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Marotta V, Rocco D, Crocco A, Deiana MG, Martinelli R, Di Gennaro F, Valeriani M, Valvano L, Caleo A, Pezzullo L, Faggiano A, Vitale M, Monti S. Survival predictors of radioiodine-refractory differentiated thyroid cancer treated with lenvatinib in the real-life. J Clin Endocrinol Metab 2024:dgae181. [PMID: 38501238 DOI: 10.1210/clinem/dgae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
CONTEXT Lenvatinib is approved for the treatment of radioiodine-refractory differentiated thyroid cancer (RR-DTC). The definition of predictive factors of survival is incomplete. OBJECTIVE To identify pre- and post- treatment survival predictors in a real-life cohort of RR-DTC treated with lenvatinib. DESIGN Multicenter, retrospective, cohort study. SETTING Three Italian thyroid cancer referral centers. PARTECIPANTS 55 RR-DTC treated with lenvatinib. MAIN OUTCOME MEASURES Progression-free survival (PFS) and overall survival (OS). RESULTS Lenvatinib was the first-line kinase-inhibitor in 96.4% of subjects. Median follow-up was 48 months. Median PFS and OS were 26 (95% CI 19.06-32.93) and 70 months (95% CI 36-111.99), respectively. Pre-treatment setting: Eastern Cooperative Oncology Group (ECOG) performance status was independently related to PFS (p < 0.001; HR 18.82; 95% CI 3.65-97.08: score 0-1 as reference) and OS (p = 0.001; HR 6.20; 95% CI 2.11-18.20; score 0-1 as reference); radioactive iodine (RAI)-avidity was independently related to PFS (p = 0.047; HR 3.74; 95% CI 1.01-13.76; avid disease as reference). Patients with good ECOG status (0-1) and RAI-avid disease obtained objective response in 100% of cases and achieved a median PFS of 45 months without any death upon a median follow-up of 81 months. Post-treatment setting: best radiological response independently predicted PFS (p = 0.001; HR 4.6; 95% CI 1.89-11.18; partial/complete response as reference) and OS (p = 0.013; HR 2.94; 95% CI 1.25-6.89; partial/complete response as reference). CONCLUSIONS RR-DTC with good performance status and RAI-avid disease obtain the highest clinical benefit from lenvatinib. After treatment initiation, objective response was the only independent survival predictor.
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Affiliation(s)
- Vincenzo Marotta
- UOC Clinica Endocrinologica e Diabetologica, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Domenico Rocco
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Italy
| | - Anna Crocco
- Struttura Complessa Chirurgia Oncologica Della Tiroide, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Maria Grazia Deiana
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of excellence, Sapienza University of Rome, Rome, Italy
| | - Ruggero Martinelli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of excellence, Sapienza University of Rome, Rome, Italy
| | - Francesca Di Gennaro
- Struttura Complessa Medicina Nucleare e Terapia Radiometabolica- UOS Terapia Metabolica Sperimentale, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | | | - Luca Valvano
- UOC Chirurgia Generale, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Alessia Caleo
- UOC Anatomia Patologica, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Luciano Pezzullo
- Struttura Complessa Chirurgia Oncologica Della Tiroide, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of excellence, Sapienza University of Rome, Rome, Italy
| | - Mario Vitale
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Italy
| | - Salvatore Monti
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of excellence, Sapienza University of Rome, Rome, Italy
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Marretta AL, Ottaiano A, Iervolino D, Bracigliano A, Clemente O, Di Gennaro F, Tafuto R, Santorsola M, Lastoria S, Tafuto S. Response to Peptide Receptor Radionuclide Therapy in Pheocromocytomas and Paragangliomas: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12041494. [PMID: 36836029 PMCID: PMC9964778 DOI: 10.3390/jcm12041494] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE and 90Y-DOTATOC showed efficacy in the metastatic setting of pheocromocytomas (PCCs) and paragangliomas (PGLs) where no standard therapies have been established. BACKGROUND A search of peer-reviewed and English articles reporting on 177Lu-DOTATATE and 90Y-DOTATOC efficacy was performed through Medline and Scopus. A subsequent meta-analysis was performed to evaluate the pooled effect size on disease control rate (DCR) with PRRT. Secondary endpoints were description of patients' genetic characteristics, hematologic toxicity, and time-to-outcome. The pooled effect was estimated with both a mixed-effects model and a random-effects model. RESULTS Twelve studies met the criteria for this meta-analysis: ten with 177Lu- and two with 90Y-PRRTs (213 patients). The largest one included 46 patients. Median ages ranged from 32.5 to 60.4 years. When reported, mutations of SDHB were the most frequent genetic alterations. The pooled DCRs were 0.83 (95% CI: 0.75-0.88) and 0.76 (95% CI: 0.56-0.89) for 177Lu- and 90Y-PRRT, respectively. The pooled DCR for PRRT was 0.81 (95% CI: 0.74-0.87). CONCLUSIONS We report an updated and solid estimate of DCR achieved with 177Lu- and 90Y-PRRT in PCCs and PGLs, showing that these therapies can be considered in the multidisciplinary treatment of PCCs and PGLs as alternatives to I-131 MIBG and chemotherapy.
