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Francolini G, Porreca A, Facchini G, Santini D, Bruni A, Simoni N, Trovò M, Osti MF, Fornarini G, Sisani M, Di Cataldo V, Detti B, Garlatti P, Bertini N, Serni S, Minervini A, Livi L. PERSIAN trial (NCT05717660): an ongoing randomized trial testing androgen deprivation therapy, apalutamide and stereotactic body radiotherapy. An alternative "triplet" for oligometastatic hormone sensitive prostate cancer patients. Med Oncol 2023; 41:39. [PMID: 38157111 DOI: 10.1007/s12032-023-02268-3] [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: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
Earlier treatment intensification with systemic potent androgen receptor inhibition has been shown to improve clinical outcomes in metastatic hormone sensitive prostate cancer. Nonetheless, oligometastatic patients may benefit from local treatment approaches such as stereotactic body radiotherapy (SBRT). Aiming to explore the benefit of SBRT in this scenario, we designed this trial to specifically test the hypothesis that SBRT will improve clinical outcomes in select population affected by metachronous oligometastatic HSPC treated with androgen deprivation therapy + apalutamide. Enrolled patients will be randomized to receive the standard systemic treatment alone or in combination with SBRT on all metastatic sites of disease. Here we report the protocol design and an overview of the ongoing trials testing different integration strategies between RT and systemic therapies.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Daniele Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università Di Roma, Rome, Italy
| | - Alessio Bruni
- Radiation Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Nicola Simoni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Marco Trovò
- Department of Radiation Oncology, University General Hospital, Udine, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Pietro Garlatti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Francolini G, Garlatti P, Di Cataldo V, Triggiani L, Simoni N, Detti B, Lorenzetti V, Colombo F, Morelli V, Ganovelli M, Caprara L, Orsatti C, Burchini L, Frosini G, Bertini N, Loi M, Simontacchi G, Greto D, Desideri I, Meattini I, Livi L. Pattern of recurrence after stereotactic body radiotherapy for para-aortic oligo-recurrent prostate cancer, a multicentric analysis. Radiol Med 2023; 128:1423-1428. [PMID: 37597125 DOI: 10.1007/s11547-023-01701-x] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND M1a disease represents an intermediate status between loco-regional relapse and bone metastatic disease. Metastasis directed therapy (MDT), through stereotactic body RT (SBRT) may be offered to patients, aiming to exclusively treat sites of macroscopic relapse and avoiding wide prophylactic treatment volumes. This appears as a viable treatment, especially after the rise of PSMA tailored treatment approaches. MATERIALS AND METHODS Data about patients treated in two different institutions were retrieved from a prospectively collected dataset. All included patients were affected by oligo-recurrent M1a disease after definitive RT or radical prostatectomy, defined as ≤ 3 nodal lesions situated above aortic bifurcation and below renal arteries. Both castration resistant PCa (CRPC) and castration sensitive (CSPC) PCa patients were included. All imaging methods were allowed to detect recurrence (CT scan, Choline or PSMA PET/CT).All sites of recurrences were treated with SBRT. RESULTS Median PFS was 10 months (95% CI 8-17). Twelve patients died, with a median OS of 114 months (95% CI 85-114). Out of the 83 recurrences, 2 (2.4%), 11 (13.25%), 36 (43.37%) and 15 (18%) patients had respectively prostate bed only, pelvic nodal, para-aortic or distant relapse. Furthermore, 19 (22.9%) patients experienced a biochemical only relapse with negative imaging at re-staging. DISCUSSION MDT conferred a remarkable PFS outcome in a mixed cohort of CSPC and CRPC patients with m1a disease, with an optimal safety profile. Prospective trials are needed in order to compare MDT and ENRT for these patients, allowing to select the best treatment option.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Pietro Garlatti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Nicola Simoni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126, Parma, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Victoria Lorenzetti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Federico Colombo
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126, Parma, Italy
| | - Vittorio Morelli
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Michele Ganovelli
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Luisa Caprara
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Carolina Orsatti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Luca Burchini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giulio Frosini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Simontacchi G, Sparano C, Loi M, Mangoni M, Olmetto E, Garlatti P, Scoccimarro E, Frosini G, Bertini N, Morelli I, Romei A, Orsatti C, Pallotta S, Calusi S, Cataldo VD, Livi L. The Role of Stereotactic Radiotherapy in Deferring the Need for Systemic Therapies in Patients with Progressive Oligometastatic Iodine-Refractory Thyroid Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e626. [PMID: 37785871 DOI: 10.1016/j.ijrobp.2023.06.2015] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Differentiated thyroid cancer (DTC) is usually associated with a good prognosis, although development of metastases in iodine-refractory patients adversely affects quality of life and survival. The advent of tyrosine-kinase inhibitors drugs (TKI) allowed for a significant improvement in patients' outcome: however, in case of oligometastatic disease, a locoregional ablative approach such as Stereotactic Radiation Therapy (SBRT) may be proposed. The aim of our study is to assess if SBRT in oligometastatic DTC patients could effectively control tumor progression and possibly defer the need of systemic therapies. MATERIALS/METHODS We retrospectively analyzed patients with differentiated oligometastatic iodine refractory thyroid cancer treated with SBRT in our Radiation Oncology Unit from 2011 to 2022. We collected demographics and treatment-related characteristics. Local Control (LC), Progression Free Survival (PFS), Overall Survival (OS) and the need for systemic therapy were evaluated. Patients with anaplastic histology, incomplete treatment or without follow-up information were excluded. RESULTS Twenty-two patients were included in our analysis, accounting for 63 tumors: 26 were located in bones (41,2%), 21 in lymph nodes (33,3%), 7 in the brain (11,1%), 6 in the lungs (9,5%) and 3 visceral (4,7%). SBRT was delivered in 1-8 fractions, with a median dose of 30Gy (range 24-60Gy). Median follow-up was 36,8 months (range 6,1-130,9 months). After SBRT we observed a complete response in 29 lesions (46,0%), partial response in 20 (31,7%), stable disease in 13 (20,6%) and only 1 progressive lesion (1,6%). We observed 10 local recurrences (15,8%) with an actuarial LC of 92,4% and 76,1% at 24 and 48 months respectively, while PFS was 62,8% and 52,3% at 12 and 24 months respectively. The OS at 24 and 48 months was 89,2% and 82,3% respectively. Patients with oligoprogressive disease were treated with further SBRT, while patients with polymetastatic progression of disease or oligoprogression not suitable for ablative treatment received systemic therapy. Eleven patients (50%) needed to start TKI treatment (6 Lenvatinib, 3 Sunitinib and 2 Sorafenib) for progressive disease: median time to first systemic treatment from SRT was 18,5 months (range 0,5-67 months). At the time of this analysis, 11 patients (50%) were still without systemic therapy, showing a good disease control after a median follow-up of 26,2 months (range 5,7-83). Freedom from systemic therapy rate from the time of SBRT was 85,6% and 57,6% at 12 and 24 months respectively. CONCLUSION In our experience, SBRT yields satisfying local control rates in oligometastatic Iodine-refractory DTC, potentially allowing for a deferral of systemic therapies, and should always be considered in these patients.
