1
|
Conte B, Boni L, Bisagni G, Durando A, Sanna G, Gori S, Garrone O, Tamberi S, De Placido S, Schettini F, Pazzola A, Ponzone R, Montemurro F, Lunardi G, Notaro R, De Angioletti M, Turletti A, Mansutti M, Puglisi F, Frassoldati A, Porpiglia M, Fabi A, Generali D, Scognamiglio G, Rossi M, Brasó-Maristany F, Prat A, Cardinali B, Piccioli P, Serra M, Lastraioli S, Bighin C, Poggio F, Lambertini M, Del Mastro L. SNP of Aromatase Predict Long-term Survival and Aromatase Inhibitor Toxicity in Patients with Early Breast Cancer: A Biomarker Analysis of the GIM4 and GIM5 Trials. Clin Cancer Res 2023; 29:5217-5226. [PMID: 37888299 PMCID: PMC10722129 DOI: 10.1158/1078-0432.ccr-23-1568] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE In estrogen receptor-positive (ER+) breast cancer, single-nucleotide polymorphisms (SNP) in the aromatase gene might affect aromatase inhibitors (AI) metabolism and efficacy. Here, we assessed the impact of SNP on prognosis and toxicity of patients receiving adjuvant letrozole. EXPERIMENTAL DESIGN We enrolled 886 postmenopausal patients in the study. They were treated with letrozole for 2 to 5 years after taking tamoxifen for 2 to 6 years, continuing until they completed 5 to 10 years of therapy. Germline DNA was genotyped for SNP rs4646, rs10046, rs749292, and rs727479. Log-rank test and Cox model were used for disease-free survival (DFS) and overall survival (OS). Cumulative incidence (CI) of breast cancer metastasis was assessed through competing risk analysis, with contralateral breast cancer, second malignancies and non-breast cancer death as competing events. CI of skeletal and cardiovascular events were assessed using DFS events as competing events. Subdistribution HR (sHR) with 95% confidence intervals were calculated through Fine-Gray method. RESULTS No SNP was associated with DFS. Variants rs10046 [sHR 2.03, (1.04-2.94)], rs749292 [sHR 2.11, (1.12-3.94)], and rs727479 [sHR 2.62, (1.17-5.83)] were associated with breast cancer metastasis. Three groups were identified on the basis of the number of these variants (0, 1, >1). Variant-based groups were associated with breast cancer metastasis (10-year CI 2.5%, 7.6%, 10.7%, P = 0.035) and OS (10-year estimates 96.5%, 93.0%, 89.6%, P = 0.030). Co-occurrence of rs10046 and rs749292 was negatively associated with 10-year CI of skeletal events (3.2% vs. 10%, P = 0.033). A similar association emerged between rs727479 and cardiovascular events (0.3% vs. 2.1%, P = 0.026). CONCLUSIONS SNP of aromatase gene predict risk of metastasis and AI-related toxicity in ER+ early breast cancer, opening an opportunity for better treatment individualization.
