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Nigro O, Gattuso G, Sironi G, Podda M, Schiavello E, Spreafico F, Terenziani M. Childhood cancer survivors: improving our practice today to reduce late, major surgical interventions tomorrow. Transl Pediatr 2024; 13:6-9. [PMID: 38323172 PMCID: PMC10839282 DOI: 10.21037/tp-23-417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Podda MG, Schiavello E, Nigro O, Clerici CA, Simonetti F, Luksch R, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Chiaravalli S, Biassoni V, Gattuso G, Puma N, Bergamaschi L, Sironi G, Massimino M. Palliative sedation in paediatric solid tumour patients: choosing the best drugs. BMJ Support Palliat Care 2024; 13:e1141-e1148. [PMID: 36418035 DOI: 10.1136/bmjspcare-2022-003534] [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: 01/12/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Cancer remains the leading cause of mortality by disease in childhood in high-income countries. For terminally ill children, care focuses on quality of life, and patient management fundamentally affects grieving families. This paper describes our experience of palliative sedation (PS) for children with refractory symptoms caused by solid tumours, focusing on the drugs involved. METHODS We retrospectively collected data on all children treated for cancer who died at the pediatric oncology unit of the Fondazione IRCCS Istituto Nazionale dei Tumori between January 2016 and December 2020. RESULTS Of the 29 patients eligible for the study, all but 4 received PS. Midazolam was always used, combined in 16 cases with other drugs (mainly classic neuroleptics, alpha-2 agonists and antihistamines). Throughout the period of PS and on the day of death, patients with sarcoma were given higher doses of midazolam and morphine, and more often received combinations of drugs than patients with brain tumours. Sarcoma causes significant symptoms, while brain tumours require less intensive analgesic-sedative therapies because they already impair a patient's state of consciousness. CONCLUSIONS Optimising pharmacological treatments demands a medical team that knows how drugs (often developed for other indications) work. Emotional and relational aspects are important too, and any action to lower a patient's consciousness should be explained to the family and justified. Parents should not feel like helpless witnesses. Guidelines on PS in paediatrics could help, providing they acknowledge that a child's death is always a unique case.
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Affiliation(s)
- Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Alfredo Clerici
- Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Department of Oncology and Hematology, Università degli Studi di Milano, Milano, Italy
| | - Fabio Simonetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Givanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Nigro O, Podda MG, Pellegatta F, Schiavello E, Clerici CA, Catalano I, Visconti G, Albarini M, Luksch R, Terenziani M, Ferrari A, Casanova M, Biassoni V, Meazza C, Spreafico F, Gattuso G, Sironi G, Puma N, Bergamaschi L, Chiaravalli S, Massimino M. End-of-Life transfusion support at hospice and pediatric oncology unit: Bridging the gap between benefits and therapeutic alliance. Tumori 2023; 109:NP6-NP10. [PMID: 37154050 DOI: 10.1177/03008916231168670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Although transfusion support is commonly used in oncological palliative care, there is still a paucity of literature. We examined the transfusion support provided in the terminal stage of the disease and compared the approach at a pediatric oncology unit and a pediatric hospice. CASE DESCRIPTION This case series analyzed patients treated at the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT)'s pediatric oncology unit who died between January 2018 and April 2022. We compared these with those who died at the VIDAS hospice and analyzed the number of complete blood counts taken in a patient's last 14 days of life, and the number of transfusions performed in the same period.We analyzed 44 patients (22 in pediatric oncology unit; 22 in hospice) in total. Twenty-eight complete blood counts were performed (7/22 patients at the hospice; 21/22 patients at the pediatric oncology unit). Nine patients were given transfusions, three at the hospice, six at our pediatric oncology unit (24 transfusions in total): 20 transfusions at the pediatric oncology unit, four at the hospice. In total 17/44 patients were given active therapies in the last 14 days of life: 13 at the pediatric oncology unit, four at the pediatric hospice. Ongoing cancer treatments did not correlate with a greater likelihood of receiving a transfusion (p=0.91). CONCLUSIONS The hospice's approach was more conservative than the pediatric oncology one. In the in-hospital setting, the need for a transfusion cannot always be decided on by a combination of numerical values and parameters alone. The family's emotional-relational response must be considered too.
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Affiliation(s)
- Olga Nigro
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta G Podda
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Pellegatta
- Hospice and Palliative Care Unit, Casa Sollievo Bimbi, Associazione VIDAS, Milano, Italy
| | | | - Carlo A Clerici
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milano, Milano, Italy
| | - Igor Catalano
- Hospice and Palliative Care Unit, Casa Sollievo Bimbi, Associazione VIDAS, Milano, Italy
| | - Giovanna Visconti
- Hospice and Palliative Care Unit, Casa Sollievo Bimbi, Associazione VIDAS, Milano, Italy
| | - Marco Albarini
- Hospice and Palliative Care Unit, Casa Sollievo Bimbi, Associazione VIDAS, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Podda MG, Meazza C, Gattuso G, Sironi G, Nigro O, Bergamaschi L, Biassoni V, Casanova M, Chiaravalli S, Ferrari A, Luksch R, Puma N, Schiavello E, Spreafico F, Grampa P, Manoukian S, Vennarini S, Collini P, Daolio PA, Gennaro M, Guzzo M, Morosi C, Biasoni D, Massimino M, Terenziani M. Treating secondary malignant neoplasms: A burden of childhood cancer survivors. Tumori 2023; 109:436-441. [PMID: 36964667 PMCID: PMC10540476 DOI: 10.1177/03008916231160824] [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: 01/24/2023] [Accepted: 02/11/2023] [Indexed: 03/26/2023]
Abstract
Each year approximately 35,000 children and adolescents are diagnosed with cancer in Europe. Five-year survival rates have improved and now reach 80% in most European countries, thanks to a combination of chemotherapy, radiotherapy, and surgery. To date, there are more than 44,000 Italians still living several years after being diagnosed with cancer in developmental age. The risk of premature morbidity and mortality for cancer survivors is well known and documented. Approximately 60% of survivors of cancer in childhood and adolescence have at least one chronic health condition in later life, and more than one in four develop severe or life-threatening disorders. Among the various long-term iatrogenic sequelae of cancer treatments, the most worrisome are second malignant neoplasms. We reported on our mono-institutional experiences of screening and treating secondary breast cancer, secondary thyroid cancer and secondary osteosarcoma. Recommendations on the surveillance needed for cancer survivors because of the risk of late effects of their disease or its treatment suggest that discussing the potential problems early on can be crucial to a patient's future health. These considerations and our consolidated experience strengthen our conviction that survivors of cancer in childhood and adolescence who develop second malignant neoplasms should be treated at highly-specialized centers. Multidisciplinary care requires close communications and high levels of up-to-date professional expertise. This challenging area of health care is also changing rapidly because cancer survivorship is a work in progress, but we cannot wait for definitive conclusions on many aspects because this will take decades, especially for pediatric patients.
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Affiliation(s)
- Marta G Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Grampa
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Siranoush Manoukian
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Primo A Daolio
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Massimiliano Gennaro
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Guzzo
- Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Terenziani M, Barretta F, Gattuso G, Bisogno G, Conte M, Crocoli A, De Pasquale MD, Biasoni D, Spreafico F, D'Angelo P. Should we reduce routine surveillance imaging in pediatric germ cell tumors? Pediatr Blood Cancer 2023; 70:e30200. [PMID: 36625403 DOI: 10.1002/pbc.30200] [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: 06/23/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
This paper retrospectively investigated the site and the detection method of relapses in children and adolescents with malignant germ cell tumors enrolled in the TCGM-AIEOP-2004 Study and subsequently developed a relapse, in order to evaluate a possible reduction in radiological exposure during follow-up. Including all malignant cases, serum tumor markers identified a relapse in more than 70% and, according to the selection criteria published by Children Oncology Group in 2018, in more than 90% of cases. These results confirm the importance of serum tumor markers as a relapse detection method, with possible reduction of radiology exams in specific subgroups.
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Affiliation(s)
- Monica Terenziani
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | - Alessandro Crocoli
- General Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Pediatric Hematology/Oncology Cell and Gene Therapy Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Biasoni
- Urologic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, ARNAS "Civico, Di Cristina and Benfratelli" Hospitals, Palermo, Italy
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Casanova M, Bergamaschi L, Chiaravalli S, Morosi C, Livellara V, Hovsepyan S, Sironi G, Puma N, Nigro O, Gattuso G, Luksch R, Terenziani M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Gasparini P, Vennarini S, Massimino M, Ferrari A. Relapse after non-metastatic rhabdomyosarcoma: The impact of routine surveillance imaging on early detection and post-relapse survival. Pediatr Blood Cancer 2023; 70:e30095. [PMID: 36411264 DOI: 10.1002/pbc.30095] [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: 08/22/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with rhabdomyosarcoma (RMS) whose disease relapses have little chance of being cured, so front-line treatments are usually followed up with surveillance imaging in an effort to detect any recurrences as early as possible, and thereby improve post-relapse outcomes. The real benefit of such routine surveillance imaging in RMS remains to be demonstrated, however. This retrospective, single-center study examines how well surveillance imaging identifies recurrent tumors and its impact on post-relapse survival. METHODS The analysis concerned 79 patients <21 years old treated between 1985 and 2020 whose initially localized RMS relapsed. Clinical findings, treatment modalities, and survival were analyzed, comparing patients whose relapse was first suspected from symptoms they developed (clinical symptoms group) with those whose relapse was identified by radiological surveillance (routine imaging group). RESULTS Tumor relapses came to light because of clinical symptoms in 42 cases, and on routine imaging in 37. The time to relapse was much the same in the two groups. The median overall survival (OS) and 5-year OS rate were, respectively, 10 months and 12.6% in the clinical symptoms group, and 11 months and 27.5% in the routine imaging group (p-value .327). Among patients with favorable prognostic scores, survival was better for those in the routine imaging group (5-year OS 75.0% vs. 33.0%, p-value .047). CONCLUSION It remains doubtful whether surveillance imaging has any real impact on RMS relapse detection and patients' post-relapse survival. Further studies are needed to establish the most appropriate follow-up recommendations, taking the potentially negative effects of regular radiological exams into account.
