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La Rocca E, Arrobbio C, Colombo F, Gandini S, Zaffaroni M, Galimberti V, Kahler-Ribeiro-Fontana S, Dicuonzo S, Rojas D, Leonardi M, Orecchia R, Jereczek-Fossa B. PO-1091 Positive axillary non-sentinel nodes predictors in breast cancer patients after neoadjuvant therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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2
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Morigi C, Peradze N, Firpo E, Veronesi P, Intra M, Galimberti V. Feasibility and surgical impact of Z0011 trial criteria application: The experience of the European institute of oncology. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.06.060] [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] Open
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3
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Arculeo S, Frassoni S, Cavallo I, Dicuonzo S, Gerardi M, Morra A, Dell'Acqua V, Cattani F, Comi S, Veronesi P, Pansini F, Galimberti V, Fodor C, Bagnardi V, Orecchia R, Leonardi M, Jereczek-Fossa B. PO-0937: Partial breast re-irradiation with IMRT for local recurrence after whole breast radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Montagna E, Pagan E, Bagnardi V, Colleoni M, Cancello G, Munzone E, Dellapasqua S, Bianco N, Campennì G, Iorfida M, Mazza M, De Maio A, Veronesi P, Sangalli C, Scateni B, Pettini G, Pravettoni G, Mazzocco K, Galimberti V. Evaluation of endocrine therapy and patients preferences in early breast cancer: results of Elena study. Breast Cancer Res Treat 2020; 184:783-795. [PMID: 32929568 DOI: 10.1007/s10549-020-05900-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The development of the adjuvant therapy requires that clinicians and patients should discuss the magnitude of benefit of treatment for individual patient, estimating the pros and cons and the personal preferences. The aim of the present study was to determine the preferences of women treated with adjuvant hormonal therapy (HT) for breast cancer. METHODS The analyses were conducted into three different groups of early breast cancer patients to evaluate the survival benefit needed to make treatment worthwhile before starting HT (A), after a few months from the beginning (B) and after several years of HT (C). The questionnaires, showing hypothetical scenarios based on potential survival times and rates without HT, were used to determine the lowest gains women judged necessary to make the treatment worthwhile. RESULTS A total of 452 patients were included in the study: 149 in group A, 150 in group B and 153 in group C. In group C, 65% of patients were receiving HT with aromatase inhibitors (with or without a LHRH analogue). In the groups A, B, C 8%, 20% and 26%, respectively, received adjuvant chemotherapy. Overall, 355 women (79%) had children. The responses were quite similar between the three groups. A median gain of 10 years was judged necessary to make adjuvant HT worthwhile based on the hypothetical scenario of untreated mean survival time of 5 and 15 years. Median gain of 20% more women surviving was judged necessary to make adjuvant HT worthwhile based on an untreated 5-year survival rate expectation of 60%. Cognitive dysfunction was considered the side effect least compatible with the continuation of treatment in all three groups. CONCLUSIONS This is a large study of patient preferences on HT. Compared with other studies with similar design, the patients included in the present study required larger benefits to make adjuvant therapy worthwhile.
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Affiliation(s)
- E Montagna
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - E Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - M Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Cancello
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Munzone
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - S Dellapasqua
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - N Bianco
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Campennì
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Iorfida
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Mazza
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - A De Maio
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - P Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Sangalli
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - B Scateni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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5
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Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, Santomauro G, Jereczek-Fossa BA, Veronesi P, Galimberti V, Sacchini V, Intra M. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Ann Surg Oncol 2020; 27:4488-4499. [PMID: 32436193 DOI: 10.1245/s10434-020-08605-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge. PATIENTS AND METHODS Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS). RESULTS Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5-500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9-7.0 years). The estimated OS was 72% at 5 years (95% CI 54-83), and 61% at 8 years (95% CI 43-75). The estimated DFS was 61% at 5 years (95% CI 44-74), and 42% at 8 years (95% CI 25-59). CONCLUSION These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - M Colleoni
- Division of Breast Cancer Medical Treatments, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - D Mattar
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Corso
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - S Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - G Santomauro
- Service of Data Management, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - B A Jereczek-Fossa
- Faculty of Medicine, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - P Veronesi
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - V Sacchini
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - M Intra
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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6
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Galimberti V, Tironi R, Lerario A, Scali M, Del Bo R, Rodolico C, Brizzi T, Gibertini S, Maggi L, Mora M, Toscano A, Comi GP, Sciacco M, Moggio M, Peverelli L. Value of insoluble PABPN1 accumulation in the diagnosis of oculopharyngeal muscular dystrophy. Eur J Neurol 2019; 27:709-715. [DOI: 10.1111/ene.14131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Affiliation(s)
- V. Galimberti
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - R. Tironi
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - A. Lerario
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - M. Scali
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - R. Del Bo
- Dino Ferrari Centre Neuroscience Section Department of Pathophysiology and Transplantation (DEPT) University of Milan MilanoItaly
- Neurology Unit IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - C. Rodolico
- Neurology and Neuromuscular Diseases Unit Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - T. Brizzi
- Neurology and Neuromuscular Diseases Unit Department of Clinical and Experimental Medicine University of Messina Messina Italy
- DIBIMIS University of Palermo Palermo Italy
| | - S. Gibertini
- Neuromuscular Diseases and Neuroimmunology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milano Italy
| | - L. Maggi
- Neuromuscular Diseases and Neuroimmunology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milano Italy
| | - M. Mora
- Neuromuscular Diseases and Neuroimmunology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milano Italy
| | - A. Toscano
- Neurology and Neuromuscular Diseases Unit Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - G. P. Comi
- Dino Ferrari Centre Neuroscience Section Department of Pathophysiology and Transplantation (DEPT) University of Milan MilanoItaly
- Neurology Unit IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - M. Sciacco
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - M. Moggio
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - L. Peverelli
- Neuromuscular and Rare Disease Unit Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
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7
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Montagna E, Pagan E, Bagnardi V, Colleoni M, Cancello G, Munzone E, Dellapasqua S, Bianco N, Campennì G, Iorfida M, Mazza M, De Maio A, Milano M, Veronesi P, Sangalli C, Scateni B, Pravettoni G, Mazzocco K, Galimberti V. Evaluation of endocrine therapy and patients preferences in early breast cancer: Results of Elena study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.051] [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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8
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Cancello G, Montagna E, Pagan E, Bagnardi V, Munzone E, Dellapasqua S, Iorfida M, Mazza M, De Maio A, Viale G, Mazzarol G, Veronesi P, Galimberti V, Santomauro G, Colleoni M. Prognosis of selected triple negative apocrine breast cancer patients who did not receive adjuvant chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.079] [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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9
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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Corrigendum to "Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of breast surgeons (ANISC)" [Breast 2019 56-60]. Breast 2019; 48:101. [PMID: 31543291 DOI: 10.1016/j.breast.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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10
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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of Breast Surgeons (ANISC). Breast 2019; 45:56-60. [PMID: 30877870 DOI: 10.1016/j.breast.2019.02.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast angiosarcoma is a malignant mesenchymal neoplasm, which accounts for approximately 2% of all soft tissue sarcomas. Secondary breast angiosarcoma (SBA) may be related to chronic lymphedema after a mastectomy with lymph node dissection (Stewart Treves syndrome) and previous radiotherapy for complications from breast radiation treatment. It is a very rare condition; therefore, diagnosis and management are still a challenge. METHODS The ANISC collected SBA data by means of a survey sent to all Italian breast centres in the ANISC. The clinicopathological characteristics and the management of this disease were analysed. RESULTS Twenty-four centres participated in this survey in which 112 cases of SBA were analysed. The median age of the women with SBA was 68.9 years and it appeared approximately 90 months after the first irradiation for breast cancer. In 92% of cases, a mastectomy was performed without axillary dissection for those patients having a high grade of SBA (74.2%). The prognosis was worse in the high-grade cases (overall survival-OS: 36 months) as compared with the low-grade cases (OS: 48 months). After a follow-up of 5 years, 50.5% of the patients were still alive. Disease-free survival (DFS) was 35 months, and there were no differences between the groups of patients with either high- or low-grade histology. CONCLUSIONS Secondary breast angiosarcoma is a very aggressive disease associated with a short survival outcome. The surgical approach still remains an important step in the course of treatment; furthermore, an accurate histological examination is helpful in establishing the prognosis of the patient. A mastectomy is mandatory. A longer OS was observed in patients with low-grade angiosarcoma as compared to high-grade angiosarcoma (C.I. 40-57 vs. 31-41 months).
