneal cancer index (PCI), NACT responses, surgical complexity score (SCS), completeness of cytoreduction (CC), complete follow-up with timing, site, and treatment of recurrence. Outcome measures were morbidity, progression-free survival (PFS), PFS2, and overall survival during a mean 5-year follow-up. RESULTS A total of 34 patients (23.6%) underwent UDS and 110 (76.4%) NACT-IDS both combined with HIPEC. At a median 66.3-month follow-up, patients who underwent UDS or NACT-IDS had similar outcomes. NACT subgroup responses correlated with PCI, SCS, morbidity, and CC. Patients who underwent UDS had lower recurrence rates than those who responded partly or poorly to NACT (PFS, P < .04; PFS2, P < .01). Despite HIPEC, the peritoneal disease recurred in 42.5% of the overall patients. CONCLUSION In patients with primary HGSC who undergo UDS or NACT-IDS, despite similar outcomes, peritonectomy procedures combined with HIPEC seem unable to prevent peritoneal recurrence.
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Affiliation(s)
- Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Fabio Accarpio
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Luca Ansaloni
- Department of Surgery, General and Emergency Surgery Unit Bufalini Hospital, Cesena, Italy
| | - Antonio Macrì
- Department of Surgery, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Italy
| | - Antonio Ciardi
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Orietta Federici
- Department of Surgery, Surgical Oncology National Cancer Institute Regina Elena, Rome, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infection Disease, Statistics Section, Sapienza University of Rome, Rome, Italy
| | - Davide Cavaliere
- Department of General Surgery and Advanced Oncologic Therapies Unit, AUSL della Romagna, Forlì, Italy
| | - Marco Vaira
- Department of Surgical Oncology, Candiolo Institute for Cancer Research and Treatment, Torino, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
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Robella M, Vaira M, Argenziano M, Spagnolo R, Cavalli R, Borsano A, Gentilli S, De Simone M. Exploring the Use of Pegylated Liposomal Doxorubicin (Caelyx ®) as Pressurized Intraperitoneal Aerosol Chemotherapy. Front Pharmacol 2019; 10:669. [PMID: 31293417 PMCID: PMC6603215 DOI: 10.3389/fphar.2019.00669] [Citation(s) in RCA: 15] [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: 02/26/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Peritoneal carcinomatosis is a common metastatic pattern in ovarian, gastric, colorectal, and appendiceal cancer; systemic chemotherapy is the current standard of care for peritoneal metastatic disease; however, in a subset of patients its beneficial effect remains questionable. More effective perioperative chemotherapy is needed. Materials and methods: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new treatment that applies chemotherapeutic drugs into the peritoneal cavity as an aerosol under pressure. It’s a safe and feasible approach that improves local bioavailability of chemotherapeutic drugs as compared with conventional intraperitoneal chemotherapy. Till now the drugs used in PIPAC for the treatment of the peritoneal carcinomatosis (PC) are cisplatin, doxorubicin, and oxaliplatin; as of yet, there are no in vivo data comparing different drug formulations and dosage schedules of PIPAC. Pegylated liposomal doxorubicin 1.5 mg/sm was aerosolized in PIPAC procedures. Results: Pharmacokinetics analysis of 10 procedures performed with conventional doxorubicin solution at the dose of 1.5 mg/m2 were compared to 15 procedures with the same dose of pegylated liposomal doxorubicin (PLD). Significant differences between experimental groups were detected by one-way ANOVA followed by Bonferroni correction; a p value < 0.05 was considered statistically significant. A statistically different doxorubicin tissue concentration was observed for the doxorubicin solution compared to pegylated liposomal doxorubicin in the right parietal peritoneum and right diaphragm. In the Caelyx® series a mean tissue concentration of 1.27 ± 1.33 mg/g was reported, while in the second one we registered a mean concentration of 3.1 ± 3.7 mg/g. Conclusions: The delivery of nano-particles in PIPAC was feasible, but pegylated liposomal concentrations are lower than standard doxorubicin formulation. Probably mechanical and physical properties of pressurized aerosol chemotherapy might alter their stability and cause structural disintegration.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Italy
| | - Monica Argenziano
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Rita Spagnolo
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Roberta Cavalli
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Alice Borsano
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Sergio Gentilli
- General Surgery Unit, Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Michele De Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Italy
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Fenocchio E, Colombi F, Calella MG, Filippi R, Depetris I, Chilà G, Lombardi P, Marino D, Cagnazzo C, Ferraris R, Vaira M, Aglietta M, Leone F. Improvement of Metastatic Colorectal Cancer Patient Survival: Single Institution Experience. Cancers (Basel) 2019; 11:cancers11030369. [PMID: 30884763 PMCID: PMC6468423 DOI: 10.3390/cancers11030369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 12/22/2022] Open
Abstract
The survival rates of patients with metastatic colorectal cancer (mCRC) have improved in recent years. We analysed the survival of mCRC patients followed at a single institution over the last 17 years. We retrospectively collected data from 899 mCRC patients treated from 2001 to 2016. Patients were divided into two groups based on the year of diagnosis: Cohort A (2001⁻2006) and Cohort B (2007⁻2014). A total of 788 patients were analysed. The median survival of the whole population was 32.0 months with a significant difference between Cohort A and B (29.2 vs. 33.5 months; p = 0.041). Surgical procedures significantly increased in Cohort B, however, no significant changes in survival were observed in patients undergoing surgery (58.9 months Cohort A vs. 58.2 months Cohort B, p = 0.822). Similarly, we did not demonstrate survival improvement in patients treated with systemic therapy alone (18.9 months Cohort A vs. 20.7 months Cohort B; p = 0.948). At the multivariate analysis, right-sided primary and synchronous metastatic tumour were found to be independent unfavorable prognostic factors. Improvements of mCRC patient survival might relate to integrated approach, with more patients undergoing extra-hepatic surgery. The medical approach seems to have had a more favourable impact on subgroups characterized by a worse prognosis.