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shushan Hovsepyan
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Hurkmans EGE, Klumpers MJ, Dello Russo C, De Witte W, Guchelaar HJ, Gelderblom H, Cleton-Jansen AM, Vermeulen SH, Kaal S, van der Graaf WTA, Flucke U, Gidding CEM, Schreuder HWB, de Bont ESJM, Caron HN, Gattuso G, Schiavello E, Terenziani M, Massimino M, McCowage G, Nagabushan S, Limaye A, Rose V, Catchpoole D, Jorgensen AL, Barton C, Delaney L, Hawcutt DB, Pirmohamed M, Pizer B, Coenen MJH, te Loo DMWM. Genome-wide analyses of platinum-induced ototoxicity in childhood cancer patients: Results of GO-CAT and United Kingdom MAGIC consortia. Front Pharmacol 2023; 13:980309. [PMID: 36699085 PMCID: PMC9870026 DOI: 10.3389/fphar.2022.980309] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Hearing loss (ototoxicity) is a major adverse effect of cisplatin and carboplatin chemotherapy. The aim of this study is to identify novel genetic variants that play a role in platinum-induced ototoxicity. Therefore, a genome-wide association study was performed in the Genetics of Childhood Cancer Treatment (GO-CAT) cohort (n = 261) and the United Kingdom Molecular Genetics of Adverse Drug Reactions in Children Study (United Kingdom MAGIC) cohort (n = 248). Results of both cohorts were combined in a meta-analysis. In primary analysis, patients with SIOP Boston Ototoxicity Scale grade ≥1 were considered cases, and patients with grade 0 were controls. Variants with a p-value <10-5 were replicated in previously published data by the PanCareLIFE cohort (n = 390). No genome-wide significant associations were found, but variants in TSPAN5, RBBP4P5, AC010090.1 and RNU6-38P were suggestively associated with platinum-induced ototoxicity. The lowest p-value was found for rs7671702 in TSPAN5 (odds ratio 2.0 (95% confidence interval 1.5-2.7), p-value 5.0 × 10-7). None of the associations were significant in the replication cohort, although the effect directions were consistent among all cohorts. Validation and functional understanding of these genetic variants could lead to more insights in the development of platinum-induced ototoxicity.
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Affiliation(s)
| | - Marije J. Klumpers
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Cinzia Dello Russo
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, United Kingdom,Department of Healthcare Surveillance and Bioethics, Section of Pharmacology, Università Cattolica del Sacro Cuore-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ward De Witte
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sita H. Vermeulen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suzanne Kaal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Eveline S. J. M. de Bont
- Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, Netherlands
| | - Huib N. Caron
- Department of Pediatrics, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, Netherlands
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Geoff McCowage
- Cancer Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Sumanth Nagabushan
- Cancer Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia,Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| | - Anuja Limaye
- Department of Audiology, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Victoria Rose
- Department of Neuro-Otology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Daniel Catchpoole
- Children’s Cancer Research Unit, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea L. Jorgensen
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Christopher Barton
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom
| | - Lucy Delaney
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom
| | - Daniel B. Hawcutt
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom,NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Barry Pizer
- Department of Pediatric Oncology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Marieke J. H. Coenen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - D. Maroeska W. M. te Loo
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: D. Maroeska W. M. te Loo,
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8
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Bergamaschi L, Chiaravalli S, Livellara V, Sironi G, Puma N, Nigro O, Gattuso G, Luksch R, Terenziani M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Hovsepyan S, Morosi C, Vennarini S, Massimino M, Casanova M, Ferrari A. Relapse after nonmetastatic rhabdomyosarcoma: Salvage rates and prognostic variables. Pediatr Blood Cancer 2023; 70:e30050. [PMID: 36215173 DOI: 10.1002/pbc.30050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with relapsing rhabdomyosarcoma (RMS) pose a therapeutic challenge, and the survival rate is reportedly poor. We describe a retrospective series of relapsing RMS patients treated at a referral center for pediatric sarcoma, investigating the pattern of relapse, salvage rates, and factors correlating with final outcomes. METHODS The analysis concerned 105 patients <21 years old treated from 1985 to 2020 with initially localized RMS at first relapse. For risk-adapted stratification purposes, patient outcomes were examined using univariable and multivariable analyses based on patients' clinical features at first diagnosis, first-line treatments, clinical findings at first relapse, and second-line treatments. RESULTS First relapses occurred 0.08-4.8 years (median 1 year) following initial diagnosis and were local/locoregional in 59% of cases. Treatment at first relapse included chemotherapy in all but two cases, radiotherapy in 38, and surgery in 21. Median event-free survival (EFS) after first relapse was 4 months, while 5-year EFS was 16.3%; median overall survival (OS) was 9 months, while 5-year OS was 16.7%. Several variables influenced survival rates. Considering only clinical findings and treatment at relapse, Cox's multivariable analysis showed that OS correlated significantly with time to relapse, radiotherapy administered at relapse, response to chemotherapy, and whether a second remission was achieved. CONCLUSION Survival following first relapse of patients with localized RMS at initial diagnosis is poor. The variables found to influence survival can be utilized in a risk-adapted model to estimate the chances of salvage to guide decisions for second-line treatments.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shushan Hovsepyan
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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9
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Ferrari A, Bergamaschi L, Chiaravalli S, Livellara V, Sironi G, Nigro O, Puma N, Gattuso G, Morosi C, Gasparini P, Caccavo R, Pecori E, Alessandro O, Vennarini S, Gandola L, Massimino M, Casanova M. Metastatic rhabdomyosarcoma: Evidence of the impact of radiotherapy on survival. A retrospective single-center experience. Pediatr Blood Cancer 2022; 69:e29853. [PMID: 35731852 DOI: 10.1002/pbc.29853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/14/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prognosis for patients with metastatic rhabdomyosarcoma (RMS) remains largely unsatisfactory despite the adoption of intensive multimodal therapy. To assess the role of different treatments adopted over the years, we retrospectively analyzed a cohort of patients <21 years old with metastatic RMS, treated from 1990 to 2020 at a referral center for pediatric sarcomas. METHODS Patients were treated using a multimodal approach that included surgery, radiotherapy, and chemotherapy (both high-dose chemotherapy and maintenance therapy in some cases). The type of radiotherapy administered was categorized as radical (to all sites of disease); partial (to at least one, but not all sites of disease); or none. A landmark analysis was used to examine the impact of radiotherapy on survival, that is, patients who had an event before day 221 were excluded from the analysis. RESULTS The series included 80 patients. Event-free survival (EFS) and overall survival (OS) rates at 5 years were 17.3% and 21.3%, respectively. Survival was significantly associated with radiotherapy to metastatic sites, and with the radiotherapy category. In particular, 5-year EFS and OS rates were 70.6% and 76.0% for patients given radical radiotherapy, and 4.8% and 10.7%, respectively, for those given partial radiotherapy or none. Using the Cox multivariable analysis, OS correlated significantly with radiotherapy category. CONCLUSIONS While confirming the poor overall outcome of patients with metastatic RMS, this study identified radiotherapy-when given to all sites of disease (including metastases)-as the main variable influencing survival.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Caccavo
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ombretta Alessandro
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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10
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Massimino M, Vennarini S, Barretta F, Colombo F, Antonelli M, Pollo B, Pignoli E, Pecori E, Alessandro O, Schiavello E, Boschetti L, Podda M, Puma N, Gattuso G, Sironi G, Barzanò E, Nigro O, Bergamaschi L, Chiaravalli S, Luksch R, Meazza C, Spreafico F, Terenziani M, Casanova M, Ferrari A, Chisari M, Pellegrini C, Clerici CA, Modena P, Biassoni V. How ten-years of reirradiation for paediatric high-grade glioma may shed light on first line treatment. J Neurooncol 2022; 159:437-445. [PMID: 35809148 DOI: 10.1007/s11060-022-04079-4] [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: 05/31/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Recurrence incidence for paediatric/adolescent high-grade glioma (HGG) exceeds 80%. Reirradiation (reRT) palliates symptoms and delays further progression. Strategies for reRT are scarce: we retrospectively analysed our series to develop rational future approaches. METHODS We re-evaluated MRI + RT plans of 21 relapsed HGG-patients, accrued 2010-2021, aged under 18 years. All underwent surgery and RT + chemotherapy at diagnosis. Pathologic/molecular re-evaluation allowed classification based on WHO 2021 criteria in 20/21 patients. Survival analyses and association with clinical parameters were performed. RESULTS Relapse after 1st RT was local in 12 (7 marginal), 4 disseminated, 5 local + disseminated. Re-RT obtained 8 SD, 1 PR, 1PsPD, 1 mixed response, 10 PD; neurological signs/symptoms improved in 8. Local reRT was given to 12, followed again by 6 local (2 marginal) and 4 local + disseminated second relapses in 10/12 re-evaluated. The 4 with dissemination had 1 whole brain, 2 craniospinal irradiation (CSI), 1 spine reRT and further relapsed with dissemination and local + dissemination in 3/four assessed. Five local + disseminated tumours had 3 CSI, 1 spine reRT, further progressing locally (2), disseminated (1), n.a. (1). Three had a third RT; three were alive at 19.4, 29, 50.3 months after diagnosis. Median times to progression/survival after re-RT were 3.7 months (0.6-16.2 months)/6.9 months (0.6-17.9 months), improved for longer interval between 1st RT and re-RT (P = 0.017) and for non-PD after reRT (P < 0.001). First marginal relapse showed potential association with dissemination after re-RT (P = 0.081). CONCLUSIONS This is the biggest series of re-RT in paediatric HGG. Considering the dissemination observed at relapse, our results could prompt the investigation of different first RT fields in a randomized trial.