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Affiliation(s)
- G Simontacchi
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - M Loi
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - M Mangoni
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy; Medical Physics Unit, AOU Careggi Florence, Italy, Florence, Italy
| | - E Olmetto
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - P Garlatti
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - E Scoccimarro
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - G Frosini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - N Bertini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - I Morelli
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - A Romei
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Orsatti
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Pallotta
- University of Florence, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Florence, Italy
| | - S Calusi
- Medical Physics, Careggi University Hospital, University of Florence, Florence, Italy
| | - V Di Cataldo
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - L Livi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Salvestrini V, Becherini C, Desideri I, Simontacchi G, Loi M, Garlatti P, Bertini N, Bonaparte I, Mattioli C, Banini M, Morelli I, Meattini I, Bonomo P, Livi L. Long Term Clinical Outcomes of a Cohort of Lung-Only Oligometastatic HNSCC Patients Treated with SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e601-e602. [PMID: 37785816 DOI: 10.1016/j.ijrobp.2023.06.1965] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Oligometastatic disease in head and neck squamous cell carcinoma (HNSCC) is a rare setting. Local ablative therapies are the most adopted strategies although no evidence-based recommendations are currently published. The aim of our analysis was to update and report on long-term clinical outcomes of a cohort of HNSCC patients treated with stereotactic body radiotherapy (SBRT) for lung-only oligometastatic disease. MATERIALS/METHODS Eligible patients had 1 to 5 lung metastases. The oligometastatic pattern was classified as "de novo" (suitable for SBRT only) or "oligoprogressive" (after first line of systemic therapy). We evaluated time to progression (TTP) as the time from the last day of SBRT to disease progression or death from any cause. Predictive factors of better clinical outcome and survival analysis were performed by Cox regression and Kaplan Meier methods, respectively. RESULTS A cohort of 46 patients and 47 metastases were retrospectively evaluated. The median age was 67 years (range 37-86) and 87% of patients had a ECOG PS 0-1. HPV negative status (77%) and "de novo" oligometastatic pattern (78%) were reported by the majority of patients. After a median follow up of 28 months (range 2-88), median TTP and overall survival (OS) were 18 months (95% CI 4.8 - 31.2) and 62 months (95% CI 10,8 - 113.2), respectively. The median volume of planning target volume (PTV) was 20.4 cc (range 7.1-55.3). At univariate analysis, patients aged > 70 years reported a better TTP (p 0.013). No statistically significant correlation was observed in respect with gender (p 0.23), ECOG PS (p 0.34), oligometastatic pattern (p 0.13) and p16/HPV status (p 0.22). Out of 26 histologically proven metastases, we collected only 2 patients reporting concordance between p16/HPV positive status of primary tumor and lung metastases. Overall, 6 patients reported grade (G) 1-2 acute toxicity and no acute G3 adverse events were observed. CONCLUSION Our findings suggested that SBRT may improve clinical outcome prolonging time to progression and to systemic treatments in a properly selected cohort of HNSCC patients with lung-only oligometastatic disease. Distant metastases from HPV-related primary HNSCC should be tested for p16/HPV status given the clinical implications of HPV positivity for diagnosis and treatment.
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Affiliation(s)
- V Salvestrini
- Istituto Fiorentino di Cura e Assistenza (IFCA), CyberKnife Center, Florence, Italy
| | - C Becherini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - I Desideri
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Simontacchi
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - M Loi
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - P Garlatti
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - N Bertini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - I Bonaparte
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Mattioli
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - M Banini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - I Morelli
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - P Bonomo
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - L Livi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Francolini G, Detti B, Di Cataldo V, Garlatti P, Aquilano M, Allegra A, Lucidi S, Cerbai C, Ciccone LP, Salvestrini V, Stocchi G, Guerrieri B, Visani L, Loi M, Desideri I, Mangoni M, Meattini I, Livi L. Study protocol and preliminary results from a mono-centric cohort within a trial testing stereotactic body radiotherapy and abiraterone (ARTO-NCT03449719). Radiol Med 2022; 127:912-918. [PMID: 35763249 PMCID: PMC9349091 DOI: 10.1007/s11547-022-01511-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
Background ARTO trial was designed to evaluate the difference in terms of outcomes between patients affected by oligo metastatic castrate resistant prostate cancer (mCRPC) treated with Abiraterone acetate and randomized to receive or not SBRT on all sites of disease. Here, we present a preliminary analysis conducted on patients enrolled at promoting institution. Objective To present a preliminary overview about population features, clinical outcomes, adverse events, quality of life and explorative translational research. Design, setting, and participants ARTO (NCT03449719) is a phase II trial including patients affected by oligo mCRPC, randomized to receive standard of care (GnRH agonist or antagonist plus abiraterone acetate 1000 mg and oral prednisone 10 mg daily) with or without SBRT on all metastatic sites of disease. All subjects have < 3 bone or nodal metastases. All patients are treated in I line mCRPC setting, no previous lines of treatment for mCRPC are allowed. Outcome measurements and statistical analysis Data about a mono-centric cohort of 42 patients enrolled are presented in the current analysis, with focus on baseline population features, PSA drop at 3 months, biochemical response, and quality of life outcomes. Descriptive statistics regarding translational research are also presented. Results and limitation Significant difference in terms of PSA drop at three months was not detected (p = 0.68). Biochemical response (PSA reduction > 50%) was reported in 73.7 versus 76.5% of patients in control vs SBRT arm, respectively (p = 0.84). All patients are alive. Progression occurred in 1 versus 0 patients in the control versus SBRT arm, respectively. After 3 months, an average decrease of 13 points in terms of Global Health Score was reported for the overall population. However, complete recovery was noticed at 6 months. Circulating tumor cells detection rate was 40%. Conclusions SBRT + Abiraterone treatment was safe and well tolerated, non-significant trend in terms of PSA drop and biochemical response at 3 months was detected in SBRT arm. Interestingly, CTCs detection in this selected cohort of oligo-mCRPC was lower if compared to historical data of unselected mCRPC patients.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Largo Brambilla 3, 50139, Florence, Italy.
