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Cardone C, De Stefano A, Rosati G, Cassata A, Silvestro L, Borrelli M, Di Gennaro E, Romano C, Nappi A, Zanaletti N, Foschini F, Casaretti R, Tatangelo F, Lastoria S, Raddi M, Bilancia D, Granata V, Setola S, Petrillo A, Vitagliano C, Gargiulo P, Arenare L, Febbraro A, Martinelli E, Ciardiello F, Delrio P, Budillon A, Piccirillo MC, Avallone A. Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): an academic, multicenter, single-arm, two-stage, phase II study. ESMO Open 2023; 8:100748. [PMID: 36603521 PMCID: PMC10024144 DOI: 10.1016/j.esmoop.2022.100748] [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: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Maintaining angiogenesis inhibition and switching the chemotherapy backbone represent the current second-line therapy in patients with RAS-mutant metastatic colorectal cancer (mCRC). Regorafenib, an oral multikinase inhibitor, prolonged overall survival (OS) in the chemorefractory setting. MATERIALS AND METHODS STREAM was an academic, multicenter, single-arm phase II trial, evaluating the activity of regorafenib in RAS-mutant mCRC, in terms of the rate of patients who were progression-free after 6 months from study entry (6mo-PF). Patients were pretreated with fluoropyrimidine, oxaliplatin, and bevacizumab. According to Simon's two-stage design, ≥18 patients 6mo-PF were needed in the overall population (N = 46). Secondary endpoints were safety, objective response rate (ORR), progression-free survival (PFS), and OS. Early metabolic response by [18F]2-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography ([18F]-FDG PET/CT) scan was an exploratory endpoint. EudraCT Number: 2015-001105-13. RESULTS The number of patients 6mo-PF was 8/22 at the first stage and 14/46 in the overall population. The ORR was 10.9%, disease control rate was 54.6%, median (m)PFS was 3.6 months [95% confidence interval (CI) 1.9-6.7 months], mOS was 18.9 months (95% CI 10.3-35.3 months), and mPFS2 (from study entry to subsequent-line progression) was 13.3 months (95% CI 8.4-19.7 months). Long benefiter patients (>6mo-PF) significantly more often had a single metastatic site and lung-limited disease. No unexpected toxicity was reported. Grade ≥3 events occurred in 39.1% of patients, with hand-foot syndrome (13%), fatigue, and hyperbilirubinemia (6.5%) occurring mostly. Baseline metabolic assessment was associated with OS in the multivariate analysis, while early metabolic response was not associated with clinical outcomes. CONCLUSIONS The study did not meet its primary endpoint. However, regorafenib was well tolerated and did not preclude subsequent treatments. Patients with good prognostic features (single metastatic site and lung-limited disease) reported clinical benefit with regorafenib. The exploratory metabolic analysis suggests that baseline [18F]-FDG PET/CT might be useful to select patients with a favorable outcome. A chemotherapy-free interval with regorafenib was associated with durable disease control in a selected group of patients with favorable clinical characteristics.
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Affiliation(s)
- C Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/clacardone
| | - A De Stefano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/alfdestefano
| | - G Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - A Cassata
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - L Silvestro
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Borrelli
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - E Di Gennaro
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Romano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Nappi
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - N Zanaletti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - F Foschini
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - R Casaretti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - F Tatangelo
- Pathology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - S Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Raddi
- Nuclear Medicine Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - D Bilancia
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - V Granata
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - S Setola
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Petrillo
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Vitagliano
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - P Gargiulo
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Febbraro
- Hospital Sacro Cuore di Gesu, Fatebenefratelli, Benevento, Italy
| | - E Martinelli
- Medical Oncology, Precision Medicine Department, University of Campania Luigi Vanvitelli, Naples, Italy. https://twitter.com/grikamartinelli
| | - F Ciardiello
- Medical Oncology, Precision Medicine Department, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Delrio
- Colorectal Oncological Surgery, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Budillon
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/AlfredoBudillon
| | - M C Piccirillo
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
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O'Sullivan J, Heinrich D, Castro Marcos E, George S, Song D, Dizdarevic S, Baldari S, Essler M, de Jong I, Lastoria S, Hammerer P, Tombal B, James N, Verholen F, Meltzer J, Sandström P, Sartor O. 1394P Alkaline phosphatase (ALP) decline and pain response as markers for overall survival (OS) in patients (Pts) with metastatic castration-resistant prostate cancer (mCRPC) treated with radium-223 (223Ra) in the REASSURE study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1526] [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: 11/16/2022] Open
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Cardone C, Piccirillo M, Rosati G, De Stefano A, Romano C, Nappi A, Zanaletti N, Foschini F, Cassata A, Casaretti R, Silvestro L, Tatangelo F, Lastoria S, Raddi M, Bilancia D, Febbraro A, Martinelli E, Ciardiello F, Delrio P, Perrone F, Budillon A, Avallone A. P-68 Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): An academic, multicenter, single-arm, two-stage, phase 2 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.158] [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: 11/30/2022] Open
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Palmese VP, D’Ambrosio L, Aurilio M, Di Martino D, Porfidia V, Morisco A, Maisto C, Prisco A, Gaballo P, De Lauro F, Di Gennaro F, Quarto M, Lastoria S. Clinical practice implementation of personalized dosimetry in patients treated with 177Lu-DOTATATE. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00046-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Menzies AM, Lastoria S. PET imaging for cancer immunotherapy: the Immuno-PET. Ann Oncol 2021; 33:13-14. [PMID: 34808339 DOI: 10.1016/j.annonc.2021.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia.