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Affiliation(s)
- Elisabetta Fenocchio
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Federica Colombi
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Maria Grazia Calella
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
| | - Roberto Filippi
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Ilaria Depetris
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Giovanna Chilà
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Pasquale Lombardi
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Donatella Marino
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Celeste Cagnazzo
- Unità di Ricerca e Sviluppo Clinico S.C. Oncoematologia Pediatrica-AOU Città della Salute e della Scienza, Presidio Ospedaliero Infantile Regina Margherita, 10126 Turin, Italy.
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche-Università degli Studi di Torino, 10126 Turin, Italy.
| | - Renato Ferraris
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Marco Vaira
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95-10060 Candiolo (TO), Italy.
| | - Massimo Aglietta
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
| | - Francesco Leone
- Department of Oncology, University of Turin Medical School, Corso Dogliotti, 38, Turin 10126, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS-Str. Prov.le 142, km, 3.95- 10060 Candiolo (TO), Italy.
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Robella M, Vaira M, Borsano A, De Simone M. Exploring the use of pegylated liposomal doxorubicin (Caelyx®) as pressurized intraperitoneal aerosol chemotherapy (PIPAC). Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.015] [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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Van De Sande L, Graversen M, Hubner M, Pocard M, Reymond M, Vaira M, Cosyns S, Willaert W, Ceelen W. Intraperitoneal aerosolization of albumin-stabilized paclitaxel nanoparticles (Abraxane™) for peritoneal carcinomatosis - a phase I first-in-human study. Pleura Peritoneum 2018; 3:20180112. [PMID: 30911657 PMCID: PMC6405003 DOI: 10.1515/pp-2018-0112] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/19/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nanoparticles hold considerable promise for aerosol-based intraperitoneal delivery in patients with carcinomatosis. Recently, results from preclinical and early clinical trials suggested that albumin-bound paclitaxel (ABP, Abraxane™) may result in superior efficacy in the treatment of peritoneal metastases (PM) compared to the standard solvent-based paclitaxel formulation (Taxol™). Here, we propose a phase I study of pressurized intraperitoneal aerosol chemotherapy (PIPAC) using ABP in patients with upper Gastrointestinal, breast, or ovarian cancer. METHODS Eligible patients with advanced, biopsy-proven PM from ovarian, breast, gastric, hepatobiliary, or pancreatic origin will undergo three PIPAC treatments using ABP with a 4-week interval. The dose of ABP will be escalated from 35 to 140 mg/m² using a Bayesian approach until the maximally tolerated dose is determined. The primary end point is dose-limiting toxicity. Secondary analyses include surgical morbidity, non-access rate, pharmacokinetic and pharmacodynamic analyses, quality of life, and exploratory circulating biomarker analyses. DISCUSSION ABP holds considerable promise for intraperitoneal aerosol delivery. The aim of this study is to determine the dose level for future randomized phase II trials using ABP in PIPAC therapy. TRIAL REGISTRATION This trial is registered as EudraCT: 2017-001688-20 and Clinicaltrials.gov: NCT03304210.
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Affiliation(s)
| | - Martin Graversen
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Martin Hubner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc Pocard
- Digestive and Cancer Surgical Unit, Lariboisière Hospital, Paris, France
| | - Marc Reymond
- Department of Surgery and Transplantation, University Hospital, Tuebingen, Germany
| | | | - Sarah Cosyns
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wouter Willaert
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
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28
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Fenocchio E, Colombi F, Calella M, Filippi R, Depetris I, Lombardi P, Marino D, Cagnazzo C, Ferraris R, Vaira M, Aglietta M, Leone F. Improvement of metastatic colorectal cancer patient survival: Single institution experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Ghisoni E, Katsaros D, Maggiorotto F, Aglietta M, Vaira M, De Simone M, Mittica G, Giannone G, Robella M, Genta S, Lucchino F, Marocco F, Borella F, Valabrega G, Ponzone R. A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience. J Ovarian Res 2018; 11:42. [PMID: 29843747 PMCID: PMC5975698 DOI: 10.1186/s13048-018-0415-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 02/05/2023] Open
Abstract
Background Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn’t exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. Methods We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. Results At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8%), limiting the number of incomplete surgeries to 16,5%. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Conclusions Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.
