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Serenari M, Ratti F, Stocco A, De Cobelli F, Serra C, Santangelo D, Fallani G, Della Corte A, Marino R, Ravaioli M, Aldrighetti L, Cescon M. Achievement of textbook outcome after hepatectomy combined with thermal ablation for colorectal liver metastases. Surg Endosc 2024:10.1007/s00464-024-10757-3. [PMID: 38499784 DOI: 10.1007/s00464-024-10757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Hepatic resection combined with intraoperative ablation has been described as a technical solution potentially widening the resectability rate of patients with colorectal liver metastases (CRLM). Nevertheless, the perioperative and oncological benefit provided by this combined approach remains unclear. We hypothesized that textbook outcome (TO), which is a composite measure achieved for patients for whom some desired health indicators are met, may help to refine the indications of this approach. METHODS Patients submitted to hepatectomy with curative intent in combination with radiofrequency ablation or microwave ablation for CRLM ≤ 3 cm in two tertiary referral centers were included. TO was defined according to a recent definition for liver surgery based on a Delphi process including also the achievement of complete radiological response of the ablated lesion/s at 4 weeks. RESULTS Between 2015 and 2022, 112 patients were enrolled. Among them, 63 (56.2%) achieved a TO. According to multivariate analysis, minimally invasive (MI) approach (OR 2.72, 95% CI 0.99-7.48, p = 0.050), simultaneous CR resection (OR 0.28, 95% CI 0.11-0.70, p = 0.007), tumor burden score (OR 0.89, 95% CI 0.82-0.96, p = 0.004), and major hepatectomy (OR 0.12, 95% CI 0.03-0.52, p = 0.004) were significantly associated with the achievement of TO. Median overall survival was longer in those patients who were able to achieve a TO compared to those who did not. CONCLUSIONS The combination of hepatectomy and ablation constitutes a valuable solution in patients affected by multiple CRLM and it may provide, also using a MI approach, adequate perioperative and oncological outcomes, allowing to achieve TO, however, in a selected number of patients and depending on several factors including the burden of disease.
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Affiliation(s)
- Matteo Serenari
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Stocco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Domenico Santangelo
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Guido Fallani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Ravaioli
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Cescon
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Della Corte A, Santangelo D, Augello L, Ratti F, Cipriani F, Canevari C, Gusmini S, Guazzarotti G, Palumbo D, Chiti A, Aldrighetti L, De Cobelli F. Single-Center Retrospective Study Comparing Double Vein Embolization via a Trans-Jugular Approach with Liver Venous Deprivation via a Trans-Hepatic Approach. Cardiovasc Intervent Radiol 2023; 46:1703-1712. [PMID: 37704862 DOI: 10.1007/s00270-023-03538-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To compare safety, technical and clinical outcomes of double vein embolization (DVE) via a trans-jugular approach with liver venous deprivation (LVD) via a trans-hepatic approach. MATERIALS AND METHODS A single-center retrospective analysis was conducted on patients undergoing simultaneous portal and hepatic veins embolization in view of a major hepatectomy (June 2019-November 2022). Hepatic vein embolization was performed either by transjugular plug (DVE) or by transhepatic plug followed by glue injection (LVD). Inclusion criteria were availability of pre-procedural CT scan, and availability of CT scans acquired 10 days and 25 days post-procedure. Comparative data included complication rate, fluoroscopy time, dose area product (DAP), Future Liver Remnant volume and function increase (FLR-V and FLR-F increase, respectively) and clinical outcomes. RESULTS Thirty-six patients (n = 14 DVE; n = 22 LVD) were included. No baseline significant differences were observed among the two groups. One grade-3 complication (2.8%) was observed in the LVD group; one case of technical failure (2.8%) was observed in the DVE group. Fluoroscopy time and DAP were similar between DVE and LVD (29 ± 17.7 vs. 25 ± 8.2 min, p = 0.97; 105.1 ± 63.5 vs. 143.4 ± 79.5 Gy·cm2, p = 0.15). No differences arose at either time-point in FLR-V increase (46.7 ± 23.1% vs. 48.2 ± 28.2%, 52.9 ± 30.9% vs. 53.2 ± 29%, respectively, p = 0.9). FLR-F increase also did not differ significantly (62.8 ± 55.2 vs. 67.4 ± 57.5, p = 0.9). No differences in drop-out rate from surgery were observed. (28.6% vs. 27.3%, p = 0.93). One case of grade-B post-hepatectomy liver failure (2.8%) was observed in the LVD group. CONCLUSION LVD via transhepatic approach and DVE via transjugular approach seem equally safe and effective. Level of Evidence Level 3, Retrospective Cohort Study.
