1
|
Palumbo P, Martinese A, Antenucci MR, Granata V, Fusco R, De Muzio F, Brunese MC, Bicci E, Bruno A, Bruno F, Giovagnoni A, Gandolfo N, Miele V, Di Cesare E, Manetta R. Diffusion kurtosis imaging and standard diffusion imaging in the magnetic resonance imaging assessment of prostate cancer. Gland Surg 2023; 12:1806-1822. [PMID: 38229839 PMCID: PMC10788566 DOI: 10.21037/gs-23-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 11/09/2023] [Indexed: 01/18/2024]
Abstract
Background and Objective In recent years, magnetic resonance imaging (MRI) has shown excellent results in the study of the prostate gland. MRI has indeed shown to be advantageous in the prostate cancer (PCa) detection, as in guiding targeting biopsy, improving its diagnostic yield. Although current acquisition protocols provide for multiparametric acquisition, recent evidence has shown that biparametric protocols can be non-inferior in PCa detection. Diffusion-weighted imaging (DWI) sequence, in particular, plays a key role, particularly in the peripheral zone which accounts for the larger part of the prostate. High b-values are generally recommended, although with the possibility of obtaining non-Gaussian diffusion effects, which requires a more sophisticated model for the analysis, namely through the diffusion kurtosis imaging (DKI). Purpose of this narrative review was to analyze the current applications and clinical evidence regarding the use of DKI with a main focus on PCa detection, also in comparison with DWI. Methods This narrative review synthesized the findings of literature retrieved from main researches, narrative and systematic reviews, and meta-analyses obtained from PubMed. Key Content and Findings DKI analyses the non-Gaussian water diffusivity and describe the effect of signal intensity decay related to high b-value through two main metrics (Dapp and Kapp). Differently from DWI-apparent diffusion coefficient (DWI-ADC) which reflects only water restriction outside of cells, DKI metrics are supposed to represent also the direct interaction of water molecules with cell membranes and intracellular compounds. This review describes current evidence on ADC and DKI metrics in clinical imaging, and finally collect the results derived from the main articles focused on DWI and DKI models in detecting PCa. Conclusions DKI advantages, compared to conventional ADC analysis, still remain controversial. Wider application and greater technical knowledge of DKI, however, may help in proving its intrinsic validity in the field of oncology and therefore in the study of clinically significant PCa. Finally, a deep understanding of DKI is important for radiologists to better understand what Kapp and Dapp mean in the context of different cancer and how these metrics may vary specifically in PCa imaging.
Collapse
Affiliation(s)
- Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L’Aquila, Italy
| | - Andrea Martinese
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Maria Rosaria Antenucci
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, Naples, Italy
| | | | - Federica De Muzio
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, Campobasso, Italy
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, Campobasso, Italy
| | - Eleonora Bicci
- Department of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Ancona, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Genoa, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, Abruzzo Health Unit 1, L’Aquila, Italy
- Prostate Unit, San Salvatore Hospital, Abruzzo Health Unit 1, L’Aquila, Italy
| |
Collapse
|
2
|
Frieri G, Valvano M, Frassino S, Faenza S, Cesaro N, Amicucci G, Manetta R, Viscido A, Latella G. Prophylactic Treatment with Vedolizumab in the Prevention of Postoperative Recurrence (POR) in High-Risk Crohn's Patients. J Clin Med 2023; 12:jcm12093130. [PMID: 37176570 PMCID: PMC10179568 DOI: 10.3390/jcm12093130] [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: 01/15/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
About 50% of Crohn's Disease (CD) patients undergo an intestinal resection during their lifetime. Although the patients experience a fairly long period of well-being after the intestinal resection, they presented a postoperative recurrence (POR) in 40% of cases within 5 years. In this case series, we aimed to evaluate the incidence of POR in CD patients with high risk for early POR, prophylactically treated with Vedolizumab. All consecutive CD patients (followed from 2017 to 2020) who underwent ileocolonic resection after the loss of response at anti-Tumor Necrosis Factor α (anti-TNFα) and with one or more risk factors for early POR were included. POR was defined as a Rutgeerts score (Ri) > 1 at the colonoscopic evaluation. All the included patients underwent a Magnetic resonance enterography (MRE) at least one year after the surgical resection. Six patients (4 Female; 2 Males) were included. At the first endoscopic evaluation, all patients were in endoscopic remission (5 patients Ri 0; 1 patient Ri 1). No stenosis nor other intestinal wall changes or complications were observed at MRE. Five patients underwent colonoscopy over two years of follow-up (median: 32 months; range 25-33). The Ri score was 0 in four patients, while the fifth patient showed severe endoscopic relapse. The same patient presented a clinical relapse (Harvey-Bradshaw index = 10) with a flare of disease in the colonic mucosa. These data suggest that early post-operative treatment with Vedolizumab could be a valuable strategy to be submitted to a prospective controlled trial for preventing POR.