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Affiliation(s)
- Maura Massimino
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Sabina Vennarini
- Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics (FB), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Manila Antonelli
- Radiological, Oncological and Anatomo-Pathological Sciences (MA), Department of La Sapienza University, Rome, Italy
| | - Bianca Pollo
- Neuropathology (BP) Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuele Pignoli
- Medical Physics (EP), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ombretta Alessandro
- Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Luna Boschetti
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Elena Barzanò
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marco Chisari
- Pain Therapy and Rehabilitation Units (MC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Chiara Pellegrini
- Pain Therapy and Rehabilitation Units (MC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Hemato-Oncology Department La Statale University, Milan, Italy
| | | | - Veronica Biassoni
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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11
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Schiavello E, Biassoni V, Gattuso G, Podda M, Chiaravalli S, Barretta F, Antonelli M, De Cecco L, Pecori E, Gandola L, Massimino M. A homogeneous treatment for non-DIPG diffuse midline glioma. Tumori 2022:3008916221099067. [PMID: 35708347 DOI: 10.1177/03008916221099067] [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: 11/17/2022]
Abstract
INTRODUCTION The H3K27M-mutant diffuse midline glioma (DMG) was first included in the World Health Organization (WHO) Classification of central nervous system (CNS) tumors in 2016, and confirmed in its fifth edition. The biological behavior and dismal prognosis of this tumor resemble diffuse intrinsic pontine gliomas (DIPG). Homogeneously-treated series are rarely reported. METHODS From 2016 onwards, we treated patients with DMG with radiotherapy and concomitant/adjuvant nimotuzumab/vinorelbine, plus re-irradiation at relapse, as already done for DIPG. RESULTS We treated nine patients, seven females, with a median age at diagnosis of 13 years. Tumor sites were: thalamic in five cases, pontocerebellar in two, pineal in one, and paratrigonal with nodular/leptomeningeal dissemination in one. Three patients were biopsied, and six had partial tumor resections. Central pathological review was always performed. The median time to local progression was 12.7 months, and the median overall survival was 17.8 months. Six patients died of tumor progression, one of cerebral bleeding at progression. Two were alive, one in continuous remission, the other after relapsing, at 38.6 and 46.3 months after diagnosis. Progression-free survival was 33.3% at one year. Overall survival was 88.9%, 33.3% and 22.2% at 1, 2 and 3 years, respectively. CONCLUSIONS This is a small series of homogeneously-treated DMG patients. The results obtained are comparable with those of DIPG patients. Given the phenotypically- and molecularly-defined setting of DMG and severe outcome in this orphan population, they should be treated and included in registries and protocols of DIPG.
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Affiliation(s)
- Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University Viale Regina Elena, Rome, Italy
| | - Loris De Cecco
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Schiavello E, Biassoni V, Barretta F, Gattuso G, Pecori E, Gandola L, Boschetti L, Mastronuzzi A, Cacchione A, Quaglietta L, Milanaccio C, Simonetti F, Buttarelli FR, Antonelli M, Massimino M. DIPG-64. Feasibility and early results of radiotherapy, concomitant nimotuzumab and vinorelbine and re-irradiation at progression, for newly diagnosed childhood and adolescence diffuse midline glioma (DMG). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.121] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The purposes of this trial were evaluating the feasibility, response and PFS/OS of patients receiving upfront radiotherapy and reirradiation at progression with concomitant nimotuzumab/vinorelbine chemotherapy as the standard arm of the ongoing protocol for DIPG. METHODS: Patients aged 2-21 years with not-pretreated DMG (evidence of H3.3K27M mutation at immunohistochemistry) received vinorelbine 20 mg/m2+nimotuzumab 150 mg/m2 weekly for 12 weeks; thereafter every other week until tumor progression or for up to 2 years. Focal photons irradiation was delivered within the 3rd week after first nimotuzumab+vinorelbine administration with a total dose of 54 Gy in 1.8 Gy daily fractions. For local progression re-irradiation was proposed at 19.8 Gy; in case of dissemination craniospinal-irradiation at 36 Gy was adopted. MRI were blindly centrally reviewed at diagnosis and every 12 weeks thereafter. RESULTS: Aggregated preliminary results are available for 20 patients from 4 Italian centers: 12 males, median age 11 years (range 3-17). Median time of observation was 12.5 months; 8 had thalamic/basal ganglia disease, in 5 pons was involved (2 pontobulbar, 3 pontomesencephalic), 6 spinal, 2 cerebellar. 13 patients had only biopsy, the others partial or near-total resection.14 relapsed: 5 locally, 4 with dissemination, 5 with both; 12 died, one was lost at follow-up. Two patients received reirradiation, one of them was irradiated three times without evidence of radionecrosis, still alive at 26 months from diagnosis. Median EFS/OS were 8.3/10.2 months, respectively; EFS/OS at 1 year were 25.8/36.7%. Survival curves between spinal and cerebral locations showed no difference. Patients after partial/near-total resection vs biopsied seemed to have earlier relapses (P 0.017) with EFS at 6 months of 34.3/75.0% respectively. CONCLUSIONS: This is one of the first series of DMG homogeneously and prospectively treated; treatment was feasible. A potential role of reirradiation emerge as in DIPGs.
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Affiliation(s)
- Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Emilia Pecori
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Luna Boschetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Angela Mastronuzzi
- Pediatric Hematology and Oncology Department, Ospedale Pediatrico Bambino Gesù , Roma , Italy
| | - Antonella Cacchione
- Pediatric Hematology and Oncology Department, Ospedale Pediatrico Bambino Gesù , Roma , Italy
| | - Lucia Quaglietta
- Pediatric Oncology Unit, Ospedale Santobono-Pausillipon , Napoli , Italy
| | - Claudia Milanaccio
- Neuro-Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini , Genova , Italy
| | - Fabio Simonetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Francesca Romana Buttarelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University La Sapienza , Roma , Italy
| | - Manila Antonelli
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza , Roma , Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
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13
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Massimino M, Biassoni V, Mastronuzzi A, Schiavello E, Barretta F, Quaglietta L, Milanaccio C, Pecori E, Cacchione A, Boschetti L, Ruscio VD, Chiesa S, Scimone G, Barra S, De Martino L, Ramaglia A, Picariello S, Verrico A, Alessandro O, Vennarini S, Podda M, Gattuso G, Cinalli G, Antonelli M, Modena P, De Cecco L, Buttarelli FR, Gandola L. DIPG-04. Feasibility and early results of phase 2 open label randomized study of radiotherapy(RT), concomitant nimotuzumab and vinorelbine and re-irradiation at relapse, versus multiple elective radiotherapy courses with concomitant vinorelbine and nimotuzumab for newly diagnosed childhood and adolescence Diffuse intrinsic Pontine Glioma (DIPG). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.061] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The purposes of this trial were to evaluate the feasibility, response, PFS/OS of a randomized study comparing two different RT schedules for DIPG while administering the same systemic treatment. METHODS: Patients: 2-21 years-old with a not-pretreated radiologically verified DIPG (MRI blindly reviewed at diagnosis and every 12 weeks thereafter) and symptoms duration below 6 months. Biopsy was required if suggested by atypical imaging. Vinorelbine 20 mg/m2+nimotuzumab 150 mg/m2 were administered weekly for 12 weeks; thereafter every other week until tumor progression or for up to 2 years. Standard(ST) arm included focal RT at total dose of 54Gy (1.8Gy/day); for local progression re-irradiation was proposed at 19.8Gy, in case of dissemination craniospinal irradiation(CSI) at 36Gy was adopted. Experimental(SP) arm included three elective courses of RT at defined timepoints at 36Gy, 19.8Gy and 19.8Gy with possible reirradiation for relapse at 9 Gy. Incidences of local(L) and distant(D) progression were assessed in a competing risk setting. RESULTS: Aggregated preliminary results are given for 4 Italian centers. 54 pts were screened and 51 included, 27 in ST, 28 males, median age 7 years (range 3-17). Median time of observation was 17.9 months. Twelve patients needed a shunt, 10 during treatment; 20 were biopsied, in 18 cases according local protocols. 19/20 tumors had H3.3 K27 mutation. 41 relapsed, 28 locally, 13 with a component of dissemination. 36 died, one for tracheotomy bleeding. SP irradiation was feasible and never produced significant radionecrosis. Median EFS/OS were 7.3/12.9 months, respectively; EFS/OS at 1 year were 19.0%/57.3%, not differing between patients with local vs. disseminated relapses. Patients submitted to biopsies had more dissemination (P=0.04) and less local progression (P=0.077). CONCLUSIONS: Treatment was feasible and OS confirmed previous results obtained in a single center. Randomization results will be later reported.