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Affiliation(s)
- Antonella Lucia Marretta
- Department of Clinical and Surgery Oncology Unit, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Department of Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Domenico Iervolino
- Pathology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Alessandra Bracigliano
- Nuclear Medicine Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Ottavia Clemente
- Sarcomas and Rare Tumours Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-329-9786209
| | - Francesca Di Gennaro
- Nuclear Medicine Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Roberto Tafuto
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Mariachiara Santorsola
- SSD Innovative Therapies for Abdominal Metastases, Department of Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Salvatore Tafuto
- Sarcomas and Rare Tumours Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
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Pirozzi Palmese V, D'Ambrosio L, Di Gennaro F, Maisto C, de Marino R, Morisco A, Coluccia S, Di Gennaro P, De Lauro F, Raddi M, Gaballo P, Tafuto S, Celentano E, Lastoria S. A comparison of simplified protocols of personalized dosimetry in NEN patients treated by radioligand therapy (RLT) with [ 177Lu]Lu-DOTATATE to favor its use in clinical practice. Eur J Nucl Med Mol Imaging 2023; 50:1753-1764. [PMID: 36688980 PMCID: PMC10119237 DOI: 10.1007/s00259-023-06112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023]
Abstract
The role of internal dosimetry is usually proposed for investigational purposes in patients treated by RLT, even if its application is not yet the standard method in clinical practice. This limited use is partially justified by several concomitant factors that make calculations a complex process. Therefore, simplified dosimetry protocols are required. METHODS In our study, dosimetric evaluations were performed in thirty patients with NENs who underwent RLT with [177Lu]Lu-DOTATATE. The reference method (M0) calculated the cumulative absorbed dose performing dosimetry after each of the four cycles. Obtained data were employed to assess the feasibility of simplified protocols: defining the dosimetry only after the first cycle (M1) and after the first and last one (M2). RESULTS The mean differences of the cumulative absorbed doses between M1 and M0 were - 10% for kidney, - 5% for spleen, + 34% for liver, + 13% for red marrow, and + 37% for tumor lesions. Conversely, differences lower than ± 10% were measured between M2 and M0. CONCLUSION Cumulative absorbed doses obtained with the M2 protocol resembled the doses calculated by M0, while the M1 protocol overestimated the absorbed doses in all organs at risk, except for the spleen.
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Affiliation(s)
| | - Laura D'Ambrosio
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesca Di Gennaro
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Costantina Maisto
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Roberta de Marino
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Anna Morisco
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Sergio Coluccia
- S.C. Epidemiologia E Biostatistica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Francesco De Lauro
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Raddi
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Paolo Gaballo
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Salvatore Tafuto
- S.C. Sarcomi E Tumori Rari, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Egidio Celentano
- S.C. Epidemiologia E Biostatistica, INT IRCCS Fondazione G. Pascale, Naples, Italy
| | - Secondo Lastoria
- S.C. Medicina Nucleare E Terapia Radiometabolica, INT IRCCS Fondazione G. Pascale, Naples, Italy.
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Rossetti S, Di Napoli M, Pisano C, C Cecere S, Tambaro R, Ventriglia J, Passarelli A, Iovane G, Feroce F, Lastoria S, Di Gennaro F, Muto P, Borzillo V, Di Franco R, Perdonà S, Quarto G, Pignata S. Oligometastatic prostate cancer treatment. Future Oncol 2021; 17:3893-3899. [PMID: 34296622 DOI: 10.2217/fon-2021-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oligometastatic prostate cancer is an intermediate state between localized disease and widespread metastasis. Its biological and clinical peculiarities are still to be elucidated. New imaging techniques contribute to the detection of patients with oligometastatic disease. PET/CT scanning with prostate-specific membrane antigen can improve the selection of men with true early, low-volume oligometastatic disease, who are candidates for metastasis-directed therapy. Clinical studies demonstrated that androgen deprivation therapy can be delayed in oligometastatic patients with a low tumor burden, although no survival benefit has been demonstrated at present. This article presents available evidence on the treatment strategies for oligometastatic prostate cancer.