| | - S Lastoria
- IRCCS National Cancer Institute, Fondazione Senatore G. Pascale, Napoli, Italy
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D’Ambrosio L, Gaballo P, Prisco A, Di Gennaro F, Lastoria S. 321. Role of Diagnostic Reference Levels (DRLs) in Nuclear Medicine: The experience of INT Pascale in Naples. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.330] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Budillon A, Delrio P, Pecori B, Tatangelo F, Di Gennaro E, Romano C, D'Angelo V, Marone P, Granata C, Cavalacanti E, De Stefano A, Pace U, Bianco F, Petrillo A, Lastoria S, Botti G, Muto P, Perrone F, Piccirillo M, Avallone A. Phase I/II study of valproic acid (VPA) and short-course radiotherapy (SCRT) plus capecitabine (CAP) as preoperative treatment in low-moderate risk rectal cancer (V-shoRT-R3). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Avallone A, Delrio P, Nasti G, Cassata A, Silvestro L, De Stefano A, Lastoria S, Casaretti R, Romano C, Ottaiano A, Di gennaro E, Nappi A, Maiolino P, Cavalcanti E, Petrillo A, Tatangelo F, Giannarelli D, Galon J, Ascierto P, Budillon A. Preoperative nivolumab in patients(pts) with locally advanced colon cancer (T3 or T4): A window-of-opportunity study (NICOLE). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.155] [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: 11/13/2022] Open
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9
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Avallone A, Nasti G, Rosati G, Carlomagno C, Romano C, Bilancia D, De Stefano A, Silvestro L, Ottaiano A, Cassata A, Bianco F, Izzo F, Delrio P, De Gennaro E, Casaretti R, Tafuto S, Albino V, Pace U, Lastoria S, Gallo C, Budillon A, Piccirillo M. Survival analysis of a multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.262] [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: 11/14/2022] Open
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Abstract
Aims and Background In stage I oral squamous cell carcinoma, clinical examination and imaging techniques are unable to identify 60-90% of patients at risk of micrometastasis, while the sentinel node biopsy technique allows to avoid the morbidity of elective neck dissection in patients not actually affected by micrometastases. Materials and methods Forty-one T1-T2N0 patients underwent lymphoscintigraphy after peritumoral injection of human albumin labeled with 99Tc. Focal areas of radiotracer uptake were marked on the skin preoperatively. The sentinel lymph node (SLN) was identified by the combined use of blue dye and gamma probe and subsequently removed. Complete neck dissection was then performed in all patients and the histological findings were compared with those of SLN biopsy. Results The SLN was identified in 95% of the patients; in four cases (10%) two SLNs were isolated. In 18% of our patients the SLNs were located outside the expected drainage area. When the histology of the negative SLNs was compared with the pathological status of the neck dissection specimens no false negatives were found. Five SLNs in four patients contained micrometastases and were the only positive lymph nodes. Conclusion SLN biopsy can be a valuable staging technique in T1 and T2 oral cancer with uninvolved neck in patients whose lymphatic drainage of the neck has not been altered by previous surgery or radiotherapy. It provides reliable detection of micrometastasis, indicating which level(s) should be removed ipsilaterally or contralaterally, and allows the surgeon to accurately plan neck dissection, taking into consideration the pattern of lymphatic drainage of each individual patient. In this way unnecessary neck dissection and its morphofunctional sequelae can be avoided in a considerable number of patients.
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Affiliation(s)
- F Ionna
- Istituto Nazionale Tumori, Fondazione Pascale, Naples
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11
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Caracò C, Chiofalo MG, Niro J, Ascierto PA, Botti G, Lastoria S, Mozzillo N. Sentinel Lymph Node Biopsy to Stage Patients with Cutaneous Melanoma at the National Cancer Institute of Naples. Results from 240 Sentinel Node Biopsies. Tumori 2018; 88:S12-3. [PMID: 12365370 DOI: 10.1177/030089160208800324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/15/2022]
Abstract
Aimsand background The presence of lymph node metastases in patients with cutaneous melanoma represents the basis for correct therapy planning and is the most powerful prognostic factor to evaluate overall survival at diagnosis. Methods and Study Design Since 1992, when Dr Morton published his first experience, the sentinel lymph node (SLN) biopsy technique seems to have resolved this matter by correctly staging patients. We analyzed our data from 240 SLN biopsies performed in the last five years at the National Cancer Institute of Naples, evaluating the total identification rate and the nodal recurrence rate, and compared them with the preliminary data of the MSLT (melanoma sentinel lymph node trial). Results Of all SLNs evaluated 18.5% were micrometastatic and 14% were identified by immunohistochemical staining. Forty-one patients had metastatic SLNs and nodal dissection of the positive basins revealed no other tumor-positive lymph nodes in more than 80% of them. All patients with a Breslow thickness of less than 2 mm had micrometastases only in the SLN, while with increasing thickness two, three or more positive nodes were found. Among SLN-negative patients nine (4%) developed lymph node recurrence in the previously treated basin and were therefore considered as false negative SLN biopsies. Conclusions The prognostic value of SLN biopsy needs to be confirmed by the final results of the MSLT evaluating the therapeutic use of this procedure in patients with a Breslow thickness of less than 2 mm and its possible impact on the course of the disease.
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Affiliation(s)
- C Caracò
- Surgical Division B, National Cancer Institute, Naples, Italy.
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Piccolo S, Lastoria S, Muto P, Apicella A, Alaia C, Petrosino T, Thomas R, Cortino G, d'Aiuto G, Bazzicalupo L. Scintimammography (Smm) with 99mTc-Mdp: An Overview of the Experience at the National Cancer Institute of Napoli. Tumori 2018; 83:515-9. [PMID: 9226007 DOI: 10.1177/030089169708300203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S Piccolo
- Department of Nuclear Medicine, National Cancer Institute, Napoli, Italy
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Abstract
Localization of gastrointestinal tumors by means of labeled monoclonal antibodies is a new, sensitive and suitable technique currently used in several centers. Encouraging results have been documented with several monoclonal antibodies by different authors. This article reviews our experience with radioimmunoscintigraphy in 59 patients with colorectal cancer in follow-up, using 131I and 111In labeled B72.3, and in 16 patients with primary gastrointestinal tumors using 99mTc anti-CEA monoclonal antibody (type F023C5). The sensitivity of both B72.3 and anti-CEA was greater than 70% either for primary tumors and abdominal recurrences or distant metastases except hepatic ones. A significant gradient in antibody uptake was measured on surgical biopsies between tumors and normal tissues allowing a good in vivo contrast for gamma detection. We have defined the impact of some factors affecting in vivo tumor targeting. In fact, pharmacodynamics of MAbs, percentage of injected dose bound to tissues were measured, and in particular antigenic content in tumor nodules was quantified. Furthermore, the results of RIS were compared to those obtained by CT and other imaging modalities.