Collapse
Affiliation(s)
- Giuseppe Frieri
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Marco Valvano
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Sara Frassino
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Susanna Faenza
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Nicola Cesaro
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | | | - Rosa Manetta
- Division of Radiology, S. Salvatore Hospital, 67100 L'Aquila, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| | - Giovanni Latella
- Gastroenterology Unit, Division of Gastroenterology, Hepatology and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila, Italy
| |
Collapse
|
3
|
Ascenti G, Cicero G, Cardone G, Bertelli E, Papa M, Ciccone V, Manetta R, Gentili F, Francioso AP, Mazzei MA, Floridi C, Di Cesare E, Gandolfo N, De Filippo M, Miele V, Giovagnoni A. Cornerstones of CT urography: a shared document by the Italian board of urogenital radiology. Radiol Med 2023; 128:601-611. [PMID: 37027091 DOI: 10.1007/s11547-023-01623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023]
Abstract
CT urography is a single term used to refer to different scanning protocols that can be applied for a number of clinical indications. If, on the one hand, this highlights the role of the radiologist in deciding the most suitable technique to perform according to the patient's needs, on the other hand, a certain confusion may arise due to the different technical and clinical variables that have to be taken into account. This has been well demonstrated by a previous work based on an online questionnaire administered to a population of Italian radiologists that brought out similarities as well as differences across the national country. Defining precise guidelines for each clinical scenario, although desirable, is a difficult task to accomplish, if not even unfeasible. According to the prementioned survey, five relevant topics concerning CT urography have been identified: definition and clinical indications, opacification of the excretory system, techniques, post-processing reconstructions, and radiation dose and utility of dual-energy CT. The aim of this work is to deepen and share knowledge about these main points in order to assist the radiology in the daily practice. Moreover, a synopsis of recommendations agreed by the Italian board of genitourinary imaging is provided.
Collapse
Affiliation(s)
- Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria, 1, 98100, Messina, Italy
| | - Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria, 1, 98100, Messina, Italy.
| | - Gianpiero Cardone
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Papa
- Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy
| | - Vincenzo Ciccone
- Radiology Department, San Giovanni Di Dio E Ruggi D'Aragona Hospital, Salerno, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, "Santa Maria Alle Scotte" General Hospital, Viale Mario Bracci, 16, Siena, 53100, Italy
| | - Antonio Pio Francioso
- Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Chiara Floridi
- Department of Radiological Sciences, Ospedali Riuniti Ancona, Università Politecnica Delle Marche - University Hospital, Via Tronto 10, 60126, Ancona, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Massimo De Filippo
- University of Parma, Parma Hospital, Via Gramsci 14, 43126, Parma, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Ospedali Riuniti Ancona, Università Politecnica Delle Marche - University Hospital, Via Tronto 10, 60126, Ancona, Italy
| |
Collapse
|
4
|
Palumbo P, Manetta R, Izzo A, Bruno F, Arrigoni F, De Filippo M, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement. Gland Surg 2020; 9:2235-2247. [PMID: 33447576 DOI: 10.21037/gs-20-547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/06/2022]
Abstract
Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity. Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.