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Affiliation(s)
- Eleonora Ghisoni
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Furio Maggiorotto
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Massimo Aglietta
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Marco Vaira
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Michele De Simone
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Gloria Mittica
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Gaia Giannone
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Manuela Robella
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Sofia Genta
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Fabiola Lucchino
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Marocco
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Fulvio Borella
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy. .,Department of Oncology, University of Torino, Turin, Italy.
| | - Riccardo Ponzone
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
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Fenocchio E, Colombi F, Calella MG, Filippi R, Depetris I, Chilà G, Lombardi P, Marino D, Cagnazzo C, Ferraris R, Vaira M, Aglietta M, Leone F. Improvement of metastatic colorectal cancer patient survival: Single institution experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15633] [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: 11/20/2022] Open
Affiliation(s)
- Elisabetta Fenocchio
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Candiolo, Italy
| | - Federica Colombi
- Division of Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Italy, Candiolo, Italy
| | | | - Roberto Filippi
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Candiolo, Italy
| | - Ilaria Depetris
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Candiolo, Italy
| | - Giovanna Chilà
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Candiolo, Italy
| | - Pasquale Lombardi
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Torino, Italy
| | - Donatella Marino
- Division of Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Italy, Candiolo, Italy
| | - Celeste Cagnazzo
- Clinical Research Office, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy, Candiolo, Italy
| | - Renato Ferraris
- Division of Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Italy, Candiolo, Italy
| | - Marco Vaira
- Department of Surgery, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy, Candiolo, Italy
| | - Massimo Aglietta
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Candiolo, Italy
| | - Francesco Leone
- Division of Medical Oncology, Candiolo Cancer Institute, University of Turin, FPO, IRCCS, Italy, Candiolo, Italy
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Vaira M, Robella M, Isella C, Borsano A, Mignone A, Medico E, De Simone M. Transcriptional signature of Pseudomyxoma Peritonei: An enhancement of treatment strategy and outcome prediction. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Robella M, Vaira M, Cinquegrana A, De Simone M. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: morbidity and postoperative outcomes. MINERVA CHIR 2018; 74:195-202. [PMID: 29589675 DOI: 10.23736/s0026-4733.18.07649-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) represents a treatment option for peritoneal surface malignancies. Even if it has been reported that this new approach improved survival of selected patients, it is still associated with high morbidity and mortality rates. METHODS From October 1995 to December 2017, over 450 patients affected by peritoneal carcinomatosis (PC) underwent in our Institute CRS associated with HIPEC. For this preliminary analysis we considered 300 patients presenting PC of different origin: pseudomyxoma peritonei (PMP, N.=98), epithelial ovarian cancer (EOC, N.=87), peritoneal mesothelioma (DMPM, N.=49) and colorectal cancer (CRC, N.=66). Postoperative morbidity and mortality were studied in order to identify possible risk factors. RESULTS The morbidity rate was 36.3% in all procedures (109/300). According to the Clavien-Dindo Classification, 67 cases (22.3%) were associated with grade I-II complications and 35 cases (11.7%) with grade III-IV. Surgical and medical complication rates were 8.3% (25/300) and 11.3% (34/300), respectively. The mortality rate was 2.3%. Reoperation was needed in 28 patients (9.3%). The operative time, the number of anastomosis, of peritonectomy procedures, of visceral resections performed and the PCI value resulted the most statistically significant factors influencing postoperative morbidity and mortality. CONCLUSIONS The risks of perioperative morbidity and mortality after CRS and HIPEC are analogous to any other major gastrointestinal surgery. CRS and HIPEC should remain a treatment option for highly-selected patients in whom a curative or life prolonging treatment is a pursuit and should be performed in high volume specialized institutions.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Institute for Cancer Research and Care, Candiolo, Turin, Italy -
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Institute for Cancer Research and Care, Candiolo, Turin, Italy
| | - Armando Cinquegrana
- Unit of Surgical Oncology, Candiolo Institute for Cancer Research and Care, Candiolo, Turin, Italy
| | - Michele De Simone
- Unit of Surgical Oncology, Candiolo Institute for Cancer Research and Care, Candiolo, Turin, Italy
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Erriquez J, Olivero M, Mittica G, Scalzo MS, Vaira M, De Simone M, Ponzone R, Katsaros D, Aglietta M, Calogero R, Di Renzo MF, Valabrega G. Xenopatients show the need for precision medicine approach to chemotherapy in ovarian cancer. Oncotarget 2018; 7:26181-91. [PMID: 27027433 PMCID: PMC5041973 DOI: 10.18632/oncotarget.8325] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/14/2016] [Indexed: 01/17/2023] Open
Abstract
Platinum-based chemotherapy is the recommended first-line treatment for high-grade serous (HGS) epithelial ovarian cancer (EOC). However, most patients relapse because of platinum refractory/resistant disease. We aimed at assessing whether other drugs, commonly used to treat relapsed HGS-EOC and poorly active in this clinical setting, might be more effective against chemotherapy-naïve cancers. We collected couples of HGS-EOC samples from the same patients before and after neo-adjuvant platinum-based chemotherapy. Samples were propagated as Patient Derived Xenografts (PDXs) in immunocompromised mice ("xenopatients"). Xenopatients were treated in parallel with carboplatin, gemcitabine, pegylated liposomal doxorubicin (PLD) and trabectedin. PDXs derived from a naïve HSG-EOC showed responsiveness to carboplatin, trabectedin and gemcitabine. The PDXs propagated from a tumor mass of the same patient, grown after carboplatin therapy, did no longer respond to trabectedin and gemcitabine and showed heterogeneous response to carboplatin. In line, the patient experienced clinically platinum-sensitivity first and then discordant responses of different tumor sites to platinum re-challenge. Loss of PDX responsiveness to drugs was associated with 4-fold increase of NR2F2 gene expression. PDXs from another naïve tumor showed complete response to PLD, which was lost in the PDXs derived from a mass grown in the same patient after platinum-based chemotherapy. This patient showed platinum refractoriness and responded poorly to PLD as second-line treatment. PDX response to PLD was associated with high expression of TOP2A protein. PDXs demonstrated that chemotherapy-naïve HGS-EOC might display susceptibility to agents not used commonly as first line treatment. Data suggest the importance of personalizing also chemotherapy.