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Affiliation(s)
- Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | | | | | | | | | | | - Emilia Pecori
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Luna Boschetti
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Silvia Chiesa
- , Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma , Italy
| | - Giuseppe Scimone
- Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno , Italy
| | | | | | | | | | | | | | | | - Marta Podda
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | | | | | | | - Loris De Cecco
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Lorenza Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
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14
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Klumpers MJ, Witte WD, Gattuso G, Schiavello E, Terenziani M, Massimino M, Gidding CEM, Vermeulen SH, Driessen CM, van Herpen CM, van Meerten E, Guchelaar HJ, Coenen MJH, te Loo DMWM. Genome-Wide Analyses of Nephrotoxicity in Platinum-Treated Cancer Patients Identify Association with Genetic Variant in RBMS3 and Acute Kidney Injury. J Pers Med 2022; 12:jpm12060892. [PMID: 35743677 PMCID: PMC9224783 DOI: 10.3390/jpm12060892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/25/2022] [Indexed: 02/06/2023] Open
Abstract
Nephrotoxicity is a common and dose-limiting side effect of platinum compounds, which often manifests as acute kidney injury or hypomagnesemia. This study aimed to investigate the genetic risk loci for platinum-induced nephrotoxicity. Platinum-treated brain tumor and head–neck tumor patients were genotyped with genome-wide coverage. The data regarding the patient and treatment characteristics and the laboratory results reflecting the nephrotoxicity during and after the platinum treatment were collected from the medical records. Linear and logistic regression analyses were performed to investigate the associations between the genetic variants and the acute kidney injury and hypomagnesemia phenotypes. A cohort of 195 platinum-treated patients was included, and 9,799,032 DNA variants passed the quality control. An association was identified between RBMS3 rs10663797 and acute kidney injury (coefficient −0.10 (95% confidence interval −0.13–−0.06), p-value 2.72 × 10−8). The patients who carried an AC deletion at this locus had statistically significantly lower glomerular filtration rates after platinum treatment. Previously reported associations, such as BACH2 rs4388268, could not be replicated in this study’s cohort. No statistically significant associations were identified for platinum-induced hypomagnesemia. The genetic variant in RBMS3 was not previously linked to nephrotoxicity or related traits. The validation of this study’s results in independent cohorts is needed to confirm this novel association.
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Affiliation(s)
- Marije J. Klumpers
- Department of Pediatrics, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands;
| | - Ward De Witte
- Department of Human Genetics, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands; (W.D.W.); (M.J.H.C.)
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy; (G.G.); (E.S.); (M.T.); (M.M.)
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy; (G.G.); (E.S.); (M.T.); (M.M.)
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy; (G.G.); (E.S.); (M.T.); (M.M.)
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy; (G.G.); (E.S.); (M.T.); (M.M.)
| | - Corrie E. M. Gidding
- Princess Maxima Center for Pediatric Oncology, Postbox 113, 3720 AC Bilthoven, The Netherlands;
| | - Sita H. Vermeulen
- Department for Health Evidence, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands;
| | - Chantal M. Driessen
- Department of Medical Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands; (C.M.D.); (C.M.v.H.)
| | - Carla M. van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands; (C.M.D.); (C.M.v.H.)
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Postbox 2040, 3000 CA Rotterdam, The Netherlands;
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, The Netherlands;
| | - Marieke J. H. Coenen
- Department of Human Genetics, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands; (W.D.W.); (M.J.H.C.)
| | - D. Maroeska W. M. te Loo
- Department of Pediatrics, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands;
- Correspondence: ; Tel.: +31-24-361-44-15
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15
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Livellara V, Bergamaschi L, Puma N, Chiaravalli S, Podda M, Casanova M, Gasparini P, Pecori E, Alessandro O, Nigro O, Sironi G, Gattuso G, Terenziani M, Spreafico F, Meazza C, Biassoni V, Schiavello E, Massimino M, Luksch R, Ferrari A. Extraosseous Ewing sarcoma in children and adolescents: A retrospective series from a referral pediatric oncology center. Pediatr Blood Cancer 2022; 69:e29512. [PMID: 34962687 DOI: 10.1002/pbc.29512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/23/2021] [Revised: 11/01/2021] [Accepted: 11/20/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Extraosseous Ewing sarcoma is a rare entity and less is known about its clinical behavior and optimal treatment than for its counterpart in bone. This study is a retrospective analysis on a cohort of patients <21 years treated according to a "soft tissue sarcoma approach." METHODS The "extraosseous" origin of the tumor was established on radiological findings, based on the lack of any bone involvement. Patients were treated using a multimodality approach including surgery, radiotherapy, and chemotherapy. All patients received chemotherapy with alkylating agents and anthracyclines for 25 weeks (nine courses). Radiotherapy (45-54.8 Gy) was required for all cases except those who had an initial R0 resection of tumors smaller than 5 cm. RESULTS Fifty-seven patients (age 2-20 years, median 14) were treated from 1990 to 2020. Ten-year event-free survival (EFS) and overall survival (OS) were 77.5% and 85.5% in patients with localized disease, and 11.1% and 29.6% in those with metastatic disease (p < .001) (follow-up 5-349 months, median 107 months). In patients with localized disease, the most recent IVADo-IVE regimen achieved excellent survivals, that is, 10-year EFS 95.5%. CONCLUSIONS Our study showed that satisfactory results were achieved in patients with localized extraosseous Ewing sarcoma treated with a tailored approach derived from soft tissue sarcoma protocols, which was less intensive and shorter as compared to the standards utilized for the management of bone Ewing sarcoma. Our study suggests that the extraskeletal site might be considered as a variable to stratify patients and modulate treatment intensity accordingly in Ewing sarcoma protocol.
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Affiliation(s)
- Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Radiation Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ombretta Alessandro
- Pediatric Radiotherapy Unit, Radiation Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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16
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Klumpers MJ, Brand ACAM, Hakobjan M, Gattuso G, Schiavello E, Terenziani M, Massimino M, Gidding CEM, Guchelaar HJ, Te Loo DMWM, Coenen MJH. Contribution of Common and Rare Genetic Variants in CEP72 on Vincristine-Induced Peripheral Neuropathy in Brain Tumor Patients. Br J Clin Pharmacol 2022; 88:3463-3473. [PMID: 35150001 PMCID: PMC9313903 DOI: 10.1111/bcp.15267] [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: 08/15/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022] Open
Abstract
Aims Studies implicated a role for a genetic variant in CEP72 in vincristine‐induced peripheral neuropathy. This study aims to evaluate this association in a cohort of brain tumour patients, to perform a cross‐disease meta‐analysis and explore the protein‐coding region of CEP72. Methods In total, 104 vincristine‐treated brain tumour patients were genotyped for CEP72 rs924607, and sequenced for the protein‐coding region. Data regarding patient and treatment characteristics, and peripheral neuropathy, were collected. Logistic regression and meta‐analysis were performed for rs924607 replication. A weighted burden analysis was applied to evaluate impact of overall genetic variation in CEP72. Results Analysis of 24 cases and 80 controls did not show a significant association between CEP72 rs924607 and neuropathy (odds ratio, OR [95% confidence interval, CI] 2.076 [0.359–11.989], P = .414). When combined with 8 cohorts (1095 cancer patients), a significant increase in risk for neuropathy was found for patients with a TT genotype (OR [95% CI] 2.15 [1.35–3.43], P = .001). Additionally, a missense variant (rs12522955) was significantly associated (OR [95% CI] 2.3 [1.2–4.4], P = .041) and patients with severe neuropathy carried more impactful variants in CEP72 coding regions (P = .039). Conclusion The association of CEP72 rs924607 in vincristine‐induced neuropathy was not confirmed in a cohort of brain tumour patients, but did contribute to its suggested effect when combined in a cross‐disease meta‐analysis. The importance of other genetic variations in CEP72 on vincristine‐induced neuropathy was demonstrated. This study contributes to evidence of the importance of genetic variants in CEP72 in development of vincristine‐induced toxicity, and provides guidance for future prospective studies.