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Affiliation(s)
- Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, 20132, Milan, Italy.
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy.
| | - Domenico Santangelo
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Luigi Augello
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Gusmini
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgia Guazzarotti
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Arturo Chiti
- Vita-Salute San Raffaele University, 20132, Milan, Italy
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Aldrighetti
- Vita-Salute San Raffaele University, 20132, Milan, Italy
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
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Marino R, Ratti F, Della Corte A, Santangelo D, Clocchiatti L, Canevari C, Magnani P, Pedica F, Casadei-Gardini A, De Cobelli F, Aldrighetti L. Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? Cancers (Basel) 2023; 15:4363. [PMID: 37686638 PMCID: PMC10486473 DOI: 10.3390/cancers15174363] [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] [Received: 08/11/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Purpose: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the role of LVD for preoperative optimization of future liver remnant (FLR) in perihilar cholangiocarcinoma (PHC), especially when compared with portal vein embolization (PVE). Methods: Between January 2013 and July 2022, all patients diagnosed with PHC and scheduled for preoperative optimization of FTR, through radiological hypertrophy techniques, prior to liver resection, were included. FTR volumetric assessment was evaluated at two distinct timepoints to track the progression of both early (T1, 10 days post-procedural) and late (T2, 21 days post-procedural) efficacy indicators. Post-procedural outcomes, including functional and volumetric analyses, were compared between the LVD and the PVE cohorts. Results: A total of 12 patients underwent LVD while 19 underwent PVE. No significant differences in either post-procedural or post-operative complications were found. Post-procedural FLR function, calculated with (99m) Tc-Mebrofenin hepatobiliary scintigraphy, and kinetic growth rate, at both timepoints, were greater in the LVD cohort (3.12 ± 0.55%/min/m2 vs. 2.46 ± 0.64%/min/m2, p = 0.041; 27.32 ± 16.86%/week (T1) vs. 15.71 ± 9.82%/week (T1) p < 0.001; 17.19 ± 9.88%/week (T2) vs. 9.89 ± 14.62%/week (T2) p = 0.034) when compared with the PVE cohort. Post-procedural FTR volumes were similar for both hypertrophy techniques. Conclusions: LVD is an effective procedure to effectively optimize FLR before liver resection for PHC. The faster growth rate combined with the improved FLR function, when compared to PVE alone, could maximize surgical outcomes by lowering post-hepatectomy liver failure rates.
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Affiliation(s)
- Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (R.M.); (F.R.); (L.C.)
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (R.M.); (F.R.); (L.C.)
| | - Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Domenico Santangelo
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucrezia Clocchiatti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (R.M.); (F.R.); (L.C.)
| | - Carla Canevari
- Nuclear Medicine Department, San Raffaele University and Research Hospital, 20132 Milan, Italy; (C.C.); (P.M.)
| | - Patrizia Magnani
- Nuclear Medicine Department, San Raffaele University and Research Hospital, 20132 Milan, Italy; (C.C.); (P.M.)