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Affiliation(s)
- Sabrina Rossetti
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Marilena Di Napoli
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Carmela Pisano
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Sabrina C Cecere
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Rosa Tambaro
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Jole Ventriglia
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Anna Passarelli
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Gelsomina Iovane
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Florinda Feroce
- Pathology Unit, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Secondo Lastoria
- Nuclear Medicine, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Francesca Di Gennaro
- Nuclear Medicine, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Paolo Muto
- Radiotherapy, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Valentina Borzillo
- Radiotherapy, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Rossella Di Franco
- Radiotherapy, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Sisto Perdonà
- Urology Unit, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Giuseppe Quarto
- Urology Unit, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Sandro Pignata
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
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Marotta V, Chiofalo MG, Di Gennaro F, Daponte A, Sandomenico F, Vallone P, Costigliola L, Botti G, Ionna F, Pezzullo L. Kinase-inhibitors for iodine-refractory differentiated thyroid cancer: still far from a structured therapeutic algorithm. Crit Rev Oncol Hematol 2021; 162:103353. [PMID: 34000414 DOI: 10.1016/j.critrevonc.2021.103353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/16/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022] Open
Abstract
The kinase-inhibitors (KIs) sorafenib and lenvatinib demonstrated efficacy in iodine-refractory DTC upon phase III studies. However, evidence allowing a punctual balance of benefits and risks is poor. Furthermore, the lack of a direct comparison hampers to establish the proper sequence of administration. However, some insights may provided: a) indirect comparison between phase III trials showed milder toxicity for sorafenib, which should be preferred in case of cardiovascular comorbidities; b) prospective evidence of efficacy in KIs pre-treated patients is available only for lenvatinib, which should be used as second-line. Promising activity was found for the majority of other tested KIs, but no placebo-controlled trials are available. Emerging, but still early, frontiers include the restoration of iodine-sensitivity and the selective activity on pathogenic mutations. In conclusion, the use of KIs in iodine-refractory DTC is far from a structured therapeutic algorithm.
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Affiliation(s)
- Vincenzo Marotta
- Struttura Complessa Chirurgia Oncologica Della Tiroide, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy.
| | - Maria Grazia Chiofalo
- Struttura Complessa Chirurgia Oncologica Della Tiroide, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Francesca Di Gennaro
- Struttura Complessa Medicina Nucleare e Terapia Metabolica, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Antonio Daponte
- Struttura Complessa Oncologia Clinica Sperimentale Testa-Collo e Muscolo-Scheletrica, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Fabio Sandomenico
- Struttura Complessa Radiodiagnostica, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Paolo Vallone
- Struttura Complessa Radiodiagnostica, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Luciana Costigliola
- Unità Operativa Compessa Di Chirugia Generale, d'Urgenza e Metabolica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Gerardo Botti
- Struttura Complessa Anatomia Patologica e Citopatologia, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Franco Ionna
- Struttura Complessa Chirurgia Oncologica Maxillo-Facciale Ed ORL, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy
| | - Luciano Pezzullo
- Struttura Complessa Chirurgia Oncologica Della Tiroide, Istituto Nazionale Tumori - Irccs - Fondazione G.Pascale, Napoli, Italy.