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Affiliation(s)
| | - Martina Olivero
- Department of Oncology, University of Torino, Candiolo, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS Candiolo, Torino, Italy
| | - Gloria Mittica
- Department of Oncology, University of Torino, Candiolo, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS Candiolo, Torino, Italy
| | | | - Marco Vaira
- Candiolo Cancer Institute, FPO-IRCCS Candiolo, Torino, Italy
| | | | | | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecologic Oncology, AO-Universitaria Città della Salute, Torino, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Torino, Candiolo, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS Candiolo, Torino, Italy
| | - Raffaele Calogero
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Maria Flavia Di Renzo
- Department of Oncology, University of Torino, Candiolo, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS Candiolo, Torino, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Candiolo, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS Candiolo, Torino, Italy
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Pereyra LC, Akmentins MS, Vaira M, Moreno CE. Disentangling the multiple components of anuran diversity associated to different land-uses in Yungas forests, Argentina. Anim Conserv 2018. [DOI: 10.1111/acv.12406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. C. Pereyra
- Instituto de Ecorregiones Andinas (INECOA); CONICET - Universidad Nacional de Jujuy; San Salvador de Jujuy Argentina
| | - M. S. Akmentins
- Instituto de Ecorregiones Andinas (INECOA); CONICET - Universidad Nacional de Jujuy; San Salvador de Jujuy Argentina
| | - M. Vaira
- Instituto de Ecorregiones Andinas (INECOA); CONICET - Universidad Nacional de Jujuy; San Salvador de Jujuy Argentina
| | - C. E. Moreno
- Centro de Investigaciones Biológicas; Universidad Autónoma del Estado de Hidalgo; Pachuca México
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35
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Robella M, Vaira M, Borsano A, Mossetti C, DE Simone M. Low-dose Pressurized Intrathoracic Aerosol Chemotherapy (PITAC) as an Alternative Therapy for Pleuropulmonary Involvement in Pseudomyxoma Peritonei. Anticancer Res 2018; 38:929-932. [PMID: 29374723 DOI: 10.21873/anticanres.12305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pseudomyxoma peritonei (PMP) is a rare disease characterized by mucinous ascites and widespread peritoneal implants. It usually originates from the rupture of an adenoma/adenocarcinoma of the appendix. Although this tumor is only superficially invasive and does not metastasize, it could be a fatal disease. Extra-abdominal spread of PMP is an unusual occurrence with few reports in medical literature. CASE REPORT A 50-year-old man was diagnosed with PMP according to the findings of thorax and abdomen CT scan and cytologic and histological examinations. The radiological exam showed irregular thickening on the surface of left diaphragmatic and parietal pleura. RESULTS First, cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy (HIPEC) for the abdominal disease was performed. Histopathological examination confirmed the diagnosis of low grade PMP. The radiological evaluation performed 5 months later showed a dimensional increase in pleural nodules. The treatment consisted of an extensive intrathoracic cytoreductive surgery in combination with pressurized intra-thoracic aerosol chemotherapy (PITAC). Postoperative course was uneventful. CONCLUSION PMP with pleural extension is a rare phenomenon and carries an unfavourable prognosis. Due to the rarity of this presentation, its correct treatment is still unclear. We present a therapeutic approach to be applied in selected patients.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS - FPO, Candiolo, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS - FPO, Candiolo, Italy
| | - Alice Borsano
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS - FPO, Candiolo, Italy
| | - Claudio Mossetti
- Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Turin, Italy
| | - Michele DE Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS - FPO, Candiolo, Italy
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36
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Robella M, Vaira M, Borsano A, DE Simone M. Analysis of patient selection policy and pattern of recurrence after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal carcinomatosis. MINERVA CHIR 2018; 73:133-141. [PMID: 29397633 DOI: 10.23736/s0026-4733.18.07547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Actual cure rate and patterns of recurrence after cytoreductive surgery (CRS) associated to hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with colorectal peritoneal carcinomatosis (PC) are not yet well explored. Moreover, the selection policy to this resource-consuming treatment is still a matter of debate. METHODS From a dataset of 400 CRS+HIPEC performed between October 1996 and December 2015, we selected 54 consecutive patients with colorectal PC. Exclusion criteria were age>70, PS>2, or disease progression during chemotherapy. From 2004, we also excluded patients with both PCI>16 and poor prognostic factors of primary tumor (i.e. T4, N2 and G3) and only proceeded to HIPEC in case of optimal cytoreduction. Prognostic factors, cure rate and patterns of recurrence were investigated, comparing the two time periods. RESULTS After 2004, median overall survival was 52 months, with a 40% 5-year survival. Completeness of cytoreduction, primary tumor histology and time period were independent prognostic factors. Median recurrence-free survival was 16 months. A relapse was detected in 41 out of 46 patients with optimal cytoreduction. Main sites of first relapse were peritoneum (73%), and distant metastases (37%), mainly to liver and lungs. Peritoneal and liver/lung metastases presented as isolated recurrence in 73% and 58% of cases, respectively. CONCLUSIONS By a selection policy based on patient, disease extension and primary tumor factors, a median survival higher than 50 months can be expected. Most patients will eventually recur, mainly in the peritoneum. The pattern of recurrence suggests a potential role for more effective intraperitoneal therapies and repeat surgical treatments.