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Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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11
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Morigi C, Peradze N, Santomauro G, Bagnardi V, Firpo E, Veronesi P, Intra M, Galimberti V. Z0011 Trial criteria application: experience of clinical and surgical impact on a single institution practice. Breast 2019. [DOI: 10.1016/s0960-9776(19)30383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Magnoni F, Massari G, Santomauro G, Bagnardi V, Pagan E, Peruzzotti G, Galimberti V, Veronesi P, Sacchini VS. Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ. Br J Surg 2019; 106:375-383. [PMID: 30791092 DOI: 10.1002/bjs.11079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/25/2018] [Accepted: 11/12/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Microinvasive breast cancer is an uncommon pathological entity. Owing to the rarity of this condition, its surgical axillary management and overall prognosis remain controversial. METHODS A database was analysed to identify patients with microinvasive ductal carcinoma in situ (DCIS) who had surgery for invasive breast cancer at the European Institute of Oncology, Milan, between 1998 and 2010. Women who had undergone axillary staging by sentinel lymph node biopsy were included in the study. RESULTS Of 257 women with microinvasive breast cancer who underwent sentinel lymph node biopsy (SLNB), 226 (87·9 per cent) had negative sentinel lymph nodes (SLNs) and 31 had metastatic SLNs. Twelve patients had isolated tumour cells (ITCs), 14 had micrometastases and five had macrometastases in sentinel nodes. Axillary lymph node dissection was performed in 16 of the 31 patients with positive SLNs. After a median follow-up of 11 years, only one regional first event was observed in the 15 patients with positive SLNs who did not undergo axillary lymph node dissection. There were no regional first events in the 16 patients with positive SLNs who had axillary dissection. CONCLUSION Good disease-free and overall survival were found in women with positive SLNs and microinvasive DCIS. This study is in line with studies showing that SLNB in microinvasive DCIS may not be useful, and supports the evidence that less surgery can provide the same level of overall survival with better quality of life.
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Affiliation(s)
- F Magnoni
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - G Massari
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - G Santomauro
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - E Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - G Peruzzotti
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - V Galimberti
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - P Veronesi
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - V S Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
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13
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Dubsky P, Curigliano G, Burstein HJ, Winer EP, Gnant M, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. Reply to 'The St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017: the point of view of an International Panel of Experts in Radiation Oncology' by Kirova et al. Ann Oncol 2018; 29:281-282. [PMID: 29045519 DOI: 10.1093/annonc/mdx543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- P Dubsky
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.,Klinik St. Anna, Luzern, Switzerland
| | - G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | | | - H-J Senn
- Tumor and Breast Center ZeTuP, St Gallen, Switzerland
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St Gallen, Switzerland
| | | | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - J Garber
- Klinik St. Anna, Luzern, Switzerland
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | - K Pritchard
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N.Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy.,Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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14
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2018; 29:2153. [PMID: 29733336 DOI: 10.1093/annonc/mdx806] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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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15
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Vicini E, Invento A, Cuoghi M, Bafile A, Battaglia C, Biglia N, Busani M, Bussone R, Cianchetti E, Caruso F, Cucchi M, Dessena M, Di Filippo F, Fabi N, Folli S, Friedman D, Macellari G, Mainente P, Murgo R, Neri A, Pollini G, Palli D, Ricci F, Scalco G, Taffurelli M, Trunfio M, Galimberti V. Neoadjuvant systemic treatment for breast cancer in Italy: The Italian Society of Surgical Oncology (SICO) Breast Oncoteam survey. Eur J Surg Oncol 2018; 44:1157-1163. [DOI: 10.1016/j.ejso.2018.03.018] [Citation(s) in RCA: 4] [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] [Received: 10/01/2017] [Revised: 03/01/2018] [Accepted: 03/20/2018] [Indexed: 01/09/2023] Open
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16
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Cosmacini P, Veronesi P, Galimberti V, Ferranti C, Viganotti G, Coopmans de Yoldi G. Ultrasonographic Evaluation of Palpable Breast Masses: Analysis of 134 Cases. Tumori 2018; 76:495-8. [PMID: 2256197 DOI: 10.1177/030089169007600516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sonography has become a helpful adjunct to mammography mainly for a differential diagnosis between simple cysts and solid masses. The authors examined by ultrasound 134 palpable masses in the breast which had been previously evaluated by clinical examination and mammography and then submitted to biopsy or fine needle aspiration. The exact diagnosis of a simple cyst was made in 94.1% of the cases, whereas the diagnosis of fibroadenoma was made in 80% of the cases. Ultrasound examination proved to be useful in patients with dense breasts: in this group, 82.1% of the patients with a histologic diagnosis of benign status had a correct ultrasound diagnosis. In agreement with other authors, we believe that breast sonography has no part in screening programs.
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Affiliation(s)
- P Cosmacini
- Divisione di Radiodiagnostica, Istituto Nazionale Tumori, Milano, Italy
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17
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Dicuonzo S, Leonardi M, Radice D, Morra A, Dell'Acqua V, Gerardi M, Rojas D, Surgo A, Cattani F, Cambria R, Fodor C, De Lorenzi F, Galimberti V, Orecchia R, Jereczek-Fossa B. EP-1344: Long-term reconstruction failure after postmastectomy RT to temporary expander or permanent implant. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31653-0] [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: 10/14/2022]
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18
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Gerardi M, Morra A, Dicuonzo S, Arculeo S, Patti F, Ricotti R, Dell'Acqua V, Augugliaro M, Arrobbio C, Viola A, Rojas D, Fodor C, Emiro F, Cattani F, Raimondi S, Galimberti V, Orecchia R, Leonardi M, Jereczek-Fossa B. EP-1323: Dosimetry results and toxicity of a 3-week schedule RT with SIB in breast cancer, with TomoDirect. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Galimberti V, Cole BF, Viale G, Veronesi P, Vicini E, Intra M, Mazzarol G, Massarut S, Zgajnar J, Taffurelli M, Littlejohn D, Egli T, Tondini C, Di Leo A, Colleoni M, Regan MM, Coates AS, Gelber RD, Goldhirsch A. Abstract GS5-02: Axillary dissection vs. no axillary dissection in patients with cT1-T2cN0M0 breast cancer and only micrometastases in the sentinel node(s): Ten-year results of the IBCSG 23-01 trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs5-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The phase III IBCSG 23-01 multicenter, randomized, non-inferiority trial compared disease-free survival (DFS) in breast cancer patients with one or more micrometastatic (≤2 mm) sentinel nodes (SNs) randomized to either axillary dissection (AD) or no axillary dissection (no-AD). Results after 5 years showed no difference in DFS between the arms. Here we report results after a median follow-up of 9.8 years.