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Corvino A, Caruso M, Varelli C, Di Gennaro F, Pignata S, Corvino F, Vallone G, Catalano O. Diagnostic imaging of parotid gland oncocytoma: a pictorial review with emphasis on ultrasound assessment. J Ultrasound 2020; 24:241-247. [PMID: 32710434 DOI: 10.1007/s40477-020-00511-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022] Open
Abstract
Parotid gland oncocytoma (PGO) is a rare benign epithelial tumor that usually occurs in the elderly population. The most common clinical presentation is a painless, slow-growing, non-tender, lobulated, and mobile mass. Histologically, it is composed of monotonous sheets of epithelial cells (oncocytes) with a central scar. The cross-sectional appearance is not specific, and it overlaps with other parotid lesions. On ultrasound (US), oncocytoma appears as an ovoid, well-defined, homogeneous, and hypoechoic lesion. Cystic and hemorrhagic areas as well as intralesional fat may be observed. Doppler analysis shows intratumoral vessels, sometimes with a spoke-wheel pattern. The peak systolic flow is high (up to 100 cm/sec). Furthermore, oncocytoma is avid of FDG on a PET scan, as well as a malignant tumor. Thus, a combined clinical, imaging, and pathologic assessment is essential to establish the most accurate diagnosis and plan the best treatment. US, combined with Doppler techniques, can play an important role in suggesting the diagnosis and confirming it through percutaneous sampling. The purpose of this review is to show the imaging findings in PGO, with special emphasis on the US appearance.
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Affiliation(s)
- Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", via F. Acton 38, I-80133, Naples, Italy.
- , Casal di Principe, Italy.
| | - Martina Caruso
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, 80131, Naples, Italy
| | - Carlo Varelli
- Radiology Unit, Varelli Institute, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Francesca Di Gennaro
- Nuclear Medicine Division, Radiology and Radiotherapy Department, National Cancer Institute Pascale Foundation, via M. Semmola 53, 80131, Naples, Italy
| | - Saverio Pignata
- Ultrasound Unit, Ninetta Rosano Institute, via Capo Tirone 14, 87021, Belvedere Marittimo (CS), Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, via A. Cardarelli 9, 80131, Naples, Italy
| | - Gianfranco Vallone
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, 80131, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Institute, via Cornelia dei Gracchi 65, 80126, Naples, Italy
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Avallone A, Aloj L, Pecori B, Caracò C, De Stefano A, Tatangelo F, Silvestro L, Granata V, Bianco F, Romano C, Di Gennaro F, Budillon A, Petrillo A, Muto P, Botti G, Delrio P, Lastoria S. 18F-FDG PET/CT Is an Early Predictor of Pathologic Tumor Response and Survival After Preoperative Radiochemotherapy with Bevacizumab in High-Risk Locally Advanced Rectal Cancer. J Nucl Med 2019; 60:1560-1568. [PMID: 30877175 DOI: 10.2967/jnumed.118.222604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/27/2018] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
There is an unmet need for predictive biomarkers of the clinical benefit of antiangiogenic drugs. The aim of the present study was to prospectively evaluate the value of 18F-FDG PET/CT performed during and after preoperative chemoradiotherapy with bevacizumab for the prediction of complete pathologic tumor regression and survival in patients with MRI-defined high-risk locally advanced rectal cancer. Methods: Sixty-one patients treated in a nonrandomized phase II study (BRANCH) with concomitant or sequential (4 d before chemoradiotherapy) administration of bevacizumab with preoperative chemoradiotherapy were included. 18F-FDG PET/CT was performed at baseline, 11 d after the beginning of chemoradiotherapy (early), and before surgery (late). Metabolic changes were compared with pathologic complete tumor regression (TRG1) versus incomplete tumor regression (TRG2-TRG5), progression-free survival, cancer-specific survival, and overall survival. Receiver-operating-characteristic curves were calculated for those 18F-FDG PET/CT parameters that significantly correlated with TRG1. Results: Early total-lesion glycolysis and its percentage change compared with baseline (ΔTLG-early) could discriminate TRG1 from TRG2-TRG5. Only receiver-operating-characteristic analysis of ΔTLG-early showed an area under the curve greater than 0.7 (0.76), with an optimal cutoff at 59.5% (80% sensitivity, 71.4% specificity), for identifying TRG1. Late metabolic assessment could not discriminate between the 2 groups. After a median follow-up of 98 mo (range, 77-132 mo), metabolic responders (ΔTLG-early ≥ 59.5%) demonstrated a significantly higher 10-y progression-free survival (89.3% vs. 63.6%, P = 0.02) and cancer-specific survival (92.9% vs. 72.6%, P = 0.04) than incomplete metabolic responders. Conclusion: Our results suggest that early metabolic response can act as a surrogate marker of the benefit of antiangiogenic therapy. The findings provide further support for the use of early 18F-FDG PET/CT evaluation to predict pathologic response and survival in the preoperative treatment of patients with locally advanced rectal cancer. ΔTLG-early showed the best accuracy in predicting tumor regression and may be particularly useful in guiding treatment-modifying decisions during preoperative chemoradiotherapy based on expected response.