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Turin, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Turin, Italy -
| | - Alice Borsano
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Turin, Italy
| | - Michele DE Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Turin, Italy
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Vaira M, Robella M, Borsano A, De Simone M. Single-port access for Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC): technique, feasibility and safety. Pleura Peritoneum 2016; 1:217-222. [PMID: 30911626 PMCID: PMC6386499 DOI: 10.1515/pp-2016-0021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/28/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a drug delivery system for treatment of peritoneal metastasis (PM). A limitation of this technique is the non-access rate (10-15 %) due to peritoneal adhesions. The aim of the study was to assess feasibility and safety of the single-port access technique for PIPAC. METHODS Single-center, pilot study. Case series, retrospective analysis on 17 patients with PM of various origin treated with intraperitoneal cisplatin, doxorubicin and/or oxaliplatin administered as PIPAC. Single-port access was attempted in all patients by minilaparotomy. RESULTS Twenty-nine PIPAC procedures were performed. Nine patients were subjected to 1 PIPAC, four patients to 2 PIPAC and four patients to 3 PIPAC. Access to peritoneal cavity was possible in all cases. There was no bowel access lesion. Tightness of the abdomen (CO2-flow = 0) was achieved in all cases. No postoperative complications according to CTCAE (Common Terminology Criteria for Adverse Events)>2 were observed, no re-laparotomies required and no postoperative mortality recorded. CONCLUSIONS Single port-access is feasible and safe for PIPAC. Potential advantages over multiple trocars technique are a lower non-access rate, a lower risk of bowel lesions and a better tightness of the abdomen. This has now to be confirmed in a comparative study.
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Affiliation(s)
- Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
| | - Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
| | - Alice Borsano
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
| | - Michele De Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
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Di Giorgio A, De Iaco P, De Simone M, Garofalo A, Scambia G, Pinna AD, Verdecchia GM, Ansaloni L, Macrì A, Cappellini P, Ceriani V, Giorda G, Biacchi D, Vaira M, Valle M, Sammartino P. Cytoreduction (Peritonectomy Procedures) Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Advanced Ovarian Cancer: Retrospective Italian Multicenter Observational Study of 511 Cases. Ann Surg Oncol 2016; 24:914-922. [PMID: 27896512 PMCID: PMC5339330 DOI: 10.1245/s10434-016-5686-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Indexed: 12/15/2022]
Abstract
Purpose The aim of this study was to help with the process of selecting patients with advanced ovarian cancer to undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) by analyzing outcome data at distinct clinical time points reflecting the natural history of the disease. Methods In a retrospective Italian multicenter study investigating patients with advanced ovarian cancer who underwent CRS plus HIPEC between 1998 and 2014, we analyzed data for consecutive patients at eight treatment time points: primary debulking surgery (PDS); interval debulking surgery after partial response, after no response, and after a pathologic complete response to neoadjuvant chemotherapy; first recurrence with a progression-free interval >12, <12 months, or >12 months in patients who underwent further chemotherapy before CRS and HIPEC; and patients who underwent two or more CRS procedures and chemotherapy lines before CRS and HIPEC. Results The 511 enrolled patients underwent 3373 procedures; 72.6% achieved complete cytoreduction, with an overall major morbidity of 17.4%. At a median follow-up of 53.8 months, overall survival (OS) was 54.2 months (95% confidence interval [CI] 44–58.4) and progression-free (PFS) survival was 16.6 months (95% CI 14.7–19.1). Outcome analysis in patients in whom CRS plus HIPEC was used for primary advanced cancer or recurrent ovarian cancer showed significant differences in OS and PFS according to the time points analyzed. Multivariate analysis identified completeness of CRS, Peritoneal Cancer Index, and the times when patients underwent CRS plus HIPEC as independent prognostic factors. Conclusions This selective information on survival should help in interpreting the findings from ongoing randomized studies focusing on CRS plus HIPEC in patients with advanced ovarian cancer.
