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Roberti E, Merlano M, Ravanelli M, Alberti A, Esposito A, Gili R, Spinazzé S, Baré C, Jocollé G, Benasso M, Bertolotti F, Vecchio S, Bacigalupo A, Licitra L, Denaro N, Damico M, Lorini L, Gurizzan C, Alfieri S, Bossi P. Muscle quality and not quantity as a predictor of survival in head and neck squamous cell carcinoma. Oral Oncol 2023; 145:106540. [PMID: 37567147 DOI: 10.1016/j.oraloncology.2023.106540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Sarcopenia is frequent in head and neck squamous cell carcinoma (HNSCC), as a consequence of malnutrition related to risk factors or tumoral mass. Treatment is associated with toxicities that lead to reduced calories intake and muscle mass wasting. Sarcopenia has been negatively associated with tumor control and survival outcomes. PURPOSE Our aim is to evaluate the prognostic impact of sarcopenia on overall survival (OS) and progression free survival (PFS) in HNSCC patients undergoing chemoradiation therapy within a prospective clinical trial of chemoradiation vs induction chemotherapy followed by radiation and cetuximab (INTERCEPTOR). MATERIALS AND METHODS On baseline CT or MRI, we investigated the association between OS and PFS with radiological markers of sarcopenia, measured at the third cervical vertebra level. We studied paravertebral skeletal muscles area (cm2), muscle density (HU), muscle index (cm2/m2), and intermuscular adipose tissue (IMAT) area (cm2). RESULTS Imaging of 128 patients was evaluable. We found out that higher body mass index (BMI) was associated with better OS (p = 0.02), and PFS (p = 0.04). Skeletal muscle area (p = 0.02), and IMAT (p = 0.02) were negatively associated with PFS. IMAT was positively correlated with muscle area (Correlation coefficient 0.6, CI95% 0.47-0.7), and negatively associated with muscle density (Correlation coefficient -0.37, CI95% -0.53 - -0.18). CONCLUSIONS IMAT can be used as predictor of PFS in HNC patients undergoing chemoradiation therapy. The amount of intermuscular fat deposits induces alterations of muscle quality, without alterations of muscle quantity, influencing patients' prognosis.
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Affiliation(s)
- Elisabetta Roberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy; University of Brescia Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy
| | - Marco Merlano
- Department of Medical Oncology, S Croce and Carle Teaching Hospital, Cuneo, Italy
| | | | - Andrea Alberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Andrea Esposito
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Riccardo Gili
- UO Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Silvia Spinazzé
- Medical Oncology Unit, Ospedale U. Parini, Viale Ginevra 3, 11100 Aosta, Italy
| | - Cristina Baré
- Medical Oncology Unit, Ospedale U. Parini, Viale Ginevra 3, 11100 Aosta, Italy
| | - Genny Jocollé
- Medical Oncology Unit, Ospedale U. Parini, Viale Ginevra 3, 11100 Aosta, Italy
| | - Marco Benasso
- Department of Oncology, San Paolo Hospital, Savona, Italy
| | | | - Stefania Vecchio
- UO Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Almalina Bacigalupo
- UO Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori & University of Milan, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Nerina Denaro
- Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mauro Damico
- Unit of Medical Oncology, Galliera Hospital, Genoa, Italy
| | - Luigi Lorini
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Cristina Gurizzan
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Alfieri
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Paolo Bossi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.
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Cavalieri S, Serafini MS, Carenzo A, Canevari S, Lenoci D, Pistore F, Miceli R, Vecchio S, Ferrari D, Moro C, Sponghini A, Caldara A, Rocca MC, Secondino S, Moretti G, Denaro N, Caponigro F, Vaccher E, Rinaldi G, Ferraù F, Bossi P, Licitra L, De Cecco L. An Inflammatory Signature to Predict the Clinical Benefit of First-Line Cetuximab Plus Platinum-Based Chemotherapy in Recurrent/Metastatic Head and Neck Cancer. Cells 2022; 11:cells11193176. [PMID: 36231138 PMCID: PMC9563947 DOI: 10.3390/cells11193176] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/28/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) pathway has been shown to play a crucial role in several inflammatory conditions and host immune-inflammation status is related to tumor prognosis. This study aims to evaluate the prognostic significance of a four-gene inflammatory signature in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients treated with the EGFR inhibitor cetuximab plus chemotherapy. The inflammatory signature was assessed on 123 R/M HNSCC patients, enrolled in the multicenter trial B490 receiving first-line cetuximab plus platinum-based chemotherapy. The primary endpoint of the study was progression free survival (PFS), while secondary endpoints were overall survival (OS) and objective response rate (ORR). The patient population was subdivided into 3 groups according to the signature score groups. The four-genes-signature proved a significant prognostic value, resulting in a median PFS of 9.2 months in patients with high vs. 6.2 months for intermediate vs. 3.9 months for low values (p = 0.0016). The same findings were confirmed for OS, with median time of 18.4, 13.4, and 7.5 months for high, intermediate, and low values of the score, respectively (p = 0.0001). When ORR was considered, the signature was significantly higher in responders than in non-responders (p = 0.0092), reaching an area under the curve (AUC) of 0.65 (95% CI: 0.55–0.75). Our findings highlight the role of inflammation in the response to cetuximab and chemotherapy in R/M-HNSCC and may have translational implications for improving treatment selection.
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Affiliation(s)
- Stefano Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Mara Serena Serafini
- Molecular Mechanisms Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Andrea Carenzo
- Molecular Mechanisms Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Silvana Canevari
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Deborah Lenoci
- Molecular Mechanisms Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Federico Pistore
- Head and Neck Medical Oncology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Stefania Vecchio
- Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Daris Ferrari
- Medical Oncology, Ospedali Santi Paolo e Carlo, 20142 Milan, Italy
| | - Cecilia Moro
- Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Andrea Sponghini
- Medical Oncology, A.O. Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Alessia Caldara
- Medical Oncology, Ospedale Santa Chiara, 38122 Trento, Italy
| | - Maria Cossu Rocca
- Division of Urogenital and Head and Neck Medical Oncology, European Institute of Oncology IRCCS, 20133 Milan, Italy
| | - Simona Secondino
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Nerina Denaro
- Medical Oncology, St. Croce e Carle University Teaching Hospital and ARCO Foundation, 12045 Cuneo, Italy
| | - Francesco Caponigro
- Medical Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione Pascale, 80131 Naples, Italy
| | - Emanuela Vaccher
- Medical Oncology and Immune-Related Tumours, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Gaetana Rinaldi
- Medical Oncology, AOU Policlinico "Paolo Giaccone", 90127 Palermo, Italy
| | | | - Paolo Bossi
- Head and Neck Medical Oncology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Loris De Cecco
- Molecular Mechanisms Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
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Lorini L, Perri F, Vecchio S, Belgioia L, Vinches M, Brana I, Elad S, Bossi P. Confounding factors in the assessment of oral mucositis in head and neck cancer. Support Care Cancer 2022; 30:8455-8463. [PMID: 35639187 PMCID: PMC9512735 DOI: 10.1007/s00520-022-07128-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
Treatment of locally advanced head and neck carcinoma not amenable for surgical resection or resected with high-risk features is usually based on (chemo-)radiation treatment. Oral mucositis represents one of the main side effects of (chemo-)radiation, with an important impact on quality of life and causing approximately 20% of early interruption of treatment, leading to a suboptimal dose administered. Treatment and prevention of oral mucositis have a central role in the therapeutic pathways of head and neck cancer patients but remains quite challenging. Although extensive research is conducted to identify interventions for the management of mucositis, very few interventions had sufficient evidence to generate an international expert consensus. This may be partially explained by confounding factors that could influence the development and assessment of oral mucositis. Little is known about the confounding factors of oral mucositis, which, if not well balanced in an experimental study, could lead to non-solid results. The current paper aims to review the main oral mucositis confounding factors related to head and neck cancer patients.
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Affiliation(s)
- Luigi Lorini
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, 25123, Brescia, Italy
| | - Francesco Perri
- Head and Neck Cancer Unit, Istituto Nazionale Tumori Di Napoli, IRCCS "G. Pascale", Naples, Italy
| | - Stefania Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genoa, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, Health Science Department (DISSAL), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marie Vinches
- Montpellier Cancer Research Institute, Montpellier, Languedoc-Roussillon, France
| | - Irene Brana
- Department of Medical Oncology, Vall D'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, 25123, Brescia, Italy.
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4
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Carletti R, Galvani M, Gardini E, De Vita M, Dallaserra C, Vizzuso A, Ottani F, Campacci F, Grosseto D, Di Gianuario G, Rinaldi G, Vecchio S, Mantero F, Mellini L, Albini A, Mughetti M, Gardelli G, Piciucchi S. P397 PROGNOSTIC VALUE OF CORONARY CALCIUM IN PATIENTS WITH COVID–19 AND SUSPECTED INTERSTITIAL PNEUMONIA: A CASE–CONTROL STUDY. Eur Heart J Suppl 2022. [PMCID: PMC9384032 DOI: 10.1093/eurheartj/suac012.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Short–term prognosis of SARS–CoV2 infection is mainly conditioned by the extent and severity of COVID–19 interstitial pneumonia. Coexistence of cardiac disease is however important and independently associated with an adverse outcome. Coronary calcium (CAC), detected at the time of chest computed tomography, can be a useful prognostic tool, as suggested by some cohort studies. Material and Methods We performed a retrospective, multi–centre, case–control (1:2) study in 195 COVID–19 patients admitted from 01–03–2020 to 30–04–2020. Cases were consecutive patients died within 30 days or admitted to the Intensive Care Units for invasive ventilation during the hospitalization (primary outcome measure). Controls were age– and sex–matched patients surviving until 30 days without need for invasive ventilation. For each case, we selected two controls, matched by age and sex dividing cases in age strata of 10 years, assuring within each age stratum twice the number of controls with an identical gender proportion. CAC estimation was performed with a with a semi–quantitative score (0 to 30) based on 10 segments and 4 degrees of severity of the calcification. Estimation of interstitial pneumonia, was similarly performed with a semi–quantitative score (from 0 to 20), based on 5 lobes and 5 degrees of severity of interstitial involvement. CT scans were acquired according to a standard protocol for non–cardio–synchronized chest CT, always on a multi–detector scanner with at least 16 layers. Results The mean CAC value in cases was significantly higher (p = 0.001) compared to controls: 5,52±1,38 vs 3,28±0,54 (mean value ± 95% CI). The percentage of cases with moderate–severe CAC was significantly higher (p = 0.013) compared to controls (41.5% vs 22.8%, OR 2.27 95% CI 1.20–4.29; primary end–point of the study). In multivariate analysis, independent predictors of outcome were (in descending order): interstitial pneumonia severity score (Wald 8.143, p = 0.004), CC score (Wald 5.569, p = 0.018), and the LDH value on admission (Wald 3.335, p = 0.034). Conclusions In our case–control study, the severity and extent of CAC is the main prognostic factor for the occurrence of adverse clinical outcome, beside the severity of interstitial pneumonia. These data suggest that a semi–quantitative estimation of CAC, feasible on any CT detector without the need of dedicated software, is clinically useful for the prognostic assessment of patients with COVID–19 interstitial pneumonia.