Collapse
Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Izzo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
5
|
Manetta R, Palumbo P, Gianneramo C, Bruno F, Arrigoni F, Natella R, Maggialetti N, Agostini A, Giovagnoni A, Di Cesare E, Splendiani A, Masciocchi C, Barile A. Correlation between ADC values and Gleason score in evaluation of prostate cancer: multicentre experience and review of the literature. Gland Surg 2019; 8:S216-S222. [PMID: 31559188 DOI: 10.21037/gs.2019.05.02] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Prostate cancer (PCa) is one of the most common cancers in male population. Multiparametric prostate magnetic resonance imaging (mp-MRI) has assumed a primary role in the diagnosis of PCa, combining morphological and functional data. Among different sequences, functional diffusion weighted imaging (DWI) is a powerful clinical tool which provides information about tissue on a cellular level. However, there is a considerable overlap between either BPH (Benign Prostate Hypertrophy) and prostatic cancer condition, as a different DWI signal intensity could be shown in the normal architecture gland. Apparent diffusion coefficient (ADC) has shown an increasing accuracy in addition to the DWI analysis in detection and localization of PCa. Notably, ADC maps derived DWI sequences has shown an overall high correlation with Gleason score (GS), considering the importance of an accurate grading of focal lesion, as main predictor factor. Furthermore, beyond the comparative analysis with DWI, ADC values has proven to be an useful marker of tumor aggressiveness, providing quantitative information on tumor characteristics according with GS and Gleason pattern, even more strenuous data are needed in order to verify which ADC analysis is more accurate.
Collapse
Affiliation(s)
- Rosa Manetta
- Division of Radiology, San Salvatore Hospital, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Camilla Gianneramo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Natella
- Radiology Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Maggialetti
- Department of Life and Health "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Agostini
- Department of Radiology, Ospedale Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedale Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
6
|
Manetta R, Capretti I, Belleggia N, Marsecano C, Viscido A, Bruno F, Arrigoni F, Ma L, Guglielmi G, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Magnetic resonance enterography (MRE) and ultrasonography (US) in the study of the small bowel in Crohn's disease: state of the art and review of the literature. Acta Biomed 2019; 90:38-50. [PMID: 31085972 PMCID: PMC6625566 DOI: 10.23750/abm.v90i5-s.8337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 02/06/2023]
Abstract
Crohn’s disease (CD) is a chronic idiopathic disease and its diagnosis is based on a combination of clinical symptoms, laboratory tests and imaging data. There isn’t a diagnostic gold standard: the ileocolonoscopy with mucosal biopsies represents the standard for luminal disease, while cross-sectional imaging such as Ultrasound (US), Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) can show transmural alterations and extraintestinal manifestations. CD is usually diagnosed in the young age and after baseline diagnosis, the patients have to undergo to variable follow-up depending on remission or active disease. The aim of our review is to compare Magnetic Resonance Enterography (MRE) to Ultrasonography (US) in the follow-up of CD. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Rosa Manetta
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Bruera G, Massacese S, Candria S, Galvano A, Manetta R, Giordano AV, Carducci S, Di Sibio A, Ciacco E, Russo A, Ricevuto E. Real life triplet FIr/FOx chemotherapy in first-line metastatic pancreatic ductal adenocarcinoma patients: recommended schedule for expected activity and safety and phase II study. Oncotarget 2018; 9:31861-31876. [PMID: 30159128 PMCID: PMC6112758 DOI: 10.18632/oncotarget.25870] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gemcitabine/nab-paclitaxel and FOLFIRINOX demonstrated significantly increased survival compared with gemcitabine in metastatic pancreatic ductal adenocarcinoma (PDAC): objective response rate (ORR) 23 and 31.6%, progression-free survival (PFS) 5.5 and 6.4 months, overall survival (OS) 8.7 and 11.1 months. Present phase II study evaluated recommended first-line triplet FIr/FOx schedule. METHODS Simon two-step design: p010%, p130%, power 80%, α5%, β20%. Projected ORR: I step, 1/10; II 5/29. Schedule: 12h-timed-flat-infusion/5-fluorouracil 750-800-900 mg/m2 d1-2,8-9,15-16,22-23; irinotecan 120-140-160 mg/m2 d1,15; oxaliplatin 70-80 mg/m2 d8,22; every 4 weeks, according to clinical parameters (age, comorbidities, performance status (PS), liver function). Activity and efficacy were evaluated, and compared using log-rank; limiting toxicity syndromes (LTS), using chi-square. RESULTS Twenty-nine consecutive patients were enrolled, according to primary/intermediate/secondary Cumulative Illness Rating Scale (CIRS). Median age 62; elderly 13 (44.7%); PS2 3 (10.4%), secondary CIRS 5 (17.2%). Primary endpoint was met: ORR 53% (7/13 patients) as-treated, 50% intent-to-treat. Cumulative G3-4 toxicities: diarrhea 17%, asthenia 14%, hypertransaminasemy 7%, mucositis 7%, vomiting 3%, anemia 3%, thrombocytopenia 3%. LTS were 27.5% overall, 38.4% in elderly. At 3 months median follow-up, PFS 4 months, OS 11 months. PS2 patients showed significantly worse OS (P 0.022). CONCLUSION Intensive first-line triplet FIr/FOx is tolerable at modulated doses, and confirms high activity/efficacy in metastatic PDAC. Patients' careful selection, and exclusion of PS2, can maintain safety profile and efficient dose intensity.