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Pietro Garlatti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Michele Aquilano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Andrea Allegra
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Sara Lucidi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lucia Pia Ciccone
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Giulia Stocchi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Barbara Guerrieri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Monica Mangoni
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Becherini C, Banini M, Desideri I, Salvestrini V, Mariotti M, Caprara L, Scotti V, Agresti B, Garlatti P, Livi L, Bonomo P. Nivolumab in elderly patients with recurrent/metastatic head and neck squamous cell carcinoma: efficacy and safety data from a monocentric experience. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Francolini G, Stocchi G, Detti B, Di Cataldo V, Bruni A, Triggiani L, Guerini AE, Mazzola R, Cuccia F, Mariotti M, Salvestrini V, Garlatti P, Borghesi S, Ingrosso G, Bellavita R, Aristei C, Desideri I, Livi L. Dose-escalated pelvic radiotherapy for prostate cancer in definitive or postoperative setting. Radiol Med 2021; 127:206-213. [PMID: 34850352 DOI: 10.1007/s11547-021-01435-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/16/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Given the absence of standardized planning approach for clinically node-positive (cN1) prostate cancer (PCa), we collected data about the use of prophylactic pelvic irradiation and nodal boost. The aim of the present series is to retrospectively assess clinical outcomes after this approach to compare different multimodal treatment strategies in this scenario. METHODS Data from clinical records of patients affected by cN1 PCa and treated in six different Italian institutes with prophylactic pelvic irradiation and boost on pathologic pelvic lymph nodes detected with CT, MRI or choline PET/CT were retrospectively reviewed and collected. Clinical outcomes in terms of overall survival (OS) and biochemical relapse-free survival (b-RFS) were explored. The correlation between outcomes and baseline features (International Society of Urological Pathology-ISUP pattern, total dose to positive pelvic nodes ≤ / > 60 Gy, sequential or simultaneous integrated boost (SIB) administration and definitive vs postoperative treatment) was explored. RESULTS ISUP pattern < 2 was a significant predictor of improved b-RFS (HR = 0.3, 95% CI 0.1220-0.7647, P = 0.0113), while total dose < 60 Gy to positive pelvic nodes was associated with worse b-RFS (HR = 3.59, 95% CI 1.3245-9.741, P = 0.01). Conversely, treatment setting (postoperative vs definitive) and treatment delivery technique (SIB vs sequential boost) were not associated with significant differences in terms of b-RFS (HR = 0.85, 95% CI 0.338-2.169, P = 0.743, and HR = 2.39, 95% CI 0.93-6.111, P = 0.067, respectively). CONCLUSION Results from the current analysis are in keeping with data from literature showing that pelvic irradiation and boost on positive nodes are effective approaches. Upfront surgical approach was not associated with better clinical outcomes.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, University of Florence, Viale Morgagni 85, 50134, Florence, Italy. .,CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy.
| | - Giulia Stocchi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - Vanessa Di Cataldo
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Alessio Bruni
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, Brescia University, Brescia, Italy
| | | | - Rosario Mazzola
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Francesco Cuccia
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Matteo Mariotti
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Pietro Garlatti
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Rita Bellavita
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Francolini G, Loi M, Salvestrini V, Mangoni M, Detti B, Di Cataldo V, Aquilano M, Pinzani P, Salvianti F, Desideri I, Mariotti M, Garlatti P, Stocchi G, Ciccone LP, Lucidi S, Salvatore G, Sottili M, Meattini I, Livi L. Prospective assessment of AR splice variant and PSMA detection on circulating tumor cells of mCRPC patients: preliminary analysis of patients enrolled in PRIMERA trial (NCT04188275). Clin Exp Metastasis 2021; 38:451-458. [PMID: 34410545 PMCID: PMC8510932 DOI: 10.1007/s10585-021-10118-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022]
Abstract
In our institution, a prospective observational trial testing micro-RNA (miRNA) and ARV7 mutational status in metastatic, castration resistant prostate cancer (mCRPC), is currently recruiting (PRIMERA trial, NCT04188275). A pre-planned interim analysis was performed when 50% of the planned accrual was reached. In this report, we explored the predictive value of Circulating Tumor Cell (CTC) detection in mCRPC patients undergoing 1st line therapy. Moreover, ARV7, ARFL, PSMA and PSA expression on CTC was reported to explore potential correlation with patient prognosis and response to therapy. PRIMERA is a prospective observational trial enrolling mCRPC patients undergoing standard treatment (ARTA + ADT) after I line ADT failure. Clinical and pathological features were collected. Outcomes selected for this preliminary analysis were time to castration resistance (TTCR), PSA at 8 weeks after ARTA therapy start, PSA drop at 8 weeks, Overall PSA drop, PSA nadir. Correlation between these outcomes and CTC detection was tested. Expression of ARV7, ARFL, PSA and PSMA was explored in CTC+ patients to assess their prevalence in this cohort and their impact on selected outcomes. Median TTCR was significantly shorter in CTC+ vs CTC− patients (32.3 vs 75 months, respectively, p = 0.03) and in ARFL+ vs ARFL− patients (30.2 vs 51.1 months, respectively, p = 0.02). ARV7, PSMA and PSA expression on CTC had no impact on median TTCR, nor on biochemical response to therapy. Patients in whom CTC and ARFL expression were detected had significant reduced TTCR. However, PSA response was not influenced by CTCs detection and specific biomarkers expression.