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Affiliation(s)
- S Lastoria
- Department of Nuclear Medicine, Instituto Nazionale Tumori, Napoli, Italy
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Baldari S, Annibale V, Lastoria S, Tucci M, Borsatti E, Monari F, Paganelli G, Verri E, Muto P, Panareo S, Mosca A, Storto G, Bagnato A, Farsad M, Bilancia D, Marchetti P, Sternberg C, Procopio G, Seregni E, Valdagni R. Patient (pt) characteristics and treatment patterns in the radium (Ra)-223 REASSURE observational study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx423.018] [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: 11/13/2022] Open
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15
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Avallone A, Nasti G, Rosati G, Carlomagno C, Romano C, Bilancia D, De Stefano A, Ottaiano A, Cassata A, Silvestro L, Tafuto S, Bianco F, Delrio P, Izzo F, Di Gennaro E, Lastoria S, Gallo C, Perrone F, Budillon A, Piccirillo M. A multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with mFOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.040] [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
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16
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Leongito M, Palaia R, Albino V, Di Giacomo R, Amore A, Piccirillo M, Tafuto S, Granata V, Petrillo A, Lastoria S, Izzo F. Electrochemotherapy with bleomycin in locally advanced pancreatic adenocarcinoma. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.042] [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: 11/15/2022] Open
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Albino V, Izzo F, Palaia R, Di Giacomo R, Piccirillo M, Leongito M, Nasti G, Aloj L, Caracò C, Lastoria S. Neoadjuvant folfiri + bevacizumab in patients with resectable liver metastases from colo-rectal cancer: Results from a phase 2 trial and comparative analysis of early PET/CT scan vs recist criteria in predicting outcome. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.034] [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] Open
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18
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Antonio A, Piccirillo M, Nasti G, Rosati G, Chiara C, Romano C, Bilancia D, De Stefano A, Ottaiano A, Cassata A, Bianco F, Delrio P, Izzo F, Di Gennaro E, Caracò C, Iaffaioli R, Lastoria S, Gallo C, Budillon A, Perrone F. A multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in the treatment of patients with metastatic colorectal cancer (mCRC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.11] [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
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D'Ambrosio L, Aloj L, Chiaramida P, Cerciello V, Gaballo P, Prisco A, Lastoria S. Quantitative SPECT/CT imaging using a commercial software. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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D'Ambrosio L, Lastoria S, Rossano S, Calicchio G, Frattolillo C, Currarone R, Cerciello V, Luchini P, Calandrino R. Decommissioning procedures for a 17 MeV medical cyclotron. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Izzo F, Palaia R, Albino V, Di Giacomo R, Amore A, Saponara R, Leongito M, Nasti G, Lastoria S. 331. Neoadjuvant folfiri + bevacizumab in patients with resectable liver metastases from colorectal cancer: Results from a phase 2 trial and comparative analysis of early PET/CT scan vs RECIST criteria in predicting outcome. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.321] [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: 10/24/2022] Open
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Granata V, Fusco R, Piccirillo M, Palaia R, Lastoria S, Petrillo A, Izzo F. Feasibility and Safety of Intraoperative Electrochemotherapy in Locally Advanced Pancreatic Tumor: A Preliminary Experience. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy is an effective treatment for various cutaneous tumors and could be translated into treatment of deep-seated tumors. With this aim, a prospective clinical phase I/II study was conducted to evaluate the feasibility and safety of intraoperative Electrochemotherapy (ECT) in locally advanced pancreatic adenocarcinoma: the preliminary results are reported in this study. The secondary endpoint was to assess treatment response in terms of morphological and functional criteria based on Magnetic Resonance Imaging. Eleven consecutive patients were enrolled in a clinical phase I/II study approved by the Ethics Committee of the National Cancer Institute G. Pascale Foundation - IRCCS of Naples. Electrochemotherapy with bleomycin was performed during open surgery. All patients underwent MR and CT scan, before and after ECT treatment, using morphological and functional imaging. RECIST criteria were used to evaluate ECT response on CT and MR images. Functional parameters were also used to evaluate ECT response on MR images. No acute (intraoperative) and/or postoperative serious adverse events related to electrochemotherapy were observed; no clinically significant electrocardiographic, hemodynamic, or serum biologic changes were noted. No clinically relevant elevation of amylase or lipase levels was observed and no bleeding or damage to surrounding viscera occurred. Electrochemotherapy of locally advanced pancreatic adenocarcinoma proved to be a feasible and safe treatment modality. Dynamic and diffusion MR imaging is more suitable to assess ECT treatment response than CT imaging and morphological MR alone, after one month of treatment.
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Affiliation(s)
- V. Granata
- Diagnostic Imaging Department, “Istituto Nazionale Per Lo Studio e La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
| | - R. Fusco
- Diagnostic Imaging Department, “Istituto Nazionale Per Lo Studio e La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
| | - M. Piccirillo
- Hepato-biliary Surgery Department, “Istituto Nazionale Per Lo Studio E La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
| | - R. Palaia
- Hepato-biliary Surgery Department, “Istituto Nazionale Per Lo Studio E La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
| | - S. Lastoria
- Diagnostic Imaging Department, “Istituto Nazionale Per Lo Studio e La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
| | - A. Petrillo
- Diagnostic Imaging Department, “Istituto Nazionale Per Lo Studio e La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
| | - F. Izzo
- Hepato-biliary Surgery Department, “Istituto Nazionale Per Lo Studio E La Cura Dei Tumori Fondazione Giovanni Pascale - IRCCS”, Naples, Italy
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23
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Nasti G, Piccirillo MC, Izzo F, Ottaiano A, Albino V, Delrio P, Romano C, Giordano P, Lastoria S, Caracò C, de Lutio di Castelguidone E, Palaia R, Daniele G, Aloj L, Romano G, Iaffaioli RV. Neoadjuvant FOLFIRI+bevacizumab in patients with resectable liver metastases from colorectal cancer: a phase 2 trial. Br J Cancer 2013; 108:1566-70. [PMID: 23558891 PMCID: PMC3668480 DOI: 10.1038/bjc.2013.140] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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] [Indexed: 02/07/2023] Open
Abstract
Background: Preoperative treatment of resectable liver metastases from colorectal cancer (CRC) is a matter of debate. The aim of this study was to assess the feasibility and activity of bevacizumab plus FOLFIRI in this setting. Methods: Patients aged 18–75 years, PS 0–1, with resectable liver-confined metastases from CRC were eligible. They received bevacizumab 5 mg kg−1 followed by irinotecan 180 mg m−2, leucovorin 200 mg m−2, 5-fluorouracil 400 mg m−2 bolus and 5-fluorouracil 2400 mg m−2 46-h infusion, biweekly, for 7 cycles. Bevacizumab was stopped at cycle 6. A single-stage, single-arm phase 2 study design was applied with 1-year progression-free rate as the primary end point, and 39 patients required. Results: From October 2007 to December 2009, 39 patients were enrolled in a single institution. Objective response rate was 66.7% (95% exact CI: 49.8–80.9). Of these, 37 patients (94.9%) underwent surgery, with a R0 rate of 84.6%. Five patients had a pathological complete remission (14%). Out of 37 patients, 16 (43.2%) had at least one surgical complication (most frequently biloma). At 1 year of follow-up, 24 patients were alive and free from disease progression (61.6%, 95% CI: 44.6–76.6). Median PFS and OS were 14 (95% CI: 11–24) and 38 (95% CI: 28–NA) months, respectively. Conclusion: Preoperative treatment of patients with resectable liver metastases from CRC with bevacizumab plus FOLFIRI is feasible, but further studies are needed to define its clinical relevance.