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Affiliation(s)
- Antonio Avallone
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Luigi Aloj
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Biagio Pecori
- Radiotherapy, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Corradina Caracò
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Alfonso De Stefano
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Fabiana Tatangelo
- Pathology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Lucrezia Silvestro
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Vincenza Granata
- Radiology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Francesco Bianco
- Colorectal Oncological Surgery, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy; and
| | - Carmela Romano
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Francesca Di Gennaro
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Alfredo Budillon
- Experimental Pharmacology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Antonella Petrillo
- Radiology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Paolo Muto
- Radiotherapy, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Gerardo Botti
- Pathology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Paolo Delrio
- Colorectal Oncological Surgery, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy; and
| | - Secondo Lastoria
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
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Chiofalo MG, D'Anna R, Di Gennaro F, Setola SV, Marotta V. Great veins invasion in follicular thyroid cancer: single-centre study assessing prevalence and clinical outcome. Endocrine 2018; 62:71-75. [PMID: 29749566 DOI: 10.1007/s12020-018-1622-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Great veins invasion is considered as a rare and prognostically unfavourable event in thyroid cancer. However, current knowledge about this issue is mainly based on single case reports. Follicular thyroid cancer (FTC) represents the histotype with the most pronounced angioinvasive feature. This study is aimed at assessing the actual prevalence of great veins invasion in FTC and providing information about prognosis and the proper clinical management of these patients. METHODS Clinico-pathological and radiological data of patients with thyroid cancer undergoing thyroidectomy in our institution were retrospectively retrieved. Inclusion criteria were as follows: (a) histological diagnosis of FTC; (b) instrumental and histological evidence of great veins invasion and (c) documented follow-up entirely performed at our institution. Pre-surgical assessment of great veins status was performed in all patients by means of Doppler ultrasonography. RESULTS Out of 637 patients operated from 2003 to 2013, four subjects, all affected with FTC, showed great veins involvement (0.62% of the overall cohort and 7.85% of the FTC group). One of them was lost at follow-up. All three patients with available follow-up were subjected to aggressive surgery obtaining a complete eradication of neck disease. All of them achieved the 5-year survival target (60, 63 and 96 months of survival for patients 1, 2 and 3, respectively). CONCLUSIONS Great veins invasion may not be uncommon in FTC and preoperative detection and characterisation of such condition may optimise surgical approach and improve survival.
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Affiliation(s)
- Maria Grazia Chiofalo
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale per lo Studio e la Cura dei Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Raffaella D'Anna
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale per lo Studio e la Cura dei Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Francesca Di Gennaro
- Struttura Complessa Medicina Nucleare e Terapia metabolica, Istituto Nazionale per lo Studio e la Cura dei Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Sergio Venanzio Setola
- Struttura Complessa Radiodiagnostica, Istituto Nazionale per lo Studio e la Cura dei Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Vincenzo Marotta
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale per lo Studio e la Cura dei Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy.
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Lastoria S, Marciello F, Faggiano A, Aloj L, Caracò C, Aurilio M, D'Ambrosio L, Di Gennaro F, Ramundo V, Camera L, De Luca L, Fonti R, Napolitano V, Colao A. Role of (68)Ga-DOTATATE PET/CT in patients with multiple endocrine neoplasia type 1 (MEN1). Endocrine 2016; 52:488-94. [PMID: 26242621 DOI: 10.1007/s12020-015-0702-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a hereditary syndrome predisposing to many endocrine and neuroendocrine tumors (NET). Conventional imaging (CI) cannot provide satisfactory results for all the different types of MEN1-related tumors. Objective of this prospective observational study was to evaluate the role of (68)Ga-DOTATATE PET/CT in MEN1 compared to CI. Diagnostic performance of (68)Ga-DOTATATE PET/CT for the detection of NET was evaluated as well as the prognostic role of SUVmax. Eighteen patients with genetically confirmed MEN1 were evaluated by (68)Ga-DOTATATE PET/CT, endoscopic ultrasounds, multidetector-row computed tomography, magnetic resonance imaging, and hormone/markers serum measurements. Four MEN1-related tumor sites (pancreas, pituitary, parathyroids, adrenals) were considered. Sensitivity and specificity of (68)Ga-DOTATATE PET/CT for the detection of NET were calculated. There was (68)Ga-DOTATATE PET/CT uptake in 11/11 patients with pancreatic lesions, in 9/12 with pituitary adenoma, in 5/15 with parathyroid enlargements, and in 5/7 with adrenal lesions. (68)Ga-DOTATATE PET/CT showed sensitivity and specificity of 100 and 100 % in pancreas, 75 and 83 % in pituitary, 28 and 100 % in parathyroids, and 62.5 and 100 % in adrenals, respectively. Compared with CI, no significant difference in sensitivity for pancreas, pituitary, and adrenals was found, while CI had a better sensitivity for parathyroids (p = 0.002). On the ROC analysis, progression of pancreatic lesions was significantly associated to SUVmax <12.3 (p < 0.05). (68)Ga-DOTATATE PET/CT is greatly helpful in the work-up of MEN1 providing a panoramic view of MEN1-related lesions. There is also a prognostic role of (68)Ga-PET in patients with MEN1-pancreatic lesions.