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Affiliation(s)
- R Carletti
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - M Galvani
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - E Gardini
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - M De Vita
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - C Dallaserra
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - A Vizzuso
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - F Ottani
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - F Campacci
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - D Grosseto
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - G Di Gianuario
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - G Rinaldi
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - S Vecchio
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - F Mantero
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - L Mellini
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - A Albini
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - M Mughetti
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - G Gardelli
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
| | - S Piciucchi
- UOC CARDIOLOGIA FORLÌ, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, FORLÌ; UOC RADIOLOGIA FORLÌ, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, FORLÌ; UNITÀ DI RICERCA CARDIOVASCOLARE, FONDAZIONE SACCO, FORLÌ; UOC CARDIOLOGIA RIMINI, DIPARTIMENTO CARDIOVASCOLARE, AUSL ROMAGNA, RIMINI; UOC RADIOLOGIA RIMINI, DIPARTIMENTO DELLE IMMAGINI, AUSL ROMAGNA, RIMINI; UOC CARDIOLOGIA RAVENNA, DIPARTIMENTO CARDIO
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5
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Economopoulou P, Pantazopoulos A, Spathis A, Kotsantis I, Kyriazoglou A, Kavourakis G, Zakopoulou R, Chatzidakis I, Anastasiou M, Prevezanou M, Resteghini C, Licitra L, Bergamini C, Colombo E, Caspani F, Denaro N, Vecchio S, Bonomo P, Cossu Rocca M, Bertolini F, Ferrari D, Psyrri A, Bossi P. Immunotherapy in Nonendemic Nasopharyngeal Carcinoma: Real-World Data from Two Nonendemic Regions. Cells 2021; 11:32. [PMID: 35011594 PMCID: PMC8750043 DOI: 10.3390/cells11010032] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND nasopharyngeal carcinoma (NPC) is a complex disease entity that mainly predominates in endemic regions. Real-world data with immunotherapy from nonendemic regions are limited. METHODS we collected data from patients with recurrent/metastatic (R/M) NPC treated at a center in Greece and 8 centers in Italy. Between 2016 and 2021, 46 patients who were treated with at least one cycle of immune checkpoint inhibitors (ICI) were identified. Herein, we present our results and a review of the literature. RESULTS assessment of response was available in 42 patients. Overall, 11 patients responded to immunotherapy (Overall Response Rate-ORR 26.2%). Three patients had complete response (CR), and 8 patients had partial response (PR). Disease control rate (DCR) was 61.9%. Median Progression Free Survival (PFS) was 5.6 months and median Overall Survival (OS) was 19.1 months. Responders to ICI improved PFS and OS as compared to that of nonresponders. A lower probability of responding to ICI was shown in patients with more than three metastatic sites (p = 0.073), metastatic disease at initial diagnosis, (p = 0.039) or EBV DNA positive before ICI initiation, (p = 0.074). Decline in EBV DNA levels was found to be statistically significant associated with best response to ICI (p = 0.049). Safety was manageable. CONCLUSIONS among 46 patients with R/M NPC treated with immunotherapy in two nonendemic regions, ORR was 26.2% and durable responses were observed. Low disease burden could serve as a biomarker for response to ICI.
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Affiliation(s)
- Panagiota Economopoulou
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Anastasios Pantazopoulos
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Aris Spathis
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Ioannis Kotsantis
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Anastasios Kyriazoglou
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - George Kavourakis
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Roubini Zakopoulou
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Ioannis Chatzidakis
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Maria Anastasiou
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Maria Prevezanou
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Carlo Resteghini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133 Milan, Italy; (C.R.); (L.L.); (C.B.); (E.C.); (F.C.)
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133 Milan, Italy; (C.R.); (L.L.); (C.B.); (E.C.); (F.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133 Milan, Italy; (C.R.); (L.L.); (C.B.); (E.C.); (F.C.)
| | - Elena Colombo
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133 Milan, Italy; (C.R.); (L.L.); (C.B.); (E.C.); (F.C.)
| | - Francesca Caspani
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133 Milan, Italy; (C.R.); (L.L.); (C.B.); (E.C.); (F.C.)
| | - Nerina Denaro
- Medical Oncology Santa Croce and Carle General Hospital Cuneo, 12100 Cuneo, Italy;
| | | | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy;
| | - Maria Cossu Rocca
- Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Treatment, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Federica Bertolini
- Medical Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy;
| | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, 20142 Milan, Italy;
| | - Amanda Psyrri
- Section of Medical Oncology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.E.); (A.P.); (I.K.); (A.K.); (G.K.); (R.Z.); (I.C.); (M.A.); (M.P.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST-Spedali Civili, 25123 Brescia, Italy;
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6
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Bossi P, Trama A, Bernasconi A, Grisanti S, Mohamad I, Galiana IL, Ozyar E, Franco P, Vecchio S, Bonomo P, Cirauqui BC, El-Sherify M, Ursino S, Argiris A, Pan J, Wittekindt C, D'Angelo E, Costa L, Buglione M, Johnson J, Airoldi M, Mesia R, Resteghini C, Licitra L, Orlandi E. Nasopharyngeal cancer in non-endemic areas: Impact of treatment intensity within a large retrospective multicentre cohort. Eur J Cancer 2021; 159:194-204. [PMID: 34773903 DOI: 10.1016/j.ejca.2021.09.005] [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: 04/13/2021] [Revised: 08/16/2021] [Accepted: 09/05/2021] [Indexed: 02/08/2023]
Abstract
AIM Recommendations for managing patients with nasopharyngeal carcinoma (NPC) in non-endemic areas are largely derived from studies conducted in endemic areas. We analysed the impact of treatment approaches on survival in non-endemic areas. METHODS In an international, multicentre, retrospective study, we analyse consecutive patients with NPC diagnosed between 2004 and 2017 in 36 hospitals from 11 countries. Treatment was categorised as non-intensive (NIT), including radiotherapy alone or concomitant chemoradiotherapy (cCRT), and intensive (IT) including cCRT preceded by and/or followed by chemotherapy (CT). The impact of IT on overall survival (OS) and disease-free survival (DFS) was adjusted for all the available potential confounders. RESULTS Overall, 1021 and 1113 patients were eligible for overall survival (OS) and disease-free survival (DFS) analyses, respectively; 501 and 554 with Epstein Barr-encoded RNA (EBER) status available. In the whole group, 5-year OS was 84% and DFS 65%. The use of NIT was associated with a risk of death or recurrence 1.37 times higher than patients receiving IT. Patients submitted to NIT and induction CT + concurrent concomitant chemo and three-dimensional Conformal Radiation Therapy (3DCRT) had a risk of death or recurrence 1.5 and 1.7 times higher than patients treated with induction CT + cCRT with intensity-modulated radiotherapy (IMRT), respectively. The IT had no impact on OS in neither patients with EBER+ nor in patients with EBER-; IT showed better DFS in EBER+ but not in patients with EBER-. CONCLUSIONS In low-incidence areas, patients with NPC treated with induction CT followed by concurrent IMRT cCRT achieved the highest DFS rate. The benefit of IT on DFS was restricted to patients with EBER+, suggesting that additional therapy offers no advantages in EBER- cases.
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Affiliation(s)
- Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy; Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Annalisa Trama
- Evalutative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Alice Bernasconi
- Evalutative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy.
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan.
| | - Isabel L Galiana
- Radiation Oncology Department, Hospital Duran IReynals, Institut Català D'Oncologia-L'Hospitalet, Radiobiology and Cancer Group, IDIBELL, Barcelona, Spain.
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey.
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont and AOU 'Maggiore Della Carita', Novara, Italy.
| | - Stefania Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy.