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Affiliation(s)
- G Nasti
- Medical Oncology, Abdominal Department, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, 80131 Napoli, Italy
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Avallone A, Di Gennaro E, Aloj L, Delrio P, Pecori B, Tatangelo F, Petrillo A, Iaffaioli V, Lastoria S, Budillon A. Neoadjuvant Multidisciplinary Phase II Study (BRANCH) of an Early Bevacizumab Schedule Plus Chemo-Radiation Therapy in Rectal Cancer: Efficacy, Safety, and Biomarkers. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nuzzo F, Gallo C, Lastoria S, Di Maio M, Piccirillo MC, Gravina A, Landi G, Rossi E, Pacilio C, Labonia V, Di Rella F, Bartiromo A, Buonfanti G, De Feo G, Esposito G, D'Aniello R, Maiolino P, Signoriello S, De Maio E, Tinessa V, Colantuoni G, De Laurentiis M, D'Aiuto M, Di Bonito M, Botti G, Giordano P, Daniele G, Morabito A, Normanno N, de Matteis A, Perrone F. Bone effect of adjuvant tamoxifen, letrozole or letrozole plus zoledronic acid in early-stage breast cancer: the randomized phase 3 HOBOE study. Ann Oncol 2012; 23:2027-2033. [PMID: 22412041 DOI: 10.1093/annonc/mdr600] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 12/30/2022] Open
Abstract
BACKGROUND To measure bone mineral density (BMD) reduction produced by letrozole as compared with tamoxifen and the benefit of the addition of zoledronic acid. PATIENTS AND METHODS A phase 3 trial comparing tamoxifen, letrozole or letrozole+zoledronic acid in patients with hormone receptor-positive early breast cancer was conducted; triptorelin was given to premenopausal patients. Two comparisons were planned: letrozole versus tamoxifen and letrozole+zoledronic acid versus letrozole. Primary end point was the difference in 1-year change of T-score at lumbar spine (LTS) measured by dual energy X-ray absorptiometry scan. RESULTS Out of 483 patients enrolled, 459 were available for primary analyses. Median age was 50 (range 28-80). The estimated mean difference (95% confidence interval [CI]) in 1-year change of LTS was equal to -0.30 (95% CI -0.44 to -0.17) in the letrozole versus tamoxifen comparison (P<0.0001) and to +0.60 (95% CI +0.46 to +0.77) in the letrozole+zoledronic acid versus letrozole comparison (P<0.0001). Bone damage by letrozole decreased with increasing baseline body mass index in premenopausal, but not postmenopausal, patients (interaction test P=0.004 and 0.47, respectively). CONCLUSIONS In the HOBOE (HOrmonal BOne Effects) trial, the positive effect of zoledronic acid on BMD largely counteracts damage produced by letrozole as compared with tamoxifen. Letrozole effect is lower among overweight/obese premenopausal patients.
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Affiliation(s)
- F Nuzzo
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - C Gallo
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli
| | - S Lastoria
- Nuclear Medicine and Metabolic Therapy, Department of Imaging, National Cancer Institute, Napoli
| | - M Di Maio
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - M C Piccirillo
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - A Gravina
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - G Landi
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - E Rossi
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli; Division of Medical Oncology, Department of Oncohematology, S. Giuseppe Moscati Hospital, Avellino
| | - C Pacilio
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - V Labonia
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - F Di Rella
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - A Bartiromo
- Nuclear Medicine and Metabolic Therapy, Department of Imaging, National Cancer Institute, Napoli
| | - G Buonfanti
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - G De Feo
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - G Esposito
- Laboratory Medicine, Department of Pathology and Laboratory Diagnostics, National Cancer Institute, Napoli
| | - R D'Aniello
- Department of Pharmacy, National Cancer Institute, Napoli
| | - P Maiolino
- Department of Pharmacy, National Cancer Institute, Napoli
| | - S Signoriello
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli
| | - E De Maio
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - V Tinessa
- Division of Medical Oncology, Department of Oncology, Rummo Hospital, Benevento
| | - G Colantuoni
- Division of Medical Oncology, Department of Oncohematology, S. Giuseppe Moscati Hospital, Avellino
| | - M De Laurentiis
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - M D'Aiuto
- Division of Surgical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - M Di Bonito
- Pathology, Department of Pathology and Laboratory Diagnostics, National Cancer Institute, Napoli
| | - G Botti
- Pathology, Department of Pathology and Laboratory Diagnostics, National Cancer Institute, Napoli
| | - P Giordano
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - G Daniele
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - A Morabito
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - N Normanno
- Cellular Biology and Biotherapy, Department of Research, National Cancer Institute, Napoli, Italy
| | - A de Matteis
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - F Perrone
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli.
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Perrone F, Gallo C, Lastoria S, Nuzzo F, Gravina A, Landi G, Rossi E, Pacilio C, Labonia V, Di Rella F, De Laurentiis M, Piccirillo MC, Di Maio M, Giordano P, Daniele G, De Feo G, Fiore R, Signoriello S, Esposito G, de Matteis A. Bone effects of adjuvant tamoxifen (T), letrozole (L), or L plus zoledronic acid (Z) in early breast cancer (EBC): The phase III HOBOE study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lastoria S, D'Ambrosio L, Aurilio M, Marreno R, Giovannoni L, Menssen HD, Neri D, Shah A, Di Gennaro F, Caraco C, Pecori B, Aloj L. Preliminary evaluation of radioimmunotherapy with an 131I labelled small immunoprotein targeted against the extra domain B of fibronectin in combination with whole brain radiation therapy in patients with multiple brain metastases from solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e12502] [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: 11/20/2022] Open
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28
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Aloj L, D'Ambrosio L, Aurilio M, Marreno R, Neri D, Menssen HD, Giovannoni L, Di Gennaro F, Caraco C, Arcamone M, Frigeri F, Pinto A, Lastoria S. Preliminary evaluation of radioimmunotherapy with Tenarad, a I-131 labeled antibody fragment targeting the extra-domain A1 of tenascin-C, in patients with refractory Hodgkin lymphoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Riccardi F, Nappi O, Balzano A, De Palma M, Buonerba C, Rizzo M, Barbato C, De Dominicis G, Buonocore U, De Sena G, Lastoria S, Molino C, Monaco G, Rabitti PG, Romano L, Scavuzzo F, Suozzo R, Uomo G, Volpe R, Di Lorenzo G, Carteni G. Neuroendocrine tumors diagnosed at the Antonio Cardarelli hospital (Naples, Italy) between 2006-2009: a single-institution analysis. Int J Immunopathol Pharmacol 2011; 24:251-6. [PMID: 21496411 DOI: 10.1177/039463201102400132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neuroendocrine tumors (NETs) are rare, with an incidence of about 5 per 100,000 inhabitants. As no study on NETs has ever been specifically conducted on the population of Campania, we performed a retrospective analysis of all newly diagnosed NETs at the Antonio Cardarelli hospital between 2006-2009. A search of the registry of the Pathology Department of the Antonio Cardarelli hospital was carried out to retrieve available data on all newly diagnosed NET cases. Two hundred and ninety-nine NET tumors were diagnosed at our Institution from January, 2006 to December, 2009. Globally, 121 patients (40% of the population) had a lung NET, while 92 patients (30% of the population) presented a GEP-NET. The most common primary tumor site varied by sex, with female patients being more likely to have a primary NET in the lung, breast or colon, and male patients being more likely to have a primary tumor in the lung. Also, twenty-three cases of breast NETs were identified, and clinical information regarding therapy and response was available for 22 patients. Our study represents a pioneering effort to provide the medical community in Campania with basic information on a large number of patients with different types of NETs. The Antonio Cardarelli hospital could greatly benefit from cooperation with other hospitals in order to become a highly specialized center for NETs in the region and Southern Italy.