| | - Federica Pedica
- Pathology Unit, Department of Experimental Oncology, San Raffaele Hospital, 20132 Milan, Italy;
| | | | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Luca Aldrighetti
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy
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Pegoraro F, Santangelo D, Santangelo A, Pelosio L, Jamshidi A, Camera L, Imbriaco M, Mainolfi CG, Insabato L, Accarino R, Giuliano M, Carlomagno N, D'Alessandro V, Santangelo ML. R0 surgical resection of giant dedifferentiated retroperitoneal liposarcomas in the COVID era with and without nephrectomy: A case report. Oncol Lett 2023; 26:410. [PMID: 37600332 PMCID: PMC10436160 DOI: 10.3892/ol.2023.13996] [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] [Received: 02/23/2023] [Accepted: 06/13/2023] [Indexed: 08/22/2023] Open
Abstract
Retroperitoneal sarcomas (RPSs) are rare findings that can grow into large masses without eliciting severe symptoms. At present, surgical resection is the only radical therapy, whenever it can be performed with the aim to achieve a complete removal of the tumor. The present report describes two consecutive cases of RPSs that resulted in dedifferentiated liposarcomas (DDLPSs) and these patients underwent R0 surgical resection with and without a nephron-sparing procedure. The diagnostic workup, the surgical approach, the impact of late surgical management due to the COVID pandemic and the latest literature on the topic are discussed and analyzed. The patients, who refused to undergo any medical examination during the prior 2 years due to the COVID pandemic, were admitted to Federico II University Hospital (Naples, Italy) complaining about weight loss and general abdominal discomfort. In the first case, a primitive giant abdominal right neoplasm of retroperitoneal origin enveloping and medializing the right kidney was observed. The second patient had a similar primitive retroperitoneal giant left neoplasm, which did not affect the kidney. Given the characteristics of the masses and the absence of distant metastases, after a multidisciplinary discussion, radical surgical removal was carried out for both patients. The lesions appeared well-defined from the surrounding tissues, and markedly compressed all the adjacent organs, without signs of infiltration. In the first patient, the right kidney was surrounded and undetachable from the tumor and it was removed en bloc with the mass. The second patient benefited from a nephron-sparing resection, due to the existence of a clear cleavage plane. The postoperative courses were uneventful. Both the histological examinations were oriented towards a DDLPS and both patients benefited from adjuvant chemotherapy. In conclusion, the treatment of giant RPS is still challenging and requires multidisciplinary treatment as well as, when possible, radical surgical removal. The lack of tissue infiltration and the avoidance of excision or reconstruction of major organs (including the kidney) could lead to an easier postoperative course and an improved prognosis. When possible, surgical management of recurrences or incompletely resected masses must be pursued. Since the COVID pandemic caused limited medicalization of a number of population groups and delayed diagnosis of other oncologic diseases, an increased number of DDLPSs could be expected in the near future.
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Affiliation(s)
- Francesca Pegoraro
- Operative Unit of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Domenico Santangelo
- Department of Radiology, ‘Scientific Hospitalization and Treatment Institute’ San Raffaele Hospital, I-20132 Milano, Italy
| | - Alfonso Santangelo
- Department of General Surgery and Emergency Surgery, ‘Scientific Hospitalization and Treatment Institute’ San Raffaele Hospital, I-20132 Milano, Italy
| | - Luigi Pelosio
- Operative Unit of General Surgery and Retroperitoneal Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Akbar Jamshidi
- Operative Unit of General Surgery and Retroperitoneal Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Luigi Camera
- Operative Unit of Diagnostic Imaging and Radiotherapy, Federico II University Hospital, I-80131 Naples, Italy
| | - Massimo Imbriaco
- Operative Unit of Diagnostic Imaging and Radiotherapy, Federico II University Hospital, I-80131 Naples, Italy
| | - Ciro Gabriele Mainolfi
- Operative Unit of Diagnostic Imaging and Radiotherapy, Federico II University Hospital, I-80131 Naples, Italy
| | - Luigi Insabato
- Operative Unit of Pathology, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
| | - Rossella Accarino