METHODS: Eligible patients had cancers of pathological diameter ≤5 cm and one or more micrometastatic (≤2 mm) foci, including isolated tumor cells, in the SNs. Patients with axillary macrometastases were excluded. Breast surgery was conservative or mastectomy. Eligible patients were randomized to AD vs. no-AD. The primary endpoint was disease-free survival (DFS); secondary endpoints were overall survival (OS), site of recurrence (particularly axillary recurrence), and surgical complications of AD. DFS and OS were estimated using the product-limit method, and the log-rank test was used to compare the treatment groups. Patients without a DFS or OS event were censored at the date of last follow-up. Non-inferiority margin for no-AD vs. AD was defined as a DFS hazard ratio (HR, no-AD relative to AD) of <1.25, and was assessed using a z-test applied to the log HR. Active follow-up of patients was terminated in February 2017.
RESULTS: From 2001 to 2010, 934 patients were randomized at 27 centers; 931 were evaluable (467 in the no-AD group and 464 in the AD group). Median follow-up was 9.8 (IQR: 7.8–12.7) years. The number and types of first DFS events according to treatment group are shown in the Table.
Disease-free Survival EventsNo-ADADTotal101117Breast cancer related events7475Local1413Contralateral breast1012Regional [ipsilateral axillary events]9 [8]3 [2]Distant4147Non-breast cancer related events2742Second malignancies1723Death without prior cancer event62Death with unknown cancer status417
10-year DFS was 75% (95% confidence interval [CI]: 72%–81%) in the no-AD group and 75% (95% CI: 71%–79%) in the AD group (HR [no-AD vs. AD]=0.85; 95% CI: 0.65–1.11; log-rank p=0.23; non-inferiority p=0.002). There were 45 deaths in the no-AD group and 58 in the AD group. 10-year OS was 91% (95% CI: 88%–94%) in the no-AD group and 88% (95% CI: 85%–92%) in the AD group (HR [no-AD vs. AD]=0.77; 95% CI: 0.56–1.07; log-rank p=0.19).
CONCLUSION: Findings after a median follow-up of 9.8 years fully support the findings at 5 years in that no-AD is not inferior to AD with respect to DFS, and there is no significant difference between the arms for DFS and OS, thus confirming that AD is not indicated in patients with micrometastatic SNs.
Citation Format: Galimberti V, Cole BF, Viale G, Veronesi P, Vicini E, Intra M, Mazzarol G, Massarut S, Zgajnar J, Taffurelli M, Littlejohn D, Egli T, Tondini C, Di Leo A, Colleoni M, Regan MM, Coates AS, Gelber RD, Goldhirsch A. Axillary dissection vs. no axillary dissection in patients with cT1-T2cN0M0 breast cancer and only micrometastases in the sentinel node(s): Ten-year results of the IBCSG 23-01 trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS5-02.
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Affiliation(s)
- V Galimberti
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - BF Cole
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - G Viale
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - P Veronesi
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - E Vicini
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - M Intra
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - G Mazzarol
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - S Massarut
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - J Zgajnar
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - M Taffurelli
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - D Littlejohn
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - T Egli
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - C Tondini
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - A Di Leo
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - M Colleoni
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - MM Regan
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - AS Coates
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - RD Gelber
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - A Goldhirsch
- International Breast Cancer Study Group Trial 23-01 Investigators
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20
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Guerrieri-Gonzaga A, Gandini S, Serrano D, Lazzeroni M, Pruneri G, Varricchio C, Cazzaniga M, Leonardi MC, Galimberti V, Viale G, De Censi A, Bonanni B. Abstract P4-15-06: Low dose tamoxifen lowers recurrences after mastectomy for in situ neoplasia. Ten-year results of a monoinstitutional study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-15-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
There is no agreement upon the need of a preventive treatment after breast mastectomy for in situ neoplasia. Low-dose tamoxifen (5 mg/day) has comparable antiproliferative effect than the standard dose of 20 mg/day in biomarker trials and has been shown to halve ipsilateral recurrence in a large cohort of postmenopausal ER positive DCIS treated with breast conserving surgery (Guerrieri-Gonzaga et al., Int J Cancer 2016).
Here we investigated the effect of low dose tamoxifen in patients treated with mastectomy for an in situ neoplasia and followed-up in a single Institution for a median of 10 years.
Our cohort consists of 404 consecutive premenopausal (n=281) or postmenopausal (n=123) women who underwent unilateral mastectomy at the European Institute of Oncology (IEO), with or without nipple preservation, between 1996 and 2011. Patients had a diagnosis of pure LCIS (n=12) or ER positive (ER>1%) DCIS (n=363) or both (n=29) and were treated with tamoxifen 5 mg/day (n=162) or no treatment (n=242) upon medical judgment, patient preference and/or clinical trial assignment. The main subject and tumor characteristics are reported in table 1.
Patient and tumor characteristics No tam (n=242)Low dose tam (n=162)P-valueMedian age, years (IQR)46 (41, 54)47 (42, 51)0.65Premenopausal status (n, %)160 (66)121 (75)0.07Median BMI (kg/m2, IQR)22 (20, 25)22 (20, 24)0.7Breast cancer family history (%)29320.44Histology (LCIS, DCIS, both; %)4/92/42/86/120.01Grading (G1,G2,G3;%)11/59/2918/61/200.04Median ER (%, IQR)90 (70, 95)90 (80, 95)0.005Median PgR (%, IQR)40 (5, 80)68 (25, 90)0.0002Median Ki67 (%, IQR)15 (10, 23)14 (10, 20)0.03Radiotherapy (n, %)95 (39)76 (47)0.13
After a median follow-up of 10 years (range 4-21 years) and a median low dose tamoxifen treatment of 4.9 years (IQR 2.7, 5.0), a total of 85 events were observed (28 in situ, 40 invasive breast cancers, 3 metastatic diseases, 12 other primary cancers, 2 deaths). A total of 36 ipsilateral breast events (23 versus 13 in the no tam versus tam group, respectively), 32 contralateral breast events (22 versus 10 in the no tam versus tam, respectively) and 17 other events (11 versus 6 in the no tam versus tam, respectively) occurred. Overall, eleven deaths (3%) occurred and no endometrial cancers were observed. A time-dependent competing risk model was applied for tamoxifen use and we have shown that low-dose tamoxifen was associated with a 48% reduction on all breast events (adjusted HR=0.52, 95% CI: 0.31–0.88, p=0.01), adjusting for radiotherapy and age.
Although limited by the observational nature of the study, we show for the first time that treatment with low dose tamoxifen is effective and safe in women who underwent mastectomy for non-invasive breast neoplasms and should be taken into consideration as a risk reduction strategy for premenopausal and postmenopausal women with breast intraepithelial neoplasia.
Citation Format: Guerrieri-Gonzaga A, Gandini S, Serrano D, Lazzeroni M, Pruneri G, Varricchio C, Cazzaniga M, Leonardi MC, Galimberti V, Viale G, De Censi A, Bonanni B. Low dose tamoxifen lowers recurrences after mastectomy for in situ neoplasia. Ten-year results of a monoinstitutional study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-15-06.