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Cardone E, Delrio P, Avallone A, Pecori B, Budillon A, De Gennaro E, Lastoria S, Tatangelo F, Marone P, Petrillo A, Romano C, Sassaroli C, Bianco F, Cremona F, Romano G. Circulating endothelial cells and FDG-PET as markers for early prediction of response to neoadjuvant chemoradiation and bevacizumab for locally advanced rectal cancer. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.06.051] [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] Open
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31
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Cosimelli M, Golfieri R, Cagol PP, Carpanese L, Sciuto R, Maini CL, Mancini R, Sperduti I, Pizzi G, Diodoro MG, Perrone M, Giampalma E, Angelelli B, Fiore F, Lastoria S, Bacchetti S, Gasperini D, Geatti O, Izzo F. Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 2010; 103:324-31. [PMID: 20628388 PMCID: PMC2920024 DOI: 10.1038/sj.bjc.6605770] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [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] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. METHODS Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). RESULTS Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at 60 days respectively. By intention-to-treat analysis using Response Evaluation Criteria in Solid Tumours, 1 patient (2%) had a complete response, 11 (22%) partial response, 12 (24%) stable disease, 22 (44%) progressive disease; 4 (8%) were non-evaluable. Median overall survival was 12.6 months (95% CI, 7.0-18.3); 2-year survival was 19.6%. CONCLUSION Radioembolisation produced meaningful response and disease stabilisation in patients with advanced, unresectable and chemorefractory mCRC.
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Affiliation(s)
- M Cosimelli
- Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy.
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Frasci G, D’Aiuto G, Comella P, D’Aiuto M, Di Bonito M, Ruffolo P, Iodice G, Petrillo A, Lastoria S, Oliviero P, Capasso I, Montella M, Siani C, Santangelo M, Vizioli L, Comella G. Preoperative weekly cisplatin, epirubicin, and paclitaxel (PET) improves prognosis in locally advanced breast cancer patients: an update of the Southern Italy Cooperative Oncology Group (SICOG) randomised trial 9908. Ann Oncol 2010; 21:707-716. [DOI: 10.1093/annonc/mdp356] [Citation(s) in RCA: 27] [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] [Indexed: 12/29/2022] Open
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Frasci G, Comella P, Rinaldo M, Iodice G, Di Bonito M, D'Aiuto M, Petrillo A, Lastoria S, Siani C, Comella G, D'Aiuto G. Preoperative weekly cisplatin-epirubicin-paclitaxel with G-CSF support in triple-negative large operable breast cancer. Ann Oncol 2009; 20:1185-92. [PMID: 19218307 DOI: 10.1093/annonc/mdn748] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Findings from our previously published phase II study showed a high pathologic complete remission (pCR) rate in patients with triple-negative large operable breast cancer after the administration of eight cisplatin-epirubicin-paclitaxel (PET) weekly cycles. The safety and efficacy data of the initial population were updated, with inclusion of additional experience with the same therapy. METHODS Patients with triple-negative large operable breast cancer (T2-T3 N0-1; T > 3 cm) received eight preoperative weekly cycles of cisplatin 30 mg/m2, epirubicin 50 mg/m2, paclitaxel (Taxol) 120 mg/m2, with granulocyte colony-stimulating factor (5 microg/kg days 3-5) support. RESULTS Overall 74 consecutive patients (T2/T3 = 35/39; N0/N+ = 26/48) were treated, from May 1999 to May 2008. At pathological assessment, 46 women (62%; 95% confidence interval 50-73) showed pCR in both breast and axilla. At a 41-month median follow-up (range 3-119), 13 events (nine distant metastases) had occurred, 5-year projected disease-free survival (DFS) and distant disease-free survival being 76% and 84%, respectively. Five-year DFS was 90% and 56% in pCRs and non-pCRs, respectively. Severe neutropenia and anemia occurred in 23 (31%) and eight (10.8%) patients, respectively. Severe non-hematological toxicity was recorded in <20% of patients. Peripheral neuropathy was quite frequent but never severe. CONCLUSIONS Eight weekly PET cycles are a highly effective primary treatment in women with triple-negative large operable breast cancer. This approach results in a very promising long-term DFS in this poor prognosis population. This triplet regimen is worthy of evaluation in phase III trials.
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Affiliation(s)
- G Frasci
- Department of Senology, Unit of Preoperative Treatments, National Cancer Institute of Naples, Naples, Italy.
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Russo P, Lauria A, Mettivier G, Montesi MC, Marotta M, Aloj L, Lastoria S. 18F-FDG positron autoradiography with a particle counting silicon pixel detector. Phys Med Biol 2008; 53:6227-43. [DOI: 10.1088/0031-9155/53/21/022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Marcacci G, Caracò C, D'Arena G, Aloj L, Corazzelli G, Frigeri F, Lastoria S, Pinto A. 97: Positron Emission Tomography Identifies a Differential Pattern of Bone Marrow FdG Uptake in “Poor” and “Good” Peripheral Stem Cell Mobilizers. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.106] [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: 10/22/2022]
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36
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Avallone A, Delrio P, Guida C, Tatangelo F, Petrillo A, Lastoria S, Parisi V, Comella G, Budillon A, Comella P. High rate of TRG1–2 and prolonged RFS with OXA/TOM and FU/LFA during preoperative pelvic RT in patients with poor prognosis locally advanced rectal cancer (LARC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14500 Background: We have previously reported that 3 cycles of Oxaliplatin (OXA), Raltitrexed (TOM) and 5-Fluorouracile (FU) + levo-folinic acid (LFA) during pelvic RT had an acceptable toxicity and produced a complete (TRG1, 42%) or subtotal (TRG2, 29%) pathologic tumor regression in 71% of 31 pts with poor prognosis LARC (Avallone et al, Br J Cancer 2006). Here we report an expanded experience on such treatment. Methods: We enrolled 62 eligible pts (M, 33; F, 29), with median age of 58 (27–79) yrs, and adenocarcinoma of the extraperitoneal rectum, with at least one of the following characteristics: cT4 (N pts), cN+ (N), cT3N0 with tumor location = 5 cm from the anal verge and/or CRM +ve (assessed by MRI) (N). Pts received 3 biweekly courses of OXA 100 mg/sqm + TOM 2.5 mg/sqm on day 1, and LFA 250 mg/sqm + FU 900 mg/sqm (31 pts) or 800 mg/sqm (31 pts) on day 2, and concomitant pelvic RT (1.8 Gy/day, total dose 45 Gy). TME was planned 8 weeks after the end of treatment. Pathologic response was evaluated by tumor regression grading (TRG) according to Mandard’s modified classification. Pts with cT4, pN+ and pCRM +ve received also 4 months of weekly FU/FA. Results: All pts received full dose of RT, and 98% of the planned CT cycles. Neutropenia was the most common grade = 3 toxicity (40%), while grade 3 diarrhea was seen in 19% of pts with FU 900 mg/sqm, and in only 6% of pts with FU 800 mg/sqm. All but 2 pts had a TME with R0 resection, and no treatment-related or perioperative death occurred. Median number of sampled lymph nodes was 36 (range, 10–80). 28 (45%) pts obtained a TRG1, and 17 (27%) pts a TRG2. Activity of the treatment was similar in all risk groups, regardless of FU dosage. 1 pt suffered a local recurrence (after 9 months), and 3 pts had distant metastases (after 22, 33, and 47 months). After a median follow-up of 34 (range 6–54) months, all pts are alive, and the estimated 34-month RFS was 95%. All pts achieving a TRG1, and all but one with TRG2 (pCRM +ve), were recurrence-free. Conclusions: These data confirm the feasibility and activity of the whole treatment. A slight reduction of FU dosage appeared to improve the safety of this combination. Currently, we are now evaluating the addition of bevacizumab 5 mg/kg every 2 weeks before and during this concurrent treatment. No significant financial relationships to disclose.