- Operative Unit of Pathology, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
| | - Mario Giuliano
- Operative Unit of Medical Oncology, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Nicola Carlomagno
- Operative Unit of General Surgery and Kidney Transplantation, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
| | - Vincenzo D'Alessandro
- Operative Unit of General Surgery and Retroperitoneal Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Michele L. Santangelo
- Operative Unit of General Surgery and Kidney Transplantation, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
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Neri S, Gasparini S, Pascarella A, Santangelo D, Cianci V, Mammì A, Lo Giudice M, Ferlazzo E, Aguglia U. Epilepsy in Cerebrovascular Diseases: A Narrative Review. Curr Neuropharmacol 2023; 21:1634-1645. [PMID: 35794769 PMCID: PMC10514540 DOI: 10.2174/1570159x20666220706113925] [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: 01/14/2022] [Revised: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epilepsy is a common comorbidity of cerebrovascular disease and an increasing socioeconomic burden. OBJECTIVE We aimed to provide an updated comprehensive review on the state of the art about seizures and epilepsy in stroke, cerebral haemorrhage, and leukoaraiosis. METHODS We selected English-written articles on epilepsy, stroke, and small vessel disease up until December 2021. We reported the most recent data about epidemiology, pathophysiology, prognosis, and management for each disease. RESULTS The main predictors for both ES and PSE are the severity and extent of stroke, the presence of cortical involvement and hemorrhagic transformation, while PSE is also predicted by younger age at stroke onset. Few data exist on physiopathology and seizure semiology, and no randomized controlled trial has been performed to standardize the therapeutic approach to post-stroke epilepsy. CONCLUSION Some aspects of ES and PSE have been well explored, particularly epidemiology and risk factors. On the contrary, few data exist on physiopathology, and existing evidence is mainly based on studies on animal models. Little is also known about seizure semiology, which may also be difficult to interpret by non-epileptologists. Moreover, the therapeutic approach needs standardization as regards indications and the choice of specific ASMs. Future research may help to better elucidate these aspects.
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Affiliation(s)
- Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Domenico Santangelo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Michele Lo Giudice
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
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Ascoli M, Elia M, Gasparini S, Bonanni P, Mastroianni G, Cianci V, Neri S, Pascarella A, Santangelo D, Aguglia U, Ferlazzo E. Therapeutic approach to neurological manifestations of Angelman syndrome. Expert Rev Clin Pharmacol 2022; 15:843-850. [PMID: 35917229 DOI: 10.1080/17512433.2022.2109463] [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: 11/04/2022]
Abstract
INTRODUCTION Angelman syndrome (AS) is a neurogenetic disorder due to deficient expression of the maternal copy of the UBE3A gene, which encodes ubiquitin ligase E3A protein. Severe developmental delay, seizures and other neurological disorders characterizes AS. AREAS COVERED In this review, we focus on a comprehensive therapeutic approach to the most disabling neurological manifestations of AS: epilepsy, sleep disturbances, behavioral and movement disorders. Articles were identified through PubMed and Google Scholar up to October 2021. EXPERT OPINION Evidence for the treatment of neurological manifestations in AS mainly derives from poor quality studies (case reports, small case series, expert opinions). Seizures can be polymorphic and includes atypical absences, myoclonic, generalized tonic-clonic, unilateral clonic, or atonic attacks. Sodium valproate, levetiracetam and benzodiazepines are the most commonly used anti-seizure medications. Melatonin or mirtazapine seem to improve sleep quality. Antipsychotics, antidepressants and anxiolytics have been proposed for treatment of behavioral manifestations, but no evidence-based studies are available. Non-pharmacological approach may also be useful. Mild dystonia is common but usually does not significantly impact patients' motor performances. Well-conducted clinical trials aimed to evaluate treatment of neurological complications of AS are warranted. Gene and molecular precision therapies represent a fascinating area of research in the future.