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Affiliation(s)
- A Guerrieri-Gonzaga
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - S Gandini
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - D Serrano
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - M Lazzeroni
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - G Pruneri
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - C Varricchio
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - M Cazzaniga
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - MC Leonardi
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - V Galimberti
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - G Viale
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - A De Censi
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - B Bonanni
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
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21
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Corso G, Bonanni B, Veronesi P, Galimberti V. Mutual exclusion of CDH1 and BRCA germline mutations in the pathway of hereditary breast cancer. Arch Gynecol Obstet 2018; 297:1067-1068. [PMID: 29397440 DOI: 10.1007/s00404-018-4705-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/18/2018] [Indexed: 01/25/2023]
Affiliation(s)
- G Corso
- Division of Breast Cancer Surgery, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy.
| | - B Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy
| | - P Veronesi
- Division of Breast Cancer Surgery, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Breast Cancer Surgery, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy
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22
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Botteri E, Veronesi P, Vila J, Rotmensz N, Galimberti V, Thomazini MV, Viale G, Orecchia R, Goldhirsch A, Gentilini O. Improved prognosis of young patients with breast cancer undergoing breast-conserving surgery. Br J Surg 2017; 104:1802-1810. [PMID: 28791694 DOI: 10.1002/bjs.10658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 06/24/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate how breast cancer prognosis has evolved over time in young women treated with breast-conserving surgery (BCS). METHODS Data from patients younger than 40 years who had BCS and whole-breast radiotherapy in a single cancer centre between 1997 and 2010 were analysed. The patients were followed until 2016. Endpoints were local recurrence, any breast cancer-related event and death from any cause. RESULTS A total of 1331 patients were included in the study. After a median follow-up of 9·3 years, 114 local recurrences, 289 breast cancer-related events and 138 deaths had occurred. Women were divided into three groups of similar size based on tertiles of the date of diagnosis: 1997-2002 (524 patients), 2003-2005 (350) and 2006-2010 (457). The risk of local recurrence was 1·42 per 100 person-years in women diagnosed in the first interval, 0·85 per 100 person-years in the second and 0·48 per 100 person-years in the third (P for trend = 0·028). The respective values were 3·01, 2·52 and 2·07 per 100 person-years for any breast cancer-related event (P = 0·004), and 1·59, 1·22 and 0·64 per 100 person-years for death (P = 0·003). Each passing year was associated with a decreasing risk of local recurrence (hazard ratio (HR) 0·93, 95 per cent c.i. 0·87 to 1·00), any breast cancer-related event (HR 0·94, 0·91 to 0·98) and death (HR 0·89, 0·83 to 0·94). A major improvement in prognosis was observed after 2005, when the classification of breast cancer molecular subtypes and use of trastuzumab were implemented in routine clinical practice. CONCLUSION In the past two decades, both local control and overall prognosis have improved significantly in young women (aged less than 40 years) with breast cancer who undergo BCS.
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Affiliation(s)
- E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.,National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.,Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - P Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - J Vila
- Scientific Directorate, European Institute of Oncology, Milan, Italy.,Department of Breast Surgery, La Fe University Hospital, Valencia, Spain
| | - N Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - V Galimberti
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - M V Thomazini
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - G Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy.,Department of Oncology, Haemato-oncology, University of Milan, Milan, Italy
| | - A Goldhirsch
- Scientific Directory and Medical Senology, European Institute of Oncology, Milan, Italy
| | - O Gentilini
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
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23
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2017; 28:1700-1712. [PMID: 28838210 PMCID: PMC6246241 DOI: 10.1093/annonc/mdx308] [Citation(s) in RCA: 696] [Impact Index Per Article: 99.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.
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Affiliation(s)
- G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Klinik St. Anna, Luzern, Switzerland
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, UniversitÕ Libre de Bruxelles, Brussels, Belgium
| | - H-J Senn
- Tumor and Breast Center ZeTuP, St. Gallen
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - J Garber
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A H Partridge
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - K Pritchard
- Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku, Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy
- Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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Dicuonzo S, Spoto R, Leonardi M, Surgo A, Viola A, Augugliaro M, Pansini F, Cattani F, Galimberti V, Morra A, Dell’Acqua V, Orecchia R, Jereczek-Fossa B. PO-0660: Partial breast re-irradiation with IMRT in patients with local failure after conservative treatment. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31097-6] [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: 10/19/2022]
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Galimberti V. Nipple‐sparing and skin‐sparing mastectomy – goals, pitfalls, contraindications. Breast 2017. [DOI: 10.1016/s0960-9776(17)30085-1] [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] Open
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Poletto V, Galimberti V, Guerra G, Rosti V, Moccia F, Biggiogera M. Fine structural detection of calcium ions by photoconversion. Eur J Histochem 2016; 60:2695. [PMID: 27734989 PMCID: PMC5062637 DOI: 10.4081/ejh.2016.2695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/17/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022] Open
Abstract
We propose a tool for a rapid high-resolution detection of calcium ions which can be used in parallel with other techniques. We have applied a new approach by photo-oxidation of diaminobenzidine in presence of the emission of an excited fluorochrome specific for calcium detection. This method combines the selectivity of available fluorophores to the high spatial resolution offered by transmission electron microscopy to detect fluorescing molecules even when present in low amounts in membrane-bounded organelles. We show in this paper that Mag-Fura 2 photoconversion via diaminobenzidine oxidation is an efficient way for localizing Ca2+ ions at electron microscopy level, is easily carried out and reproducible, and can be obtained on a good amount of cells, since the exposure in our conditions is not limited to the direct irradiation of the sample via an objective but obtained with a germicide lamp. The end product is sufficiently electron dense to be detected clearly when present in sufficient amount within a membrane boundary.
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Affiliation(s)
- V Poletto
- San Matteo foundation for health, hospitalization and care.
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27
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Luraschi R, Lazzari R, Galimberti V, Bazani A, Rondi E, Leonardi M, Corso G, Colombo N, Jereczek-Fossa B, Cattani F. EP-1596: Intraoperative radiotherapy with electrons in breast cancer patients with cardiac devices. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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De Lorenzi F, Hubner G, Rotmensz N, Bagnardi V, Loschi P, Maisonneuve P, Venturino M, Orecchia R, Galimberti V, Veronesi P, Rietjens M. Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution. Eur J Surg Oncol 2016; 42:71-7. [DOI: 10.1016/j.ejso.2015.08.160] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/24/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022] Open
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Intra M, Viale G, Vila J, Grana CM, Toesca A, Gentilini O, Galimberti V, Veronesi P, Luini A, Rotmensz N, Bagnardi V, Mattar D, Colleoni M. Second Axillary Sentinel Lymph Node Biopsy for Breast Tumor Recurrence: Experience of the European Institute of Oncology. Ann Surg Oncol 2014; 22:2372-7. [DOI: 10.1245/s10434-014-4282-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Indexed: 11/18/2022]
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31
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Montagna E, Bagnardi V, Viale G, Rotmensz N, Sporchia A, Cancello G, Balduzzi A, Galimberti V, Veronesi P, Luini A, Mastropasqua MG, Casadio C, Sangalli C, Goldhirsch A, Colleoni M. Changes in PgR and Ki-67 in residual tumour and outcome of breast cancer patients treated with neoadjuvant chemotherapy. Ann Oncol 2014; 26:307-13. [PMID: 25411418 DOI: 10.1093/annonc/mdu528] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 12/15/2022] Open
Abstract
BACKGROUND Limited data are available on the prognostic value of changes in the biological features of residual tumours following neoadjuvant therapies in breast cancer patients. PATIENTS AND METHODS We collected information through the institutional clinical database on all consecutive breast cancer patients treated with neoadjuvant chemotherapy at the European Institute of Oncology (IEO), Milan, Italy, between 1999 and 2011. We selected patients who did not achieve pathological complete response at final surgery. All patients had a pathological evaluation, including ER, PgR, HER2 protein and Ki-67 expression carried out at the IEO both at diagnostic core biopsy and at final surgery. RESULTS We identified a total of 904 patients. The 5% of patients who were ER positive at diagnostic biopsy had ER-negative residual tumour at final surgery. For PgR expression, 67% of the patients, whose tumours had a PgR >20% at diagnostic biopsy had a PgR <20% at final surgery. The Ki-67 expression changed from >20% to <20% in 40% of the patients. At the multivariate analysis, the decrease of PgR-immunoreactive cells correlated with improved outcome in terms of disease-free survival (DFS) [hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.54-1.00, P 0.046]. In addition, the decrease of Ki-67 expression to <20% of the cells at final surgery was found to be associated with better outcome both in terms of DFS (HR 0.52; 95% CI 0.40-0.68 P < 0.0001) and overall survival (HR 0.45; 95% CI 0.32-0.64, P < 0.0001). CONCLUSION The decrease of PgR and Ki-67 expression after preoperative chemotherapy has a prognostic role in breast cancer patients with residual disease.