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Beatriz C Cirauqui
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Badalona, Spain.
| | | | - Stefano Ursino
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Jonathan Pan
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Justus-Liebig University Giessen, Giessen, Germany.
| | - Elisa D'Angelo
- Radiation Oncology Unit, University Hospital of Modena, Italy.
| | - Loredana Costa
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| | - Michela Buglione
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| | - Jennifer Johnson
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Mario Airoldi
- Medical Oncology, Città Della Salute e Della Scienza, Torino, Italy.
| | - Ricard Mesia
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Badalona, Spain.
| | - Carlo Resteghini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
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7
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Alfieri S, Romanò R, Bologna M, Calareso G, Corino V, Mirabile A, Ferri A, Bellanti L, Poli T, Marcantoni A, Grosso E, Tarsitano A, Battaglia S, Blengio F, De Martino I, Valerini S, Vecchio S, Richetti A, Deantonio L, Martucci F, Grammatica A, Ravanelli M, Ibrahim T, Caruso D, Locati LD, Orlandi E, Bossi P, Mainardi L, Licitra LF. Prognostic role of pre-treatment magnetic resonance imaging (MRI)-based radiomic analysis in effectively cured head and neck squamous cell carcinoma (HNSCC) patients. Acta Oncol 2021; 60:1192-1200. [PMID: 34038324 DOI: 10.1080/0284186x.2021.1924401] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To identify and validate baseline magnetic resonance imaging (b-MRI) radiomic features (RFs) as predictors of disease outcomes in effectively cured head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS AND METHODS Training set (TS) and validation set (VS) were retrieved from preexisting datasets (HETeCo and BD2Decide trials, respectively). Only patients with both pre- and post-contrast enhancement T1 and T2-weighted b-MRI and at least 2 years of follow-up (FUP) were selected. The combination of the best extracted RFs was used to classify low risk (LR) vs. high risk (HR) of disease recurrence. Sensitivity, specificity, and area under the curve (AUC) of the radiomic model were computed on both TS and VS. Overall survival (OS) and 5-year disease-free survival (DFS) Kaplan-Meier (KM) curves were compared for LR vs. HR. The radiomic-based risk class was used in a multivariate Cox model, including well-established clinical prognostic factors (TNM, sub-site, human papillomavirus [HPV]). RESULTS In total, 57 patients of TS and 137 of VS were included. Three RFs were selected for the signature. Sensitivity of recurrence risk classifier was 0.82 and 0.77, specificity 0.78 and 0.81, AUC 0.83 and 0.78 for TS and VS, respectively. VS KM curves for LR vs. HR groups significantly differed both for 5-year DFS (p<.0001) and OS (p=.0004). A combined model of RFs plus TNM improved prognostic performance as compared to TNM alone, both for VS 5-year DFS (C-index: 0.76 vs. 0.60) and OS (C-index: 0.74 vs. 0.64). CONCLUSIONS Radiomics of b-MRI can help to predict recurrence and survival outcomes in HNSCC.
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Affiliation(s)
- Salvatore Alfieri
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Rebecca Romanò
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Marco Bologna
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Giuseppina Calareso
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Valentina Corino
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Aurora Mirabile
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Ferri
- Department of Surgery, Maxillo-Facial Surgery Division, University Hospital of Parma, Parma, Italy
| | - Luca Bellanti
- Department of Surgery, Maxillo-Facial Surgery Division, University Hospital of Parma, Parma, Italy
| | - Tito Poli
- Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), Unit of Maxillo-Facial Surgery, University of Parma, Parma, Italy
| | | | - Enrica Grosso
- Division of Head and Neck Surgery, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Achille Tarsitano
- Department of Biomedical and Neuromotor Sciences, Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Salvatore Battaglia
- Department of Biomedical and Neuromotor Sciences, Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fulvia Blengio
- Medical Oncology Department, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Iolanda De Martino
- Medical Oncology Department, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Valerini
- Neuroscience Head and Neck Department, Otolaryngology Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Stefania Vecchio
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonella Richetti
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Letizia Deantonio
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Alberto Grammatica
- Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Unit of Radiology, University of Brescia, Brescia, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Damiano Caruso
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Laura Deborah Locati
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Ester Orlandi
- Radiotherapy Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public, Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Lisa F. Licitra
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
- University of Milan, Milan, Italy
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8
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Merlano MC, Denaro N, Vecchio S, Licitra L, Curcio P, Benasso M, Bagicalupo A, Numico G, Russi E, Corvo' R, Bruzzi P. Phase III Randomized Study of Induction Chemotherapy Followed by Definitive Radiotherapy + Cetuximab Versus Chemoradiotherapy in Squamous Cell Carcinoma of Head and Neck: The INTERCEPTOR-GONO Study (NCT00999700). Oncology 2020; 98:763-770. [PMID: 32629446 DOI: 10.1159/000507733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/25/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Induction chemotherapy followed by cetuximab and RT (IBRT) (Arm A) was compared to cisplatin/RT (CRT) (Arm B) in a randomized phase III study. PATIENTS AND METHODS Naïve patients with stage III-IVa, histologically proven locally advanced head and neck cancer (LASCCHN) were eligible. Arm A (IBRT): 3 TPF induction followed by cetuximab-RT (equivalent daily dose 2 Gy up to 70 Gy); Arm B: 3 cisplatin concurrent with the same RT scheduling. Due to slow accrual and incomplete data collection a futility analysis was performed. RESULTS 236/282 patients were evaluable. Therefore, no formal analyses can be made between the two arms. OS was 45.2/53.6 months in Arm A/B. Complete responses were achieved in 64% of patients in both arms. Neutropenia and skin toxicity were significantly worse in Arm A and body weight loss was significantly worse in Arm B. Compliance with the planned drug administration was higher in Arm B (p = 0.0008). CONCLUSION The study suggests that IBRT and CRT have similar efficacy, activity and toxicity.
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Affiliation(s)
- Marco Carlo Merlano
- Medical Oncology, St. Croce & Carle University Teaching Hospital and ARCO Foundation, Cuneo, Italy
| | - Nerina Denaro
- Medical Oncology, St. Croce & Carle University Teaching Hospital and ARCO Foundation, Cuneo, Italy,
| | - Stefania Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Paola Curcio
- Trials Office, Medical Oncology, St. Croce & Carle University Teaching Hospital, Cuneo, Italy
| | - Marco Benasso
- Medical Oncology, San Paolo General Hospital, Savona, Italy
| | | | - Gianmauro Numico
- Medical Oncology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Elvio Russi
- Radiation Oncology, St. Croce & Carle University Teaching Hospital, Cuneo, Italy
| | - Renzo Corvo'
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy.,Radiation Oncology, San Martino Hospital, Genova, Italy
| | - Paolo Bruzzi
- Statistic Unit, Genova University, Genova, Italy
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9
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Alfieri S, Romanò R, Bologna M, Calareso G, Mirabile A, Ferri A, Marcantoni A, Grosso E, Tarsitano A, Valerini S, Vecchio S, Deantonio L, Blengio F, Ibrahim T, Mancinelli M, Ascoli F, Bossi P, Locati LD, Mainardi L, Licitra LF. Prognostic role of pre-treatment magnetic resonance imaging (MRI) radiomic analysis in patients with squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6553 Background: Emerging data suggest that radiomics can be used to predict outcomes in SCCHN. At present, only few data are available for pre-treatment MRI. Methods: Study population was retrieved from an ongoing multicenter, randomized, prospective trial (NCT02262221, HETeCo) evaluating health and economic outcomes of two different follow-up (FUP) strategies (intensive vs non-intensive) in effectively cured stage III-IV (VIII TNM ed.) SCCHN. We selected only patients with both pre- and post-contrast enhancement T1 and T2-weighted baseline MRI (b-MRI) and at least 2 years (2y) of FUP. A radiomic model was developed to identify high risk (HR) and low risk (LR) of disease recurrence. Radiomic features (RF) were extracted from the primary tumor in the b-MRI. The best RF combination was selected by Least Absolute Shrinkage and Selection Operator (LASSO). Ten-fold cross-validation was used to compute sensitivity, specificity and area under the curve (AUC) of the classifier. Kaplan-Meier (KM) curves were estimated for HR and LR, for both overall survival (OS) and disease-free survival (DFS) and log rank test was performed. Three years (3y)-DFS and OS were also estimated for the two groups. The radiomic risk class was used as a new variable in a multivariate Cox model including well established prognostic factors in SCCHN (TNM stage, subsite and HPV). Results: Out of 155 enrolled HETeCO patients, 98 baseline imaging were retrieved of which 57 b-MRI. Of these, 51 met the eligibility criteria (25 in intensive and 26 in non-intensive arm). Baseline patients’ characteristics were: median age 66 yr (38-86); sex (M 42; F 9); median smoking history: 30 packs/y (1-100); 25 oral cavity (49%), 18 oropharynx (35%, 14 HPV+), 6 larynx (12%), 2 hypopharynx (4%). At a median FUP of 42 months (25-64), 45 (88%) patients are still alive. The recurrence rate was 20% (10/51, of which 2 distant). In total, 1608 RF were extracted. The sensitivity, specificity and AUC of the classifier were 90%, 76%, and 80%, respectively. The radiomic risk class was found to be an independent prognostic factor for both DFS and OS (p=0.01 and p=0.046, respectively). KM curves for DFS and OS were significantly different between HR and LR groups (p=0.002 and p=0.04, respectively). In HR vs LR, 3-y DFS and OS were: 78% [61-100%] vs 97% [90-100%], and 88% [75-100%] vs 96% [88-100%], respectively. Conclusions: Radiomics of pre-treatment MRI can predict outcomes in SCCHN. External validation of this preliminary radiomics-based model is currently ongoing.