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Affiliation(s)
- Marije J Klumpers
- Department of Pediatrics, Radboud Institute for Molecular Life Science, Radboud university medical center, Nijmegen, The Netherlands
| | - Annouk C A M Brand
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Marina Hakobjan
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Maroeska W M Te Loo
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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17
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Affiliation(s)
- Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giovanna Gattuso
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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18
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Gattuso G, Schiavello E, Oltolini C, Biassoni V, Terenziani M, Chiaravalli S, Podda MG, Meazza C, Luksch R, Ferrari A, Casanova M, Sironi G, Bergamaschi L, Puma N, Spreafico F, Massimino M. Prolonged COVID-19 infection in a child with lymphoblastic non-Hodgkin lymphoma: which is the best management? Tumori 2021; 108:NP1-NP4. [PMID: 34965799 DOI: 10.1177/03008916211067825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, oncologists have managed patients at higher risk of having a severe course of this infection. This raises new questions about their correct management, as well as the difficulty of distinguishing tumor/treatments complications from those related to COVID-19. We report a case of an 11-year-old boy undergoing treatment for T-cell lymphoblastic lymphoma who experienced a prolonged COVID-19 course. Oncologic therapy was continued without significant changes compared to the initially planned treatment. No relevant complications occurred. COVID-19 convalescent plasma was administered, resulting in a positive antibody titer after 24 days.
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Affiliation(s)
- Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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19
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Chiaravalli S, Ferrari A, Bergamaschi L, Puma N, Gattuso G, Sironi G, Nigro O, Livellara V, Schiavello E, Biassoni V, Podda M, Meazza C, Spreafico F, Casanova M, Terenziani M, Luksch R, Massimino M. Langerhans cell histiocytosis in adults: a retrospective, single-center case series. Ann Hematol 2021; 101:265-272. [PMID: 34635964 DOI: 10.1007/s00277-021-04694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Langerhans cell histiocytosis is rare in adults, and most of what we know about its diagnosis and treatment comes from pediatric studies. We report clinical findings and results of treatment in a retrospective series of 63 consecutive adult patients (18-76 years old), treated at our pediatric unit from 1990 to 2020 using the same approach as for children. Patients were classified as having single-system disease (SS-LCH) in 41 cases, which was unifocal in 34 of them and multifocal in 7, or multisystem disease (MS-LCH) in 17 and primary pulmonary (pLCH) in 5. Twenty patients also had diabetes insipidus. A "wait and see" strategy was recommended after biopsy/surgery for patients with unifocal SS-LCH. Systemic treatment was proposed for cases of SS-LCH involving "special sites" or with multifocal disease, and in cases of MS-LCH. EFS and OS for the cohort as a whole were 62.2% and 100%, respectively, at 5 years and 52.5% and 97.6% at 10 years. Three patients died due to the damage caused by the multiple therapies administered. The rate of disease reactivation was high (affecting 40% of cases), with several reactivations over the years despite multiple lines of treatment. Though clinical history of LCH may differ between adults and children, in the absence of specific, tailored protocols, clinical approach to adult cases may draw on pediatric experience. Patients with limited disease have a good prognosis without any need for systemic therapy. Potentially greater toxicity in adults of systemic treatments generally used in pediatric setting should be borne in mind.
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Affiliation(s)
- Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy.
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milano, MI, Italy
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20
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Nigro O, Sironi G, Bergamaschi L, Gattuso G, Puma N, Livellara V, Chiaravalli S, Ferrari A, Massimino M. SARS-CoV-2 vaccination for adolescents and young adult patients treated at a specialist pediatric oncology unit. Pediatr Blood Cancer 2021; 68:e29240. [PMID: 34264546 PMCID: PMC8441810 DOI: 10.1002/pbc.29240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/24/2022]
Abstract
This brief report describes the SARS-CoV-2 vaccination program at our pediatric oncology unit. Adopting Italian regulations, patients treated for cancer within the previous 6 months were offered vaccination with the Pfizer-BioNtech vaccine if aged ≥16 years, and with the Pfizer-BioNtech or Moderna vaccine if aged ≥18 years. From March 24 to April 28, 2021, 80/89 adolescent and young adult patients enrolled were vaccinated, while nine refused the vaccine due to fear of side effects, disbelief regarding the pandemic, or lack of trust in the scientific community. The refusal rate in our cohort was lower than in the Italian general population.
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Affiliation(s)
- Olga Nigro
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanna Sironi
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Luca Bergamaschi
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanna Gattuso
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Nadia Puma
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Virginia Livellara
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Stefano Chiaravalli
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Andrea Ferrari
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Maura Massimino
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
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21
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Rosina E, Rinaldi B, Silipigni R, Bergamaschi L, Gattuso G, Signoroni S, Guerneri S, Carnevali A, Marchisio PG, Milani D. Correction to: Incidental finding of APC deletion in a child: double trouble or double chance? - a case report. Ital J Pediatr 2021; 47:185. [PMID: 34521463 PMCID: PMC8442357 DOI: 10.1186/s13052-021-01135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Erica Rosina
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122, Milan, Italy
| | - Berardo Rinaldi
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122, Milan, Italy.
| | - Rosamaria Silipigni
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bergamaschi
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvana Guerneri
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Carnevali
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Giovanna Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Donatella Milani
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122, Milan, Italy
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22
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Podda MG, Schiavello E, Clerici CA, Luksch R, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Biassoni V, Chiaravalli S, Puma N, Bergamaschi L, Gattuso G, Sironi G, Nigro O, Massimino M. Children and adolescent solid tumours and high-intensity end-of-life care: what can be done to reduce acute care admissions? BMJ Support Palliat Care 2021:bmjspcare-2021-003031. [PMID: 34493535 DOI: 10.1136/bmjspcare-2021-003031] [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: 03/05/2021] [Accepted: 08/17/2021] [Indexed: 11/03/2022]
Abstract
Despite improvements in survival, cancer remains the leading cause of non-accidental death in children and adolescents, who risk receiving high-intensity end-of-life (HI-EOL) care. OBJECTIVE To analyse treatments for relapses (particularly in the last weeks of life), assess their impact on the EOL, identify patients most likely to receive HI-EOL care and examine whether palliative care services can contain the intensity of EOL care. METHODS This retrospective study involved patients treated at the paediatric oncology unit of the Istituto Nazionale Tumori in Milan who died between 2018 and 2020. The primary outcome was HI-EOL care, defined as: ≥1 session of intravenous chemotherapy <14 days before death; ≥1 hospitalisation in intensive care in the last 30 days of life and ≥1 emergency room admission in the last 30 days of life. RESULTS The study concerned 68 patients, and 17 had HI-EOL care. Patients given specific in-hospital treatments in the last 14 days of their life more frequently died in hospital. Those given aggressive EOL care were less likely to die at home or in the hospice. Patients with central nervous system (CNS) tumours were more likely to have treatments requiring hospitalisation, and to receive HI-EOL care. CONCLUSION These results underscore the importance of considering specific treatments at the EOL with caution. Treatments should be administered at home whenever possible.The early activation of palliative care, especially for fragile and complicated patients like those with CNS cancers, could help families cope with the many problems they face.
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Affiliation(s)
- Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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23
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Massimino M, Signoroni S, Boschetti L, Chiapparini L, Erbetta A, Biassoni V, Schiavello E, Ferrari A, Spreafico F, Terenziani M, Chiaravalli S, Puma N, Bergamaschi L, Ricci MT, Cattaneo L, Gattuso G, Buttarelli FR, Gianno F, Miele E, Poggi G, Vitellaro M. Medulloblastoma and familial adenomatous polyposis: Good prognosis and good quality of life in the long-term? Pediatr Blood Cancer 2021; 68:e28912. [PMID: 33459525 DOI: 10.1002/pbc.28912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Mutations of the APC (adenomatous polyposis coli) gene correlate mainly with familial adenomatous polyposis (FAP), but can occasionally be pathogenic for medulloblastoma (MBL) wingless-related integration site (WNT) subtype, the course of which has only recently been described. METHODS We retrieved all patients with documented germline APC mutations and a diagnosis of MBL to examine their outcome, late effects of treatment, and further oncological events. RESULTS Between 2007 and 2016, we treated six patients, all with a pathogenic APC variant mutation and all with MBL, classic histotype. None had metastatic disease. All patients were in complete remission a median 65 months after treatment with craniospinal irradiation at 23.4 Gy, plus a boost on the posterior fossa/tumor bed up to 54 Gy, followed by cisplatin/carboplatin, lomustine, and vincristine for a maximum of eight courses. Five of six diagnostic revised MRI were suggestive of the WNT molecular subgroup typical aspects. Methylation profile score (in two cases) and copy number variation analysis (chromosome 6 deletion in two cases) performed on four of six retrieved samples confirmed WNT molecular subgroup. Four out of six patients had a positive family history of FAP, while gastrointestinal symptoms prompted its identification in the other two cases. Four patients developed other tumors (desmoid, MELTUMP, melanoma, pancreatoblastoma, thyroid Tir3) from 5 to 7 years after MBL. DISCUSSION Our data confirm a good prognosis for patients with MBL associated with FAP. Patients' secondary tumors may or may not be related to their syndrome or treatment, but warrant adequate attention when planning shared guidelines for these patients.