Collapse
Affiliation(s)
- Benedetta Conte
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Luca Boni
- S.C. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giancarlo Bisagni
- Azienda unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Durando
- Breast Unit Ospedale S Anna, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria – Sassari, Sassari, Italy
| | - Stefania Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Ornella Garrone
- Breast Unit, AO S. Croce e Carle Ospedale di insegnamento, Cuneo, Italy
- Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Milano
| | | | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain
| | | | - Riccardo Ponzone
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo, Italy
| | - Filippo Montemurro
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo, Italy
| | - Gianluigi Lunardi
- Laboratorio Analisi Chimico-Cliniche, IRCCS-Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Maria De Angioletti
- Core Research Laboratory-ISPRO, Firenze, Italy
- National Research Council (CNR) - ICCOM, Firenze, Italy
| | | | - Mauro Mansutti
- Department of Oncology, ASUFC Santa Maria della Misericordia, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Depatment of Medical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Antonio Frassoldati
- Department of Morphology, Surgery and Experimental medicine, Clinical Oncology, St. Anna University Hospital, Ferrara, Italy
| | - Mauro Porpiglia
- Breast Unit Ospedale S. Anna, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Fabi
- Medical Oncology, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Daniele Generali
- Medical Oncology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Maura Rossi
- SOC Oncologia, ASO SS.Antonio e Biagio, Alessandria, Italy
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
- Reveal Genomics, Barcelona, Spain
- Institute of Oncology (IOB)-Hospital Quirónsalud, Barcelona, Spain
| | - Barbara Cardinali
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Patrizia Piccioli
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Martina Serra
- Laboratory of Clinical and Experimental Immunology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sonia Lastraioli
- Molecular Diagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology Department 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Medical Oncology Department 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| |
Collapse
|
2
|
Gentilini OD, Botteri E, Sangalli C, Galimberti V, Porpiglia M, Agresti R, Luini A, Viale G, Cassano E, Peradze N, Toesca A, Massari G, Sacchini V, Munzone E, Leonardi MC, Cattadori F, Di Micco R, Esposito E, Sgarella A, Cattaneo S, Busani M, Dessena M, Bianchi A, Cretella E, Ripoll Orts F, Mueller M, Tinterri C, Chahuan Manzur BJ, Benedetto C, Veronesi P. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol 2023; 9:1557-1564. [PMID: 37733364 PMCID: PMC10514873 DOI: 10.1001/jamaoncol.2023.3759] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/29/2023] [Indexed: 09/22/2023]
Abstract
Importance Sentinel lymph node biopsy (SLNB) is the standard of care for axillary node staging of patients with early breast cancer (BC), but its necessity can be questioned since surgery for examination of axillary nodes is not performed with curative intent. Objective To determine whether the omission of axillary surgery is noninferior to SLNB in patients with small BC and a negative result on preoperative axillary lymph node ultrasonography. Design, Setting, and Participants The SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound) trial was a prospective noninferiority phase 3 randomized clinical trial conducted in Italy, Switzerland, Spain, and Chile. A total of 1463 women of any age with BC up to 2 cm and a negative preoperative axillary ultrasonography result were enrolled and randomized between February 6, 2012, and June 30, 2017. Of those, 1405 were included in the intention-to-treat analysis. Data were analyzed from October 10, 2022, to January 13, 2023. Intervention Eligible patients were randomized on a 1:1 ratio to receive SLNB (SLNB group) or no axillary surgery (no axillary surgery group). Main Outcomes and Measures The primary end point of the study was distant disease-free survival (DDFS) at 5 years, analyzed as intention to treat. Secondary end points were the cumulative incidence of distant recurrences, the cumulative incidence of axillary recurrences, DFS, overall survival (OS), and the adjuvant treatment recommendations. Results Among 1405 women (median [IQR] age, 60 [52-68] years) included in the intention-to-treat analysis, 708 were randomized to the SLNB group, and 697 were randomized to the no axillary surgery group. Overall, the median (IQR) tumor size was 1.1 (0.8-1.5) cm, and 1234 patients (87.8%) had estrogen receptor-positive ERBB2 (formerly HER2 or HER2/neu), nonoverexpressing BC. In the SLNB group, 97 patients (13.7%) had positive axillary nodes. The median (IQR) follow-up for disease assessment was 5.7 (5.0-6.8) years in the SLNB group and 5.7 (5.0-6.6) years in the no axillary surgery group. Five-year distant DDFS was 97.7% in the SLNB group and 98.0% in the no axillary surgery group (log-rank P = .67; hazard ratio, 0.84; 90% CI, 0.45-1.54; noninferiority P = .02). A total of 12 (1.7%) locoregional relapses, 13 (1.8%) distant metastases, and 21 (3.0%) deaths were observed in the SLNB group, and 11 (1.6%) locoregional relapses, 14 (2.0%) distant metastases, and 18 (2.6%) deaths were observed in the no axillary surgery group. Conclusions and Relevance In this randomized clinical trial, omission of axillary surgery was noninferior to SLNB in patients with small BC and a negative result on ultrasonography of the axillary lymph nodes. These results suggest that patients with these features can be safely spared any axillary surgery whenever the lack of pathological information does not affect the postoperative treatment plan. Trial Registration ClinicalTrials.gov Identifier: NCT02167490.