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Affiliation(s)
- G Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - M Loi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - M Mangoni
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - B Detti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - V Di Cataldo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - M Aquilano
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - P Pinzani
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - F Salvianti
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - I Desideri
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - M Mariotti
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - P Garlatti
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - G Stocchi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - S Lucidi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - G Salvatore
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - M Sottili
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - I Meattini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
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9
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Francolini G, Di Cataldo V, Detti B, Lucidi S, Scoccimarro E, Mariotti M, Peruzzi A, Guerrieri B, Garlatti P, Loi M, Mangoni M, Desideri I, Meattini I, Livi L. PO-1393 ARTO (NCT03449719), quality of life monocentric report after stereotactic treatment and abiraterone. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Bonomo P, Desideri I, Ciabatti C, Lucidi S, Garlatti P, Teriaca MA, Salvestrini V, Mariotti M, Becherini C, Livi L. P-41 Pattern of failure in oropharyngeal cancer patients treated with IMRT: comparison of two different CTV expansion modalities. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Francolini G, Desideri I, Stocchi G, Ciccone LP, Salvestrini V, Garlatti P, Aquilano M, Greto D, Bonomo P, Meattini I, Scotti V, Scoccianti S, Simontacchi G, Livi L. Impact of COVID-19 on workload burden of a complex radiotherapy facility. Radiol Med 2021; 126:717-721. [PMID: 33646520 PMCID: PMC7917169 DOI: 10.1007/s11547-021-01338-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 02/07/2021] [Indexed: 12/12/2022]
Abstract
Background and purpose COVID-19 constitutes a worldwide threat, prompting Italian Government to implement specific measures on March 8, 2020, to protect patients and health workers from disease transmission. The impact of preventive measures on daily activity of a radiotherapy facility may hamper the ability to fulfill normal workload burden. Thus, we assessed the number of delivered treatments in a specific observation period after the adoption of preventive measures (since March 11 to April 24, 2020) and compared it with the corresponding period of the year 2019. Materials and methods Overall number of delivered fractions was related to actual time of platform daily activity and reported as a ratio between number of delivered fractions and activity hours (Fr/Hrs). Fr/Hrs were calculated and compared for two different periods of time, March 11–April 24, 2019 (Fr/Hrs1), and March 11–April 24, 2020 (Fr/Hrs2). Results Fr/Hrs1 and Fr/Hrs2 were 2.66 and 2.54 for year 2019 and 2020, respectively, for a Fr/Hrsratio of 1.07 (95% CI 1.03–1.12, p = 0.0005). Fr/Hrs1 was significantly higher than Fr/Hrs2 for SliR and PreciseR, with Fr/Hrsratio of 1.92 (95% CI 1.66–2.23, p < 0.0001) and 1.11 (95% CI 1.03–1.2, p = 0.003), respectively. No significant difference was reported for SynergyR and CyberknifeR with Fr/Hrsratio of 0.99 (95% CI 0.91–1.08, p = 0.8) and 0.9 (95% CI 0.77–1.06, p = 0.2), respectively. Fr/Hrs1 was significantly lower than Fr/Hrs2 for TomotherapyR, with Fr/Hrsratio of 0.88 (95% CI 0.8–0.96, p = 0.007). Conclusion Preventive measures did not influence workload burden performed. Automation in treatment delivery seems to compensate effectively for health workers number reduction.
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Affiliation(s)
- Giulio Francolini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Radiation Oncology Unit, University of Florence, Florence, Italy. .,Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giulia Stocchi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lucia Pia Ciccone
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Pietro Garlatti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Michele Aquilano
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.,Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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12
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Francolini G, Garlatti P, Loi M, Detti B, Aquilano M, Allegra A, Guerrieri B, Salvestrini V, Pinzani P, Bellini C, Salvianti F, Stocchi G, Ciccone LP, Salvatore G, Sottili M, Di Cataldo V, Desideri I, Mangoni M, Meattini I, Livi L. ARTO trial (NCT03449719), a randomized phase II trial enrolling oligometastatic castration-resistant prostate cancer patients treated with first-line abiraterone acetate with or without stereotactic body radiation therapy: Preliminary results comprehensive of biochemical outcomes and circulating tumor cells analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
118 Background: Androgen Receptor Targeted Agents (ARTA) represent one of the main treatment options for metastatic castrate resistant prostate cancer (mCRPC). Addition of stereotactic radiation therapy (SBRT) to ablate metastatic foci may improve clinical outcomes in oligometastatic setting. ARTO trial (NCT03449719) is a randomized phase II trial testing the benefit of upfront SBRT on all sites of metastatic disease in oligo-mCRPC patients undergoing I line therapy with Abiraterone Acetate (AA). In this preliminary analysis, we report results after 6 months of follow up, together with an exploratory analysis of androgen receptor splice variants (ARV7/ARFL) Prostate Specific Antigen (PSA) and Prostate Specific Membrane Antigen (PSMA) expression on Circulating Tumor Cells (CTCs) detected in this cohort of patients. Methods: 31 patients affected by oligo-mCRPC (defined as < 3 non-visceral metastatic lesions) were randomized to receive I line AA therapy with or without SBRT on all metastatic sites. Baseline blood samples to detect CTCs and evaluate their ARV7, ARFL, PSA and PSMA expression were taken before AA treatment start. Assessments comprehensive of clinical examination and serum PSA were performed every three months. Toxicity was assessed by the Common Terminology Criteria for Adverse Events toxicity scale (CTCAE v.4.03). Results: Thirteen and 18 patients were enrolled in the treatment and control arm, respectively. Nineteen metastatic lesions were treated with SBRT in the treatment arm. At 6 months, complete response (defined as a serum PSA level < 0.2 ng/dl) and biochemical response (defined as a PSA reduction > 50% if compared to baseline) were achieved in 6 vs 4 and in 10 vs 8 patients in the treatment vs control arm, respectively. One patient in the treatment arm died for other causes, 1 biochemical progression occurred in the control arm. No adverse events occurred in both arms of treatment. CTCs analysis was available for 10 patients, out of whom 4 were found positive for CTCs (1 and 3 from the treatment and control arm, respectively). ARV7 and ARFL were expressed in 1 patient from the control arm, PSMA was expressed in all CTC positive patients, PSA was expressed in 2 patients from the control and one from the treatment arm. Conclusions: SBRT+AA in oligo-mCRPC patients was safe and yielded promising biochemical results. CTCs detection in this selected cohort of oligo-mCRPC was lower if compared to historical data of unselected mCRPC patients. Data about ARV7, ARFL, PSA and PSMA expression represent an interesting snapshot of biomarker arrangement in this setting. Clinical trial information: NCT03449719.