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Affiliation(s)
- E Montagna
- Division of Medical Senology, European Institute of Oncology, Milan
| | - V Bagnardi
- Department of Quantitative Methods and Statistics, University of Milan-Bicocca, Milan Division of Epidemiology and Biostatistics
| | - G Viale
- Department of Pathology, European Institute of Oncology, Milan School of Medicine, University of Milan, Milan
| | - N Rotmensz
- Division of Epidemiology and Biostatistics
| | - A Sporchia
- Division of Medical Senology, European Institute of Oncology, Milan
| | - G Cancello
- Division of Medical Senology, European Institute of Oncology, Milan
| | - A Balduzzi
- Division of Medical Senology, European Institute of Oncology, Milan
| | | | | | | | | | - C Casadio
- Department of Pathology, European Institute of Oncology, Milan
| | - C Sangalli
- Division of Medical Senology, European Institute of Oncology, Milan
| | - A Goldhirsch
- Program of Senology (Breast Health), European Institute of Oncology, Milan, Italy
| | - M Colleoni
- Division of Medical Senology, European Institute of Oncology, Milan
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Marzo S, Galimberti V, Biggiogera M. Unexpected distribution of KRIT1 inside the nucleus: new insight in a complex molecular pathway. Eur J Histochem 2014; 58:2358. [PMID: 24705002 PMCID: PMC3980215 DOI: 10.4081/ejh.2014.2358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 12/19/2013] [Revised: 02/07/2014] [Accepted: 02/11/2014] [Indexed: 02/03/2023] Open
Abstract
KRIT1 is an 84kDa protein that lacks any relevant catalytic domains, associated with the cerebral cavernous malformation disease. We have investigated by means of ultrastructural immunocytochemistry the nuclear distribution of KRIT1 in different cell lines, revealing its unexpected localization on actively transcribing nuclear domains such as the perichromatin fibrils and the nucleolar dense fibrillar component. These preliminary data indicate a still undescribed and unknown role for KRIT1 inside the nucleus.
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Malatesta M, Pellicciari C, Cisterna B, Costanzo M, Galimberti V, Biggiogera M, Zancanaro C. Tracing nanoparticles and photosensitizing molecules at transmission electron microscopy by diaminobenzidine photo-oxidation. Micron 2013; 59:44-51. [PMID: 24530364 DOI: 10.1016/j.micron.2013.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 10/07/2013] [Revised: 12/12/2013] [Accepted: 12/12/2013] [Indexed: 11/29/2022]
Abstract
During the last three decades, diaminobenzidine photo-oxidation has been applied in a variety of studies to correlate light and electron microscopy. Actually, when a fluorophore is excited by light, it can induce the oxidation of diaminobenzidine into an electron-dense osmiophilic product, which precipitates in close proximity to the fluorophore, thereby allowing its ultrastructural detection. This method has very recently been developed for two innovative applications: tracking the fate of fluorescently labeled nanoparticles in single cells, and detecting the subcellular location of photo-active molecules suitable for photodynamic therapy. These studies established that the cytochemical procedures exploiting diaminobenzidine photo-oxidation represent a reliable tool for detecting, inside the cells, with high sensitivity fluorescing molecules. These procedures are trustworthy even if the fluorescing molecules are present in very low amounts, either inside membrane-bounded organelles, or at the surface of the plasma membrane, or free in the cytosol. In particular, diaminobenzidine photo-oxidation allowed elucidating the mechanisms responsible for nanoparticles internalization in neuronal cells and for their escape from lysosomal degradation. As for the photo-active molecules, their subcellular distribution at the ultrastructural level provided direct evidence for the lethal multiorganelle photo-damage occurring after cell photo-sensitization. In addition, DAB photo-oxidized samples are suitable for the ultrastructural detection of organelle-specific molecules by post-embedding gold immunolabeling.
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Affiliation(s)
- M Malatesta
- Department of Neurological and Movement Sciences (Anatomy and Histology Section), University of Verona, Strada Le Grazie 8, 37134 Verona, Italy.
| | - C Pellicciari
- Department of Biology and Biotechnology "Lazzaro Spallanzani" (Laboratory of Cell Biology and Neurobiology), University of Pavia, Via A. Ferrata, 9, 27100 Pavia, Italy.
| | - B Cisterna
- Department of Neurological and Movement Sciences (Anatomy and Histology Section), University of Verona, Strada Le Grazie 8, 37134 Verona, Italy.
| | - M Costanzo
- Department of Neurological and Movement Sciences (Anatomy and Histology Section), University of Verona, Strada Le Grazie 8, 37134 Verona, Italy.
| | - V Galimberti
- Department of Biology and Biotechnology "Lazzaro Spallanzani" (Laboratory of Cell Biology and Neurobiology), University of Pavia, Via A. Ferrata, 9, 27100 Pavia, Italy.
| | - M Biggiogera
- Department of Biology and Biotechnology "Lazzaro Spallanzani" (Laboratory of Cell Biology and Neurobiology), University of Pavia, Via A. Ferrata, 9, 27100 Pavia, Italy.
| | - C Zancanaro
- Department of Neurological and Movement Sciences (Anatomy and Histology Section), University of Verona, Strada Le Grazie 8, 37134 Verona, Italy.