Collapse
Affiliation(s)
- Oreste Davide Gentilini
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Breast Surgery Unit, San Raffaele Scientific and Research Hospital, Milan, Italy
| | - Edoardo Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Claudia Sangalli
- Clinical Trial Office, European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mauro Porpiglia
- Department of Surgical Sciences Gynecology and Obstetrics, City of Health and Science of Turin, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Roberto Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Luini
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
- Oncology and Oncohematology Department, University of Milan, Milan, Italy
| | - Enrico Cassano
- Division of Breast Imaging, European Institute of Oncology IRCCS, Milan, Italy
| | - Nickolas Peradze
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Massari
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Virgilio Sacchini
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Oncology and Oncohematology Department, University of Milan, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Rosa Di Micco
- Breast Surgery Unit, San Raffaele Scientific and Research Hospital, Milan, Italy
| | - Emanuela Esposito
- Struttura Complessa (SC) di Chirurgia Oncologica di Senologia, Istituto Nazionale Tumori Napoli, IRCCS, Fondazione Pascale, Naples, Italy
| | - Adele Sgarella
- Breast Center, Department of Surgical Sciences, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Silvia Cattaneo
- Department of General Surgery, Sant’Anna Hospital, Como, Italy
| | - Massimo Busani
- Struttura Semplice Dipartimentale di Chirurgia Senologica Azienda Socio-Sanitaria Territoriale (ASST), Mantova, Italy
| | - Massimo Dessena
- SC di Chirurgia Oncologica e Senologia, Ospedale Oncologico, Azienda Ospedaliera Brotzu, Selargius, Cagliari, Italy
| | - Anna Bianchi
- Breast Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Elisabetta Cretella
- Medical Oncology Division, Azienda Sanitaria dell’Alto Adige, Bolzano, Italy
| | | | - Michael Mueller
- Frauenklinik Inselpital Hospital, Theodor-Kocher-Haus, Bern, Switzerland
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences Gynecology and Obstetrics, City of Health and Science of Turin, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Oncology and Oncohematology Department, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Porpiglia M, Borella F, Chieppa P, Brino C, Ala A, Marra V, Castellano I, Benedetto C. Carbon tattooing of axillary lymph nodes in breast cancer patients before neoadjuvant chemotherapy: A retrospective analysis. Tumori 2022:3008916221107712. [PMID: 35751383 DOI: 10.1177/03008916221107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to investigate the feasibility and accuracy of tattooing suspicious axillary lymph nodes with carbon suspension at the time of breast cancer (BC) diagnosis and the intraoperative correspondence between tattooed lymph node (TLN) and sentinel lymph node (SLN) in patients who underwent neoadjuvant chemotherapy (NACT). METHODS In this retrospective study, we analyzed consecutive BC patients who underwent NACT, between April 2019 and May 2021, at the Breast Unit of Sant'Anna Hospital in Turin, Italy. Before NACT, all suspicious biopsied lymph nodes were marked with carbon suspension. All SLNs, TLNs, and axillary nodal dissection specimens were sent for histopathological examination. RESULTS The study group included a total of 49 patients with BC. The overall identification rate of TLNs was 83.7% (41/49; 95%, confidence interval - CI 0.70-0.92). In patients who underwent target axillary dissection (TAD) the carbon tattooing had an intraoperative identification rate of 84.4% (27/32; 95% CI 0.67-0.95) while, in the case of axillary lymph node dissection, TLNs were detected in 82.3% (14/17; 95% CI 0.56-0.96) of patients. The correlation between TLN and SLN was 71.8% (23/32). CONCLUSIONS These results confirmed that tattooing axillary lymph nodes has an acceptable identification rate. We also confirmed that this procedure, in addition to SLN biopsy, improves the accuracy of surgical axillary staging.