Collapse
Affiliation(s)
- Gemma Bruera
- Oncology Territorial Care Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L’Aquila, L’Aquila, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Silvia Massacese
- Pharmacy Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| | - Stefania Candria
- Oncology Territorial Care Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L’Aquila, L’Aquila, Italy
| | - Antonio Galvano
- Medical Oncology Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Rosa Manetta
- Radiology Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| | - Aldo Victor Giordano
- Radiology Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| | - Sergio Carducci
- Radiology Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| | - Alessandra Di Sibio
- Radiology Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| | - Eugenio Ciacco
- Pharmacy Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| | - Antonio Russo
- Medical Oncology Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Enrico Ricevuto
- Oncology Territorial Care Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L’Aquila, L’Aquila, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - on behalf of Oncology Network ASL1 Abruzzo, Italy
- Oncology Territorial Care Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L’Aquila, L’Aquila, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
- Pharmacy Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
- Medical Oncology Unit, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
- Radiology Unit, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, L’Aquila, Italy
| |
Collapse
|
8
|
Bruera G, Massacese S, Manetta R, Giordano A, Carducci S, Ciacco E, Ricevuto E. Real life triplet FIr/FOx chemotherapy in first line metastatic pancreatic ductal adenocarcinoma: Recommended schedule for expected activity and safety and phase II study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.153] [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: 11/12/2022] Open
|
9
|
Bruera G, Di Staso M, Bonfili P, Galvano A, Manetta R, Coletti G, Vicentini R, Guadagni S, Ficorella C, Di Cesare E, Russo A, Ricevuto E. Dose-finding study of oxaliplatin associated to capecitabine-based preoperative chemoradiotherapy in locally advanced rectal cancer. Oncotarget 2018; 9:17906-17914. [PMID: 29707156 PMCID: PMC5915164 DOI: 10.18632/oncotarget.24665] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/27/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Proper administration timing, dose-intensity, efficacy/toxicity ratio of oxaliplatin added to fluoropyrimidin should be improved to safely perform two-drugs intensive preoperative chemoradiotherapy in locally advanced rectal cancer (LARC). This dose-finding study investigated recommended oxaliplatin dose, safety of oxaliplatin/capecitabine regimen and preliminary activity. Methods Schedule: oxaliplatin dose-levels, 35-40 mg/m2/week; capecitabine 825 mg/m2/ twice daily, radiotherapy on rectum/nodes, 50/45 Gy, 45 and 9 boost/45 Gy, in first 5 and subsequent patients, 5 days/week, respectively; for 5 weeks. Pathologic complete response (pCR) 10% was projected in order to positively affect clinical outcome. Results Seventeen fit <75 years patients enrolled: median age 60; young-elderly 4 (23%); T3/T4, 15/2, N0/N1/N2, 7/9/1. At first dose-level, no dose-limiting toxicity (DLT). At second, 2 DLT, G3 mucositis, G3 thrombocytopenia, in 2/6 patients (33%). Oxaliplatin recommended dose, 40 mg/m2/week. Cumulative G3-4 toxicities: mucositis 6%, thrombocytopenia 6%. Limiting toxicity syndromes 18%, 25% in young-elderly, all single site. Objective response rate intent-to-treat 94%. Sphinter preservation 87%, pCR 6%. After 17 months follow-up, progression-free survival and overall survival were not reached. Conclusions Oxaliplatin can be safely added to preoperative capecitabine-based chemoradiotherapy at the recommended dose 40 mg/m2/week, in LARC, with promising pCR and high activity.