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Affiliation(s)
- Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Stefano Signoroni
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luna Boschetti
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luisa Chiapparini
- Neuroradiology Department, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Erbetta
- Neuroradiology Department, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Veronica Biassoni
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Andrea Ferrari
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Nadia Puma
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Teresa Ricci
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Laura Cattaneo
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Francesca Gianno
- Radiologic, Oncologic and Anatomo-Pathological Sciences Department, Sapienza University, Rome, Italy
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Geraldina Poggi
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Marco Vitellaro
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Colorectal Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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24
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Rosina E, Rinaldi B, Silipigni R, Bergamaschi L, Gattuso G, Signoroni S, Guerneri S, Carnevali A, Marchisio PG, Milani D. Incidental finding of APC deletion in a child: double trouble or double chance? - a case report. Ital J Pediatr 2021; 47:31. [PMID: 33588901 PMCID: PMC7885235 DOI: 10.1186/s13052-021-00969-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background 22q11.2 deletion syndrome is one of the most common genomic disorders, characterized by the variable presence of facial dysmorphisms, congenital cardiac defects, velopharyngeal insufficiency/cleft palate, thymic hypoplasia/aplasia, immunodeficiency, parathyroid hypoplasia, developmental delay, learning disabilities, psychiatric disorders, renal, ocular, and skeletal malformations, hearing loss and laryngeal abnormalities. Chromosomal microarray (CMA) hybridization is one of the most performed diagnostic tests but as a genome wide analysis, it can point out relevant incidental copy number variations. Case presentation We report the case of a 2-year-old boy that came to our attention for mild psychomotor delay, poor growth, and minor facial anomalies. Considering a diagnosis of 22q11.2 deletion syndrome, we performed CMA that not only confirmed our diagnosis, but also pointed out an additional de novo 5q21.3q22.2 microdeletion, encompassing APC gene. As a result of the genetic testing we enrolled the patient in a tailored surveillance protocol that enabled the early detection of a hepatoblastoma. The child underwent surgical and chemotherapic treatments with complete cancer eradication. Conclusions The concurrent finding of an expected result and an additional deletion of APC gene represents an example of a relevant issue about the health and ethical management of secondary findings revealed by genome-wide tests. Furthermore, this report highlights the need to develop dedicated surveillance guidelines for children with APC-related polyposis and raise the question whether to suspect and screen for APC-related conditions in cases of sporadic hepatoblastomas.
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Affiliation(s)
- Erica Rosina
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Via della Commenda, 9, 20122, Milan, Italy
| | - Berardo Rinaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Via della Commenda, 9, 20122, Milan, Italy.
| | - Rosamaria Silipigni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Laboratory of Medical Genetics, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvana Guerneri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Laboratory of Medical Genetics, Milan, Italy
| | - Alessandra Carnevali
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Giovanna Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Via della Commenda, 9, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Donatella Milani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Via della Commenda, 9, 20122, Milan, Italy
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25
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Silva M, Barretta F, Luksch R, Terenziani M, Casanova M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Chiaravalli S, Puma N, Bergamaschi L, Gattuso G, Sironi G, Adduci A, Grampa P, Massimino M, Ferrari A. Adolescents with cancer on privacy: Fact-finding survey on the need for confidentiality and space. Tumori 2021; 107:452-457. [PMID: 33509050 DOI: 10.1177/0300891620988357] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer diagnosis and related treatment can limit young patients' privacy. Their need for private physical and psychological spaces can be impeded by limited freedom, e.g., sharing hospital rooms with others and exposing their body to their parents and doctors. METHODS We conducted a survey among young patients of our center to investigate how their perception of privacy changed after being diagnosed with cancer and their need for hospital dedicated physical spaces and time for patients to enjoy their privacy. A questionnaire with 16 items was developed by the staff involving psychologists and physicians. The relevance of changes before and after the cancer diagnosis was assessed by calculating two scores indicating the situation before and after diagnosis for each answer, as well as a delta score. RESULTS Between May and June 2020, the questionnaire was completed by 60 patients aged 16-24 years. The median delta scores describing the changes before and after diagnosis were -8 points for perception of privacy, indicating a significant decrement of the level of privacy perceived. A major issue was the constant presence of parents being perceived as intrusive. Concerning hospital dedicated physical spaces and time for patients to enjoy their privacy, respondents requested dedicated spaces (50% of patients) and opportunities to have private interviews with medical personnel (88%). CONCLUSIONS Our study offers a snapshot of how young people with cancer perceive the impact of the disease and its treatment on their privacy with the restrictions imposed on their individual freedom. Patients' personal needs must be taken into consideration to adopt appropriate measures and better organize wards.
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Affiliation(s)
- Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annarita Adduci
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Grampa
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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26
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Spreafico F, Barretta F, Murelli M, Chisari M, Gattuso G, Terenziani M, Ferrari A, Veneroni L, Meazza C, Massimino M. Positive Impact of Organized Physical Exercise on Quality of Life and Fatigue in Children and Adolescents With Cancer. Front Pediatr 2021; 9:627876. [PMID: 34164353 PMCID: PMC8215206 DOI: 10.3389/fped.2021.627876] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/10/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Cancer and its treatment can cause serious health issues that impair physical and mental well-being in children and adolescents. Exercise may be a valid strategy for managing some symptoms, including fatigue. In the light of our experience, we provide further justification for including exercise as part of routine childhood cancer care. Methods: Forty-four children and adolescents who had solid cancers not contraindicating their movement were invited to join an in-hospital 6-week supervised exercise program, and asked afterwards to complete validated quality of life and fatigue scales. The program consisted of personalized workout sessions of aerobic, resistance and flexibility exercises. The results obtained on the scales were compared between 21 patients who engaged in the exercise program (GYM group) and 23 who refused (No-GYM group), examining the different dimensions of health-related quality of life (physical, emotional, cognitive, social) and fatigue (general, sleep/rest, cognitive) in the two groups. Results: Being diagnosed with cancer initially prompted all but one of the respondents to drop-out of previous routine exercise or sports although their continuation had not been contraindicated. After 6 weeks of exercise, the GYM group's scores for quality of life and fatigue showed a statistically significant better perceived emotional functioning, and a trend toward a better social functioning than in the No-GYM group. Conclusion: We suggest that exercise improves the satisfaction of children and adolescents with cancer with their physical, mental and social functioning. We would emphasize the potential benefits of general practitioners discussing and recommending exercise for their young patients with cancer.
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Affiliation(s)
- Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Murelli
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Chisari
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Veneroni
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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27
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Clerici CA, Pagani Bagliacca E, Silva M, Chopard S, Puma N, Bergamaschi L, Gattuso G, Sironi G, Massimino M, Ferrari A. Illusionist techniques as a complement to psychological support for children with cancer. Tumori 2020; 107:171-174. [PMID: 33092488 DOI: 10.1177/0300891620967750] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Magic and illusionism may be a potentially valid resource for children with cancer, as a complement to more traditional psychological support approaches. This study considered the psychological interviews conducted with patients with cancer <10 years of age from January to December 2019. We classified the reasons why consultations were performed and the specific situations when psychologists adopted illusionist techniques. Overall, 96 children (age 4-10 years, median 7) received psychological interventions. Magic techniques were used in 30 patients: in 15 cases to support communication and relations, in 9 as a diversion, and in 2 each for physical therapy and rehabilitation, humour therapy, and psychotherapy. This preliminary descriptive experience suggests that the use of magic tricks might be helpful in providing support for communication and relations, as well for compliance and rehabilitation, for children with cancer. More analytical studies are needed to provide quantitative assessment of the efficacy of such an approach.
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Affiliation(s)
- Carlo Alfredo Clerici
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,SSD Clinical Psychology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Saba Chopard
- Université de Fribourg (UNIFR), Fribourg, Switzerland
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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28
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Chiaravalli S, Ferrari A, Sironi G, Gattuso G, Bergamaschi L, Puma N, Schiavello E, Biassoni V, Podda M, Meazza C, Spreafico F, Casanova M, Terenziani M, Luksch R, Massimino M. A collateral effect of the COVID-19 pandemic: Delayed diagnosis in pediatric solid tumors. Pediatr Blood Cancer 2020; 67:e28640. [PMID: 32761998 PMCID: PMC7435564 DOI: 10.1002/pbc.28640] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Stefano Chiaravalli
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Andrea Ferrari
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanna Sironi
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanna Gattuso
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Luca Bergamaschi
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Nadia Puma
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Veronica Biassoni
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Marta Podda
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Cristina Meazza
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Filippo Spreafico
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Michela Casanova
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Monica Terenziani
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Roberto Luksch
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Maura Massimino
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
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Biassoni V, Schiavello E, Gandola L, Pecori E, Poggi G, Spreafico F, Terenziani M, Meazza C, Podda M, Ferrari A, Luksch R, Casanova M, Puma N, Chiaravalli S, Bergamaschi L, Cefalo G, Simonetti F, Gattuso G, Seregni EC, Pallotti F, Gianno F, Diletto B, Barretta F, Massimino M. Secreting Germ Cell Tumors of the Central Nervous System: A Long-Term Follow-up Experience. Cancers (Basel) 2020; 12:cancers12092688. [PMID: 32967085 PMCID: PMC7565315 DOI: 10.3390/cancers12092688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Due to the rarity of nongerminomatous germ cell tumors (NGGCT) with non-standard treatment as yet, we report retrospectively our 30 year experience with chemotherapy followed by craniospinal irradiation (CSI), plus a boost of whole ventricular irradiation (WVI)/tumor bed (TB), tailored to pre-radiation chemotherapy response. METHODS Between 1988 and 2016, 28 patients received four cycles of PEB (cisplatin/etoposide/bleomycin), then CSI, and two further PEB cycles. Between 1988 and1994, CSI was 25.5 Gy for patients in complete remission (CR), 30 Gy if in partial remission (PR) or metastatic, with a boost to TB up to 45-54 Gy. In the period of 1995-2010, the boost included WVI and any extra-ventricular tumor sites up to 45 Gy. After 2010, CSI was reduced to 25.5 Gy for all non-metastatic patients, and a boost was given only to TB up to 40.5/45.5 Gy, depending on patients' CR/PR status. After 2003, patients with alfafetoprotein (αFP) > 1000 ng/mL received intensified treatment, also including autologous stem cell transplantation. RESULTS Among 28 patients (23 males; median age 12 years, 6 metastatic), 25 responded to PEB, and three progressed (PD) after one to four cycles; 26 received radiotherapy obtaining 13 CR, 7 PR and 5 stable disease (SD), 1 PD; 6 (21%) died (5 for disease, 1 for pneumonia while in CR). Five-year overall survival (OS) and progression-free survival (PFS) were both 81%; 10 year OS and PFS 81% and 76%, respectively (median follow-up 11 years). CONCLUSIONS Survival for children with NGGCT, independently from disease extent, was encouraging. Further studies should elucidate which patients could benefit from reduced volume and dose irradiation.