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Affiliation(s)
- Angelo Di Giorgio
- Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy
| | - Pierandrea De Iaco
- General Surgery and Gynecologic Oncology Unit, Sant'Orsola Hospital, Bologna, Italy
| | | | - Alfredo Garofalo
- Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Luca Ansaloni
- General Surgery Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Antonio Macrì
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Paolo Cappellini
- General Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Valerio Ceriani
- General Surgery UnitPoliclinico Polispecialistico Multimedica, Sesto San Giovanni, Italy
| | - Giorgio Giorda
- Department of Gynecological Oncology, CRO National Cancer Institute, Aviano, Italy
| | - Daniele Biacchi
- Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute, Turin, Italy
| | - Mario Valle
- Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Sammartino
- Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy.
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Vaira M, Robella M, Cinquegrana A, De Simone M. Treatment of peritoneal carcinomatosis from ovarian cancer by surgical cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.046] [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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Vaira M, Robella M, Cinquegrana A, De Simone M. Treatment of peritoneal carcinomatosis from colonic cancer by cytoreduction, peritonectomy and hipec: Results in highly selected patients. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Robella M, Vaira M, De Simone M. 323. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Risk factors for morbidity and postoperative outcome. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Robella M, Vaira M, De Simone M. 358. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) associated with systemic chemotherapy: An innovative approach for peritoneal carcinomatosis. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vaira M, Robella M, Picco G, Bellomo S, Medico E, De Simone M. 47. Histological, biochemical and transcriptional classification of pseudomyxoma peritonei can solve the uncertainty of predicting outcome? Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.053] [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: 11/30/2022] Open
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Erriquez J, Olivero M, Mittica G, Scalzo MS, Vaira M, De Simone M, Ponzone R, Katsaros D, Aglietta M, Calogero R, Di Renzo MF, Valabrega G. Abstract LB-042: Xenopatients help in redefining medical therapeutic algorithms in high risk ovarian cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Platinum-based chemotherapy is the recommended first-line treatment for high-grade serous (HGS) epithelial ovarian cancer (EOC). However, most patients relapse because of platinum refractory/resistant disease. We aimed at assessing whether other drugs, commonly used to treat relapsed HGS-EOC and poorly active in this clinical setting, might be more effective against chemotherapy-naïve cancers. We collected samples of advanced HGS-EOC from the same patients before and after neo-adjuvant platinum-based chemotherapy. Samples were propagated as Patient Derived Xenografts (PDXs) in immunocompromised mice (“xenopatients”). Xenopatients were treated with carboplatin, gemcitabine, pegylated liposomal doxorubicin (PLD) and trabectedin. One patient was studied who experienced clinically platinum-sensitivity first and then discordant responses of different tumor sites to platinum re-challenge. PDXs derived from this patient before chemotherapy showed responsiveness to carboplatin, trabectedin and gemcitabine. The PDXs from the same patient after chemotherapy did no longer respond to trabectedin and gemcitabine and showed a heterogeneous response to carboplatin. Expression profiling showed that loss of responsiveness to drugs of the post-chemotherapy PDXs was associated with the up-regulation of NR2F2 gene expression. A second patient with platinum refractory HGS-EOC responded poorly to PLD as second-line treatment. PDXs obtained from this patient's tumor before chemotherapy showed a complete response to PLD, which was lost in the post-chemotherapy PDXs. Response to PLD was associated with the over-expression of the TOP2A protein, which was lost in the post-chemotherapy PDXs. Thus, PDXs demonstrated that chemotherapy-naïve HGS-EOC might display susceptibility to agents not used commonly as first line treatment. These data suggest the importance of tailoring chemotherapy.
Citation Format: Jessica Erriquez, Martina Olivero, Gloria Mittica, Maria Stella Scalzo, Marco Vaira, Michele De Simone, Riccardo Ponzone, Dionyssios Katsaros, Massimo Aglietta, Raffaele Calogero, Maria Flavia Di Renzo, Giorgio Valabrega. Xenopatients help in redefining medical therapeutic algorithms in high risk ovarian cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-042.
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Affiliation(s)
| | - Martina Olivero
- 2University of Torino at the Candiolo Cancer Institute, Candiolo, Italy
| | - Gloria Mittica
- 2University of Torino at the Candiolo Cancer Institute, Candiolo, Italy
| | | | - Marco Vaira
- 1Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | | | | | | | - Massimo Aglietta
- 2University of Torino at the Candiolo Cancer Institute, Candiolo, Italy
| | | | | | - Giorgio Valabrega
- 2University of Torino at the Candiolo Cancer Institute, Candiolo, Italy
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Pereyra L, Akmentins M, Sanabria E, Vaira M. Diurnal? Calling activity patterns reveal nocturnal habits in the aposematic toad Melanophryniscus rubriventris. CAN J ZOOL 2016. [DOI: 10.1139/cjz-2015-0197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In diurnal species with short breeding seasons, an extension of diel activity to the night hours could be favoured to maximize mating opportunities, but individuals must deal with physiological and behavioural constraints. We tested this hypothesis in the Yungas Red-belly Toad (Melanophryniscus rubriventris (Vellard, 1947)). We registered the diel pattern of male calling activity in two localities using automated recording systems, and related it to abiotic factors such as temperature, relative air humidity, and precipitation. The diel pattern of vocalization was mainly diurnal. Interestingly though, nocturnal calling activity was a common feature, representing between 40% and 43% of call records in both localities. Vocal activity was significantly influenced by time of the day and presence of rainfall. Calling males showed high plasticity, with activity in the entire environmental range of relative air humidity and temperature. Nocturnal calling seems to play an important role in the mating strategy of males, and it is probably more frequent in the genus Melanophryniscus than currently assumed. We discuss the implications of our findings in relation to different aspects of ecology of the species and suggest that bright colouration in M. rubriventris might result from a compromise between several nonconflicting functions (e.g., aposematism and thermoregulation).
