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Vannelli A, Basilico V, Zanardo M, Caizzone A, Rossi F, Battaglia L, Scaramuzza D. Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report. Eur Rev Med Pharmacol Sci 2013; 17:929-935. [PMID: 23640440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Functional pelvic disorders in patients undergoing conservative surgical approach for rectal cancer are considered a major public health issue and represent one third of cost of colorectal cancer. We investigated the hypothesis that lymphadenectomy, involves the pelvic floor results in a localized hides or silent pelvic lymphedema characterized by symptoms without signs. PATIENTS AND METHODS We examined 13 colo-rectal cancer patients: five intra-peritoneal adenocarcinoma: 1 sigmoid and 4 upper third rectal cancer (1 male and 3 female) and 9 extra-peritoneal adenocarcinoma: 3 middle and 5 lower third rectal cancer (4 male and 5 female) using 1.5-T magnetic resonance, one week before and twelve months after discharged from hospital. RESULTS Lymphedema was discovered on post-operative magnetic resonance imaging of all 9 patients with extra-pertitoneal cancer, whereas preoperative magnetic resonance imaging as well as a post-operative examination of 4 intra-peritoneal adenocarcinoma, revealed no evidence of lymphedema. Unlike the common clinical skin signs that typify all other sites of lymphedema, pelvic lymphedema is hides or silent, with no skin changes or any single symptom manifested. Magnetic resonance imaging showed that pelvic illness alone is accompanied by lymphedema related exclusively to venous congestion, and accumulation of liquid in adipose tissue or lipedema. CONCLUSIONS Alteration of the pelvic lymphatic network during pelvic surgery can lead to lymphedema and, pelvic floor disease. Patients should be routinely examined for the possibility of developing this post-surgical syndrome and further studies are needed to establish diagnosis and to evaluate treatment preferences.
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Affiliation(s)
- A Vannelli
- Division of Gastrointestinal and Surgical Oncology, Ospedale Valduce, Como, Italy.
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Perotti A, Sessa C, Mancuso A, Noberasco C, Cresta S, Locatelli A, Carcangiu ML, Passera K, Braghetti A, Scaramuzza D, Zanaboni F, Fasolo A, Capri G, Miani M, Peters WP, Gianni L. Clinical and pharmacological phase I evaluation of Exherin (ADH-1), a selective anti-N-cadherin peptide in patients with N-cadherin-expressing solid tumours. Ann Oncol 2009; 20:741-5. [PMID: 19190075 DOI: 10.1093/annonc/mdn695] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Upregulation of N-cadherin promotes dysregulated cell growth, motility, invasiveness, plus maintenance of vascular stability and is associated with cancer progression in several human tumour types. N-cadherin is expressed also on tumour cells and the anti-N-cadherin cyclic pentapeptide ADH-1, tested in the present study, can exert a direct antitumour effect. PATIENTS AND METHODS Adult patients with advanced solid malignancies expressing N-cadherin on tumour biopsies carried out in the previous 12 months received escalating i.v. doses of ADH-1 given weekly (initially for 3 of 4 weeks, then every week). Plasma pharmacokinetics (PK) was studied at cycle 1. Blood flow changes were assessed after first dosing in all patients treated in the initial regimen. RESULTS In all, 129 patients were screened, 65 (50%) were N-cadherin positive, and 30 were enrolled. The doses ranged from 150 to 2400 mg/m(2); no maximum tolerated dose was reached. Treatment was well tolerated with asthenia as the most frequent adverse event. Two patients with ovarian cancer showed prolonged disease stabilisation while one patient with fallopian tube carcinoma achieved a mixed response. PK was linear in the range of doses tested. CONCLUSION ADH-1 is the first anti-N-cadherin compound tested in humans. In N-cadherin-positive patients, ADH-1 showed an acceptable toxicity profile, linear PK and hints of antitumour activity in gynaecological cancers.