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Affiliation(s)
- Salvatore Alfieri
- Head and Neck Cancer Medical Oncology 3 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rebecca Romanò
- Head and Neck Cancer Medical Oncology Unit 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Bologna
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Giuseppina Calareso
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aurora Mirabile
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division, Department of Surgery, University Hospital of Parma, Parma, Italy
| | | | - Enrica Grosso
- Division of Head and Neck Surgery, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Achille Tarsitano
- Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sara Valerini
- Otolaryngology Unit, Neuroscience Head and Neck Department, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Stefania Vecchio
- Medical Oncology 2, IRCCS San Martino, IST National Cancer Institute, Genova and University of Genova, Genoa, Italy
| | - Letizia Deantonio
- Radiation Oncology Clinic Oncology, Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Switzerland
| | - Fulvia Blengio
- Medical Oncology Department, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Alessandria, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Moela Mancinelli
- Head and Neck Cancer Medical Oncology 3 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Ascoli
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Milan, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Deborah Locati
- Head and Neck Cancer Medical Oncology 3 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Mainardi
- Department of Electronics, Information and BioEngineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Lisa F. Licitra
- Fondazione IRCCS-Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
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Bossi P, Grisanti S, Mohamad I, Linares Galiana I, Ozyar E, Franco P, Vecchio S, Livi L, Cirauqui Cirauqui B, El-Sherify M, Ursino S, Argiris A, Pan J, Wittekindt C, D’angelo E, Buglione M, Airoldi M, Mesia Nin R, Licitra L, Orlandi E. Survival and prognostic factors of nasopharyngeal cancer patients in non-endemic countries: A large multicentric database analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Merlano M, Denaro N, Benasso M, Licitra L, Bossi P, Locati L, Vecchio S, Bruzzi P. Difficulties in conducting pure academic research, obstacles in data collection and quality of informations: The example of the INTERCEPTOR study. Oral Oncol 2019; 97:99-104. [PMID: 31472438 DOI: 10.1016/j.oraloncology.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/08/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE/OBJECTIVE On September 2009: We started a randomized multicenter phase III study comparing chemoradiation (CRT) (Aldestein RTOG regimen) versus induction chemotherapy followed by Cetuximab radiation (IBRT). The main study's aim was comparison of overall survival but no formal analyses have been made between the two arms because of low accrual and high amount of missing data. The goal of this paper is to identify the reasons of difference in accrual and quality of data among participating centers. MATERIAL/METHODS Statistic: We correlated data collection quality with relevance of the centers, accrual and number of scientific papers (both specific on HNC and other topics) of each PI. We created an HNC publishing score dividing the number of HNC specific papers for the overall number of published papers. RESULTS We observed a strong difference in the accrual of pts as well as in the quality of data among the participating centers. The accrual was independent from the quality of data since some centers with low accrual produced high quality data with an excellent follow up. We found a correlation among both number of published papers of each PI and HNC publishing score with the quality of data. CONCLUSION The study demonstrated that expertise in HNC is important not only to ensure a better outcomes but also to provide high quality data in phase III trials.
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Affiliation(s)
- M Merlano
- Medical Oncology, St. Croce & Carle University Teaching Hospital, ARCO Foundation, Cuneo, Italy
| | - N Denaro
- Medical Oncology, St. Croce & Carle University Teaching Hospital, Cuneo, Italy.
| | - M Benasso
- Medical Oncology, San Paolo General Hospital Savona, Italy
| | - L Licitra
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy.
| | - P Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy.
| | - L Locati
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy.
| | - S Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy.
| | - P Bruzzi
- Statistic Unit, Genova University, Italy
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Marchi F, Filauro M, Missale F, Parrinello G, Incandela F, Bacigalupo A, Vecchio S, Piazza C, Peretti G. A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases. Cancers (Basel) 2019; 11:E717. [PMID: 31137671 PMCID: PMC6562846 DOI: 10.3390/cancers11050717] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Almalina Bacigalupo
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Radiation Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Stefania Vecchio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
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13
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Belgioia L, Bacigalupo A, Missale F, Negrini S, Filaci G, Fenoglio D, Incandela F, Vecchio S, Peretti G, Corvò R. PV-0535 Pilot study on immunomodulation role of radiotherapy in oropharyngeal cancer: preliminary results. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30955-7] [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: 11/24/2022]
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14
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Belgioia L, Bacigalupo A, Missale F, Vecchio S, Chiola I, Callegari S, Verzanini E, Peretti G, Corvò R. Individualized treatment of head neck squamous cell carcinoma patients aged 70 or older with radiotherapy alone or associated to cisplatin or cetuximab: impact of weekly radiation dose on loco-regional control. Med Oncol 2019; 36:42. [PMID: 30927146 DOI: 10.1007/s12032-019-1264-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022]
Abstract
The purpose of this study is to evaluate if, in elderly HNC patients, loco-regional control (LRC) is influenced by average weekly radiation dose (AWD). From 2009 to 2017, 150 consecutive HNC elderly patients were analyzed. AWD was calculated by dividing total dose in Gray by overall treatment time in weeks. Patients were divided in 2 groups: Group 1 (70-75 years) and Group 2 (> 75 years). Primary endpoint was LRC; secondary endpoints were overall survival (OS) and compliance to treatment. The median age was 76 years (range 70-92), the distribution of patients by age was 72 and 78 patients in Group 1 and in Group 2, respectively; overall median follow-up was 23 months. Optimal cut-off of AWD for LRC was 9.236 (p = 0.018). Median OS was 73 months. In univariate survival analysis low PS (p = 0.005), T3-T4 (p = 0.021), Stage III-IV (p = 0.046) and AWDLow (< 9.236) (p = 0.018) were significantly associated with lower LRC; low PS (p < 0.001) and Group 2 (p = 0.006) were also associated with lower OS. Considering patients treated with radiotherapy alone AWDLow was significantly associated with lower LRC (p = 0.04) whereas among patient treated with chemoradiotherapy AWD did not affected LRC (p = 0.18). The multivariate analysis confirmed the significant value of PS for the prediction of LRC and OS (p = 0.035 and p < 0.001, respectively). In elderly patients an AWD of > 9.236 Gy was found to be beneficial for RT alone regimen. When radiotherapy alone is indicated in elderly patients an effort should be made to maintain an increased AWD in order to improve LRC.
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Affiliation(s)
- Liliana Belgioia
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Almalina Bacigalupo
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Vecchio
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ilaria Chiola
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Serena Callegari
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elisa Verzanini
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Renzo Corvò
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Grisanti S, Bianchi S, Locati LD, Triggiani L, Vecchio S, Bonetta A, Bergamini C, Conte P, Airoldi M, Merlano M, Carlini P, Ibrahim T, Rossetto C, Alfieri S, Pronzato P, Tonoli S, Maroldi R, Nicolai P, Resteghini C, Magrini SM, Berruti A. Bone metastases from head and neck malignancies: Prognostic factors and skeletal-related events. PLoS One 2019; 14:e0213934. [PMID: 30893350 PMCID: PMC6426213 DOI: 10.1371/journal.pone.0213934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/04/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We conducted a multicenter retrospective analysis to describe the characteristics, frequency of skeletal-related events (SREs), and prognosis of head and neck cancer (HNC) in patients with bone metastases (BM). PATIENTS AND METHODS The data of 192 HNC patients with BMs were collected. Analyses were conducted separately in 64 nasopharyngeal cancer (NPC) patients and in 128 non-NPC patients. RESULTS SREs occurred in 34 (27%) non-NPC and in 6 (9%) NPC patients, respectively. Median overall survival (OS) was 25 and 6 months in NPC and non-NPC patients, respectively. Locoregional recurrence (hazard ratio [HR] 2.33, 95% confidence interval (CI) 1.1-4.93), synchronous BM (HR 0.25, 95% CI 0.59-0.71) and bone-directed therapies (BDT) (HR 0.26, 95% CI 0.10-0.68) were independent prognostic factors for OS in NPC patients. Combined bone radiotherapy (RT) and BDT in NPC patients obtained longer survival (38 months) than either therapy alone (25 months) or neither of these therapies (8 months). CONCLUSIONS Patients with BMs from non-NPC have a poor prognosis and are at high risk of SREs. NPC patients with BMs are at relatively low risk of SREs. BDT may potentially improve survival, particularly when combined with bone RT. This last finding deserves prospective confirmation.
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Affiliation(s)
- Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Susanna Bianchi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Laura D. Locati
- Medical Oncology/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Triggiani
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Stefania Vecchio
- Medical Oncology Unit, IRCCS San Martino, IST National Cancer Institute and University of Genoa, Genoa Italy
| | - Alberto Bonetta
- Department of Radiotherapy, Istituti Ospitalieri di Cremona (ASST), Cremona, Italy
| | - Cristiana Bergamini
- Medical Oncology/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Italy
| | - Marco Merlano
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Paolo Carlini
- Medical Oncology, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ciro Rossetto
- Department of Oncology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Salvatore Alfieri
- Medical Oncology/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Pronzato
- Medical Oncology Unit, IRCCS San Martino, IST National Cancer Institute and University of Genoa, Genoa Italy
| | - Sandro Tonoli
- Department of Radiotherapy, Istituti Ospitalieri di Cremona (ASST), Cremona, Italy
| | - Roberto Maroldi
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology–Head & Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili, Brescia, Italy
| | - Carlo Resteghini
- Medical Oncology/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano M. Magrini
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
- * E-mail:
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Bacigalupo A, Belgioia L, Tornari E, Vecchio S, Filauro M, Marchi F, Peretti G, Corvò R. PO-052 T3 Laryngeal SCC: a mono- institutional retrospective analysis of different therapeutic approaches. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30218-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: 10/27/2022]
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17
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Merlano MC, Merlotti AM, Licitra L, Denaro N, Fea E, Galizia D, Di Maio M, Fruttero C, Curcio P, Vecchio S, Russi EG, Corvò R. Activation of immune responses in patients with relapsed-metastatic head and neck cancer (CONFRONT phase I-II trial): Multimodality immunotherapy with avelumab, short-course radiotherapy, and cyclophosphamide. Clin Transl Radiat Oncol 2018; 12:47-52. [PMID: 30186977 PMCID: PMC6107891 DOI: 10.1016/j.ctro.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/04/2018] [Accepted: 08/09/2018] [Indexed: 01/06/2023] Open
Abstract
Treatment of relapsed/metastatic head and neck cancer is unclear. Cyclophosphamide, avelumab, and radiotherapy may be effective for R/M-HNC. Combined treatment may improve avelumab activity without increasing its toxicity. Ongoing trials will clarify the potential of immunotherapy in RM-HNC patients.