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Affiliation(s)
- A. Avallone
- National Tumour Institute Naples, Naples, Italy
| | - P. Delrio
- National Tumour Institute Naples, Naples, Italy
| | - C. Guida
- National Tumour Institute Naples, Naples, Italy
| | | | - A. Petrillo
- National Tumour Institute Naples, Naples, Italy
| | - S. Lastoria
- National Tumour Institute Naples, Naples, Italy
| | - V. Parisi
- National Tumour Institute Naples, Naples, Italy
| | - G. Comella
- National Tumour Institute Naples, Naples, Italy
| | - A. Budillon
- National Tumour Institute Naples, Naples, Italy
| | - P. Comella
- National Tumour Institute Naples, Naples, Italy
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Mancini R, Carpanese L, Sciuto R, Pizzi G, Golfieri R, Giampalma L, Cappelli A, Galaverni MC, Blotta A, Fiore F, Izzo F, Lastoria S, Mastro A, Di Marzo M, Cagol PP, Gasparini D, Geatti O, Bacchetti S, Pasqual E, Zeuli M, Paoletti G, Garufi C, Cosimelli M. A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: preliminary results on toxicity and response rates. In Vivo 2006; 20:711-4. [PMID: 17203751] [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: 05/13/2023]
Abstract
BACKGROUND In patients locally progressing after two lines of chemotherapy, some locoregional approaches showed encouraging results in terms of local control of disease. The aim of our study was to evaluate toxicity, clinical response and quality of life in 48 patients with unresectable colorectal liver metastases submitted to selective internal radiotherapy (SIRT). MATERIALS AND METHODS Up to now 35 patients with unresectable colorectal liver metastases, refractory to two lines of chemotherapy, underwent intra-arterial infusion of resin microspheres with yttrium-90 (SIR-spheres). Pre-treatment evaluation included a CT scan, blood tests, a PET scan and arteriography of celiac trunk, hepatic and superior mesenteric artery; extrahepatic uptakes and pulmonary shunts more than 10% were excluded by a Scinti-scan. The gastroduodenal artery was embolized before the SIR-spheres injection. Other exclusion criteria were liver dysfunction and anatomical vascular anomalies. The clinical response was evaluated by CT-scan following the RECIST criteria. Median follow-up was 4 months. RESULTS Median number of metastases was 4 (range, 1-15), 38% of cases presenting hepatic involvement < 25%. The median SIRT dose delivered was 1.7 GBq. Median pulmonary shunt was 6%. No operative mortality occurred; early toxicity (within 48 hours) was 20.6%, shown as fever, acute pain and leucocytosis. The late toxicity was 24.1% with chronic pain, jaundice and nausea being the most frequent. All the toxic events were graded 2 or 3 according to the WHO scale. Preliminary results were available in terms of clinical response after 6 weeks: 12.5% had a partial response, 75% a stable disease, while progression of disease, was observed in 12.5% of the patients. CONCLUSION SIRT is a safe treatment in terms of acute and late toxicity. Intra-arterial microspheres could represent a good therapeutic option for patients with progressing liver metastases only, after two lines of systemic chemotherapy.
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Affiliation(s)
- R Mancini
- Regina Elena Cancer Institute, Rome, Italy
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Avallone A, Delrio P, Guida C, Tatangelo F, Petrillo A, Marone P, Cascini LG, Morrica B, Lastoria S, Parisi V, Budillon A, Comella P. Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I-II study. Br J Cancer 2006; 94:1809-15. [PMID: 16736001 PMCID: PMC2361331 DOI: 10.1038/sj.bjc.6603195] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oxaliplatin (OXA), raltitrexed (RTX), 5-fluorouracil (FU) and folinic acid (FA) have shown activity in metastatic colorectal cancer, radioenhancing effect and synergism when combined. We evaluated a chemotherapy (CT) combination of OXA, RTX and FU/FA during preoperative radiotherapy (RT) in locally advanced rectal cancer (LARC) patients. Fifty-one patients with LARC at high risk of recurrence (T4, N+ or T3N0 ⩽5 cm from anal verge and/or circumferential resection margin ⩽5 mm) received three biweekly courses of CT during pelvic RT (45 Gy). Surgery was planned 8 weeks after CT-RT. Recommended doses (RDs) determined during phase I were utilised in the subsequent phase II trial, where the rate of tumour regression grade (TRG) 1 or 2 was the main end point. No toxic deaths occurred, and severe toxicity was easily managed. In phase II, RDs delivered in 31 patients were OXA 100 mg m−2 and RTX 2.5 mg m−2 on day 1, and FU 900 mg m−2 and LFA 250 mg m−2 on day 2. Main severe toxicities by patients were grade 4 neutropenia (23%) and grade 3 diarrhoea (19%). In 71% (95% confidence limits, 52–86%) of patients, TRG1 (13) or TRG2 (9) was obtained. All patients are alive and recurrence-free after a median follow-up of 29 months. Combination of OXA, RTX and FU/FA with pelvic RT has an acceptable toxicity and a high clinical activity in LARC and should be studied further in patients at high risk of recurrence.
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Affiliation(s)
- A Avallone
- Department of Medical Oncology, National Tumour Institute, Naples, Italy.
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Delrio P, Avallone A, Guida C, Lastoria S, Tatangelo F, Cascini GM, Marone P, Petrillo A, Budillon A, Di Marzo M, Palaia R, Albino V, De Rosa V, Parisi V. Multidisciplinary approach to locally advanced rectal cancer: results of a single institution trial. Suppl Tumori 2005; 4:S8. [PMID: 16437871] [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: 05/06/2023]
Abstract
Locally advanced rectal cancer carries out a dismail prognosis despite optimal surgery in terms of local and distant relapses. Neoadjuvant chemoradiation offers good results with tumor downstaging and downsizing and leads to more radical surgery with conservative intent. Selection of patients and an intensive chemotherapy may improve long term results. Our experience with a combined polichemotherapy and radiotherapy for low advanced rectal cancer is presented.