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Affiliation(s)
- L.C. Pereyra
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy–CONICET, Avenida Bolivia 1711 (4600), Jujuy, Argentina
| | - M.S. Akmentins
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy–CONICET, Avenida Bolivia 1711 (4600), Jujuy, Argentina
| | - E.A. Sanabria
- Instituto de Ciencias Básicas, Facultad de Filosofía Humanidades y Artes, Universidad Nacional de San Juan, Avenida José Ignacio de la Roza 230 (5400), San Juan, Argentina
| | - M. Vaira
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy–CONICET, Avenida Bolivia 1711 (4600), Jujuy, Argentina
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Robella M, Vaira M, De Simone M. Safety and feasibility of pressurized intraperitoneal aerosol chemotherapy (PIPAC) associated with systemic chemotherapy: an innovative approach to treat peritoneal carcinomatosis. World J Surg Oncol 2016; 14:128. [PMID: 27125996 PMCID: PMC4850728 DOI: 10.1186/s12957-016-0892-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [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: 01/05/2016] [Accepted: 04/21/2016] [Indexed: 12/29/2022] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new treatment that applies chemotherapeutic drugs into the peritoneal cavity as an aerosol under pressure. It improves local bioavailability of chemotherapeutic drugs as compared with conventional intraperitoneal chemotherapy. It has been proved to be safe and feasible if performed as an exclusive treatment in patients affected by peritoneal carcinomatosis. The first results in patients treated with PIPAC associated with systemic chemotherapy are presented. Methods Between June 2015 and February 2016, 57 PIPAC applications with oxaliplatin or cisplatin + doxorubicin every 6 weeks at 37 °C and 12 mmHg for 30 min were performed. Forty PIPAC procedures performed in 14 patients were included in this study; thirteen patients were undergoing systemic chemotherapy with a wash-out interval of at least 2 weeks before and 1 week after each PIPAC. Safety, tolerability, and postoperative complications were assessed by collection of adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE) 2. Results Forty PIPAC administrations were performed in 14 patients with no major perioperative complications. CTCAE grades 1 and 2 were observed after six and eight procedures, respectively, for abdominal pain and nausea. Renal and hepatic functions were not impaired; no cumulative renal toxicity was observed after repeated PIPAC procedures in association with systemic chemotherapy. Conclusions These preliminary data show that the association of PIPAC and systemic chemotherapy does not induce significant hepatic and renal toxicity. It allows inclusion of patients with extraperitoneal disease or at a high risk of developing it. Further studies are needed to assess whether this combination therapy could become part of the standard treatment for peritoneal carcinomatosis.
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Affiliation(s)
- Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142, km 3.95, 10060, Candiolo, TO, Italy.
| | - Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142, km 3.95, 10060, Candiolo, TO, Italy
| | - Michele De Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142, km 3.95, 10060, Candiolo, TO, Italy
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Marocco F, Vaira M, Milani A, Genta S, Maggiorotto F, Magistris A, Cinquegrana A, Robella M, De Simone M, Aglietta M, Ponzone R, Valabrega G. Secondary cytoreductive surgery, hyperthermic intraperitoneal intraoperative chemotherapy, and chemotherapy alone: a retrospective comparison of alternative approaches in relapsed platinum sensitive ovarian cancer. EUR J GYNAECOL ONCOL 2016; 37:638-643. [PMID: 29787001] [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: 06/08/2023]
Abstract
INTRODUCTION The best treatment for relapsed platinum sensitive epithelial ovarian cancer (EOC) is controversial. The aim of the study was to compare progression-free survival (PFS) and overall survival (OS) in platinum-sensitive EOC patients treated with chemotherapy alone (CTA), secondary cytoreductive surgery (SCR) or SCR plus hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC). MATERIALS AND METHODS Retrospective analysis of the clinical outcome of 46 EOC patients with at least 30 months of follow-up. RESULTS Median follow-up time was 32 months for the CTA group, 30 months for the SCR group, and 45 months for the SCR + HIPEC group. Fifteen recurrences were observed in the CTA group, seven in the SCR group, and 16 in the SCR + HIPEC group. The median time elapsed between first and second recurrence (PFI-2) was significantly higher among patients treated with SCR + HIPEC, in comparison with patients treated with CTA (p = 0.012 andp = 0.017, respectively). On the contrary, PFI-2 did not significantly differ between the SCR and SCR + HIPEC groups (p = 0.877). A statistically significant difference in OS favouring SCR + HIPEC in comparison with CTA (p = 0.04) was observed. CONCLUSIONS SCR HIPEC compared with CTA improves PFI-2 in patients with platinum-sensitive EOC recurrence. SCR + HIPEC might also improve OS in comparison with CTA. No improvement in favor of SCR + HIPEC vs SCR was observed,. These results further support the need of a randomized trial comparing chemotherapy with SCR ± HIPEC in this setting.