Introduction and background Second-line treatment of platinum-resistant relapsed/metastatic (R/M) head and neck cancer (HNC) is a currently unmet clinical need. Clinical trials showed improvement in overall survival and quality of life of R/M-HNC patients treated with anti-PD-1 regardless of the number of prior chemotherapy lines; however, the percentage of long-term survivors remains limited. This study aims to test the hypothesis that attacking the tumor microenvironment at multiple levels can increase immunogenicity of R/M-HNC without worsening the safety profile of immune checkpoint inhibitors. Methods/design In this open label, multi-center, single-arm, Phase Ib/II, R/M-HNC patients pretreated with at least one line of therapy containing platinum, fluorouracil, and cetuximab will receive a daily metronomic dose of 50 mg cyclophosphamide without a drug-free break, 10 mg/kg avelumab on day 1 and every other week until progression, and a single fraction of 8 Gy radiotherapy on day 8. Discussion The treatment protocol aims to reverse immune evasion of the tumor through a radiotherapy-induced self-vaccination effect, suppression of CD4+ CD25+ FoxP3+ regulatory T-cell function by metronomic cyclophosphamide, and effector T-cell reactivation owing to the inhibition of the PD-1–PD-L1 axis by avelumab. The immunologic interplay induced by the proposed combined treatment may theoretically improve the activity of avelumab without increasing its toxicity profile. Finally, an ancillary translational study will be extended to all the patients’ population. Trial registration EudraCT n. 2017-000353-39.
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Affiliation(s)
| | - Anna M. Merlotti
- Radiation Oncology A.O. S.Croce e Carle, Cuneo, Italy
- Corresponding author at: Radiation Oncology, A.O. S.Croce e Carle, via M.Coppino 26, 12100 Cuneo, CN, Italy.
| | - Lisa Licitra
- Medical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | | | - Elena Fea
- Medical Oncology A.O. S.Croce e Carle, Cuneo, Italy
| | - Danilo Galizia
- Investigative and Clinical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Italy
| | - Massimo Di Maio
- Medical Oncology Mauriziano Hospital, University of Torino, Italy
| | | | | | - Stefania Vecchio
- Medical Oncology, IRCCS Sn Martino, IST National Cancer Research Institute and University, Genova, Italy
| | | | - Renzo Corvò
- Radiation Oncology, IRCCS S. Martino, IST National Cancer Research Institute and University, Genova, Italy
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De Laurentiis M, Bonfadini C, Lorusso V, Cilenti G, Di Rella F, Altavilla G, Otero M, Ardizzoia A, Marchetti P, Peverelli G, Amoroso D, Vecchio S, Fiorio E, Orecchia S. Incidence of nausea and vomiting in breast cancer patients treated with anthracycline plus cyclophosphamide-based chemotherapy regimens in Italy: NAVY observational study. Support Care Cancer 2018; 26:4021-4029. [PMID: 29943152 DOI: 10.1007/s00520-018-4259-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) is a common adverse event with cancer chemotherapy, despite the availability of effective antiemetic agents. This is a prospective observational study of Italian breast cancer patients treated with anthracycline plus cyclophosphamide (AC), assessed CINV incidence, adherence to national antiemetic guidelines (AIOM 2012), and the relationship with CINV outcomes. METHODS Patients with breast cancer scheduled to receive their first cycle of an AC-based regimen were enrolled at 12 Italian centers and their clinical data prospectively recorded. CINV incidence was assessed from patient diaries after the first chemotherapy cycle. The relationship between guideline adherence and CINV outcomes was examined using multiple logistic regression. RESULTS The overall incidence rates of nausea and vomiting among 246 evaluable patients were 63.0 and 25.4%, respectively. Most patients received a 5-HT3-RA agent and dexamethasone for acute phase CINV prophylaxis, whereas a triple combination including aprepitant (NK1-RA), consistent with national guidelines, was used in only 45.5% of cases. In the delayed phase, the guideline adherence was 48.8%, while the overall adherence was 43.5%. After adjusting for confounding factors, adherence to antiemetic prophylaxis guidelines was associated with a significant reduction in the odds of three endpoints, namely any nausea, "significant nausea," and vomiting (OR = 0.49, OR = 0.54, and OR = 0.48, respectively), and a 90% increase in the odds of overall complete protection (OR = 1.90). CONCLUSIONS CINV is still a critical issue in AC-treated patients, despite antiemetic treatment. Non-adherence to antiemetic guidelines may lead to poorer outcomes and indicates the need for strategies to enhance the use of guidelines in clinical practice.
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Affiliation(s)
- Michelino De Laurentiis
- Division of Breast Medical Oncology, Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy.
| | - Chiara Bonfadini
- Medical Oncology Department, "A.O.U. Città della Scienza e della Salute di Torino", Turin, Italy
| | - Vito Lorusso
- Medical Oncology Department, National Cancer Institute, Giovanni Paolo II, Bari, Italy
| | - Giuseppina Cilenti
- Oncohematology Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Francesca Di Rella
- Medical Oncology, Department of Senology, National Cancer Institute, Fondazione G.Pascale Naples, Naples, Italy
| | - Giuseppe Altavilla
- Human Pathology Department, Medical Oncology, University of Messina, Messina, Italy
| | | | | | - Paolo Marchetti
- Clinical and Molecular Medicine Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giorgia Peverelli
- Medical Oncology Department, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Amoroso
- Medical Oncology, Ospedale Versilia, Tuscan Tumor Institute (ITT), Lido di Camaiore, Italy
| | | | - Elena Fiorio
- Department of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Bossi P, Miceli R, Locati LD, Ferrari D, Vecchio S, Moretti G, Denaro N, Caponigro F, Airoldi M, Moro C, Vaccher E, Sponghini A, Caldara A, Rinaldi G, Ferrau F, Nolè F, Lo Vullo S, Tettamanzi F, Hollander L, Licitra L. A randomized, phase 2 study of cetuximab plus cisplatin with or without paclitaxel for the first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Ann Oncol 2017; 28:2820-2826. [PMID: 28950305 DOI: 10.1093/annonc/mdx439] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND B490 (EudraCT# 2011-002564-24) is a randomized, phase 2b, noninferiority study investigating the efficacy and safety of first-line cetuximab plus cisplatin with/without paclitaxel (CetCis versus CetCisPac) in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). PATIENTS AND METHODS Eligible patients had confirmed R/M SCCHN (oral cavity/oropharynx/larynx/hypopharynx/paranasal sinus) and no prior therapy for R/M disease. Cetuximab was administered on day 1 (2-h infusion, 400 mg/m2), then weekly (1-h infusions, 250 mg/m2). Cisplatin was given as a 1-h infusion (CetCis arm: 100 mg/m2; CetCisPac arm: 75 mg/m2) on day 1 of each cycle for a maximum of six cycles. Paclitaxel was administered as a 3-h infusion (175 mg/m2) on day 1 of each cycle. After six cycles, maintenance cetuximab was administered until disease progression or unacceptable toxicity. The primary end point was progression-free survival (PFS). We assumed a noninferiority margin of 1.40 as compatible with efficacy. RESULTS A total of 201 patients were randomized 1 : 1 to each regimen; 191 were assessable. PFS with CetCis (median, 6 months) was noninferior to PFS with CetCisPac (median, 7 months) [HR for CetCis versus CetCisPac 0.99; 95% CI: 0.72-1.36, P = 0.906; margin of noninferiority (90% CI of 1.4) not reached]. Median overall survival was 13 versus 11 months (HR = 0.77; 95% CI: 0.53-1.11, P = 0.117). The overall response rates were 41.8% versus 51.7%, respectively (OR = 0.69; 95% CI: 0.38-1.20, P = 0.181). Grade ≥3 adverse event rates were 76% and 73% for CetCis versus CetCisPac, respectively, while grade 4 toxicities were lower in the two-drug versus three-drug arm (14% versus 33%, P = 0.015). No toxic death or sepsis were reported and cardiac events were negligible (1%). CONCLUSION The two-drug CetCis regimen proved to be noninferior in PFS to a three-drug combination with CetCisPac. The median OS of both regimens is comparable with that observed in EXTREME, while the life-threatening toxicity rate appeared reduced. CLINICAL TRIAL NUMBER EudraCT# 2011-002564-24.
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Affiliation(s)
- P Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan University of Milan, Milan
| | - R Miceli
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan
| | - L D Locati
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan University of Milan, Milan
| | - D Ferrari
- Medical Oncology, Ospedale San Paolo, Milan
| | - S Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute, Genova and University of Genova, Genova
| | - G Moretti
- Medical Oncology, Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia
| | - N Denaro
- Medical Oncology, St. Croce & Carle University Teaching Hospital, and ARCO Foundation, Cuneo
| | - F Caponigro
- Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples
| | - M Airoldi
- 2nd Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin
| | - C Moro
- Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | - E Vaccher
- Medical Oncology, Centro di Riferimento Oncologico, Aviano
| | - A Sponghini
- Medical Oncology, A.O. Universitaria Maggiore della Carità, Novara
| | - A Caldara
- Medical Oncology, Ospedale Santa Chiara, Trento
| | - G Rinaldi
- Medical Oncology, AOU Policlinico "Paolo Giaccone," Palermo
| | - F Ferrau
- Medical Oncology, Ospedale San Vincenzo, Taormina
| | - F Nolè
- Medical Oncology, Istituto Europeo di Oncologia, Milan
| | - S Lo Vullo
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan
| | - F Tettamanzi
- Oncology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Hollander
- Oncology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Licitra
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan University of Milan, Milan.