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Affiliation(s)
- P Delrio
- Colorectal Cancer Cooperative Team, Istituto Nazionale dei Tumori, Napoli
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Guida C, Delrio P, Avallone A, Ravo V, Elmo M, Pecori B, Silvestro G, Di marzo M, Lastoria S, Cascini G, Tempesta A, Morrica B. High pathological response rates with a novel preoperative chemoradiaton regimen in locally advanced rectal cancer: Preliminary results and dynamic evaluation by PET. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.097] [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: 11/27/2022]
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41
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Avallone A, Delrio P, Ravo E, Marone P, Lastoria S, Petrillo A, Tatangelo F, Budillon A, Carreca I, Comella P. Neoadjuvant oxaliplatin (OXA), raltitrexed (TOM), 5- fluorouracil (FU) and folinic acid (FA) + radiotherapy followed by optimal surgery in locally advanced rectal cancer (LARC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9624] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Avallone
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - P. Delrio
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - E. Ravo
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - P. Marone
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - S. Lastoria
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - A. Petrillo
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - F. Tatangelo
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - A. Budillon
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - I. Carreca
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - P. Comella
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
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Mozzillo N, Caracò C, Chiofalo MG, Celentano E, Lastoria S, Botti G, Ascierto PA. Sentinel lymph node biopsy in patients with cutaneous melanoma: outcome after 3-year follow-up. Eur J Surg Oncol 2004; 30:440-3. [PMID: 15063899 DOI: 10.1016/j.ejso.2004.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2004] [Indexed: 11/25/2022] Open
Abstract
AIMS The management of patients with cutaneous melanoma in the absence of lymph-node metastases is still controversial. The experience of the National Cancer Institute in Naples was analysed to evaluate the 3-year disease free survival and overall survival for all patients submitted to sentinel node biopsy (SNB). METHODS Data from 265 sentinel biopsies performed in the last five years were reviewed to determine the effect of the treatment on disease free survival and overall survival stratified the patients for node status and tumour ulceration. RESULTS Statistical analysis showed a 3-year survival advantage for sentinel node negative patients compared to sentinel node positive cases with a 88.4 and 72.9%, respectively (p < 0.05). CONCLUSIONS SNB provides an accurate staging of nodal status in patients with melanoma in the absence of clinical evidence of metastases. Longer follow-up and final results from multicenter selective lymphadenectomy (MSLT) are needed to clarify the role of this procedure.
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Affiliation(s)
- N Mozzillo
- National Cancer Institute, Via M Semmola, 80131 Naples, Italy
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43
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Delrio P, Lastoria S, Avallone A, Ravo V, Guida C, Cremona F, Izzo F, Palaia R, Ruffolo F, Puppio B, Guidetti GM, Cascini GL, Casaretti R, Tatangelo F, Marone P, Rossi GB, Budillon A, Petrillo A, De Rosa V, Comella G, Morrica B, Tempesta A, Botti G, Parisi V. [Early evaluation using PET-FDG of the efficiency of neoadjuvant radiochemotherapy treatment in locally advanced neoplasia of the lower rectum]. Tumori 2003; 89:50-3. [PMID: 12903544] [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: 03/04/2023]
Abstract
BACKGROUND AND PURPOSE Preoperative chemoradiation allows downstaging of locally advanced rectal cancer and in selected patients also a sufficient downsizing to ensure sphincter preservation. Selection of patients warranting a preoperative approach is improved by magnetic resonance imaging (MRI) which is able to define the involvement of mesorectal circumferential margin. Similarly it would be crucial to define the response to chemoradiation during the treatment but traditional morphologic imaging techniques may fail in differentiating neoplastic tissue from scarring. PET-FDG has been successfully used in the detection of metastatic colorectal cancer allowing imaging of deposits as small as 0.5 cm and may have a role in evaluating early response to chemoradiation. METHODS In the present study, in patients with T3-T4 rectal cancer undergoing preoperative chemoradiation PET-FDG and flow cytometry analysis on endoscopic biopsy specimen have been performed before, during and after preoperative chemoradiation. RESULTS Chemoradiation treatment has been successful in terms of downsizing and downstaging of the tumor. PET-FDG was able to demonstrate local response at only ten-fifteen days after the beginning of neoadjuvant therapy, also identifying non responding patients. CONCLUSIONS FDG-PET may have a role in defining the response to chemoradiation and modulate the treatments strategy in patients with advanced rectal cancer.
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Affiliation(s)
- P Delrio
- Oncologia Chirurgica C, INT Fondazione G Pascale, Napoli
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Avallone A, Delrio P, Ravo V, Marone P, Palaia R, Casaretti R, Rossi GB, Guida C, Petrillo A, Budillon A, Tempesta A, Lastoria S, Morrica B, Cornelia G, Parisi V. Oxaliplatin + Raltitrexed + Fufa and Preoperative Concomitant Radiotherapy for Locally Advanced Rectal Cancer: A Phase I-ii Study. Tumori 2002. [DOI: 10.1177/030089160208800427] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Avallone
- Surgical Oncology C, Fondazione “G Pascale”, Naples, Italy
- Medical Oncology A, Fondazione “G Pascale”, Naples, Italy
| | - P Delrio
- Surgical Oncology C, Fondazione “G Pascale”, Naples, Italy
| | - V Ravo
- Radiotherapy, Fondazione “G Pascale”, Naples, Italy
| | - P Marone
- Endoscopy Unit, Fondazione “G Pascale”, Naples, Italy
| | - R Palaia
- Surgical Oncology C, Fondazione “G Pascale”, Naples, Italy
| | - R Casaretti
- Medical Oncology A, Fondazione “G Pascale”, Naples, Italy
| | - GB Rossi
- Endoscopy Unit, Fondazione “G Pascale”, Naples, Italy
| | - C Guida
- Radiotherapy, Fondazione “G Pascale”, Naples, Italy
| | - A Petrillo
- Radiology, Fondazione “G Pascale”, Naples, Italy
| | | | - A Tempesta
- Endoscopy Unit, Fondazione “G Pascale”, Naples, Italy
| | - S Lastoria
- National Cancer Institute, Fondazione “G Pascale”, Naples, Italy
| | - B Morrica
- Radiotherapy, Fondazione “G Pascale”, Naples, Italy
| | - G Cornelia
- Medical Oncology A, Fondazione “G Pascale”, Naples, Italy
| | - V Parisi
- Surgical Oncology C, Fondazione “G Pascale”, Naples, Italy
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45
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Mozzillo N, Caracò C, Ascierto PA, Botti G, Chiofalo MG, Lastoria S, Nunziata CA. [Treatment of loco-regional lymph nodes in cutaneous melanoma]. Suppl Tumori 2002; 1:S68-71. [PMID: 12415793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- N Mozzillo
- Melanoma Cooperative Group, Istituto Nazionale Tumori, Napoli
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dell'Erba L, Baldari S, Borsato N, Bruno G, Calò-Gabrieli G, Carletto M, Ciampolillo A, Dondi M, Erba P, Gerundini P, Lastoria S, Marinelli P, Santoro M, Scarano B, Zagni P, Bagnasco M, Mariani G. Retrospective analysis of the association of nodular goiter with primary and secondary hyperparathyroidism. Eur J Endocrinol 2001; 145:429-34. [PMID: 11581000 DOI: 10.1530/eje.0.1450429] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clarified. OBJECTIVE To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study. METHODS We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990-1999. A total of 487 patients in the age range 17-65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT. RESULTS A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT (P=0.0035). Thyroid disorders were evenly distributed throughout the entire 17-65 years age range in group A, but 17-40-year-old patients in group B had significantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P<0.002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1. CONCLUSIONS These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.