Collapse
Affiliation(s)
- Gemma Bruera
- Oncology Territorial Care, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Di Staso
- Radiotherapy, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Pierluigi Bonfili
- Radiotherapy, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Antonio Galvano
- Medical Oncology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Rosa Manetta
- Radiology, S. Salvatore Hospital, L'Aquila, Oncology Network ASL1 Abruzzo, Italy
| | - Gino Coletti
- Pathology, S. Salvatore Hospital, L'Aquila, Oncology Network ASL1 Abruzzo, Italy
| | - Roberto Vicentini
- Hepatobiliar-pancreatic Surgery, S. Salvatore Hospital, L'Aquila, Oncology Network ASL1 Abruzzo, Italy
| | - Stefano Guadagni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Universitary General Surgery, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Medical Oncology, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Radiotherapy, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Antonio Russo
- Medical Oncology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Enrico Ricevuto
- Oncology Territorial Care, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
10
|
Affiliation(s)
- M. Gallucci
- Department of Radiology, University of L'Aquila; Italy
| | - A. Bozzao
- Department of Radiology, University of L'Aquila; Italy
| | - B. Orlandi
- Department of Radiology, University of L'Aquila; Italy
| | - R. Manetta
- Department of Radiology, University of L'Aquila; Italy
| |
Collapse
|
11
|
Cannita K, Paradisi S, Cocciolone V, Bafile A, Rinaldi L, Irelli A, Lanfiuti Baldi P, Zugaro L, Manetta R, Alesse E, Ricevuto E, Ficorella C. New schedule of bevacizumab/paclitaxel as first-line therapy for metastatic HER2-negative breast cancer in a real-life setting. Cancer Med 2016; 5:2232-9. [PMID: 27416882 PMCID: PMC5055157 DOI: 10.1002/cam4.803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022] Open
Abstract
Angiogenesis plays an essential role in the growth and progression of breast cancer. This observational single center study evaluated the efficacy and safety of a new weekly schedule of bevacizumab/paclitaxel combination in the first-line treatment of unselected, HER2-negative, metastatic breast cancer (MBC) patients, in a real-life setting. Thirty-five patients (median age 56 years, range 40-81) with HER2-negative MBC were treated with paclitaxel (70 mg/m(2) ) dd 1,8,15 q21 (60 mg/m(2) if ≥65 years or secondary Cumulative Illness Rating Scale) plus bevacizumab (10 mg/kg) every 2 weeks. Twenty-two patients (63%) had ≥2 metastatic sites and 15 (43%) visceral disease. Eleven patients (31%) had a triple-negative breast cancer (TNBC). A clinical complete response (cCR) was observed in 6 (17%) cases after a median of seven cycles, a partial response (PR) in 22 (63%), and a stable disease (SD) in 6 (17%) cases; the overall clinical benefit rate was 97%. In TNBC subgroup, cCR occurred in 1 (9%) case, PR in 8 (73%), and SD in 2 (18%). At a median follow-up of 13 months (range 1-79 months), the median progression-free survival was 11 months and the median overall survival was 36 months. No grade 4 adverse events occurred. The main grade 3 toxicities observed were neutropenia (11.4%), hypertension (5.7%), stomatitis (2.8%), diarrhea (2.8%), and vomiting (2.8%). The administration of weekly paclitaxel plus bevacizumab in this real-life experience shows similar efficacy than previously reported schedules, with a comparable dose intensity and a good toxicity profile.
Collapse
Affiliation(s)
- Katia Cannita
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
| | - Stefania Paradisi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Valentina Cocciolone
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Lucia Rinaldi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Azzurra Irelli
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Paola Lanfiuti Baldi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy
| | - Rosa Manetta
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy
| | - Edoardo Alesse
- Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Ricevuto
- Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Oncology Network ASL1 Abruzzo, UOSD Oncology Territorial Care, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
12
|
Manetta R, Pistoia ML, Bultrini C, Stavroulis E, Di Cesare E, Masciocchi C. Ultrasound enhanced with sulphur-hexafluoride-filled microbubbles agent (SonoVue) in the follow-up of mild liver and spleen trauma. Radiol Med 2009; 114:771-9. [PMID: 19484583 DOI: 10.1007/s11547-009-0406-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 12/09/2008] [Indexed: 01/04/2023]
Abstract
PURPOSE This study assessed the role of contrast-enhanced ultrasound (CEUS) in the follow-up of patients with a diagnosis of traumatic liver or spleen lesions. MATERIALS AND METHODS Between April 2006 and February 2008, 18 patients (13 males and five females, age range 8-42 years) with blunt abdominal trauma were evaluated with computed tomography (CT) and CEUS at the emergency department of our institution. Seven were diagnosed as surgical emergencies and were excluded from the study. The remaining 11 were treated conservatively and were monitored with CEUS at variable time intervals, depending on their clinical needs. RESULTS CEUS confirmed lesion sites identified on presentation and allowed us to follow all phases of the repair process until complete resolution. CONCLUSIONS The conservative management of abdominal lesions in both adults and children is increasingly widespread but requires accurate follow-up over time. As a noninvasive, versatile, easy to perform and repeatable technique with a low rate of adverse reactions, CEUS is ideally suited for this purpose and allowed us to reduce the number of CT scans, especially in the follow-up of young patients.