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Affiliation(s)
- Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | | | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Paolo Bonanni
- Epilepsy and Neurophysiology Unit, IRCCS Medea, Conegliano, Treviso, Italy
| | - Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Domenico Santangelo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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Ghidini A, Santangelo D, Vaccaro G, Chillura M, Petrelli F. Cemiplimab in cutaneous squamous cell carcinomas (SCC): an overview and a clinical case. Oral Oncol 2022; 128:105847. [DOI: 10.1016/j.oraloncology.2022.105847] [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] [Received: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
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Ardizzone A, Bavetta D, Garo ML, Santangelo D, Bongiorno A, Bono M. Impact of the Cognitive-Behavioral Approach and Psychoeducational Intervention in Breast Cancer Management: A Prospective Randomized Clinical Trial. Healthcare (Basel) 2022; 10:healthcare10040629. [PMID: 35455807 PMCID: PMC9025943 DOI: 10.3390/healthcare10040629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Breast cancer (BC) is the most prevalent malignancy in women. High cancer-related psychological distress levels have been observed in BC patients, with a potentially relevant impact on disease management, compliance with disease treatments, and everyday life activities and relationships. This work evaluated the effectiveness of three individual cognitive−behavioral therapy psychoeducational sessions versus a self-managed informative guide with individual counseling sessions without specific psychological treatment. (2) Methods: the intervention group received three individual 50-min sessions of psychoeducational training, and the control group received a self-managed informative guide with individual counseling sessions without any kind of psychological treatment. The Hospital Anxiety Depression Scale (HADS), the Distress Thermometer (DT), and the EORTC (European Organization for Research and Treatment of Cancer) QLQ-C30 were administered at baseline and two months after study inclusion. (3) Results: A total of 60 participants were included in the study (intervention group: 30, control group: 30). Significant improvements were observed in both groups after two months (p < 0.05), but no statistically significant differences emerged between groups. (4) Conclusions: Psychoeducational interventions and CBT help BC patients manage disease-related fear and distress, allowing them to achieve a good quality of life.
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Affiliation(s)
- Antonella Ardizzone
- U.O. Oncologia Medica, Hospital Giovanni Paolo II, 92019 Sciacca, Italy;
- Samo Onlus, 92100 Agrigento, Italy
- Istituto Tolman Srl, 90121 Palermo, Italy;
- Correspondence: ; Tel.: +39-329-7211651
| | - Domenico Bavetta
- U.O. Ginecologia e Ostetricia Department, Hospital Giovanni Paolo II, 92019 Sciacca, Italy;
| | | | | | | | - Maria Bono
- C.S.M.—Hospital Giovanni Paolo II, 92019 Sciacca, Italy;
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9
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Pascarella A, Cianci V, Manzo L, Neri S, Gasparini S, Santangelo D, Ferlazzo E, Aguglia U. De novo myoclonic status epilepticus in Alzheimer disease. Seizure 2022; 97:35-36. [DOI: 10.1016/j.seizure.2022.03.005] [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] [Received: 02/14/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022] Open
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10
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Neri S, Ascoli M, Africa E, Versace P, Porcelli A, Armentano A, Santangelo D, Pascarella A, Manzo L, Lobianco C, Mastroianni G, Cianci V, Gasparini S, Aguglia U, Ferlazzo E. The relevance of MRI blood-sensitive sequences in the diagnostic assessment of late-onset epilepsy. Eur Rev Med Pharmacol Sci 2022; 26:1178-1182. [PMID: 35253174 DOI: 10.26355/eurrev_202202_28110] [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: 06/14/2023]
Abstract
OBJECTIVE Sporadic cerebral amyloid angiopathy (CAA) is a degenerative brain small vessel disease of ageing resulting from progressive amyloid deposition in small arteries and arterioles of the cortex and leptomeninges. CAA may be diagnosed by the mean of Boston criteria, particularly with the use of the blood-sensitive T2* MRI sequences (GRE and SWI). Epileptic seizures have rarely been reported in CAA. PATIENTS AND METHODS We describe two patients with late-onset unprovoked seizures due to CAA. A short literature review on this topic is presented. RESULTS In our two patients with late-onset unprovoked seizures as the first manifestation of CAA, only GRE and SWI sequences lead to a correct diagnosis. In literature, only 15 patients with CAA presenting with seizures have been reported. In these subjects, data on seizures semiology and prognosis are scarce. CONCLUSIONS Our report highlights the importance to perform blood-sensitive sequences in all subjects with LOE of otherwise unknown etiology, not to miss a diagnosis of CAA.