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Vaira M, Robella M, Mellano A, Sottile A, De Simone M. Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence. Int J Hyperthermia 2015; 30:565-9. [PMID: 25430988 DOI: 10.3109/02656736.2014.974693] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to analyse feasibility, morbidity and outcome of repeat complete cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). CRS combined with HIPEC is becoming the gold standard treatment for resectable peritoneal carcinomatosis in highly selected patients. As yet treatment of isolated peritoneal recurrence with iterative CRS and HIPEC has not been thoroughly explored. MATERIALS AND METHODS We selected 16 patients presenting isolated peritoneal recurrence who had undergone iterative CRS and HIPEC from a dataset of 322 CRS associated with HIPEC performed between 1996 and 2012. RESULTS Peritoneal carcinomatosis (PC) was due to colorectal and ovarian cancer, peritoneal mesothelioma and pseudomyxoma peritonei (PMP). Disease-free survival (DFS) was 13 months after the first procedure and 13.7 months after the second one. Overall morbidity rate was 43.7% (7/16) for all patients, with grade III-IV complications in three patients (18.7%). CONCLUSIONS Iterative procedures combining cytoreductive surgery and HIPEC are feasible with acceptable morbidity and mortality rates in strictly selected patients. DFS following repeated CRS and HIPEC is comparable to that registered after the first procedure.
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Affiliation(s)
- Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute , Fondazione del Piemonte per l'Oncologia, Istituto di Ricerca e Cura del Cancro a carattere Scientifico , Turin and
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Akmentins M, Pereyra L, Sanabria E, Vaira M. Patterns of daily and seasonal calling activity of a direct-developing frog of the subtropical Andean forests of Argentina. BIOACOUSTICS 2014. [DOI: 10.1080/09524622.2014.965217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M.S. Akmentins
- Centro de Investigaciones y Transferencia de Jujuy (CIT-JUJUY), CONICET, Universidad Nacional de Jujuy, Av. Bolivia 1711 (PC 4600), San Salvador de Jujuy, Argentina
| | - L.C. Pereyra
- Centro de Investigaciones y Transferencia de Jujuy (CIT-JUJUY), CONICET, Universidad Nacional de Jujuy, Av. Bolivia 1711 (PC 4600), San Salvador de Jujuy, Argentina
| | - E.A. Sanabria
- CONICET, Instituto de Ciencias Básicas, Facultad de Filosofía Humanidades y Artes, Universidad Nacional de San Juan, Av. José Ignacio de la Roza 230 (PC 5400), San Juan, Argentina
| | - M. Vaira
- Centro de Investigaciones y Transferencia de Jujuy (CIT-JUJUY), CONICET, Universidad Nacional de Jujuy, Av. Bolivia 1711 (PC 4600), San Salvador de Jujuy, Argentina
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Robella M, Vaira M, Mellano A, Marsanic P, Cinquegrana A, Borsano A, Barbera M, Caneparo A, Siatis D, Sottile A, De Simone M. Treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery and HIPEC. MINERVA CHIR 2014; 69:9-15. [PMID: 24675242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive tumor with poor prognosis, related in most cases to asbestos exposure. It is increasing in frequency, but currently no standard therapy is available. The biology of this disease is still poorly understood. Several highly specialized centers have recently reported improved survival by means of an innovative local-regional approach. The purpose of this article is to evaluate the survival benefit and the morbidity rate of patients affected by DMPM treated at our institution by cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC). METHODS This study includes 42 patients affected by DMPM treated by an uniform approach consisting of cytoreductive surgery associated with HIPEC using cisplatin and doxorubicin. The primary end point was overall survival and morbidity rate. The secondary end point was evaluation of prognostic variables for overall survival. RESULTS The median follow-up period was 72 months (range 1-235 months). Thirty-five patients (83.3%) presented epithelial tumors and 7 were affected by multicystic mesothelioma. The mean peritoneal cancer index (PCI) was 13. Thirty-eight patients (90.4%) had complete cytoreduction (CC-0/1). The overall morbidity rate was 35.7% associated to a perioperative mortality of 7.1%. Median overall survival rate was 65 months with a 1- and 5-year survival rates of 63% and 44%, respectively. CONCLUSION The treatment of DMPM by CRS+HIPEC in selected patients is a feasible technique that allows to achieve encouraging results in terms of overall survival rate, with an acceptable morbidity rate. Further investigations are needed to clarify the role and the timing of this promising technique.
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Affiliation(s)
- M Robella
- Unit of Surgical Oncology, IRCCS (Scientific Institute for Cancer Research and Treatment), Candiolo, Turin, Italy -
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