Collapse
Affiliation(s)
- R Manetta
- Dipartimento di Diagnostica per Immagini., Università degli Studi di L'Aquila, Via Vetoio, L'Aquila, Italy
| | | | | | | | | | | |
Collapse
|
13
|
Affiliation(s)
- E Di Cesare
- Department of Radiology, University of L'Aquila, Italy.
| | | | | | | |
Collapse
|
14
|
Bloem JL, Geirnaerdt MJA, Hogendoorn PCW, Chevrot A, Davies AM, Hájek M, Kurková D, Herynek V, Imhof H, Masciocchi C, Maffey MV, Møller JF, Putz R, Reiser MF, Braunschweig R, Bonél H, Stäbler A, Watt I, Adams JE, Harake MDJ, Lipscomp K, Selby PL, Aparisi F, Arana E, Lloret RM, Marti-Bonmati I, Menor F, Sanchez E, Rodrigo C, Beltran J, Cifrian C, Garci JL, Memis A, Arkun R, Akalin T, Ustu EE, Sabah D, Barile A, Rossi F, Zugaro L, Manetta R, Maurizi Enrici R, Beggs I, Bianchi S, Martinoli C, Molini L, Gandolfo N, Damiani S, Helmberger T, Sittek H, Steinborn M, Ritter MM, Geisst HC, Pistitsch C, Herrmann K, Bögl K, Kainberger F, Adlassnig KP, Kolousek G, Leitich H, Kolarz G, Bracke P, Ramon F, Stevens W, De Clarck L, De Schepper A, Sys J, Michielsen J, Martens M, Breitenseher MJ, Trattnig S, Gaebler C, Metz V, Kukla C, Gneger A, Rand T, Brossmann J, Andresen R, Preidler KW, Daenen B, DeMaeseneer M, Resnick D, Burnett S, Saifuddin A, White J, Cassar-Pullicino VN, Inman C, Griffiths J, McCall IW, Masri WE, Csókási Z, Forgacs S, Czerny C, Neuhold A, Hofmann S, Tschauner C, Engel A, Recht MP, Kramer J, DeBeuckeleer L, DeSchepper A, Somerville J, Vandevenne J, De Maeseneer M, Jaovishidha S, Sartoris DJ, Elizagaray E, Saez F, Faletti C, De Stefano N, Sorrentin T, Foderà Pierangeli L, Mona D, Foster JE, Taberner J, Keen M, Dieppe P, Freyschmidt J, Gibbon WW, O'Connor PJ, McGonagle D, Emery P, Grampp S, Lang P, Jergas M, Glüer CC, Steiner E, Takada M, Mathur A, Genant HK, Jevtic V, Rozman B, Kos-Golja M, Demsar F, Nehrer S, Seidl G, Baldt M, Klarlund M, Østergaard M, Sørensen K, Lorenzen I, Eschberger J, Gstettner M, Schneider W, Plenk H, Kühne JH, Steinborn A, Dürr HR, Scheidler J, Lienemann A, Landsiedl F, Mamdorff P, Honda G, Rosenau W, Johnston J, Mindell E, Peterfy CG, Nevitt M, Majumdar S, Lecouvet FE, Vande Berg BC, Maighem J, Michaux JL, Maldague BE, Lecoevet FE, Malghem J, Mastantuono M, Larciprete M, Bassetti E, Argento G, Amoroso M, Satragno L, Nucci F, Romanini L, Passariello R, McNally EG, Goodman TR, Merkle EM, Krammel E, Vogel J, Krämer S, Schulte M, Usadel S, Kern P, Brambs HJ, Mester Á, Makó E, Papp E, Kiss K, Márton E, Dévai T, Duffek L, Bártfai K, Németh L, Karlinger K, Posgay M, Kákosy T, Davies GA, Cowen AR, Fowler RC, Bury RF, Parkin GJS, Lintott DJ, Martinez D, Safadin A, Pal CR, Ostlere SJ, Phillps AJ, Athanasou N, Lemperle SM, Holmes RE, Rühm S, Zanetti M, Romero J, Hodler J, Larena JA, Marti-Bonmarti L, Martin I, Tabernero G, Alonso A, Scarabino T, Guglielmi G, Giannatempo GM, Cammisa M, Salvolini U, Schmitt R, Fellner F, Heinze A, Obletter N, Schnarkowski P, Tirman PFJ, Steinbach LS, Schneider P, Ferrettiz JL, Capozza RF, Braun M, Reiners C, Zettl R, Silvestri E, Falchi M, Delucchi S, Cella R, Neumaier CE, Prato N, Migliorini S, Jessel C, Heuck A, Stevens KJ, Preston BJ, Kerslake RW, Wright W, Wallace WA, Stiskal