Collapse
Affiliation(s)
- Mauro Porpiglia
- Department of Surgical Sciences, Gynecology and Obstetrics 1, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy.,Breast Unit, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| | - Fulvio Borella
- Department of Surgical Sciences, Gynecology and Obstetrics 1, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy.,Breast Unit, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| | - Pierluigi Chieppa
- Department of Surgical Sciences, Gynecology and Obstetrics 1, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| | - Carola Brino
- Department of Surgical Sciences, Gynecology and Obstetrics 1, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| | - Ada Ala
- Department of Surgery, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| | - Vincenzo Marra
- Department of Radiology, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| | - Isabella Castellano
- Department of Medical Sciences, Pathology Unit, University of Turin, A.O.U. City of Health and Science of Turin, Turin, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Gynecology and Obstetrics 1, A.O.U. City of Health and Science of Turin, S. Anna Hospital, Turin, Italy
| |
Collapse
|
4
|
Cazzaniga ME, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Airoldi M, Moretti G, Ficorella C, Gianni L, Michelotti A, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi GV, Artale S, Blasi L, De Laurentiis M, Atzori F, Turletti A, Porpiglia M, Santini D, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Giordano M, Donadio M, Biganzoli L, Del Mastro L, Bisagni G, Livi L, Natoli C, Montemurro F, Riccardi F, Romagnoli E, Marchetti P, Torri V, Pronzato P, Mustacchi G. Is There Still a Role for Endocrine Therapy Alone in HR+/HER2- Advanced Breast Cancer Patients? Results from the Analysis of Two Data Sets of Patients Treated with High-Dose Fulvestrant as First-Line Therapy in the Real-World Setting: The EVA and GIM-13 AMBRA Studies. Breast Care (Basel) 2020; 15:30-37. [PMID: 32231495 DOI: 10.1159/000495469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background Different studies suggest that fulvestrant 500 mg every 28 days (HD-FUL) could be an active treatment in HR+ advanced breast cancer (ABC) patients even treated with aromatase inhibitors in the adjuvant setting. The aim of this analysis is to describe the outcome of ABC patients treated with HD-FUL as first-line treatment in terms of median duration of treatment and the overall response rate in a real-world setting. Methods For the purpose of the present analysis, we considered two data sets of HR+ ABC patients collected in Italy between 2012 and 2015 (EVA and GIM-13 AMBRA studies). Results Eighty-one and 91 patients have been identified from the two data sets. The median age was 63 years (range 35-82) for the EVA and 57.8 years (range 35.0-82.3) for the AMBRA patients. ORRs were 23.5 and 24.3% in the whole population, 26.9% in the patients with bone only, and 21.8 and 21.4% in those with visceral metastases. The median duration of HD-FUL was 11.6 months (range 1-48) and 12.4 months (range 2.9-70.0) in the two data sets, respectively. Conclusion These data suggest that HD-FUL should still continue to play a significant role as first-line therapy in HR+ ABC patients.
Collapse
Affiliation(s)
- Marina Elena Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Mario Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | - Andrea Michelotti
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone, Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | | | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | | | | | | | - Mauro Porpiglia
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Alessandra Fabi
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | | | - Alessio Schirone
- Oncology Department, Policlinico "Paolo Giaccone", Palermo, Italy
| | - Raffaella Palumbo
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Ferzi
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Antonio Frassoldati
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Luca Clivio
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Michela Donadio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | | | - Giancarlo Bisagni
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Lorenzo Livi
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Clara Natoli
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | | | | | - Emanuela Romagnoli
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | - Paolo Marchetti
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valter Torri
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Pronzato
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | | |
Collapse
|
5
|
Arisio R, Borella F, Porpiglia M, Durando A, Bellino R, Bau MG, DE Sanctis C, Danese S, Benedetto C, Katsaros D. Axillary Dissection vs. no Axillary Dissection in Breast Cancer Patients With Positive Sentinel Lymph Node: A Single Institution Experience. In Vivo 2020; 33:1941-1947. [PMID: 31662523 DOI: 10.21873/invivo.11689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Axillary surgery of breast cancer patients is undergoing a paradigm shift, as axillary lymph node dissection's (ALND) usefulness is being questioned in the treatment of patients with tumor-positive sentinel lymph node biopsy (SLNB). The aim of this study was to investigate the overall survival (OS) and relapse-free survival (RFS) of patients with positive SLNB treated with ALND or not. PATIENTS AND METHODS We investigated 617 consecutive patients with cN0 operable breast cancer with positive SLNB undergoing mastectomy or conservative surgery. A total of 406 patients underwent ALND and 211 were managed expectantly. RESULTS No significant difference in OS and RFS was found between the two groups. The incidence of loco-regional recurrence in the SLNB-only group and the ALND group was low and not significant. CONCLUSION The type of breast cancer surgery and the omission of ALND does not improve OS or RSF rate in cases with metastatic SLN.