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Malatesta M, Galimberti V, Cisterna B, Costanzo M, Biggiogera M, Zancanaro C. Chitosan nanoparticles are efficient carriers for delivering biodegradable drugs to neuronal cells. Histochem Cell Biol 2013; 141:551-8. [DOI: 10.1007/s00418-013-1175-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 12/23/2022]
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Guerrieri-Gonzaga A, Lazzeroni M, Botteri E, Serrano D, Rotmensz N, Varricchio MC, Cazzaniga M, Bollani G, Mora S, Montefrancesco C, Pruneri G, Viale G, Intra M, Galimberti V, Goldhirsch A, Bagnardi V, Bonanni B, DeCensi A. Effect of low-dose tamoxifen after surgical excision of ductal intraepithelial neoplasia: results of a large retrospective monoinstitutional cohort study. Ann Oncol 2013; 24:1859-1866. [PMID: 23532115 DOI: 10.1093/annonc/mdt113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 10/07/2023] Open
Abstract
BACKGROUND Postsurgical treatment of ductal intraepithelial neoplasia (DIN) with standard doses of tamoxifen has not reached a consensus yet. Given positive results of low-dose tamoxifen on breast cancer biomarkers modulation, we analyzed a large cohort of DIN patients treated with low-dose tamoxifen or no treatment as per institutional guidelines. PATIENTS AND METHODS All consecutive women operated on at the European Institute of Oncology for estrogen receptor (ER)-positive DIN (474 treated with low-dose tamoxifen and 509 untreated patients) were followed up for a median of 7 years. RESULTS Compared with untreated patients, a significant 30% reduction in breast cancer risk was observed on low-dose tamoxifen with an adjusted hazard ratio (HR) = 0.70 [95% confidence interval (CI) 0.51-0.94], with a greater benefit in postmenopausal (HR = 0.57; 95% CI 0.34-0.94) than in premenopausal women (HR = 0.79; 95% CI 0.54-1.17). Treated patients with ER and progesterone receptor (PgR) >50% DIN had a lower incidence of breast events than untreated ones (HR = 0.61; 95% CI 0.40-0.94), whereas no protective effect has been observed in patients with ER or PgR <50% DIN. Drug discontinuation resulted in a doubled risk of recurrence in premenopausal women only (HR = 1.95; 95% CI 0.98-3.89). No excess of endometrial cancer occurred. CONCLUSIONS Low-dose tamoxifen is a promising and safe strategy for highly endocrine responsive DIN. Treatment adherence is crucial in premenopausal women. A definitive trial is ongoing.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/administration & dosage
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma in Situ/drug therapy
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Clinical Trials as Topic
- Disease-Free Survival
- Female
- Humans
- Kaplan-Meier Estimate
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local/prevention & control
- Retrospective Studies
- Tamoxifen/administration & dosage
- Treatment Outcome
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Affiliation(s)
| | | | | | - D Serrano
- Divisions of Cancer Prevention and Genetics
| | | | | | | | - G Bollani
- Divisions of Cancer Prevention and Genetics
| | - S Mora
- Divisions of Cancer Prevention and Genetics
| | | | - G Pruneri
- Pathology and Lab Medicine; University of Milan, School of Medicine, Milan
| | - G Viale
- Pathology and Lab Medicine; University of Milan, School of Medicine, Milan
| | | | | | - A Goldhirsch
- Department of Medicine, European Institute of Oncology, Milan
| | - V Bagnardi
- Epidemiology and Biostatistics; Department of Statistics, University of Milan-Bicocca, Milan
| | - B Bonanni
- Divisions of Cancer Prevention and Genetics
| | - A DeCensi
- Divisions of Cancer Prevention and Genetics; Division of Medical Oncology, Ospedali Galliera, Genoa, Italy.
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Malatesta M, Giagnacovo M, Costanzo M, Conti B, Genta I, Dorati R, Galimberti V, Biggiogera M, Zancanaro C. Diaminobenzidine photoconversion is a suitable tool for tracking the intracellular location of fluorescently labelled nanoparticles at transmission electron microscopy. Eur J Histochem 2012; 56:e20. [PMID: 22688301 DOI: 10.4081/ejh.2012.20] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 03/26/2012] [Accepted: 03/27/2012] [Indexed: 01/06/2023] Open
Abstract
Chitosan-based nanoparticles (NPs) deserve particular attention as suitable drug carriers in the field of pharmaceutics, since they are able to protect the encapsulated drugs and/or improve their efficacy by making them able to cross biological barriers (such as the blood-brain barrier) and reach their intracellular target sites. Understanding the intracellular location of NPs is crucial for designing drug delivery strategies. In this study, fluorescently-labelled chitosan NPs were administered in vitro to a neuronal cell line, and diaminobenzidine (DAB) photoconversion was applied to correlate fluorescence and transmission electron microscopy to precisely describe the NPs intracellular fate. This technique allowed to demonstrate that chitosan NPs easily enter neuronal cells, predominantly by endocytosis; they were found both inside membrane-bounded vesicles and free in the cytosol, and were observed to accumulate around the cell nucleus.
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Affiliation(s)
- M Malatesta
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Italy.
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37
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Malatesta M, Giagnacovo M, Costanzo M, Conti B, Genta I, Dorati R, Galimberti V, Biggiogera M, Zancanaro C. Diaminobenzidine photoconversion is a suitable tool for tracking the intracellular location of fluorescently labelled nanoparticles at transmission electron microscopy. Eur J Histochem 2012. [PMID: 22688301 PMCID: PMC3428969 DOI: 10.4081/ejh.2012.e20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chitosan-based nanoparticles (NPs) deserve particular attention as suitable drug carriers in the field of pharmaceutics, since they are able to protect the encapsulated drugs and/or improve their efficacy by making them able to cross biological barriers (such as the blood-brain barrier) and reach their intracellular target sites. Understanding the intracellular location of NPs is crucial for designing drug delivery strategies. In this study, fluorescently-labelled chitosan NPs were administered in vitro to a neuronal cell line, and diaminobenzidine (DAB) photoconversion was applied to correlate fluorescence and transmission electron microscopy to precisely describe the NPs intracellular fate. This technique allowed to demonstrate that chitosan NPs easily enter neuronal cells, predominantly by endocytosis; they were found both inside membrane-bounded vesicles and free in the cytosol, and were observed to accumulate around the cell nucleus.
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Affiliation(s)
- M. Malatesta
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona
| | - M. Giagnacovo
- Department of Biology and Biotechnology, Laboratory of Cell Biology, University of Pavia
| | - M. Costanzo
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona
| | - B. Conti
- Department of Drug Sciences, University of Pavia
| | - I. Genta
- Department of Drug Sciences, University of Pavia
| | - R. Dorati
- Department of Drug Sciences, University of Pavia
| | - V. Galimberti
- Department of Biology and Biotechnology, Laboratory of Cell Biology, University of Pavia
| | - M. Biggiogera
- Department of Biology and Biotechnology, Laboratory of Cell Biology, University of Pavia;,CNR Institute of Molecular Genetics, Pavia, Italy
| | - C. Zancanaro
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona
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38
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Haynes BP, Viale B, A'Hern R, Smith IE, Dowsett M, Galimberti V, Rotmensz N, Gibelli B. S6-6: Expression of Key Estrogen-Regulated Genes (ERGs) Differ Substantially across the Menstrual Cycle in ER+ Breast Tumours. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-s6-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: To determine whether there are substantial changes in the expression of ERGs in estrogen receptor positive (ER+) breast cancer through the menstrual cycle.
Background: Plasma levels of estradiol (E2) vary from c.100pM to c.1000pM and progesterone levels from <3nM to >50nM through the menstrual cycle. The changes in E2 are proportionally similar to those that occur in postmenopausal women treated with an aromatase inhibitor which lead to profound changes in the expression of ERGs. However, there are only inconsistent data on whether the cyclical changes in hormone levels during the menstrual cycle affect gene expression in ER+ tumours.
Methods; 173 paraffin-embedded ER+ breast carcinomas were analysed from premenopausal patients in which day of menstrual cycle and hormonal data were recorded at the time of surgery1 enabling accurate definition of the timing of the ovarian cycle. The patients were ascribed to one of 3 pre-defined time windows of the menstrual cycle: window 1: days 27–35 + 1–6 (low circulating E2 and progesterone); window 2: days 7–16 (high E2 and low progesterone); window 3: days 17–26 (moderate E2 and high progesterone). RNA was extracted (RecoverAll; Ambion) and QPCR used to measure expression of ESR1, 4 ERGs (TFF1, PGR, GREB1 and PDZK1)2 and 3 housekeeping genes.