M, Szolar D, Stenzel I, Mesaric P, Smolen J, Czembirek H, Tasker AD, Benson MK, Fleischmann D, Haller J, Rottmann B, Kontaxis G, Vanel D, Missenard G, Le Cesne A, Guinebretiere JM, Verhoek G, Duewell S, Zollinger H, Vrooman HA, Valstar ER, Brand GJ, Obermann WR, Rozing PM, Reiber JHC, Zafiroski G, Kamnar J, Zografski G, Jeftic V, Vidoevski G, Ledermann T, Zerbi A, Gambaretti R, Trenti N, Zanolla W, Allen AW, Willis CE, Radmer S, Hakim S, Banzer D, Sparmann M, Argent JD, Sampson MA, Baur A, Bartl R, Llopis E, Monton T, Vallcanera A, Serafini G, Bertolotto M, Trudell D, White LM, Garlaschi G, DiLella GM, Bray A, Parrella A, Salvia F, Parrella RE, Esztergályos J, Faul S, Link J, Behrendt S, Helbich T, Steingruber I, Gahleitner A, Kettenbach J, Kreuzer S, Lomoschitz F, Kaposi PN, Reti PG, Kolenc M, Turk Z, Barovic J, Kugler C, Uggowitzer M, Gröll R, Raith J, Ranner G, Liskutin J, Youssefzadeh S, Montagnon C, Billiard JS, Tanji P, Peerally S, Gazielly D, Muhaz-Vives JM, Fernández J, Girveni-Montilos R, Catasuz-Capellades X, Valls-Pascual R, Niitsu M, Mishima H, Itai Y, Pirronti T, Sallustio G, Cerase A, Priolo F, Poleksic L, Atanackovic M, Dimitrijevic B, Bacic G, Potsybina VV, Rangger C, Kathrein A, Klestil T, Gabl M, Daniaux H, Recondo JA, Alustiza JM, Villanua J, Barrera MC, Salvador E, Larrea JA, Martin J. The 3rd annual congress of the European society of skeletal radiology. Eur Radiol 1996. [DOI: 10.1007/bf00187690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Gallucci M, Bozzao A, Orlandi B, Manetta R, Brughitta G, Lupattelli L. Does postcontrast MR enhancement in lumbar disk herniation have prognostic value? J Comput Assist Tomogr 1995; 19:34-8. [PMID: 7822544 DOI: 10.1097/00004728-199501000-00006] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [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: 01/27/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the prognostic value, if any, of Gd-enhanced MR in patients with lumbar disk herniation. MATERIALS AND METHODS Fifteen patients undergoing conservative treatment for acute lumbar disk herniation were included in a prospective Gd-DTPA follow-up MR study. In each patient, the size of the herniation was measured, and, according to the changes in pathology that occurred, patients were divided into four categories. In addition, on the basis of the clinical outcome patients were divided into three classes. RESULTS In 11 of 15 patients, MR performed in the acute phase of the disease showed Gd-DTPA enhancement around the herniated disk; in all cases, disk herniation was markedly reduced at follow-up MRIs. The clinical outcome was good. In the remaining four cases, no enhancement was evident in the acute phase or at follow-up MRIs; no modification in the size of disk herniation was demonstrated at follow-up in two. Symptoms were unchanged in two patients and mildly improved in one. CONCLUSION Epidural enhancement, which is likely related to an inflammatory process, seems to play a role in the modification of the size of disk herniation.
Collapse
Affiliation(s)
- M Gallucci
- Department of Radiology, University of L'Aquila, Italy
| | | | | | | | | | | |
Collapse
|