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Affiliation(s)
- Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
- Correspondence: ; Tel.: +39-0223902590; Fax: +39-0223902648
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
| | - Geraldina Poggi
- Neuro-Oncological Unit and Neuropsychological Rehabilitation Unit Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy;
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Graziella Cefalo
- Department of Pediatrics, University of Milan, San Paolo Hospital, Santi Paolo e Carlo ASST, 20121 Milan, Italy;
| | - Fabio Simonetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Ettore Cesare Seregni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.C.S.); (F.P.)
| | - Federica Pallotti
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.C.S.); (F.P.)
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University Sapienza of Rome, 00161 Rome, Italy;
| | - Barbara Diletto
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
| | - Francesco Barretta
- Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
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Meazza C, Schiavello E, Biassoni V, Podda M, Barteselli C, Barretta F, Gattuso G, Terenziani M, Ferrari A, Spreafico F, Luksch R, Casanova M, Chiaravalli S, Puma N, Bergamaschi L, Massimino M. Cancer treatment in disabled children. Eur J Pediatr 2020; 179:1353-1360. [PMID: 32140854 DOI: 10.1007/s00431-020-03607-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/01/2023]
Abstract
The incidence of cancer in children with intellectual disability has been poorly documented. We report our experience of treating children and adolescents with cancer and intellectual disability (40 patients), from 2004 to 2018. A treatment-sparing approach was adopted for 6 patients with severe intellectual impairment to minimize toxicity: a child with postpartum asphyxia and medulloblastoma did not receive radiotherapy; 1 patient with mitochondrial encephalopathy and a testicular germ cell tumor did not receive bleomycin and lung metastasectomy; 2 patients (1 with Down + West syndrome + Wilms tumor (WT) and 1 with Denys-Drash syndrome + WT) did not receive vincristine; 1 child with corpus callosum agenesis and anaplastic ependymoma did not receive chemotherapy; 1 child with structural chromosomal aberrations and a primitive neuro-ectodermal tumor received personalized chemotherapy. Heminephrectomy was performed in 4 patients with WT to preserve their kidney function. We found no statistically significant correlation between relapse or mortality rates and the use of a treatment-sparing approach. The 5-year overall survival (OS) and event-free survival (EFS) rates were 84.5% and 66.1% as opposed to 82.5% and 46.9%, respectively, for patients in our usual-treatment and treatment-sparing groups.Conclusion: We only opted for a treatment-sparing approach for patients with severe disabilities, and their OS was in line with that of children without intellectual disability. What is Known: • There are few reports on children/adolescents with cancer and intellectual disability (ID). • It is not clear how to manage them and whether a treatment sparing should be considered, especially in the case of severe disability. What is New: • Most patients received the standard cancer treatment and only in the case of severe disability, a therapeutic saving approach was applied. • No statistically significant correlations between relapse/mortality rates and the use of a treatment-sparing approach were found.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy.
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Chiara Barteselli
- General Medicine I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Barretta
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, MI, Italy
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Casanova M, Pagani Bagliacca E, Silva M, Patriarca C, Veneroni L, Clerici CA, Spreafico F, Luksch R, Terenziani M, Meazza C, Podda M, Biassoni V, Schiavello E, Chiaravalli S, Puma N, Bergamaschi L, Gattuso G, Sironi G, Massimino M, Ferrari A. How young patients with cancer perceive the COVID-19 (coronavirus) epidemic in Milan, Italy: Is there room for other fears? Pediatr Blood Cancer 2020; 67:e28318. [PMID: 32240567 DOI: 10.1002/pbc.28318] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [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: 03/06/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/26/2023]
Abstract
The rapid spread of coronavirus disease 2019 epidemic in Italy, in particular in the Milan focal point, required drastic measures and led to panic in the population. While in our center we did not change our approach to the treatment of our young patients with cancer, we developed a qualitative survey to assess their perception of the risk and level of stress. The survey showed that a relatively large proportion of young patients felt personally at risk of severe complications. We believe that we need to adequately inform our patients, focusing on hygienic measures and personal protection and prompt reporting of any suspicious symptoms.
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Patriarca
- Pathology Unit, St. Anna Hospital (ASST Lariana), Como, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Faculty of Medicine, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Pagani Bagliacca E, Sironi G, Veneroni L, Gaggiotti P, Silva M, Signoroni S, Casanova M, Cattaneo F, Chiaravalli S, Puma N, Gattuso G, Bergamaschi L, Schiavello E, Clerici CA, Massimino M, Ferrari A. Tumorial: Video Tutorials Produced by Young Patients on the Youth Project to Voice Their Experiences. J Adolesc Young Adult Oncol 2020; 9:436-440. [DOI: 10.1089/jayao.2020.0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Gaggiotti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Cattaneo
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- SSD Clinical Psychology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Gattuso G, Casanova M, Biassoni V, Terenziani M, Schiavello E, Sironi G, Collini P, Pallotti F, Morosi C, Massimino M. Precocious pseudopuberty, a paraneoplastic manifestation: a report of 2 cases. Tumori 2020; 106:NP14-NP17. [PMID: 32462993 DOI: 10.1177/0300891620925532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripheral precocious puberty (PPP) may be a paraneoplastic manifestation, associated with beta human chorionic gonadotropin (β-hCG)-secreting tumors. We describe 2 young children with β-hCG-secreting tumors presenting with signs of pubertal activation. In the first patient, a 16-month-old boy with hepatoblastoma, only initial signs of PPP at presentation were identifiable, with concomitant high levels of β-hCG. Although the tumor had good response to therapy, β-hCG levels were fluctuant until the tumor was resected surgically. The second patient, an 18-month-old boy with intracranial germ cell tumor, presented with clear signs of pubertal activation and genitalia enlargement with no initial alteration of sex hormones. In both cases, the oncologic response to therapy was good. In the first case, full remission of the pubertal signs was observed; in the second, pubertal signs were still visible 20 months after the end of treatment.
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Affiliation(s)
- Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Pallotti
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Spreafico F, Ferrari A, Mascarin M, Collini P, Morosi C, Biasoni D, Biassoni V, Schiavello E, Gandola L, Gattuso G, Chiaravalli S, Massimino M. Wilms tumor, medulloblastoma, and rhabdomyosarcoma in adult patients: lessons learned from the pediatric experience. Cancer Metastasis Rev 2019; 38:683-694. [DOI: 10.1007/s10555-019-09831-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Barreca D, Laganà G, Magazù S, Migliardo F, Gattuso G, Bellocco E. FTIR, ESI-MS, VT-NMR and SANS study of trehalose thermal stabilization of lysozyme. Int J Biol Macromol 2014; 63:225-32. [DOI: 10.1016/j.ijbiomac.2013.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/20/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022]
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Gattuso G, Tomasoni D, Ceruti R, Scalzini A. MultiresistantStenotrophomonas maltophiliaTunneled CVC-Related Sepsis, Treated with Systemic and Lock Therapy. J Chemother 2013; 16:494-6. [PMID: 15565919 DOI: 10.1179/joc.2004.16.5.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In the last decade, a remarkable increase in the incidence of nosocomial Gram-negative infections has been observed. These pathogens represent a substantial problem in clinical practice, due to the high resistance profile of most commonly used antibiotics. This phenomenon is surely a co-factor that exposes these susceptible patients to infections caused by selected pathogens like multiresistant Gram-negative rods. A typical example is represented by VAP (ventilator-associated pneumonia) sustained by Acinetobacter spp., Pseudomonas aeruginosa, Bulkolderia cepacia. The Authors describe a case of a central venous cather (CVC)-related Stenotrophomonas maltophilia sepsis in a patient affected by solid tumor, successfully treated with systemic antibiotic therapy associated with "lock therapy". This combination was able to cure the infection, allowing the patient to continue chemotherapy and saving the in situ CVC. The surveillance of CVCs, good adherence to the protocols and guidelines and "good practice" are the cornerstones for the prevention of nosocomial infections.
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Affiliation(s)
- G Gattuso
- Infectious Diseases Department-Microbiology Unit, C. Poma Hospital, Mantova, Italy.