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Affiliation(s)
- A Perotti
- Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Sessa C, Perotti A, Maur M, Fasolo A, Scaramuzza D, Braghetti A, Marsoni S, Malik RK, Peters WP, Gianni L. An enriched phase I, pharmacokinetic and pharmacodynamic study of the N-cadherin (NCAD) cyclic competitive binder exherin (ADH-1) in patients with solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3042] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
Abstract
3042 Background: N-cad is a cell adhesion molecule expressed by vascular endothelium and tumor cells of invasive tumors. ADH-1, a cyclic pentapeptide, antagonizes N-cad, causing rapid tumor vascular disruption and apoptosis in preclinical models. We report results from a Phase I study of weekly doses of intravenous ADH-1 given to patients with N-cad+ solid tumors, to evaluate safety, PK, antitumor activity, and effect of ADH-1 on tumor vasculature assessed by DCE-MRI. Methods: ADH-1 starting dose was 150 mg/m2 administered weekly for 3 W in 28 D cycles. DCE-MRI was performed to assess changes in tumor perfusion 90 mins after the first dose of ADH-1, and repeated on D 15 if no changes were noted. Following the 3rd dose level (DL 3, 600 mg/m2 ), the schedule was amended to weekly ADH-1 without interruption, in 21 D cycles. Results: 55 pts with refractory solid tumors were screened, 56% were N-cad+ [screened/N-cad+: GYN 16/21 (Ovarian 13/17), GI 5/14, breast 2/6, renal 5/5, head & neck 2/3, others 2/6]. 13 pts (5 males, median age 53 yrs.) received 20 cycles of ADH-1 by bolus injection at 150, 300 and 600 mg/m2/weekly ×3 W Q21–28 D. No DLTs have occurred to date. No pts have experienced > grade 2 study drug related AEs. One pt, with fallopian tube ca. had a mixed response. There was a 30% reduction in retroperitoneal nodal disease at the end of cycle 3, and a 37% reduction at the end of Cy 4. However, new bone lesions were also noted at the end of cycle 4 assessment. Tumor blood flow reduction of ≥40% was noted in this patient, and she also reported pain in the region of the tumor following multiple doses of ADH-1. PK parameters are available for the first 3 DLs (150, 300, and 600 mg/m2): mean Cmax 22.1, 37.0, and 50.8μg/mL, respectively; AUCinf 24.3, 60.6, and 110.3 h·μg/mL; Vss 12.6, 15.1, and 16.3 L/m2; and T1/2 1.8, 2.7, and 2.4hr. Conclusions: ADH-1 has been well tolerated in 4 dose levels tested to date, dose escalation is proceeding. No DLTs have occurred and the MTD has not been reached. Anti-tumor activity has been noted. Updated clinical, PK and PD results will be presented. [Table: see text]
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Affiliation(s)
- C. Sessa
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - A. Perotti
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - M. Maur
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - A. Fasolo
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - D. Scaramuzza
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - A. Braghetti
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - S. Marsoni
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - R. K. Malik
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - W. P. Peters
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
| | - L. Gianni
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milano, Italy; Southern Europe New Drug Organization (SENDO), Milano, Italy; Adherex Technologies, Inc., Durham, NC
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Castoldi MC, Fauda V, Scaramuzza D, Vergnaghi D. [Hepatic and hepatocarcinoma magnetic resonance: comparison of the results obtained with paramagnetic (gadolinium) and superparamagnetic (iron oxide particles) contrast media]. Radiol Med 2000; 100:160-7. [PMID: 11148882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE To compare prospectively dynamic gadolinium (Gd)-enhanced with superparamagnetic iron oxide (SPIO)-enhanced MRI for the detection of hepatocellular carcinoma (HCC). MATERIAL AND METHODS Twenty-five patients with histologically proven HCC and liver cirrhosis (28% of them in B or C Child class) underwent dynamic Gd-enhanced MRI and, a few days later, (mean interval: three days) SPIO-enhanced MRI. Only patients with availability of clinical and imaging follow-up for at least seven months were enrolled in this prospective study. Axial dynamic Gd-enhanced imaging was performed with T1 gradient-recalled echo (GRE) sequences. Both axial and sagittal SPIO-enhanced imaging were performed with respiratory triggered T2-weighted turbo spin-echo (TSE) and T1-T2*-weighted GRE sequences. MR images were reviewed by two independent radiologists. The readers scored each lesion for the presence of HCC and assigned confidence levels based on a five-grade scale: 1, definitely or almost definitely absent; 2, possibly present; 3, probably present; 4, definitely present; 5, definitely present with optimal liver/lesion contrast or good liver/lesion contrast and morphological signs (intact capsule, intranodular septa, extra-capsular infiltration), useful for locoregional treatment planning. A positive diagnostic value was assessed for scores of 3 or higher. RESULTS Gd-enhanced and SPIO-enhanced MRI found 44 lesions. The combined use of TSE and GRE SPIO-enhanced sequences detected 11 more lesions (25% improvement in sensitivity) than Gd-enhanced MRI. One lesion (2.27%) was detected only with Gd-enhanced MRI. Eight of twelve lesions visible with a single contrast agent measured less than 1 cm in diameter. HCC detectability was 75% with Gd-enhanced MRI and 97.7% with SPIO-enhanced MRI. SPIO-enhanced T2-weighted TSE images showed significantly higher diagnostic value than SPIO-enhanced T1-T2*GRE images only in three cases, while nodule morphological characteristics (capsule, septa, different cell differentiation components) were better depicted by TSE images. DISCUSSION AND CONCLUSIONS In our study the combined use of SPIO-enhanced T2-weighted TSE and T1-T2*-weighted GRE sequences showed higher sensitivity than gadolinium-enhanced GRE dynamic imaging (97.7% versus 75%). These results are at least partly related to our study conditions, that is: 1) MRI was performed with a 1T system, 2) both axial and sagittal SPIO-enhanced imaging were performed with respiratory triggered T2-weighted TSE and T1-T2*-weighted GRE, 3) there was a low freaquency of severe cirrhosis.
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Affiliation(s)
- M C Castoldi
- Servizio di Radiologia, Ospedale S. Carlo Borromeo, Via Pio II 3, 20153 Milano MI
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