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Affiliation(s)
| | - Pietro Garlatti
- Radiotherapy Department, University of Florence, Florence, Italy
| | | | | | | | | | | | | | - Pamela Pinzani
- Clinical Biochemistry and Clinical Molecular Biology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Chiara Bellini
- Radiotherapy Department, Università di Firenze, Firenze, Italy
| | - Francesca Salvianti
- Clinical Biochemistry and Clinical Molecular Biology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giulia Stocchi
- Radiotherapy Department, University of Florence, Firenze, Italy
| | | | - Giulia Salvatore
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Florence, Italy
| | | | - Vanessa Di Cataldo
- Cyberknife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Firenze, Italy
| | - Isacco Desideri
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
| | | | - Icro Meattini
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
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13
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Francolini G, Garlatti P, Detti B, Bruni A, Mantini G, Pergolizzi S, Borghetti P, D’Angelillo R, Alongi F, Jereczek-Fossa B, Franzese C, Tagliagambe A, Di Cataldo V, Aquilano M, Mariotti M, Salvestrini V, Ciccone L, Stocchi G, Livi L. Early results from a phase II randomized trial testing stereotactic body radiation therapy in patients with oligometastatic castration resistant prostate cancer undergoing I line treatment with abiraterone acetate (ARTO trial-NCT03449719). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Desideri I, Lucidi S, Garlatti P, Lorenzetti V, Ciabatti C, Terziani F, Scotti V, Bonomo P, Francolini G, Meattini I, Livi L. Use of an alfa-lipoic, Methylsulfonylmethane, Boswellia serrata and Bromelain dietary supplement for Aromatase Inhibitors-related Arthralgia Management (AIA): A prospective phase II trial (NCT04161833). Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Francolini G, Salvestrini V, Loi M, Mangoni M, Detti B, Pinzani P, Salvianti F, Desideri I, Aquilano M, Mariotti M, Garlatti P, Stocchi G, Ciccone L, Lucidi S, Salvatore G, Sottili M, Meattini I, Livi L. 671P Prospective assessment of AR splice variant and PSMA detection on circulating tumour cells of mCRPC patients: Preliminary results of PRIMERA trial (NCT04188275). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.930] [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: 10/23/2022] Open
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16
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Bonomo P, Lucidi S, Desideri I, Scotti V, Casati M, Palomba A, Ciabatti C, Garlatti P, Massi D, Gallo O, Livi L. Re-irradiation for oligoprogression under Nivolumab in recurrent head and neck squamous cell carcinoma: A case report. Clin Transl Radiat Oncol 2020; 23:16-19. [PMID: 32368625 PMCID: PMC7186263 DOI: 10.1016/j.ctro.2020.04.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Immunotherapy is a new option for head and neck squamous cell carcinoma. Very limited data are available for concurrent radio-immunotherapy in recurrent disease. Our case report adds to this very limited series, focusing on oligopression under immunotherapy.
Immune checkpoint inhibitors (ICIs) represent a recently introduced class of agents active in head and neck squamous cell carcinoma (HNSCC). For a subgroup of patients with recurrent or metastatic disease, long-term benefit can be achieved: maintaining a sustained response to immunotherapy is therefore a critical factor for its efficacy at an individual level. In analogy to targeted agents, a limited pattern of progression, or “oligoprogression”, can occur. For locally recurrent HNSCC, the potential biologic interplay between the efficacy of ICIs and the design of radiation fields chosen for primary treatment is currently unknown. Here, we report on a patient who presented two subsequent oligoprogressions successfully treated with re-irradiation without interrupting Nivolumab. Both oligoprogressive lesions developed in previously unirradiated areas. We hypothesize the existence of a synergistic effect with optimal spatial cooperation between ICIs and re-irradiation for oligoprogressive disease under immunotherapy.
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Affiliation(s)
- Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Sara Lucidi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Marta Casati
- Medical Physics, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Annarita Palomba
- Section of Pathological Anatomy, Department of Health Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Cinzia Ciabatti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pietro Garlatti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniela Massi
- Section of Pathological Anatomy, Department of Health Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Oreste Gallo
- Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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17
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Francolini G, Loi M, Detti B, Mangoni M, Desideri I, Muntoni C, Ciccone LP, Aquilano M, Pinzani P, Salvianti F, Lucidi S, Mariotti M, Garlatti P, Salvatore G, Sottili M, Livi L. Preliminary results of a prospective assessment of androgen receptor splice variants in mCRPC patients undergoing androgen receptor targeted agents. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
246 Background: Different treatment options for metastatic castrate resistant prostate cancer (mCRPC) are currently available, including Androgen Receptor Targeted Agents (ARTA) and Taxane based chemotherapy. However, selection criteria aiming to drive the therapeutic choice in this setting are lacking, and no standardized therapeutic sequence is validated. In our institution, a prospective study testing predictive value of circulating tumor cells (CTC) in patients (pts) receiving a first line ARTA for mCRPC is currently ongoing (PRIMERA). Here, we present preliminary results from the first enrolled cohort. Methods: Pts affected by mCRPC eligible for Androgen Deprivation Therapy (ADT) plus ARTA were prospectively enrolled and underwent baseline determination of androgen-receptor splice variant 7 (AR-V7) and androgen-receptor-full length (ARFL) variants on CTC at baseline (ARTA start). Fisher Exact Test was conducted to explore the correlation between baseline features and CTC detection rate. Results: Overall, 26 pts were enrolled and baseline results are available for 13 pts. CTC were found in 5 (38.5%) pts. No significant difference was reported in terms of CTC detection probability for pts with high vs low burden of disease according to CHARTEED definition (p=0.42), neither for pts with PSA at CRPC diagnosis < or > 10 ng/ml, (p=0.2). However, a PSA > 10 ng/ml at ADT start in metastatic hormone sensitive setting (mHSPC) was significantly related to CTC detection probability (p=0.01). AR-V7 variants were found in 1 out 5 (20%) CTC-positive pts. Conclusions: PSA at ADT start may significantly be related to CTC detection rate. CTC detection could be particularly useful in pts with a high burden of disease at the beginning of systemic therapy. Metastatic disease could remain dormant until development of CRPC status, with consequent release of increased amount of CTC, more likely to be detected in this setting. AR-V7 expression was found in 20% of CTC positive pts, in line with literature data.[Table: see text]
