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Brandes AA, Finocchiaro G, Zagonel V, Reni M, Caserta C, Fabi A, Clavarezza M, Maiello E, Eoli M, Lombardi G, Monteforte M, Proietti E, Agati R, Eusebi V, Franceschi E. AVAREG: a phase II, randomized, noncomparative study of fotemustine or bevacizumab for patients with recurrent glioblastoma. Neuro Oncol 2016; 18:1304-12. [PMID: 26951379 DOI: 10.1093/neuonc/now035] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few prospective studies have assessed the role of bevacizumab and included a control arm with standard treatments for recurrent glioblastoma. We conducted a noncomparative phase II trial (AVAREG) to examine the efficacy of bevacizumab or fotemustine in this setting. METHODS Eligible patients were randomized 2:1 to receive bevacizumab (10 mg/kg every 2 weeks) or fotemustine (75 mg/m(2) on days 1, 8, and 15, then 100 mg/m(2) every 3 weeks after a 35-day interval). The primary endpoint was 6-month overall survival (OS) rate (OS-6). No formal efficacy comparison was made between the treatment arms. RESULTS Ninety-one patients were enrolled (bevacizumab n = 59; fotemustine n = 32). Median age was 57 years (range, 28-78 y), and patients had Eastern Cooperative Oncology Group performance status of 0 (n = 42), 1 (n = 35), or 2 (n = 14). OS-6 rate was 62.1% (95% confidence interval [CI], 48.4-74.5) with bevacizumab and 73.3% (95% CI, 54.1-87.7) with fotemustine. OS-6 rates were lower in bevacizumab-treated patients with MGMT promoter methylated tumors than in those with unmethylated tumors (50% and 85%, respectively), but higher in fotemustine-treated patients (87.5% and 50%, respectively). OS rates at 9 months were 37.9% (95% CI, 25.5-51.6) and 46.7% (95% CI, 28.3-65.7) with bevacizumab and fotemustine, respectively, and median OS was 7.3 months (95% CI, 5.8-9.2) and 8.7 months (95% CI, 6.3-15.4), respectively. Toxicity was as expected with the 2 agents. CONCLUSION Single-agent bevacizumab may have a role in patients with recurrent glioblastoma.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Gaetano Finocchiaro
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Vittorina Zagonel
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Michele Reni
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Claudia Caserta
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Alessandra Fabi
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Matteo Clavarezza
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Evaristo Maiello
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Marica Eoli
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Giuseppe Lombardi
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Marta Monteforte
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Emanuela Proietti
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Raffaele Agati
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Vincenzo Eusebi
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
| | - Enrico Franceschi
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy (A.A.B., E.F.); Molecular Neuro-Oncology Unit, IRCCS Foundation Carlo Besta, Milan, Italy (G.F., M.E.); Department of Clinical and Experimental Oncology, Medical Oncology, Veneto Institute of Oncology- IRCCS Padua, Italy (V.Z., G.L.); Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy (M.R.); Oncology Department, Santa Maria Hospital, Terni, Italy (C.C.); Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy (A.F.); E.O. Ospedale Galliera, Genova, Italy (M.C.); Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.M.); OPIS, Palazzo Aliprandi, Desio MB, Italy (M.M.); Roche S.p.A. Medical Affairs and CO, Monza, Italy (E.P.); Neuroradiology Department, Bellaria-Maggiore Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Ospedale Bellaria, Bologna, Italy (R.A.); Department of Biomedical and Neuromotor Science, University of Bologna, Section of Anatomic Pathology M. Malpighi-Bellaria Hospital, Bologna, Italy (V.E.)
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Brandes AA, Franceschi E, Ermani M, Tosoni A, Albani F, Depenni R, Faedi M, Pisanello A, Crisi G, Urbini B, Dazzi C, Cavanna L, Mucciarini C, Pasini G, Bartolini S, Marucci G, Morandi L, Zunarelli E, Cerasoli S, Gardini G, Lanza G, Silini EM, Cavuto S, Baruzzi A, Baruzzi A, Albani F, Calbucci F, D'Alessandro R, Michelucci R, Brandes A, Eusebi V, Ceruti S, Fainardi E, Tamarozzi R, Emiliani E, Cavallo M, Franceschi E, Tosoni A, Cavallo M, Fiorica F, Valentini A, Depenni R, Mucciarini C, Crisi G, Sasso E, Biasini C, Cavanna L, Guidetti D, Marcello N, Pisanello A, Cremonini AM, Guiducci G, de Pasqua S, Testoni S, Agati R, Ambrosetto G, Bacci A, Baldin E, Baldrati A, Barbieri E, Bartolini S, Bellavista E, Bisulli F, Bonora E, Bunkheila F, Carelli V, Crisci M, Dall'Occa P, de Biase D, Ferro S, Franceschi C, Frezza G, Grasso V, Leonardi M, Marucci G, Mazzocchi V, Morandi L, Mostacci B, Palandri G, Pasini E, Pastore Trossello M, Pession A, Ragazzi M, Riguzzi P, Rinaldi R, Rizzi S, Romeo G, Spagnolli F, Tinuper P, Trocino C, Cerasoli S, Dall'Agata M, Faedi M, Frattarelli M, Gentili G, Giovannini A, Iorio P, Pasquini U, Galletti G, Guidi C, Neri W, Patuelli A, Strumia S, Casmiro M, Gamboni A, Rasi F, Cruciani G, Cenni P, Dazzi C, Guidi A, Zumaglini F, Amadori A, Pasini G, Pasquinelli M, Pasquini E, Polselli A, Ravasio A, Viti B, Sintini M, Ariatti A, Bertolini F, Bigliardi G, Carpeggiani P, Cavalleri F, Meletti S, Nichelli P, Pettorelli E, Pinna G, Zunarelli E, Artioli F, Bernardini I, Costa M, Greco G, Guerzoni R, Stucchi C, Iaccarino C, Rizzi R, Zuccoli G, Api P, Cartei F, Fallica E, Granieri E, Latini F, Lelli G, Monetti C, Ramponi V, Saletti A, Schivalocchi R, Seraceni S, Tola MR, Urbini B, Giorgi C, Montanari E, Cerasti D, Crafa P, Dascola I, Florindo I, Mazza S, Servadei F, Silini E, Torelli P, Immovilli P, Morelli N, Vanzo C. Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center? Neurooncol Pract 2014; 1:166-171. [PMID: 26034628 PMCID: PMC4369716 DOI: 10.1093/nop/npu021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Enrico Franceschi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Mario Ermani
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Alicia Tosoni
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Fiorenzo Albani
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Roberta Depenni
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Marina Faedi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Anna Pisanello
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Girolamo Crisi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Benedetta Urbini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Claudio Dazzi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Luigi Cavanna
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Claudia Mucciarini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Giuseppe Pasini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Stefania Bartolini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Gianluca Marucci
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Luca Morandi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Elena Zunarelli
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Serenella Cerasoli
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Giorgio Gardini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Giovanni Lanza
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Enrico Maria Silini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Silvio Cavuto
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Agostino Baruzzi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
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