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Affiliation(s)
- Secondo Lastoria
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy.
| | - Francesca Marciello
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Antongiulio Faggiano
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Aloj
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Corradina Caracò
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Michela Aurilio
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Laura D'Ambrosio
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Francesca Di Gennaro
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Valeria Ramundo
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Camera
- Department of Biomorphological and Functional Sciences, "Federico II" University of Napoli, Naples, Italy
| | | | - Rosa Fonti
- Istitute of Biostructures and Bioimages (IBB), National Research Council, Naples, Italy
| | - Vincenzo Napolitano
- Department of General and Specialistic Surgery, Second University of Napoli, Caserta, Italy
| | - Annamaria Colao
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
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10
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Fulciniti F, Vuttariello E, Calise C, Monaco M, Pezzullo L, Chiofalo MG, Di Gennaro F, Malzone MG, Campanile AC, Losito NS, Botti G, Chiappetta G. Combined papillary and mucoepidermoid carcinoma of the thyroid gland: a possible collision tumor diagnosed on fine-needle cytology. Report of a case with immunocytochemical and molecular correlations. Endocr Pathol 2015; 26:140-4. [PMID: 25771987 DOI: 10.1007/s12022-015-9364-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fine-needle cytology (FNC) is frequently used to diagnose thyroid nodules discovered by palpation or imaging studies. Molecular tests on FNC material may increase its diagnostic accuracy. We report a case of a classic papillary thyroid carcinoma combined with a mucoepidermoid carcinoma correctly identified on FNC. The papillary component had a classic immunophenotype (CK19+, TTF1+), while the mucoepidermoid one was only focally CK19+. Point mutations (BRAF and RAS) and rearrangements (RET/PTC) of the papillary component have been also investigated on FNC samples, with resulting concurrent rearrangements of RET/PTC1 and RET/PTC3, but no point mutations. The histogenesis of combined papillary and mucoepidermoid carcinoma of the thyroid still remains partly unsettled, and further genomic studies are needed to shed some more light on this peculiar neoplasm.
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MESH Headings
- Adult
- Biopsy, Fine-Needle
- Carcinoma/diagnosis
- Carcinoma/metabolism
- Carcinoma/pathology
- Carcinoma, Mucoepidermoid/diagnosis
- Carcinoma, Mucoepidermoid/metabolism
- Carcinoma, Mucoepidermoid/pathology
- Carcinoma, Papillary
- Diagnosis, Differential
- Female
- Humans
- Immunohistochemistry
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/metabolism
- Mixed Tumor, Malignant/pathology
- Molecular Diagnostic Techniques
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Franco Fulciniti
- Istituto Cantonale di Patologia, Sevizio di Citologia Clinica, via Alberto Franzoni 45, 6601, Locarno, Switzerland
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Chiofalo MG, Setola SV, Di Gennaro F, Fulciniti F, Catapano G, Losito NS, Sandomenico F, Catalano O, Pezzullo L. Follicular thyroid carcinoma with skull metastases. Endocr J 2015; 62:363-9. [PMID: 25797278 DOI: 10.1507/endocrj.ej14-0553] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid carcinoma with distant metastases at initial presentation, is uncommon. Skull metastases occur very rarely, with a reported incidence of 2.5-5.8%. Here we report two cases of follicular thyroid cancer with skull involvement, and describe the diagnostic and therapeutic approach to metastatic thyroid cancer. We present the cases of a 70-year-old female and a 74-year-old female who presented with painless, large slow-growing masses of the skull. The patients underwent surgical excision of the skull masses, which were histologically diagnosed as metastatic follicular thyroid cancer, and total thyroidectomy, which confirmed the diagnosis of follicular thyroid carcinoma. They were treated with radioiodine and suppressive levothyroxine, which achieved local control of the disease. Management of metastatic thyroid cancer, requires a multidisciplinary approach and multimodality treatment. Distant metastases should be surgically removed whenever possible. Initial aggressive treatment is crucial in the management of metastatic thyroid carcinoma, providing the best chance to prolong patient survival.