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Grisanti S, Bergamini C, Bianchi S, Baiguini A, Vecchio S, Locati L, Bonetta A, Conte P, Airoldi M, Merlano M, Carlini P, Ibrahim T, Rossetto C, Nicolai P, Maroldi R, Tonoli S, Pronzato P, Magrini S, Licitra L, Berruti A. Natural history and prognostic factors of head and neck cancer patients with bone metastases: A retrospective Italian study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.038] [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: 11/14/2022] Open
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21
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Bossi P, Hollander L, Miceli R, Ferrari D, Vecchio S, Moretti G, Merlano M, Caponigro F, Moro C, Vaccher E, Alabisio O, Caldara A, Russo A, Ferrau F, Nolè F, Licitra L. First line cetuximab and cisplatin with or without paclitaxel in recurrent/metastatic head and neck cancer: A randomized phase IIb trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Denaro N, Vecchio S, Bagicalupo A, Russi E, Rampino M, Benasso M, Numico G, Licitra L, Ostellino O, D'amico M, Curcio P, Merlano M. OC-019: The phase III study INTERCEPTOR: preliminary results. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Roda E, Giampreti A, Vecchio S, Apostoli P, Coccini T. Mercury Vapour Long-Lasting Exposure: Lymphocyte Muscarinic Receptors as Neurochemical Markers of Accidental Intoxication. Case Rep Med 2016; 2016:9783876. [PMID: 27872646 PMCID: PMC5107828 DOI: 10.1155/2016/9783876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/31/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Chronic poisoning may result in home setting after mercury (Hg) vapours inhalation from damaged devices. We report a chronic, nonoccupational Hg poisoning due to 10-year indoor exposure to mercury spillage. Case Report. A 72-year-old man with polyneuropathy of suspected toxic origin. At hospitalization, toxicological clinical evaluations confirmed the altered neurological picture documented across the last decade. Periodic blood and urine Hg levels (BHg, UHg) monitoring were performed from admission (t0), until 1 year later (t2), paralleled by blood neurochemical markers assessment, that is, lymphocytes muscarinic receptors (l-MRs). At t0: BHg and UHg were 27 and 1.4 microg/L, respectively (normal values: BHg 1-4.5; UHg 0.1-4.5), associated with l-MRs increase, 185.82 femtomoL/million lymphocytes (normal range: 8.0-16.0). At t1 (two days after DMSA-mobilization test), BHg weak reduction, paralleled by UHg 3.7-fold increase, was measured together with further l-MRs enhancement (205.43 femtomoL/million lymphocytes). At t2 (eight months after two cycles of DMSA chelating therapy ending), gradual improving of clinical manifestations was accompanied by progressive decrease of BHg and UHg (4.0 and 2.8 microg/L, resp.) and peripheral l-MRs neurochemical marker (24.89 femtomoL/million lymphocytes). Conclusion. l-MRs modulatory effect supports their use as peripheral neurochemical marker in Hg poisoning diagnosis and chelation therapy monitoring.
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Affiliation(s)
- E. Roda
- Laboratory of Clinical & Experimental Toxicology and Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation, Medical Institute of Pavia, Pavia, Italy
| | - A. Giampreti
- Laboratory of Clinical & Experimental Toxicology and Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation, Medical Institute of Pavia, Pavia, Italy
| | - S. Vecchio
- Laboratory of Clinical & Experimental Toxicology and Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation, Medical Institute of Pavia, Pavia, Italy
| | - P. Apostoli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Section of Public Health and Human Sciences, University of Brescia and Occupational Medicine, Hygiene, Toxicology and Prevention Unit, Civil Hospital of Brescia, Brescia, Italy
| | - T. Coccini
- Laboratory of Clinical & Experimental Toxicology and Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation, Medical Institute of Pavia, Pavia, Italy
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24
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Scaduto DA, Goodsitt M, Chan HP, Olafsdottir H, Das M, Fredenberg E, Geiser W, Goodenough D, Heid P, Hu YH, Liu B, Mainprize J, Reiser I, Van Engen R, Varchena V, Vecchio S, Glick S, Zhao W. WE-DE-207B-05: Measuring Spatial Resolution in Digital Breast Tomosynthesis: Update of AAPM Task Group 245. Med Phys 2016. [DOI: 10.1118/1.4957865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Magrini SM, Buglione M, Corvò R, Pirtoli L, Paiar F, Ponticelli P, Petrucci A, Bacigalupo A, Crociani M, Lastrucci L, Vecchio S, Bonomo P, Pasinetti N, Triggiani L, Cavagnini R, Costa L, Tonoli S, Maddalo M, Grisanti S. Cetuximab and Radiotherapy Versus Cisplatin and Radiotherapy for Locally Advanced Head and Neck Cancer: A Randomized Phase II Trial. J Clin Oncol 2015; 34:427-35. [PMID: 26644536 DOI: 10.1200/jco.2015.63.1671] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE No randomized trials have been conducted to directly compare radiotherapy (RT) with concomitant cisplatin (CDDP) versus concomitant cetuximab (CTX) as first-line treatment of locally advanced squamous cell carcinoma of the head and neck. In this randomized trial, we compared these two treatment regimens in terms of compliance, toxicity, and efficacy. PATIENTS AND METHODS Eligible patients were randomly assigned in a 1:1 ratio to receive either CDDP 40 mg/m(2) once per week or CTX 400 mg/m(2) as loading dose followed by CTX 250 mg/m(2) once per week concomitant to radical RT. For primary end points, compliance to treatment was defined as number of days of treatment discontinuation and drug dosage reduction. The acute toxicity rate was defined according to the National Cancer Institute Common Toxicity Criteria. Efficacy end points were local recurrence-free survival, metastasis-free survival, cancer-specific survival, and overall survival. RESULTS The study was discontinued early because of slow accrual after the enrollment of 70 patients. RT discontinuation for more than 10 days occurred in 13% of patients given CTX and 0% given CDDP (P = .05). Drug dosage reduction occurred in 34% given CTX and 53% given CDDP (difference not significant). Toxicity profiles differed between the two arms, with hematologic, renal, and GI toxicities more frequent in the CDDP arm, and cutaneous toxicity and the need for nutritional support more frequent in the CTX arm. Serious adverse events related to treatment, including four versus one toxic deaths, were higher in the CTX arm (19% v 3%, P = .044). Locoregional control, patterns of failure, and survivals were similar between the treatment arms. CONCLUSION CTX concomitant to RT lowered compliance and increased acute toxicity rates. Efficacy outcomes were similar in both arms. These results raise the issue of appropriately selecting patients with head and neck cancer who can benefit from CTX in combination with RT.
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Affiliation(s)
- Stefano Maria Magrini
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Michela Buglione
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy.
| | - Renzo Corvò
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Luigi Pirtoli
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Fabiola Paiar
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Pietro Ponticelli
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Alessia Petrucci
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Almalina Bacigalupo
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Monica Crociani
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Luciana Lastrucci
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Stefania Vecchio
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Pierluigi Bonomo
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Nadia Pasinetti
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Luca Triggiani
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Roberta Cavagnini
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Loredana Costa
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Sandro Tonoli
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Marta Maddalo
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
| | - Salvatore Grisanti
- Stefano Maria Magrini, Michela Buglione, Nadia Pasinetti, Luca Triggiani, Roberta Cavagnini, Loredana Costa, Sandro Tonoli, and Marta Maddalo, Brescia University, Istituto del Radio O. Alberti, Spedali Civili Hospital; Renzo Corvò, Almalina Bacigalupo, and Stefania Vecchio, Istituto Di Ricovero e Cura a Carattere Scientifico S. Martino, National Cancer Research Institute and University, Genova; Luigi Pirtoli and Monica Crociani, University of Siena, Siena; Fabiola Paiar and Pierluigi Bonomo, Azienda Ospedaliero-Universitaria Careggi, Firenze; Pietro Ponticelli and Luciana Lastrucci, S. Donato Hospital, Azienda Unità Sanitaria Locale No. 8, Arezzo; and Alessia Petrucci, Pistoia Hospital, Azienda Unità Sanitaria Locale No. 3, Pistoia; Salvatore Grisanti, Brescia University, Brescia, Italy
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Blondeaux E, Lambertini M, Musio D, Vecchio S, Poggio F, Gazzola V, Palmieri D, Bruzzi P, Rossi G, Pastorino S, Perfumo M, Pronzato P, Palombo D, Bighin C, Del Mastro L. Correlation between treatment with aromatase inhibitors and carotid intima-media thickness, carotid stenosis and abdominal aortic diameter. A prospective cohort study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.23] [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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Merlano M, Vecchio S, Bacigalupo A, Russi E, Denaro N, Ostellino O, Rampino M, Benasso M, Boitano M, Numico G, D'Amico M, Grimaldi A, Blengio F, Licitra L, Pinto C, Aieta M, Bui S, Mattioli R, Bertolini F, Gasparini G, Boni C. The phase III study INTERCEPTOR in locally advanced head and neck cancer (LA-HNC). Preliminary safety report. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv342.01] [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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Perfetti V, Perfetti V, Dalle Carbonare S, Vecchio S, Paglino C, Secondino S, Tringali M, Della Giovanna M, Pedrazzoli P. Diffusion of biosimilar hemopoietic growth factors use in oncology practice. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv346.26] [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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Merlano M, Vecchio S, Bacigalupo A, Denaro N, Russi E, Benasso M, Vigo V, Ostellino O, Rampino M, Canobbio L, Grimaldi A, Blengio F, Berretta L, Bui S, D'Abbiero N, D'Amico M, Numico G, Bergamini C, Orlandi E, Aieta M. 2821 The phase III study INTERCEPTOR in locally advanced head and neck cancer (LA-HNC). Preliminary safety report. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31564-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Varani E, Vecchio S, Aquilina M, Vecchi G, Balducelli M, Frassineti V, Margheri M. Percutaneous intervention of de novo unprotected left main stenosis in patients with acute coronary syndrome or stable coronary artery disease: in-hospital and long-term results. Minerva Cardioangiol 2015:R05Y9999N00A150030. [PMID: 26099221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES to assess in-hospital and long-term results of the novo unprotected left main (UPLM) percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) or stable coronary artery disease (CAD), in an unselected population admitted to a single high- volume cathlab without on-site cardiac surgery. METHODS from 2008 to 2011, among 317 PCI performed in patients with the novo UPLM stenosis, 49 patients presented ST-elevation myocardial infarction (STEMI), 152 non ST-elevation MI/unstable angina (NSTEMI/UA), 116 stable CAD. RESULTS in-hospital mortality was 20% in STEMI, 5.3% in NSTEMI/UA and 1.7% in stable CAD patients (p<0.001). Two-year total mortality was 24.5%, 25.6% and 6% in the 3 groups, and cardiac death was 20%, 13.8% and 3.4% (p=0.002). Left main target lesion revascularization (TLR) was similar in the 3 groups, as the clinically- driven TLR (10% vs 11% vs 7.7% , p= 0.642), with neither definite nor probable stent thrombosis. Multivariate analysis showed the following independent predictors of 2-year mortality: bare-metal stent use (OR 4.53, p<0.001), Syntax score >32 (OR 3.53, p=0.012), ACS as the indication (OR 3.24, p=0.012), peripheral artery disease (OR 2.20, p=0.042), and age > 75 years (OR 2.09, p=0.05). CONCLUSIONS our experience showed acceptable results of UPLM PCI in STEMI patients, where short-term prognosis was related to hemodynamic conditions, good results in NSTEMI/UA patients where mortality increased in the follow-up due to comorbidities, and very good results in patients with stable CAD.