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Affiliation(s)
| | - Mauro Loi
- University of Florence, Florence, Italy
| | | | | | | | | | | | | | - Pamela Pinzani
- Clinical Biochemistry and Clinical Molecular Biology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Salvianti
- Clinical Biochemistry and Clinical Molecular Biology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Lucidi
- Radiation Oncology Department, Florence, Italy
| | | | | | - Giulia Salvatore
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Florence, Italy
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18
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Tabbò F, Annaratone L, Nocifora A, Vignale C, Carnio S, Metovic J, Veneziano F, Scodes S, Russo A, Franchina T, Sini C, Coco S, Garlatti P, Vieri S, Adamo V, Boccardo S, Grossi F, Cappuzzo F, Papotti M, Righi L, Passiglia F, Novello S. P1.04-45 Immune-Oncology Gene Expression Profiles Allow Lung Cancer Patients’ Stratification and Identification of Responders to Immunotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.948] [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: 10/25/2022]
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19
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Bonomo P, Desideri I, Becherini C, Visani L, Salvestrini V, Mariotti M, Garlatti P, Dominici L, Livi L. PO-0731 Transition from anatomical to geometric expansion modality for high-risk CTV in oropharyngeal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Desideri I, Francolini G, Carta GA, Di Cataldo V, Masi L, Meattini I, Bonomo P, Loi M, Greto D, Visani L, Lo Russo M, Grassi R, Teriaca MA, Garlatti P, Nardi C, Livi L. Efficacy and Tolerability of CyberKnife Stereotactic Robotic Radiotherapy for Primary or Secondary Orbital Lesions: A Single-Center Retrospective Experience. Technol Cancer Res Treat 2019; 18:1533033818818561. [PMID: 30803353 PMCID: PMC6373998 DOI: 10.1177/1533033818818561] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction: Orbital lesions are rare, but are likely to become symptomatic and can impact on
patients’ quality of life. Local control is often difficult to obtain, because of
proximity to critical structures. CyberKnife stereotactic robotic radiotherapy could
represent a viable treatment option. Materials and Methods: Data on patients treated for intraorbital lesions from solid malignancies were
retrospectively collected. All patients underwent treatment with CyberKnife system. We
analyzed local control, response rate, symptoms control, progression-free survival and
overall survival, acute and late toxicity. Results: From January 2012 to May 2017, 20 treatments on 19 patients were performed, with dose
ranging from 24 to 35 Gy in 1 to 5 fractions, prescribed at an average isodose line of
79.5% (range: 78-81). After a mean follow-up of 14.26 months (range: 0-58), overall
response rate was 75%, with 2 and 4 patients presenting a partial and complete response,
respectively. Mean time to best measured response was 15.16 months (range: 2-58).
Thirteen patients were alive, with a local control rate of 79%. Mean time to local
progression was 5 months (range: 3-7). Three patients reported improvement in symptoms
after treatment. Mean planning target volume dose coverage was 97.2% (range: 93.5-99.7).
Mean maximum dose (D max) to eye globe, optic nerve, optic chiasm, and lens was 2380.8
cGy (range: 290-3921), 1982.82 cGy (range: 777.3-2897.8), 713.14 cGy (range:
219.5-2273), and 867.9 cGy (range: 38-3118.5). Four patients presented acute
toxicity. Conclusion: This current retrospective series demonstrated that CyberKnife robotic stereotactic
radiotherapy is a feasible and tolerable approach for intraorbital lesions.
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Affiliation(s)
- Isacco Desideri
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Francolini
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Alberto Carta
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vanessa Di Cataldo
- 2 CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Laura Masi
- 2 CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Icro Meattini
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pierluigi Bonomo
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Loi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luca Visani
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Monica Lo Russo
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Roberta Grassi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria Ausilia Teriaca
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pietro Garlatti
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cosimo Nardi
- 3 Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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21
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Becherini C, Meattini I, Livi L, Garlatti P, Desideri I, Scotti V, Orzalesi L, Sanchez LJ, Bernini M, Casella D, Nesi S, Nori J, Bianchi S, Pallotta S, Marrazzo L. External accelerated partial breast irradiation for ductal carcinoma in situ: long-term follow-up from a phase 3 randomized trial. Tumori 2018; 105:205-209. [DOI: 10.1177/0300891618811278] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: For a long time, accelerated partial breast irradiation (APBI) effectiveness for ductal carcinoma in situ (DCIS) has been debated, due to conflicting published results. Recent encouraging data from phase 3 trials reopened new perspectives for this radiation approach. The aim of the present study was to analyze the long-term efficacy and safety results of the series of patients with DCIS enrolled in the APBI arm of the APBI-IMRT-Florence phase 3 trial (NCT02104895). Methods: Patients were treated in a phase 3 randomized trial comparing whole breast irradiation (50 Gy in 25 fractions to the whole breast, plus 10 Gy in 5 fractions to the tumor bed) to APBI (30 Gy in 5 nonconsecutive fractions) using the intensity-modulated radiotherapy technique. Results: Overall, 22 patients were treated in the APBI arm. Median age was 62 years (mean 59; range 42–75 years). At a median follow-up of 9.2 years (mean 8.8; range 3.8–12.1 years), no contralateral invasive/DCIS occurrence, distant metastasis, or breast cancer–related death were recorded. The 5- and 10-year local recurrence, distant metastasis–free survival, and breast cancer–specific survival were 100%. The 10-year overall survival rate was 90.9%. No late toxicity at 5 and 10 years was recorded. Conclusions: Waiting for pending studies and mature follow-up, we confirmed the efficacy and safety of APBI for low-risk DCIS.