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Affiliation(s)
- Maria Grazia Chiofalo
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, via Mariano Semmola, 80131 Naples, Italy
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12
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Aloj L, Caracò C, Di Gennaro F, Grimaldi AM, Simeone E, Curvietto M, Caracò C, Mozzillo N, Torri V, Ascierto PA, Lastoria S. Abstract 2672: Early evaluation of response to Vemurafenib treatment with FDG PET/CT in patients with metastatic melanoma. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2672] [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
Targeted therapy against the V600 mutated form of BRAF is a proven effective therapy for melanoma. Reduction of FDG accumulation on PET/CT studies occurs very rapidly in responding patients. This exploratory study aims to correlate early changes in FDG uptake patterns with treatment outcome in patients undergoing Vemurafenib treatment. Patients treated at our institution were evaluated with PET-CT at baseline and at day 7, 14 and 28 from the start of therapy. Maximal Standardized Uptake Value (SUVmax) and Total Lesion Glycolysis (TLG, mean SUV x lesion volume) were recorded and compared for single lesions in the 4 studies. Patients were then monitored for clinical, laboratory and imaging signs of progression and results correlated to the early PET/CT findings. Fifteen patients have been studied. A total of 87 lesions are available for comparative evaluation. A greater than 30% reduction in SUVmax compared to baseline was seen in 69 lesions at day 7, 76 at day 14 and 75 at day 28. Nineteen lesions showed a greater than 20% increase in FDG uptake between day 14 and 28. Similar results were found when comparing TLG values. Quantitative and visual analysis of PET/CT studies identified 5 patients showing signs of metabolic progression between day 14 and 28 likely indicating early signs of treatment resistance. Three of these patients showed signs of disease progression by other means within 4 months from the beginning of treatment while 2 are still in treatment with 3 months follow-up. Of the 10 patients not showing metabolic signs of progression at day 28, four have progressed between 2 and 9 months from the beginning of treatment, while the remaining 6 are still in treatment and progression free with 2 to 12 months of follow-up. In conclusion, our preliminary results suggest that PET/CT may be a powerful surrogate marker of treatment response to vemurafenib. Sequential monitoring of targeted therapy with PET/CT may be useful in early identification of treatment resistance, aid in tailoring alternative strategies and deserves further investigation.
Citation Format: Luigi Aloj, Corradina Caracò, Francesca Di Gennaro, Antonio M. Grimaldi, Ester Simeone, Marcello Curvietto, Corrado Caracò, Nicola Mozzillo, Valter Torri, Paolo A. Ascierto, Secondo Lastoria. Early evaluation of response to Vemurafenib treatment with FDG PET/CT in patients with metastatic melanoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2672. doi:10.1158/1538-7445.AM2013-2672
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Affiliation(s)
- Luigi Aloj
- 1SC Medicina Nucleare, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Corradina Caracò
- 1SC Medicina Nucleare, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Francesca Di Gennaro
- 1SC Medicina Nucleare, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Antonio M. Grimaldi
- 2Dipartimento Melanoma, Sarcoma e Tumori Testa-Collo, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Ester Simeone
- 2Dipartimento Melanoma, Sarcoma e Tumori Testa-Collo, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Marcello Curvietto
- 2Dipartimento Melanoma, Sarcoma e Tumori Testa-Collo, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Corrado Caracò
- 2Dipartimento Melanoma, Sarcoma e Tumori Testa-Collo, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Nicola Mozzillo
- 2Dipartimento Melanoma, Sarcoma e Tumori Testa-Collo, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Valter Torri
- 3Dipartimento di Oncologia, Istituto Mario Negri, Milano, Italy
| | - Paolo A. Ascierto
- 2Dipartimento Melanoma, Sarcoma e Tumori Testa-Collo, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
| | - Secondo Lastoria
- 1SC Medicina Nucleare, Istituto Nazionale Tumori, Fondazione G. Pascale Napoli, Italy
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