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Affiliation(s)
- E Varani
- Cardiology Department, S. Maria delle Croci Hospital, Ravenna, Italy -
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De Tursi M, Carella C, Tomao S, Cinieri S, Lorusso V, Marchetti P, Vecchio S, Sansoni E, Contu A, Adamo V, Silvestris N, Nuzzo A, Rosti G, Ravaioli A, Danova M, Tonini G, Passalacqua R, Cruciani G, Faedi M, Spada M, De Laurentiis M, Amoroso D, Tomao F, Sperduti I, Grassadonia A, Tinari N, Natoli C, Iacobelli S. Chemotherapy-induced nausea and vomiting in Italian cancer centers: results of CINVDAY, a prospective, multicenter study. Tumori 2015; 100:e309-13. [PMID: 25688518 DOI: 10.1700/1778.19310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Guideline consistency in the prevention of chemotherapy-induced nausea and vomiting (CINV) remains low (29% in the Pan European Emesis Registry study) and very low (11%) in regimens with a high emetogenic risk. The aim of this study was to evaluate the guideline consistency of CINV prophylaxis for acute emesis in daily clinical practice in Italy. METHODS This was a prospective, observational, multicenter study. Patients scheduled to receive antitumor treatment on a single prespecified day were included. Data on patient characteristics (demographic and clinical), type of anticancer therapy, and type of antiemetic therapy prescribed for acute emesis were collected on electronic data capture forms. Chemotherapy regimens and antiemetic prophylaxis were categorized according to the MASCC 2011 guidelines. The study was approved by the local ethics committees. RESULTS From July 2013 to February 2014, a total of 502 patients were enrolled at 26 study sites. Median age was 62 years (range 27-87 years). Colorectal cancer and breast cancer were the most common malignancies. The emetogenic potential of the chemotherapy regimens used was high (HEC) (23.7%), moderate (MEC) (40.6%), low (31.3%) or minimal (4.4%). Overall, guideline consistency was 19.3%. Consistency reached 45% when the various 5HT3 receptor antagonists were considered equivalent and interchangeable in MEC regimens. Adherence to guidelines was lowest for MEC and Minimal risk groups. Ten percent of patients in HEC and MEC regimens did not receive any 5HT3 receptor antagonists. NK1 receptor antagonists were used in 8% of all regimens. CONCLUSIONS Our study indicates that antiemetic guideline inconsistency remains an issue in daily clinical oncology practice in Italy.
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Bacigalupo A, Belgioia L, Vecchio S, Marcenaro M, Vagge S, Agnese D, Agostinelli S, Corvò R. PO-060: Long term results with intensified intensity modulated radiotherapy for nasopharyngeal cancer treatment. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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De Tursi M, Carella C, Tomao S, Cinieri S, Lorusso V, Marchetti P, Vecchio S, Sansoni E, Contu A, Adamo V, Silvestris N, Nuzzo A, Rosti G, Ravaioli A, Danova M, Tonini G, Passalacqua R, Cruciani G, Faedi M, Spada M, De Laurentiis M, Amoroso D, Tomao F, Sperduti I, Grassadonia A, Tinari N, Natoli C, Iacobelli S. Chemotherapy-Induced Nausea and Vomiting in Italian Cancer Centers: Results of CINVDAY, a Prospective, Multicenter Study. Tumori Journal 2014. [DOI: 10.1177/1778.19310] [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: 11/15/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Giovanni Rosti
- Medical Oncology, S Maria di Ca' Foncello Hospital, Treviso
| | | | - Marco Danova
- Medical Oncology, Hospital of Vigevano, Vigevano
| | | | | | | | | | | | | | | | | | | | | | - Nicola Tinari
- Medical Oncology, G D'Annunzio University, Chieti-Pescara
| | - Clara Natoli
- Medical Oncology, G D'Annunzio University, Chieti-Pescara
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Agnese D, Belgioia L, Bacigalupo A, Marcenaro M, Vecchio S, Agostinelli S, Morbelli S, Corvò R. Prolonged complete remission after induction chemotherapy followed by chemoradiation with tomotherapy in metastatic nasopharyngeal cancer. Anticancer Res 2014; 34:5075-5078. [PMID: 25202093] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is uncommon in the Western hemisphere and in Europe. The undifferentiated subtype has a relevant propensity to metastasize systemically, mostly in the skeleton. In patients with distant metastasis at presentation there is no consensus on the most appropriate approach. CASE REPORT Evaluation of a young patient with initially bony metastatic nasopharyngeal cancer treated with platinum-based induction chemotherapy followed by radiotherapy (performed with Tomotherapy) combined to chemotherapy on primary region with curative intent, and subsequent focal irradiation of the bone metastasis. CONCLUSION After 27 months from the end of the planned treatment the patient has not shown any late toxicity or complications in the treated areas and is without any evidence of progression. It seems appropriate to treat selected metastatic patients with a radical intent, using induction chemotherapy followed by radical chemoradiotherapy on the primary region and high dose radiation on the metastasis. Moreover, Tomotherapy demonstrated a tolerable grade of acute toxicity without any relevant late complications.
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Affiliation(s)
- Dario Agnese
- Division of Radiation Oncology, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Liliana Belgioia
- Division of Radiation Oncology, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Almalina Bacigalupo
- Division of Radiation Oncology, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Michela Marcenaro
- Division of Radiation Oncology, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Stefania Vecchio
- Division of Medical Oncology, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Stefano Agostinelli
- Division of Medical Physics, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Silvia Morbelli
- Division of Nuclear Medicine, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
| | - Renzo Corvò
- Division of Radiation Oncology, IRCCS San Martino - IST National Cancer Research Institute and University, Genoa, Italy
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Lonati D, Giampreti A, Rossetto O, Petrolini VM, Vecchio S, Buscaglia E, Mazzoleni M, Chiara F, Aloise M, Gentilli A, Montecucco C, Coccini T, Locatelli CA. Neurotoxicity of European viperids in Italy: Pavia Poison Control Centre case series 2001-2011. Clin Toxicol (Phila) 2014; 52:269-76. [PMID: 24708390 DOI: 10.3109/15563650.2014.904046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Some clinical aspects about neurotoxicity after snakebites by European viper species remain to be elucidated. OBJECTIVE This observational case series aims to analyze neurological manifestations due to viper envenomation in Italy in order to describe the characteristic of neurotoxicity and to evaluate the clinical response to the antidotic treatment, the outcome, and the influence of individual variability in determining the appearance of neurotoxic effects. MATERIALS AND METHODS All cases of snakebite referred to Pavia Poison Centre (PPC) presenting peripheral neurotoxic effects from 2001 to 2011 were included. Cases were assessed for time from bite to PPC evaluation, Grade Severity Score (GSS), onset/duration of clinical manifestations, severity/time course of local, non-neurological and neurological effects, and antidotic treatment. RESULTS Twenty-four were included (age, 3-75 years) and represented on average of 2.2 cases/year (about 5% of total envenomed patients). The mean interval time of PPC evaluation from snakebite was 10.80 ± 19.93 hours. GSS at ED-admission was 0 (1 case), 1 (10 cases), and 2 (13 cases). All patients showed local signs: 41.6%, minor; 58.4%, extensive swelling and necrosis. The main systemic non-neurological effects were as follows: vomiting (86.7%), diarrhea (66.7%), abdominal discomfort (53.3%), and hypotension (20%). Neurotoxic effects were accommodation troubles and diplopia (100%), ptosis (91.7%), ophtalmoplegia (58.3%), dysphagia (20.8%), drowsiness (16.6%), cranial muscle weakness (12.5%), and dyspnea (4.2%). Neurotoxicity was the unique systemic manifestation in 9 cases; in 4 cases, they were associated with only mild local swelling. In 10 patients the onset of neurotoxic effects followed the resolution of systemic non-neurological effects. Antidote was intravenously administered in 19 (79.2%) patients. The mean duration of manifestations in untreated versus treated groups was 53.5 ± 62.91 versus 41.75 ± 21.18 hours (p = 0.68, local effects) and 9.77 ± 3.29 versus 8.25 ± 12.23 hours (p = 0.1, systemic non-neurological effects) and 43.4 ± 14.69 versus 26.58 ± 20.62 hours (p = 0.03, neurotoxic effects). CONCLUSIONS Neurotoxicity may appear late (11 hours after the bite in 58.3% of cases), in contrast with the data reported in medical literature. Neurotoxic effects have been reversible in all cases and may be the unique systemic manifestation of envenomation. Neurotoxic effects are shorter in treated group. The antidotic treatment of patients considered as GSS 2 only for neurotoxic effects (with mild local effects) may not be necessary. Variable factors such as different amount of venom injected, concentration of PLA2 component, and individual susceptibility may explain the less percentage of patients presenting neurotoxic effects.