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Affiliation(s)
- L dell'Erba
- Nuclear Medicine Service, Di Venere Hospital, Bari, Italy
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Mozzillo N, Chiesa F, Botti G, Caracò C, Lastoria S, Giugliano G, Mazzarol G, Paganelli G, Ionna F. Sentinel node biopsy in head and neck cancer. Ann Surg Oncol 2001; 8:103S-105S. [PMID: 11599888] [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: 02/21/2023]
Abstract
The purpose of this study was to assess the value of sentinel node (SN) biopsy in oral cancer by means of a lymphoscintigraphic technique and intraoperative detection by blue-dye combined with gamma-ray probe to facilitate identification of the SN. Forty-one T1-T2N0 patients underwent lymphoscintigraphy, SN biopsy, and modified radical neck dissection. An SN was identified in 39 of 41 patients by the combined use of intraoperative blue dye and the probe and was removed. Complete neck dissections were performed and the histological evaluation compared. Thirty-eight SNs in 35 patients were negative at final pathology and correctly predicted the pathological status of the specimens from the full-neck dissections. Five SNs in four patients had micrometastases and were the only metastatic nodes identified. The results of this study on a homogenous series of patients show that SN biopsy is a valuable staging technique in T1 and T2 oral cancer with uninvolved neck, provided that no previous surgery or radiotherapy has altered lymphatic drainage in the oral cavity or in the neck. In a large number of patients, SN biopsy can avoid unnecessary neck dissection and its relevant morphofunctional sequelae.
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Affiliation(s)
- N Mozzillo
- National Cancer Institute, Naples, Italy
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Colao A, Dorato M, Pulcrano M, Rossi FW, Auriemma RS, Lombardi G, Lastoria S. [Somatostatin analogs in the clinical management of pituitary neoplasms]. MINERVA ENDOCRINOL 2001; 26:181-91. [PMID: 11753242] [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: 02/23/2023]
Abstract
The medical approach to patients with secreting or clinically non-functioning pituitary adenoma as made considerable progress thanks to the use of new somatostatin analogs. They were first used to treat acromegaly in the mid 1980s and numerous studies have shown a reduction in GH concentration in over 90% of acromegalic patients. Good results were obtained using slow-release analog treatment also in TSH-secreting adenomas, whereas the therapeutic efficacy of these peptides in clinically non-functioning adenomas is still controversial. Treatment with somatostatin analogs improves symptoms, normalises hormone secretion and in some cases may induce a reduction in the volume of pituitary adenomas. Scintigraphy with octreotide may help to select patients who respond to this form of treatment.
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Affiliation(s)
- A Colao
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università degli Studi Federico II, Naples, Italy.
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Palmieri G, Montella L, Lastoria S. [Thymoma and somatostatin analogs. Biology, diagnostic and clinical practice]. MINERVA ENDOCRINOL 2001; 26:193-5. [PMID: 11753243] [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: 02/23/2023]
Abstract
Thymic tumours are rare neoplasms which generally follow a slow pattern of growth, showing their aggressiveness locally through the infiltration of adjacent organs and they rarely metastasise hematogenically. In the presence of locally advanced, metastatic or inoperable disease, combined strategies including chemotherapy, radiotherapy and surgery are now being evaluated. Scintigraphy with 111In DTPA-D-Phe 1 octreotide was used for the first time in a relevant series of patients with thymic tumour (13 cases) by our research group. The presence of somatostatin receptors (ss-R) assayed in vivo provided the rationale for the use of a treatment based on the octreotide analog in a patient with thymoma and aplasia of the erythroid series (pure red cell aplasia, PRCA) in whom a complete response for the tumour and the remission of anemia was obtained. The efficacy of this treatment was confirmed by our series of patients with chemoresistant thymic tumour and by national and international confirmations. These data, ranging from in vivo diagnosis to treatment and the in vitro study of receptor expression, confirm that somatostatin plays a major role in thymic tumours.
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Affiliation(s)
- G Palmieri
- Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica, Università degli Studi Federico II, Naples, Italy
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50
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Ferone D, Pivonello R, Lastoria S, Faggiano A, Del Basso de Caro ML, Cappabianca P, Lombardi G, Colao A. In vivo and in vitro effects of octreotide, quinagolide and cabergoline in four hyperprolactinaemic acromegalics: correlation with somatostatin and dopamine D2 receptor scintigraphy. Clin Endocrinol (Oxf) 2001; 54:469-77. [PMID: 11318782 DOI: 10.1046/j.1365-2265.2001.01080.x] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE GH and PRL cosecretion frequently occurs in acromegaly and the sensitivity of both hormones to somatostatin analogs (SA) and dopamine agonists (DA) alone or in combination, is still debated. This study was designed to evaluate the in vivo and in vitro sensitivity to SA and/or DA and correlate the response in terms of hormone suppression to the results of in vivo somatostatin and dopamine receptor scintigraphy and to the immunohistochemical findings. DESIGN AND PATIENTS Scintigraphy using 111In-DTPA-D-Phe(1)-OCT (111In-OCT) and 123I-methoxybenzamide (123I-IBZM) was performed in four patients with acromegaly and high circulating GH, PRL and IGF-I levels. The results were correlated with the response to long-term treatment with octreotide (OCT), quinagolide (QN) and/or cabergoline (CAB), to the in vitro hormone suppression by OCT and DA in primary cultures from the pituitary tumors and to the immunohistochemical findings. RESULTS The first patient showed high tumour uptake of 111In-OCT and 123I-IBZM, the second high uptake of only 111In-OCT, while the third one showed faint tumour uptake of only 123I-IBZM, and the fourth a faint uptake of 111In-OCT. In the first and in the fourth patients OCT or CAB administered alone failed to normalize hormone levels while the combined treatment induced circulating GH, IGF-I and PRL normalization. In the second patient OCT administered alone normalized hormone levels while QN reduced PRL levels only. In the third patient both OCT and QN, alone or in combination, failed to normalize hormone levels. However, in this patient GH and PRL suppression was significantly greater after QN than OCT treatment. After medical therapy, all the patients were operated on. Immunohistochemistry showed diffuse GH and focal PRL staining in the first patient, while diffuse GH and PRL staining in the remaining three. In vitro, OCT significantly suppressed GH secretion in the four primary pituitary tumor cultures, while PRL secretion was significantly suppressed only in the second and the fourth cases. Dopamine agonists (DA) significantly suppressed PRL release in all the cultures, while GH secretion was significantly suppressed in three out of four. CONCLUSIONS These four acromegalics, presenting similar clinical findings and comparable peripheral hormone levels, showed different responsiveness to SA and DA. Moreover, during the in vitro study on primary tumor cell cultures, OCT and DA displayed an inhibiting activity on GH and PRL secretion positively correlated with the response observed in vivo. This evidence together with the in vivo receptor imaging study suggest the existence of somatostatin and/or dopamine D2 receptor heterogeneity in this class of pituitary tumors. The new potent DA might be primarily considered in the medical treatment of hyperprolactinemic acromegalics, while SA alone or in combination with DA in case of ineffective hormone suppression.
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Affiliation(s)
- D Ferone
- Department of Molecular and Clinical Endocrinology, Federico II, University of Naples, Italy
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