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Affiliation(s)
- Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pietro Garlatti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luis Jose Sanchez
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Donato Casella
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Silvia Nesi
- Breast Surgery Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Medical Physics Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Livia Marrazzo
- Medical Physics Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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22
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Greto D, Saieva C, Loi M, Terziani F, Visani L, Garlatti P, Lo Russo M, Muntoni C, Becherini C, Topulli J, Campanacci D, Beltrami G, Scoccianti G, Muratori F, Bonomo P, Desideri I, Francolini G, Livi L. Influence of age and subtype in outcome of operable liposarcoma. Radiol Med 2018; 124:290-300. [PMID: 30421387 DOI: 10.1007/s11547-018-0958-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
AIM Liposarcoma (LPS) is rare tumor deriving from adipocytes. LPS is classified into histological subtypes: well-differentiated (WDLPS), dedifferentiated (DDLPS), myxoid (MLPS) and pleomorphic (PLPS). A tailored approach taking into account the specificity of disease subtype and age at presentation could be helpful in delineating therapeutic management of liposarcoma. In this paper, we report a retrospective series of a single-institution cohort of patients with LPS, undergoing surgery and radiotherapy and/or chemotherapy. The aim of this study is to evaluate whether clinical characteristics, tumor- and treatment-related features affect clinical outcome in patients treated with curative intent for non-metastatic liposarcoma. METHODS Data of patients with locally advanced, non-metastatic liposarcoma treated between 1990 and 2015 were retrospectively reviewed. Data about patient, tumor and treatment features were collected. Two patients subgroups were identified according to age (cutoff: age < 65 years or > 65 years). Statistical analysis was performed to assess correlation between the above-cited variables and local recurrence-free survival (DFS-LR), distant metastasis-free survival, overall survival (OS) and disease-specific survival (DSS); moreover, differences in clinical outcome between the two age groups were identified. RESULTS Data of 186 patients were collected. At diagnosis, 27.4% of patients were 65 years or older. At a median follow-up of 8.6 years (range 0.1-27.3 years), Kaplan-Meier (KM) survival analysis showed that LR, DM, OS and DSS were 75.5%, 76.6%, 48.1% and 72.1%, respectively. KM analysis showed that age > 65, DDLPS and lower limb localization were related to LR (p = 0.001, p = 0.0001 and p = 0.0001, respectively). Association between LR, age and DDLPS persisted both at univariate (p = 0.003 and p = 0.0001, respectively) and multivariate Cox regression (CR) analysis (p = 0.024 and p = 0.002). Age, tumor depth and grading influenced distant recurrence, both at KM (p = 0.023, p = 0.026 and p = 0.016) and univariate CR (p = 0.026, p = 0.042 and p = 0.012). Age and grading were confirmed at multivariate analysis (p = 0.009 and p = 0.017). Patients with WDLPS and wide excision had significantly better OS (p = 0.001 and p = 0.03, respectively), while histological G3 and age > 65 were related with worse OS (p = 0.008 and p = 0.0001, respectively). Age, DDLPS and grade were related to OS at univariate (p = 0.0001, p = 0.0001 and p = 0.03, respectively) and multivariate CR analysis (p = 0.031, p = 0.0001 and p = 0.001, respectively). However, analyzing the specific causes of death, female died less often for tumor-related causes, with a DSS of 91.0% compared to 57.4% of male counterpart (p = 0.005). At Kaplan-Meier analysis, postoperative radiotherapy resulted in a statistically significant better disease-specific survival than postoperative radiotherapy (82.9% vs. 46.2%, p = 0.045). High grade correlated with poorer disease-specific survival (59.3%) than intermediate and low grade (73.4% and 91.6%, respectively) (p = 0.008). Association between DSS, sex and grade persisted both at univariate (p = 0.008 and p = 0.022, respectively) and multivariate Cox regression (CR) analysis (p = 0.014 and p = 0.038). Histotype-driven schedules of treatment should be developed to take into account biological heterogeneity of this disease. Further studies are needed to stratify patients subgroup and develop tailored treatment strategies (i.e., altered fractionations and different chemotherapy regimens in aggressive subtypes), in particular more prospective trials are needed to develop treatment guidelines in elderly STS, taking into account the frailty and the peculiarity of this subgroup.
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Affiliation(s)
- Daniela Greto
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy.
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Mauro Loi
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Francesca Terziani
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Luca Visani
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Pietro Garlatti
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Monica Lo Russo
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Cristina Muntoni
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Carlotta Becherini
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Juliana Topulli
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Domenico Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Giulio Francolini
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy
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23
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Mangoni M, Sottili M, Salvatore G, Meattini I, Desideri I, Greto D, Loi M, Becherini C, Garlatti P, Delli Paoli C, Dominici L, Gerini C, Scoccianti S, Bonomo P, Silvano A, Beltrami G, Campanacci D, Livi L. Enhancement of Soft Tissue Sarcoma Cell Radiosensitivity by Poly(ADP-ribose) Polymerase-1 Inhibitors. Radiat Res 2018; 190:464-472. [PMID: 30067444 DOI: 10.1667/rr15035.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Soft tissue sarcomas (STS) are aggressive tumors with a poor prognosis. Poly(ADP-ribose) polymerase (PARP)-1 inhibitors (PARPi) enhance the cytotoxic effects of radiation. In this study, we evaluated the effect of PARPi on survival and DNA damage of irradiated STS cells. For clonogenic assays, STS cell lines were irradiated with or without olaparib, iniparib or veliparib pretreatment. The effect of PARP inhibition on γ-H2AX and Rad51 foci formation, on PARP-1, phospho-ERK and cleaved caspase-3 protein expression and on cell cycle progression was evaluated on irradiated rhabdomyosarcoma cells pretreated with olaparib. The results from this work showed that PARPi induced significant radiosensitization in STS cells. Rhabdomyosarcoma cells showed the highest increase in radiosensitivity, with a radiosensitization enhancement ratio at 50% survival (ER50) of 3.41 with veliparib. All PARPi exerted a synergistic effect when combined with radiation. Fibrosarcoma cells showed an ER50 of 2.29 with olaparib. Leiomyosarcoma and liposarcoma cells showed their highest ER50 with veliparib (1.71 and 1.84, respectively). In rhabdomyosarcoma, olaparib enhanced the formation of radiation-induced γ-H2AX/Rad51 foci and PARP-1 cleavage, induced slightly increased expression of cleaved caspase-3 and reduced phospho-ERK expression. Moreover, the combination of olaparib and radiation resulted in a significantly enhanced cell cycle arrest in the G2/M phase compared to the two treatments alone. In conclusion, we have shown that PARPi are potent radiosensitizers of human STS cells. These results support the pursuit of further investigations into the effects of PARPi combined with radiation on STS.