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Affiliation(s)
- S Neri
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy.
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11
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De Martino A, Barone S, Santangelo D, Magro G, Tosto F, Pascarella A, Manzo L, Bruno P, Pasquale M, Valentino P, Gambardella A. Myositis associated to COVID-19 mimics an acute exacerbation in myasthenia gravis patient. J Neurol Sci 2021. [PMCID: PMC8498526 DOI: 10.1016/j.jns.2021.119865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Di Biasio F, Marchese R, Abbruzzese G, Baldi O, Esposito M, Silvestre F, Tescione G, Berardelli A, Fabbrini G, Ferrazzano G, Pellicciari R, Eleopra R, Devigili G, Bono F, Santangelo D, Bertolasi L, Altavista MC, Moschella V, Barone P, Erro R, Albanese A, Scaglione C, Liguori R, Cotelli MS, Cossu G, Ceravolo R, Coletti Moja M, Zibetti M, Pisani A, Petracca M, Tinazzi M, Maderna L, Girlanda P, Magistrelli L, Misceo S, Romano M, Minafra B, Modugno N, Aguggia M, Cassano D, Defazio G, Avanzino L. Motor and Sensory Features of Cervical Dystonia Subtypes: Data From the Italian Dystonia Registry. Front Neurol 2020; 11:906. [PMID: 33013628 PMCID: PMC7493687 DOI: 10.3389/fneur.2020.00906] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Cervical dystonia (CD) is one of the most common forms of adult-onset isolated dystonia. Recently, CD has been classified according to the site of onset and spread, in different clinical subgroups, that may represent different clinical entities or pathophysiologic subtypes. In order to support this hypothesis, in this study we have evaluated whether different subgroups of CD, that clinically differ for site of onset and spread, also imply different sensorimotor features. Methods: Clinical and demographic data from 842 patients with CD from the Italian Dystonia Registry were examined. Motor features (head tremor and tremor elsewhere) and sensory features (sensory trick and neck pain) were investigated. We analyzed possible associations between motor and sensory features in CD subgroups [focal neck onset, no spread (FNO-NS); focal neck onset, segmental spread (FNO-SS); focal onset elsewhere with segmental spread to neck (FOE-SS); segmental neck involvement without spread (SNI)]. Results: In FNO-NS, FOE-SS, and SNI subgroups, head tremor was associated with the presence of tremor elsewhere. Sensory trick was associated with pain in patients with FNO-NS and with head tremor in patients with FNO-SS. Conclusion: The frequent association between head tremor and tremor elsewhere may suggest a common pathophysiological mechanism. Two mechanisms may be hypothesized for sensory trick: a gating mechanism attempting to reduce pain and a sensorimotor mechanism attempting to control tremor.
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Affiliation(s)
| | | | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Ottavia Baldi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Marcello Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Francesco Silvestre
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Girolamo Tescione
- "Salvatore Maugeri" Foundation, Institute of Telese Terme (BN), Benevento, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Pellicciari
- Department of Basic Science, Neuroscience and Sense Organs, Aldo Moro University of Bari, Bari, Italy
| | - Roberto Eleopra
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, UOC Neurologia 1, Milan, Italy
| | - Grazia Devigili
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, UOC Neurologia 1, Milan, Italy
| | - Francesco Bono
- Neurology Unit, Center for Botulinum Toxin Therapy, A.O.U. Mater Domini, Catanzaro, Italy
| | - Domenico Santangelo
- Neurology Unit, Center for Botulinum Toxin Therapy, A.O.U. Mater Domini, Catanzaro, Italy
| | | | | | | | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, Universitá di Salerno, Baronissi, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, Universitá di Salerno, Baronissi, Italy
| | | | - Cesa Scaglione
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maurizio Zibetti
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Antonio Pisani
- Neurology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Martina Petracca
- Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Luca Maderna
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | | | | | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | | | - Giovanni Defazio
- Neurology Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Avanzino
- IRCCS Policlinico San Martino, Genoa, Italy.,Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
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13