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Gattuso G, Palvarini L, Tomasoni D, Ferri F, Scalzini A. [A case of community-acquired MRSA (CA-MRSA) sepsis complicated by meningoencephalitis and cerebral abscess, successfully treated with linezolid]. Infez Med 2009; 17:244-248. [PMID: 20046106] [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: 05/28/2023]
Abstract
The authors describe a clinical case regarding a young female patient affected by sepsis due to methicillin-resistant Staphylococcus aureus (MRSA), associated to meningoencephalitis and cerebral abscess. The patient had no contact with hospitals in the months prior to illness and had always been healthy. She recovered thanks to linezolid therapy. The MRSA strain proved positive for Panton-Valentine leukocidin (PVL positive) and was therefore defined as community-acquired MRSA (CA-MRSA).
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Affiliation(s)
- G Gattuso
- Unita Operativa Malattie Infettive e Laboratorio Microbiologia, Azienda Ospedaliera Carlo Poma, Mantova, Italy
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Drapeau CMJ, Pan A, Bellacosa C, Cassola G, Crisalli MP, De Gennaro M, Di Cesare S, Dodi F, Gattuso G, Irato L, Maggi P, Pantaleoni M, Piselli P, Soavi L, Rastrelli E, Tacconelli E, Petrosillo N. Surgical site infections in HIV-infected patients: Results from an Italian prospective multicenter observational study. Infection 2009; 37:455-60. [DOI: 10.1007/s15010-009-8225-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Santini C, Utili R, De Feo M, Vaglio F, Gattuso G. 025 SURGICAL WOUND INFECTIONS AFTER MEDIAN STERNOTOMY: CLINICAL AND MICROBIOLOGIC RESULTS OF A LARGE MULTICENTRIC STUDY IN ITALY. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gattuso G, Tomasoni D, Palvarini L, Chiarelli C, Stradoni R, Ceruti R, Scalzini A. [Prevention of nosocomial infections: surveillance based on microbiological data]. G Ital Nefrol 2007; 24 Suppl 38:33-38. [PMID: 17922445] [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: 05/25/2023]
Abstract
BACKGROUND In the C. Poma Hospital of Mantua we have been using a system of continuous surveillance of nosocomial infections based on microbiological data for the past 4 years. This monitoring estimates the incidence of the microorganisms found in cultures, especially those at risk of causing nosocomial infections. MATERIALS AND METHODS Since June 2001 microbiological data have been registered using the Mercurio-Dianoema software and elaborated by means of Microsoft Excel in order to obtain information about isolated bacteria, especially those resistant to antibiotics. RESULTS Surveillance in "critical" wards revealed the presence of Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans in the intensive care unit in the period 2003-2005. The most frequent bacteria in hemodialysis have been coagulase-negative Staphylococci and Staphylococcus aureus, with variable methicillin resistance. CONCLUSION The analysis of microbiological data has promoted effective measures to reduce the incidence of these bacteria (increased rules of good practice, hand washing, etc.). If nosocomial infections or high-risk microorganisms occur, assessments are carried out; monitoring of the antibiotic resistance of the bacteria is very important.
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Affiliation(s)
- G Gattuso
- UO Malattie Infettive, Azienda Ospedaliera Carlo Poma, Mantova, Italy.
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Tomasoni D, Gattuso G, Chiarelli C, Palvarini L, Ceruti R, Berra D, Stradoni R, Scalzini A. [Epidemiologic surveillance of multi-drug resistant Pseudomonas aeruginosa in Mantova Hospital (Italy)]. Infez Med 2006; 14:85-91. [PMID: 16891853] [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: 05/11/2023]
Abstract
For the period 2002-2005 we verified and compared the data of the prevalence and resistance of Pseudomonas aeruginosa (PA) isolated in Mantova Hospital (Italy) with the data from the international database. From the first six-month period of 2004 a significant increase was found (9% vs 28.8%) in the prevalence of multi-drug resistant PA (MDR-PA). The principal wards involved were the Intensive Care Unit and the Department of Respiratory Diseases. A significant increase in resistance rates was observed for all antimicrobials tested, in particular for aztreonam, ceftazidime, ciprofloxacin, gentamycin and imipenem. The lowest dual resistance rates were observed between amikacina with piperacillin/tazobactam, while the highest were for those that included ciprofloxacin and beta-lactams (aztreonam, cefepime). In this study we confirm the importance of continuous surveillance of laboratory data and tightening local control measures for nosocomial infections in order to prevent the spread and selection of MDR-PA.
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Affiliation(s)
- D Tomasoni
- Divisione di Malattie Infettive, Ospedale "C. Poma" di Mantova, Italy
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Tomasoni D, Gattuso G, Scalzini A, Ceruti R, Chiarelli C, Stradoni R, Bottura C, Berra D. Enterobacter cloacaein an Italian Neonatal Intensive Care Unit: Pattern of Drug Resistance Compared with an International Database (SENTRY Antimicrobial Surveillance Program). J Chemother 2006; 18:110-1. [PMID: 16572903 DOI: 10.1179/joc.2006.18.1.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Castelli GP, Pognani C, Stuani A, Cita M, Paladini R, Gattuso G. Risk factors for CVC-related infections in ICUs: evaluation of time, type and number of cannulations. J Hosp Infect 2005; 60:286-7. [PMID: 15949621 DOI: 10.1016/j.jhin.2004.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2004] [Accepted: 11/26/2004] [Indexed: 11/29/2022]
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Scalzini A, Gattuso G, Burato E. [Infection risk and personal protective devices]. G Ital Nefrol 2005; 22 Suppl 31:S90-3. [PMID: 15786410] [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: 05/02/2023]
Abstract
The Aa discuss the evidence and recommendations for the use of personal protective equipment by health care practitioners in general care settings; the use of aprons, gowns, gloves, eye protections, face masks is valutated on the basis of an assessment of the risk of transmission of microrganisms to the patient or from the patient to health care practitioners. The primary uses of personal protective equipment are to protect staff and reduce opportunities for transmission of microrganisms in hospitals. A trend to eliminate the unnecessary wearing of aprons, gowns and masks in general care settings has evolved over the past twenty years due to the absence of evidence that they are effective.
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Affiliation(s)
- A Scalzini
- U.O. Malattie Infettive, Azienda Ospedaliera 'Carlo Poma', Mantova, Italy.
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Viale P, Pagani L, Petrosillo N, Signorini L, Colombini P, Macri G, Cristini F, Gattuso G, Carosi G. Antibiotic lock-technique for the treatment of catheter-related bloodstream infections. J Chemother 2003; 15:152-6. [PMID: 12797393 DOI: 10.1179/joc.2003.15.2.152] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 10/31/2022]
Abstract
The management of central venous catheter-related bloodstream infections (CRBSI), though still debated, requires the removal of the line in most cases: we investigated the efficacy of an alternative approach, based on higher concentrations of antibiotics locked within the catheter lumen, in an open, pilot study aimed at preserving the line in place and at eradicating the infection. Thirty consecutive patients carrying a central line over 10 days and who fulfilled criteria for ascertained diagnosis of bacterial CRBSI, had the catheter "locked" with antimicrobials therein; all patients also received systemic antibiotic therapy within the first 48 hours. Subsequently, 15 patients underwent locks alone, and 15 locks plus systemic therapy. Twenty-eight out of 30 (93.3%) patients retained the catheter in place, appearing to be cleared of infection and no treatment-related untoward events were observed. Locks should be considered as effective as line removal in the management of bacterial CRBSI in unselected patients, and could thus provide advantages in terms of resource sparing and lowered antibiotic pressure in the hospital setting.
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Affiliation(s)
- P Viale
- Clinic of Infectious Diseases-Department of Medical and Morphological Research, Medical School, University of Udine, Italy.
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Gattuso G. Investing for the small non-profit. Fund Raising Manage 1997; 27:30-1. [PMID: 10165689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Borghi F, Petrino R, Bellora P, Gattuso G, Di Napoli A, Cellino G, Levi AC. Postnatal development of intestinal villi in the rat. Determination of villus size gradient. Panminerva Med 1994; 36:149-51. [PMID: 7877830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The existence of the so called "Villus Size Gradient" (VSG) which defines the proportional decrease in height of intestinal villi from duodenum to ileum is well documented in adult animals and man. The aim of this study is to define whether the VSG is present since birth or, if not, when and why it appears. We have measured the height of intestinal villi in 25 rats: 5 at 1 day from birth, 5 at 5 days, 5 at 8 days, 5 at 15 days and 5 at 30 days. We have prepared histological slides of a duodenal, jejunal and ileal tract of each animal and measured the height of villi on microphotographs. At day 1 we observed a higher size of duodenal villi statistically significant with respect to jejunum and ileum, while at day 5 no differences were observed between the various intestinal tracts. The VSG become evident 8 days after birth progressively increasing to day 30. The predominance of duodenum present at birth is therefore probably due to the fetal developmental growth which is known to be more precocious in duodenum than in more distal tracts. Five days after birth the intestinal villi are equally developed, while in later ages the VSG appears. So we can conclude that the VSG is a consequence of luminal and humoral factors and not a predetermined event.
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Affiliation(s)
- F Borghi
- Istituto di Patologia Chirurgica, Cattedra di Medicina Interna, Ospedale S. Vito, Turin, Italy
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