Results: ESR1 expression did not differ significantly across the menstrual cycle but there was strong evidence of differences in the ERGs (Kruskal-Wallis; p=0.0015 to 0.093). Gene expression levels of the 4 ERGs were 51–109% higher in window 2 than window 1 (see table) and this was significant for PGR, GREB1 and TFF1 and approached significance for PDZK1. The expression of all the ERGs was lower (14-59%) in window 3 compared to window 2 (significant for TFF1). PGR and GREB1 expression was significantly higher (30-40%) in window 3 compared to window 1.
The average expression of these 4 ERGs gives the AvERG, a previously defined index of estrogen responsiveness2. This showed similar changes to the individual ERGs but the reduced variability of the AvERG led to even greater statistical significance. A control set of ER− tumours (n=83) showed very low expression of the ERGs and no cyclical changes.
Discussion: These data reveal significant changes in breast tumour biology across the menstrual cycle. As these changes are likely to occur only in tumours that are estrogen-dependent their measurement may potentially be developed as a test of a tumour's likely response to estrogen deprivation. Several ERGs are present in currently used molecular profiling tests; variable expression of these markers through the menstrual cycle may affect the interpretation of the tests. Proliferation-related genes are currently being assessed to determine if their expression varies in a similar way.
1. Zurrida et al., Crit Rev Oncol Hem 2001, 38; 223–30
2. Dunbier et al., JCO 2010, 28; 1161–7
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S6-6.
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Affiliation(s)
- BP Haynes
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - B Viale
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - R A'Hern
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - IE Smith
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - M Dowsett
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - V Galimberti
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - N Rotmensz
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
| | - B Gibelli
- 1Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, Sutton, Surrey, United Kingdom; European Institute of Oncology, Milan, Italy
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Galimberti V. S27 Positive axillary sentinel lymph node: Is axillary dissection always necessary? Breast 2011. [DOI: 10.1016/s0960-9776(11)70030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bonanni B, Cazzaniga M, Puntoni M, Pruneri G, Serrano D, Lazzeroni M, Guerrieri-Gonzaga A, Macis D, Luini A, Veronesi P, Galimberti V, DeCensi A. E. Abstract PD03-02: A Randomized Pre-Surgical Trial of Metformin in Breast Cancer. Preliminary Feasibility and Safety Results. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd03-02] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Metformin has been associated with decreased breast cancer (BC) incidence in diabetic patients in epidemiological studies. Moreover, this drug results in initiation of an AMPK-dependent energy stress response which can adversely affect survival of breast cancer cell lines and inhibition of PI3K/Akt/mTOR signaling leading to reduced proliferation of BC cell lines.
Methods: We conducted a randomized, pre-surgical, phase IIb, placebo-controlled, biomarker trial in women with stage I-III BC candidate to elective surgery. The primary endpoint was the change in cell proliferation in malignant, dysplastic and hyperplastic tissue as measured by Ki-67 labeling index (LI). With 150 subjects, the study was 80% powered to test for the interaction between metformin activity and ER status. Two interim analyses are being planned after 100 and 200 women enrolled. Results: As of June 18, 2010, 175 subjects have been randomized and 162 have completed treatment. Here we report data on the first 100 women enrolled. At the symposium, full data on the first 200 women enrolled will be available. As of December 31, 2009, a total of 163 women were screened, 26 were not eligible and 40 refused to participate, 6 dropped out during the study for AEs (n=2) or refusal to continue treatment (n=4), thus leaving 95 subjects assessable for the primary endpoint. The main subject and tumor characteristics blinded as to the allocated arm were mean age 52 (31-77), Pre/postmenopause, 54/41, mean BMI, 23.6 (18.0-40.2). At baseline, median Ki-67LI was 18% (range 4%-65%) at biopsy and 19% (4%-70%) after 4 weeks at surgery. All adverse events except for 1 SAE were grade 1 or 2, consisting of G2 nausea and G2 diarrhea in 4% and 6% of the cases, respectively. The prevalence of ductal intraepithelial neoplasia was 91% (median Ki-67 LI, 10%) in samples both adjacent and distant from the tumor, whereas the prevalence of ductal hyperplasia was 77% (median Ki-67LI, 2%) in samples distant from the tumor. Conclusions: Our preliminary results show the feasibility, high compliance and safety of a metformin trial in breast cancer patients. Assessment of tissue and circulating biomarkers is currently ongoing to characterize the whole spectrum of metformin activity in malignant and dysplastic tissue.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD03-02.
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Affiliation(s)
- B Bonanni
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - M Cazzaniga
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - M Puntoni
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - G Pruneri
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - D Serrano
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - M Lazzeroni
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - A Guerrieri-Gonzaga
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - D Macis
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - A Luini
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - P Veronesi
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - V Galimberti
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
| | - E.O. DeCensi A.
- Ospedali Galliera, Genova, Italy; European Institute of Oncology, Milano, Italy
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Galimberti V. [PPE--technical characteristics and conformity assessment]. G Ital Med Lav Ergon 2010; 32:256-258. [PMID: 21438275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Curigliano G, Alkalay M, Locatelli MA, Fumagalli L, Giudici S, Bertolini F, Galimberti V, Viale G, Nole F, Goldhirsch A. Genetic signature of breast cancer with lymphangitic spread to the chest wall: Results from a randomized phase II study combining bevacizumab with oral vinorelbine plus capecitabine (BEVIX). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1078] [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: 11/20/2022] Open
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Paganelli G, De Cicco C, Ferrari ME, McVie G, Pagani G, Leonardi MC, Cremonesi M, Ferrari A, Pacifici M, Di Dia A, Botta F, De Santis R, Galimberti V, Luini A, Orecchia R, Veronesi U. IART (Intra-Operative Avidination for Radionuclide Therapy) for accelerated radiotherapy in breast cancer patients. Technical aspects and preliminary results of a phase II study with 90Y-labelled biotin. Ecancermedicalscience 2010; 4:166. [PMID: 22276027 PMCID: PMC3234029 DOI: 10.3332/ecancer.2010.166] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Breast conserving surgery (BCS) plus external beam radiotherapy (EBRT) is considered the standard treatment for early breast cancer. We have investigated the possibility of irradiating the residual gland, using an innovative nuclear medicine approach named IART(®) (Intra-operative Avidination for Radionuclide Therapy). AIM The objective of this study was to determine the optimal dose of avidin with a fixed activity (3.7 GBq) of (90)Y-biotin, in order to provide a boost of 20 Gy, followed by EBRT to the whole breast (WB) at the reduced dose of 40 Gy. Local and systemic toxicity, patient's quality of life, including the cosmetic results after the combined treatment with IART(®) and EBRT, were assessed. METHODS After tumour excision, the surgeon injected native avidin diluted in 30 ml of saline solution into and around the tumour bed (see video). Patients received one of three avidin dose levels: 50 mg (10 pts), 100 mg (15 pts) and 150 mg (10 pts). Between 12 to 24 h after surgery, 3.7 GBq (90)Y-biotin spiked with 185 MBq (111)In-biotin was administered intravenously (i.v.). Whole body scans and SPECT images were performed up to 30 h post-injection for dosimetric purposes. WB-EBRT was administered four weeks after the IART(®) boost. Local toxicity and quality of life were evaluated. RESULTS Thirty-five patients were evaluated. No side effects were observed after avidin administration and (90)Y-biotin infusion. An avidin dose level of 100 mg resulted the most appropriate in order to deliver the required radiation dose (19.5 ± 4.0 Gy) to the surgical bed. At the end of IART(®), no local toxicity occurred and the overall cosmetic result was good. The tolerance to the reduced EBRT was also good. The highest grade of transient local toxicity was G3, which occurred in 3/32 pts following the completion of WB-EBRT. The combination of IART(®)+EBRT was well accepted by the patients, without any changes to their quality of life. CONCLUSIONS These preliminary results support the hypothesis that IART(®) may represent a valid approach to accelerated WB irradiation after BCS. We hope that this nuclear medicine technique will contribute to a better management of breast cancer patients.