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Affiliation(s)
- D Lonati
- Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia , Pavia , Italy
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Vecchio S, Varani E, Nuzzo A, Balducelli M, Vecchi G, Aquilina M, Rubboli A, Margheri M. Percutaneous rheolytic thrombectomy with the AngioJet System for the treatment of intermediate-risk acute pulmonary embolism: a case report and an appraisal of contemporary indications and technique. Minerva Cardioangiol 2014; 62:221-228. [PMID: 24686999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Percutaneous mechanical thrombectomy (PMT) for treatment of clinically significant pulmonary embolism (PE) has been shown to be technically feasible and effective, aiming at thrombus resolution without increase in major bleeding. Despite its success, use of PMT in clinical practise has not become widespread, because it is challenging. Among several devices proposed, AngioJet rheolytic thrombectomy (ART) appears as the most effective and easy-to-use. We present the case of a 69-year-old woman who developed acute intermediate-risk PE, with right ventricular dysfunction and major myocardial necrosis, who was successfully treated by ART. The peculiarities of the case, toghether with the principles, tecnique and tips and tricks of ART, its effectiveness and potential complications are discussed.
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Affiliation(s)
- S Vecchio
- Division of Cardiology Cardiac Catheterization Laboratory Santa Maria delle Croci Hospital, Ravenna, Italy -
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Vecchio S, Giampreti A, Petrolini VM, Lonati D, Protti A, Papa P, Rognoni C, Valli A, Rocchi L, Rolandi L, Manzo L, Locatelli CA. Metformin accumulation: Lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Clin Toxicol (Phila) 2013; 52:129-35. [DOI: 10.3109/15563650.2013.860985] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lambertini M, Bighin C, Del Mastro L, Dozin B, Levaggi A, Giraudi S, D'Alonzo A, Poggio F, Iacono G, Vecchio S, Miglietta L, Pronzato P. PO54 ACTIVITY AND DURATION OF CHEMOTHERAPY IN DIFFERENT BIOLOGIC SUBTYPES (BS) IN METASTATIC BREAST CANCER (MBC) PATIENTS. Breast 2013. [DOI: 10.1016/s0960-9776(13)70068-7] [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] Open
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Tomassetti M, Vecchio S, Campanella L, Dragone R. Biosensors for monitoring the isothermal breakdown kinetics of peanut oil heated at 180°C. Comparison with results obtained for extra virgin olive oil. Food Chem 2013; 140:700-10. [PMID: 23692756 DOI: 10.1016/j.foodchem.2012.10.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/21/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
The present research was devoted to studying the kinetics of the artificial rancidification of peanut oil (PO) when a sample of this oil was isothermally heated at 180°C in an air stream. The formation of radical species due to heating was evaluated using a radical index whose value was determined using a biosensor method based on a superoxide dismutase (SOD), while the increasing toxicity was monitored using a suitable toxicity measuring probe based on the Clark electrode and immobilized yeast cells. An extra virgin olive oil was isothermally rancidified under the same experimental conditions and the corresponding data were used for the purpose of comparison. Both the so-called "model-fitting" and the classical kinetic methods were applied to the isothermal process biosensor data in order to obtain the kinetic constant rate value at 180°C.
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Affiliation(s)
- M Tomassetti
- Department of Chemistry, University of Rome "La Sapienza", P.le Aldo Moro 5, I-00185 Rome, Italy.
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Locatelli C, Lonati D, Buscaglia E, Vecchio S, Giampreti A, Petrolini V, Chiara F, Aloise M, Cortini E, Papa P, Rolandi L, Rocchi L, Rimondo C, Seri C, Serpelloni G. “Synthe-tic co-caine” as legal cocaine hides synthetic cannabinoids. Toxicol Lett 2013. [DOI: 10.1016/j.toxlet.2013.05.062] [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: 10/26/2022]
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Giampreti A, Lampati L, Chidini G, Rocchi L, Rolandi L, Lonati D, Petrolini VM, Vecchio S, Locatelli CA, Manzo L. Recurrent tonic–clonic seizures and coma due to ingestion of Type I pyrethroids in a 19-month-old patient. Clin Toxicol (Phila) 2013; 51:497-500. [DOI: 10.3109/15563650.2013.808747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vecchio S, Brunner C, Taylor M, Williams M, Kaczmarek R, Chakrabarti K. SU-C-116-04: Development of a Comprehensive QC Protocol for Digital Breast Tomosynthesis (DBT). Med Phys 2013. [DOI: 10.1118/1.4813986] [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: 11/07/2022] Open
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Belgioia L, Timon G, Bacigalupo A, Vagge S, Pupillo F, Marcenaro M, Vecchio S, Corvò R. PO-056: Early-Outcome and Toxicity of RT/CT in the Management of Unknown HN Primary Site with Helical Tomotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vecchio S, Varani E, Balducelli M, Aquilina M, Vecchi G, Margheri M. Acute myocardial infarction caused by multivessel spontaneous coronary artery dissection in a postpartum woman. Minerva Cardioangiol 2013; 61:89-98. [PMID: 23381384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women not experiencing traditional risk factors for coronary artery disease during pregnancy or postpartum period. The pathophysiology of spontaneous arterial dissection remains uncertain and the management may be challenging. Herein, we report a case of a 41-year woman with no apparent cardiovascular risk factors, who underwent a successfull in vitro fertilization and embryo transfer with a subsequent at term cesarean section of a twin pregnancy. Six days after delivery, she presented with anterior ST-segment elevation myocardial infarction. Coronary angiography revealed dissection of all three coronary arteries with involvement of left main stem, which was successfully treated with percutaneous coronary intervention and drug-eluting stents implantation. The peculiarities of the case, toghether with the treatment strategy and the clinical and angiographic six-month follow-up are discussed.
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Affiliation(s)
- S Vecchio
- Division of Cardiology, Cardiac Catheterization Laboratory, Santa Maria delle Croci Hospital, Ravenna, Italy.
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Bacigalupo A, Timon G, Vagge S, Belgioia L, Bellini A, Marcenaro M, Vecchio S, Corvò R. PO-057: SIB-IMRT Delivered By Helical Tomotherapy for Patients with Nasopharyngeal Carcinoma. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bacigalupo A, Marcenaro M, Vagge S, Timon G, Torielli P, Vecchio S, Cavagnetto F, Gusinu M, Corvò R. EP-1162 DOSE DISTRIBUTION AND COMPLIANCE IN NPC TREATED BY TOMOTHERAPY COMBINED WITH CT: A MONO-INSTITUTIONAL EXPERIENCE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71495-0] [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: 11/17/2022]
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Vecchio S, Zanolla L, Valencia J, Colletta M, Capecchi A, Franco N, Piovaccari G, Margheri M, Di Pasquale G, Rubboli A. Coronary stenting for ST-elevation myocardial infarction vs. other indications in patients on oral anticoagulation: any difference in in-hospital management and outcome? Minerva Cardioangiol 2011; 59:499-506. [PMID: 21983310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The aim of this paper was to compare the in-hospital management and outcome of patients on oral anticoagulation (OAC) undergoing coronary artery stenting (PCI-S) for ST-elevation myocardial infarction (STEMI) vs. other indications. METHODS One hundred and sixteen patients on OAC at the time of PCI-S who were prospectively enrolled in a multi-center, observational registry, were evaluated. Patients were segregated according to whether PCI-S was performed for STEMI (group 1) or other indications, such as non ST-elevation acute coronary syndromes, stable angina, silent ischemia, etc. (group 2), and the pharmacological and procedural management, as well as the in-hospital outcome, were compared. RESULTS No significant differences were observed in vascular access site, sheath size and type of stent implanted, nor was significantly different the use of glycoprotein IIb/IIIa inhibitors, and the use and dose of intravenous unfractionated heparin. Although not statistically different, the in-hospital occurrence of death (3.7% vs. 1.1%; OR 3.3; 95% confidence intervals [CI] 0.2-56.0), stent thrombosis (3.7% vs. 1.1%; OR 3.3; 95% CI 0.2-56.0) and major bleeding (7.4% vs. 2.2%; OR 3.4; 95% CI 0.4-25.9) was consistently about 3-fold higher in group 1. CONCLUSION The in-hospital pharmacological and procedural management of OAC patients undergoing PCI-S for STEMI vs. other indications appears not different. Although not significantly different however, the in-hospital occurrence of major bleeding, as well as of death and stent thrombosis, appears substantially higher in patients treated for STEMI, warranting therefore further larger, prospective studies.
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Affiliation(s)
- S Vecchio
- Division of Cardiology and Interventional Center, Santa Maria delle Croci Hospital, Ravenna, Italy.
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Locatelli C, Lonati D, Giampreti A, Petrolini V, Vecchio S, Rognoni C, Bigi S, Buscaglia E, Mazzoleni M, Manzo L, Papa P, Valli A, Rimondo C, Serpelloni G. New Synthetic Cannabinoids Intoxications in Italy: Clinical Identification and Analytical Confirmation of Cases. J Emerg Med 2011. [DOI: 10.1016/j.jemermed.2011.06.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Marcenaro M, Corvò R, Bacigalupo A, Sanguineti G, Benasso M, Russi E, Vecchio S, Merlano M. 816 poster ALTERNATING CHEMO-RADIOTHERAPY FOR ADVANCED HEAD AND NECK CANCER: 30 YEARS OF EXPERIENCE IN GENOA. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70938-0] [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: 10/18/2022]
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Bacigalupo A, Vagge S, Bosetti D, Vidano G, Gusinu M, Agostinelli S, Marcenaro M, Vecchio S, Zeverino M, Corvò R. PRELIMINARY EXPERIENCE WITH HELICAL TOMOTHERAPY USING SIMULTANEOUS INTEGRATED BOOST (SIB) IN NASOPHARYNX CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70079-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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