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Robesti D, Gandaglia G, Fossati N, Cucchiara V, Nocera L, Barletta F, Scuderi S, Rizzo A, Zito E, Gallina A, Camisassa E, Sciacqua L, Santangelo D, Droghetti M, Sorce G, Pellegrino F, Mazzone E, Stabile A, Bravi C, Martini A, Karakiewicz P, Moschini M, Montorsi F, Briganti A. A positive PSMA PET/CT predicts more aggressive disease progression in patients with biochemical recurrence after radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33768-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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14
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Ghidini A, Petrelli F, Fazio I, Santangelo D. Role of lanreotide in an elderly patient with Merkel cell carcinoma. Dermatol Ther 2020; 33:e13206. [PMID: 31886588 DOI: 10.1111/dth.13206] [Citation(s) in RCA: 1] [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] [Received: 11/29/2019] [Accepted: 12/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Ivan Fazio
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
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15
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Verderame F, Russo A, Di Leo R, Badalamenti G, Santangelo D, Cicero G, Valerio MR, Gulotta G, Tomasello G, Gebbia N, Fulfaro F. Gemcitabine and oxaliplatin combination chemotherapy in advanced biliary tract cancers. Ann Oncol 2006; 17 Suppl 7:vii68-72. [PMID: 16760298 DOI: 10.1093/annonc/mdl955] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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: 01/08/2023] Open
Abstract
BACKGROUND Biliary tract cancers are uncommon tumors with a poor prognosis and most patients present with invasive and inoperable disease at diagnosis. Chemotherapy represents a palliative treatment, with poor response rates and a median survival of less than 6 months. Oxaliplatin and gemcitabine have shown an interesting activity as single agents in this group of patients. PATIENTS AND METHODS We carried out a multicenter phase II study to evaluate the efficacy and safety of combined oxaliplatin and gemcitabine in locally advanced and metastatic biliary tract carcinoma. The schedule of chemotherapy included oxaliplatin 100 mg/m(2) on day 1 and gemcitabine 1000 mg/m(2) on days 1 and 8, every 21 days. RESULTS All the 24 patients were evaluable for response and toxicity. According to RECIST criteria we observed one complete response and 11 partial responses for an overall response rate of 50%. Overall survival for all the patients on study was 12 months (range 2-30). According to WHO criteria, three patients (12.5%) suffered grade 3 neutropenia and three patients (12.5%) grade 3 thrombocytopenia. Only two patients (8%) suffered grade 3 neuropathy. CONCLUSIONS Oxaliplatin and gemcitabine chemotherapy seems to be effective with a favorable safety profile in first-line chemotherapy of advanced biliary tract cancers.
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Affiliation(s)
- F Verderame
- Department of Medicine, Oncology Unit, Azienda Ospedaliera Giovanni Paolo II Sciacca (AG), Palermo, Italy
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16
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Gebbia N, Verderame F, Di Leo R, Santangelo D, Cicero G, Valerio MR, Arcara C, Badalamenti G, Fulfaro F, Carreca I. A phase II study of oxaliplatin (O) and gemcitabine (G) first line chemotherapy in patients with advanced biliary tract cancers. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4132] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. Gebbia
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - F. Verderame
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - R. Di Leo
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - D. Santangelo
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - G. Cicero
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - M. R. Valerio
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - C. Arcara
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - G. Badalamenti
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - F. Fulfaro
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
| | - I. Carreca
- Dept of Oncology, Palermo, Sicily, Italy; Azienda Osp, Sciacca, Italy; Dept of Experim and Clin Onc, Palermo, Sicily, Italy
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17
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Bajetta E, Del Vecchio M, Nova P, Gattinoni L, Santinami M, Santangelo D, Daponte A, Sertoli M, Queirolo P, Bernengo M. 837 Multicenter phase III randomized trial of polychemotherapy (CVD regimen) versus the same chemotherapy (CT) plus subcutaneous (SC) interleukin-2 (IL-2) and interferon-alpha-2b (IFN) in metastatic melanoma. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90863-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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