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Montagna E, Viale G, Rotmensz N, Maisonneuve P, Galimberti V, Luini A, Intra M, Veronesi P, Mazzarol G, Pruneri G, Renne G, Torrisi R, Cardillo A, Cancello G, Goldhirsch A, Colleoni M. Minimal axillary lymph node involvement in breast cancer has different prognostic implications according to the staging procedure. Breast Cancer Res Treat 2009; 118:385-94. [PMID: 19562480 DOI: 10.1007/s10549-009-0446-6] [Citation(s) in RCA: 27] [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] [Received: 06/08/2009] [Accepted: 06/10/2009] [Indexed: 02/07/2023]
Abstract
It is still controversial whether the identification of micrometastases and isolated tumor cells in the axillary lymph nodes of patients with breast cancer has any prognostic value. We evaluated the prognostic role of isolated tumor cells and micrometastases in the axillary lymph nodes in 3,158 consecutive patients pT1-2 pN0-N1mi (with a single involved lymph node) and M0, referred to the Division of Medical Oncology after surgery performed at the European Institute of Oncology from April 1997 to December 2002. Median follow-up was 6.3 years (range 0.1-11 years). Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) were performed in 2,087 and 1,071 patients, respectively. A worse metastasis-free survival was observed for patients with micrometastatic disease compared to node-negative patients, if staged with ALND (log-rank P < .0001; HR: 3.17; 95% CI 1.72-5.83 at multivariate analysis), but not for patients who underwent SLNB (log-rank P = 0.36). The presence of a single micrometastatic lymph node is associated with a higher risk of distant recurrence as compared to node-negative disease only for patients undergoing ALND for staging purposes. Treatment recommendations for systemic therapy should not take into account the presence of a single micrometastatic lymph node identified during complete serial sectioning of sentinel node(s).
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Affiliation(s)
- E Montagna
- Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
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Burgoa L, Luini A, Galimberti V, Gatti G, Arnone P, Vento A, Trifirò G, Viale G, Rotmensz N, Rodriguez Fernandez J, Zucca F, Paganelli G. 0091 Sentinel node biopsy after previous breast surgery: Increasing evidence. Breast 2009. [DOI: 10.1016/s0960-9776(09)70133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Colleoni M, Bagnardi V, Rotmensz N, Dellapasqua S, Viale G, Pruneri G, Veronesi P, Torrisi R, Luini A, Intra M, Galimberti V, Montagna E, Goldhirsch A. A risk score to predict disease-free survival in patients not achieving a pathological complete remission after preoperative chemotherapy for breast cancer. Ann Oncol 2009; 20:1178-84. [PMID: 19218304 DOI: 10.1093/annonc/mdn747] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to predict disease-free survival (DFS) in patients who failed to achieve a pathologic complete remission (pCR) after preoperative chemotherapy (PC). PATIENTS AND METHODS Data from 577 patients treated with PC and operated at the European Institute of Oncology (EIO) were used to develop a nomogram using Cox proportional hazards regression model based on both categorical (pT, positive nodes, human epidermal growth factor receptor 2 (HER2) status, vascular invasion) and continuous histological variables (estrogen receptors and Ki-67 expression) at surgery. The nomogram was tested on a second patient cohort (343 patients) treated in other institutions and subsequently operated at the EIO. RESULTS The nomogram for DFS based on both categorical and continuous variables had good discrimination in the training and the validation sets (concordance indices 0.73, 0.67). CONCLUSION The use of a nomogram based on the degree of selected histopathological variables can predict DFS and might help in the adjuvant therapeutic algorithm design.
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Affiliation(s)
- M Colleoni
- Department of Medicine, Division of Medical Oncology, European Institute of Oncology, Milan, Italy.
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Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V, Bedolis R, Rietjens M, Garusi C, De Lorenzi F, Bosco R, Manconi A, Ivaldi GB, Youssef O. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 2009; 117:333-8. [PMID: 19152026 DOI: 10.1007/s10549-008-0304-y] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/31/2008] [Indexed: 02/04/2023]
Abstract
In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%. Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1-69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.
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Affiliation(s)
- J Y Petit
- Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Botteri E, Rotmensz N, Sangalli C, Toesca A, Peradze N, De Oliveira Filho HR, Sagona A, Intra M, Veronesi P, Galimberti V, Luini A, Veronesi U, Gentilini O. Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome. Ann Oncol 2009; 20:1008-12. [PMID: 19150942 DOI: 10.1093/annonc/mdn732] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the case of ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS), a second conservative surgical approach maybe considered in some motivated patients whereas in others mastectomy is unavoidable. PATIENTS AND METHODS From 1997 to 2004, 282 patients presented at the European Institute of Oncology with an operable invasive IBTR after BCS. One hundred and sixty-one (57%) underwent a second conservative surgery, whereas 121 patients (43%) were given a mastectomy and represent the study population. We investigated the prognosis and determined predictive factors of outcome. RESULTS Median time from primary breast cancer to IBTR was 41 months (range 5-213). Recurrences were T2-T4 and/or multifocal in 83 cases (68.6%). With a median follow-up of 5 years after mastectomy, 5-year overall survival (OS) and disease-free survival (DFS) were 73.3% [95% confidence interval (CI) 65.0% to 81.6%] and 50.4% (95% CI 40.9% to 59.8%), respectively. At the multivariate analysis, early onset of IBTR, presence of vascular invasion and Ki67 >or=20 of the recurrent tumour were found to significantly affect both DFS and OS. CONCLUSIONS In women who need mastectomy for IBTR, early onset of the relapse, high proliferation index and presence of vascular invasion represent the worst prognostic factors.
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Affiliation(s)
- E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
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Didier F, Radice D, Gandini S, Bedolis R, Rotmensz N, Maldifassi A, Santillo B, Luini A, Galimberti V, Scaffidi E, Lupo F, Martella S, Petit JY. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat 2008; 118:623-33. [PMID: 19003526 DOI: 10.1007/s10549-008-0238-4] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/27/2008] [Indexed: 11/30/2022]
Abstract
We investigated the influence of nipple areolar complex (NAC) sparing in mastectomy, on patient satisfaction with cosmetic results, body-image, sexuality and psychological well-being. We developed a specific questionnaire and compared two groups of women who underwent radical mastectomy with immediate breast reconstruction (IBR). Between 2004 and 2006, 310 women with NAC preservation and 143 patients with successive NAC reconstruction were mailed the questionnaire at follow-up 1 year after definitive complete breast reconstruction surgery. 256 questionnaires was available. Our results showed significant differences in favour of the NAC sparing group regarding body image (difficulty in looking at themselves naked and being seen naked by their partners after surgery, P = 0.001 and P = 0.003, respectively); regarding satisfaction with the appearance of the nipple (P < .0001) and with the sensitivity of the nipple (P = 0.001); regarding the feeling of mutilation (P = 0.003). NAC sparing in mastectomy has a positive impact on patient satisfaction, body image and psychological adjustment.
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Affiliation(s)
- F Didier
- Psycho-Oncology Unit, Department of Medicine (Prof. A. Goldhirsch), European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
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