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Affiliation(s)
- Monica Mangoni
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Mariangela Sottili
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Giulia Salvatore
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Icro Meattini
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Isacco Desideri
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Daniela Greto
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Mauro Loi
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Carlotta Becherini
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Pietro Garlatti
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Camilla Delli Paoli
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Luca Dominici
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Chiara Gerini
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Silvia Scoccianti
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Pierluigi Bonomo
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Angela Silvano
- b Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Giovanni Beltrami
- c Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy and.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Domenico Campanacci
- c Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy and.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
| | - Lorenzo Livi
- Department of a Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,d Istituto Toscano Tumori, via Taddeo Alderotti 26/N, 50139 Florence, Italy
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24
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Greto D, Loi M, Terziani F, Visani L, Garlatti P, Lo Russo M, Teriaca MA, Muntoni C, Delli Paoli C, Topulli J, Campanacci D, Beltrami G, Scoccianti G, Bonomo P, Desideri I, Francolini G, Livi L. A matched cohort study of adjuvant radiochemotherapy versus radiotherapy alone in soft tissue sarcoma patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e23554] [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)
| | - Mauro Loi
- University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | - Domenico Campanacci
- Orthopaedic Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology and Reconstructive Surgery, "Azienda Ospedaliera Universitaria Careggi", Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, "Azienda Ospedaliera Universitaria Careggi", Florence, Italy
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25
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Greto D, Saieva C, Loi M, Terziani F, Visani L, Garlatti P, Lo Russo M, Muntoni C, Becherini C, Topulli J, Campanacci D, Beltrami G, Scoccianti G, Muratori F, Bonomo P, Desideri I, Francolini G, Livi L. Influence of age and histologic subtype in outcome of operable liposarcoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e23552] [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)
| | | | - Mauro Loi
- University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | - Domenico Campanacci
- Orthopaedic Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Beltrami
- Orthopaedic Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, "Azienda Ospedaliera Universitaria Careggi", Florence, Italy
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26
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Meattini I, Pezzulla D, Carta GA, Becherini C, Perna M, Grassi R, Garlatti P, Desideri I, Scotti V, Bernini M, Sanchez LJ, Orzalesi L, Nori J, Bianchi S, Livi L. Abstract P6-09-07: Triple negative apocrine carcinomas as a distinct subtype of triple negative breast cancer: A case-control study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-09-07] [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
Introduction. Invasive apocrine carcinoma of the breast is a rare type of breast cancer (BC), pure apocrine carcinoma constitutes <1% of all BC. Mammary apocrine epithelium has a characteristic steroid receptor profile that is negative for full length estrogen receptor-alpha and progesterone receptor and is androgen receptor positive. Conflicting data are available on the outcome of this type of disease: few studies reported significantly different prognosis of triple negative (TN) apocrine carcinomas when compared to most non-apocrine triple negative (NA-TN) tumors. The aim of this study is to report our long-term experience in a single-center series of TN apocrine tumors.
Methods. We analyzed clinical and pathological features of a series of TN apocrine carcinomas treated at our Centre in a 15-year period. Clinical and pathological characteristics and outcomes have been compared with a control series of NA-TN tumors treated during the same follow up period. Local relapse-free survival (LRFS), distant metastases-free survival (DMFS), and overall survival (OS) have been evaluated and compared between groups of patients.
Results. Forty-five TN apocrine carcinomas were analyzed. The mean age at diagnosis was 60 years (range 34-83 years). The proportions of apocrine tumor grades varied, with G1 being seen in 6.8% of patients, G2 in 51.1%, and G3 in 40.1%. The majority of apocrine carcinomas had small tumor size (T1: 72.7%; T2: 27.3%), and negative axillary nodal status (66.7%). The series was compared to a homogenous control group of 45 NA-TN patients. The mean age was 54 years (range 32-79 years), affected by high grade (G3: 53.7%), small tumor size (T1: 87.5%; T2: 12.5%), and mostly negative axillary nodal status (82.9%). LRFS in the apocrine group was 85% and 78% at 5- and 10-year, respectively. LRFS in the NA-TN group was 90% and 79% at 5- and 10-year, respectively. No difference was evidenced between groups (HR 1.44 95%CI 0.62-3.79; p=0.39). DMFS in the apocrine group was 85% and 85% at 5- and 10-years, respectively. DMFS in the NA-TN group was 85% and 75% at 5- and 10-year, respectively. DMFS was significantly better in the apocrine group (HR 0.69 95%CI 0.28-1.62). OS in the apocrine group was 86% and 83% at 5- and 10-year, respectively. OS in the NA-TN group was 86% and 63% at 5- and 10-years, respectively. OS was significantly better in the apocrine group (HR 0.57 95%CI 0.26-1.18).
Conclusions. Apocrine carcinomas represent a clinic-pathological distinct group of triple-negative BC, characterized by significantly more favorable clinical prognosis in terms of long-term disease-related morbidity or mortality when compared to NA-TN tumors.
Citation Format: Meattini I, Pezzulla D, Carta GA, Becherini C, Perna M, Grassi R, Garlatti P, Desideri I, Scotti V, Bernini M, Sanchez LJ, Orzalesi L, Nori J, Bianchi S, Livi L. Triple negative apocrine carcinomas as a distinct subtype of triple negative breast cancer: A case-control study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-07.
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Affiliation(s)
- I Meattini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - D Pezzulla
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - GA Carta
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - C Becherini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - M Perna
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - R Grassi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - P Garlatti
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - I Desideri
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - V Scotti
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - M Bernini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - LJ Sanchez
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - L Orzalesi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - J Nori
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - S Bianchi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - L Livi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
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Vannini A, Meattini I, Grassi R, Carta G, Perna M, Becherini C, Garlatti P, Scotti V, Desideri I, Bonomo P, Livi L. First-line bevacizumab in combination with weekly paclitaxel for metastatic breast cancer: efficacy and safety results from a routine oncology practice analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meattini I, Salvadori B, Coltelli L, Perna M, Carta G, Becherini C, Grassi R, Garlatti P, Cappelli S, Desideri I, Vannini A, Fontana A, Landucci E, Michelotti A, Ricci S, Allegrini G, Falcone A, Livi L. Efficacy and safety of everolimus and exemestane for metastatic breast cancer patients: a real-life experience of three Oncology Departments. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Meattini I, Desideri I, Francolini G, Vannini A, Perna M, Garlatti P, Grassi R, Livi L. Systemic therapies and cognitive impairment for breast cancer: an overview of the current literature. Med Oncol 2017; 34:74. [PMID: 28364269 DOI: 10.1007/s12032-017-0935-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/28/2017] [Indexed: 12/26/2022]
Abstract
Both endocrine and chemotherapy can be utilized for breast cancer patients' management, in multiple setting (i.e., primary systemic therapy, adjuvant, metastatic treatment). Health-related quality of life in breast cancer survivors can be significantly influenced by cognitive impairment, which has been related in several previously reported experiences to systemic therapies administration. However, although the growing body of literature, the impact of both chemo- and endocrine therapy on cognitive function is currently unclear, due to many confounding factors (i.e., multiple therapies, duration of therapy, comorbidity, age). The aim of the present review is to present an overview of the current literature concerning the possible influence of endocrine and systemic therapy on breast cancer patients' cognitive impairment.
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Affiliation(s)
- Icro Meattini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Isacco Desideri
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Giulio Francolini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Agnese Vannini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Marco Perna
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Pietro Garlatti
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Roberta Grassi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Livi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
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