Collapse
Affiliation(s)
- Riccardo Arisio
- Department of Surgical Sciences, Sant'Anna Hospital, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Porpiglia
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy.,Breast Unit, Sant'Anna Hospital, Turin, Italy
| | - Antonio Durando
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 2, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Roberto Bellino
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 2, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria Grazia Bau
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 3, Sant'Anna Hospital, Turin, Italy
| | - Corrado DE Sanctis
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 3, Sant'Anna Hospital, Turin, Italy
| | - Saverio Danese
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 4, Sant'Anna Hospital, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Dionyssios Katsaros
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy .,Breast Unit, Sant'Anna Hospital, Turin, Italy
| |
Collapse
|
6
|
Cazzaniga ME, Airoldi M, Arcangeli V, Artale S, Atzori F, Ballerio A, Bianchi GV, Blasi L, Campidoglio S, Ciccarese M, Cursano MC, Piezzo M, Fabi A, Ferrari L, Ferzi A, Ficorella C, Frassoldati A, Fumagalli A, Garrone O, Gebbia V, Generali D, La Verde N, Maur M, Michelotti A, Moretti G, Musolino A, Palumbo R, Pistelli M, Porpiglia M, Sartori D, Scavelli C, Schirone A, Turletti A, Valerio MR, Vici P, Zambelli A, Clivio L, Torri V. Efficacy and safety of Everolimus and Exemestane in hormone-receptor positive (HR+) human-epidermal-growth-factor negative (HER2-) advanced breast cancer patients: New insights beyond clinical trials. The EVA study. Breast 2017; 35:115-121. [PMID: 28711793 DOI: 10.1016/j.breast.2017.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The BOLERO-2 trial reported efficacy and safety of Everolimus (EVE) and Exemestane (EXE) combination in HR+ advanced breast cancer (ABC) patients. The BALLET trial further evaluated the safety of EVE-EXE in HR+ ABC patients, without reporting efficacy data. Aim of the EVA real-life study was to collect data of efficacy and safety of EVE-EXE combination in the clinical setting, as well as exploring efficacy according to EVE Dose-Intensity (DI) and to previous treatment with Fulvestrant. PATIENTS AND METHODS This study aimed to describe the outcome of ABC pts treated with EVE-EXE combination in terms of median duration of EVE treatment and ORR in a real-life setting. RESULTS From July 2013 to December 2015, the EVA study enrolled 404 pts. Median age was 61 years (33-83). Main metastatic sites were: bone (69.1%), soft tissue (34.7%) and viscera (33.2%). Median number of previous treatments was 2 (1-7). 43.3% of the pts had received Fulvestrant. Median exposure to EVE was 31.0 weeks (15.4-58.3) in the whole population. No difference was observed in terms of EVE exposure duration according to DI (p for trend = 0.27) or type of previous treatments (p = 0.33). ORR and Disease Control Rate (DCR) were observed in 31.6% and 60.7% of the patients, respectively, with the lowest ORRs confined in CHT pre-treated patients or in those who received the lowest DI of EVE. Grade 3-4 adverse events (AEs) were reported in 37.9% of the patients. Main AEs were: stomatitis (11.2%), non-infectious pneumonitis - NIP (3.8%), anaemia (3.8%) and fatigue (3.2%). CONCLUSIONS The EVA study provided new insights in the use of EVE-EVE combination in HR+ ABC pts many years after the publication of the pivotal trial. The combination is safe and the best response could be obtained in patients receiving the full dose of EVE and/or after hormone-therapy as Fulvestrant in ABC.
Collapse
Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Monza, Italy.
| | - M Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Torino, Italy
| | - V Arcangeli
- Oncology Unit Rimini Azienda USL Romagna, Rimini, Italy
| | - S Artale
- Oncology Department, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - F Atzori
- Oncology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - A Ballerio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | - G V Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - S Campidoglio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale "Vito Fazzi" di Lecce, Lecce, Italy
| | - M C Cursano
- Oncology Unit, Università Campus Bio-Medico, Roma, Italy
| | - M Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - A Fabi
- Oncology Unit 1, Istituto Regina Elena - IFO, Roma, Italy
| | - L Ferrari
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Italy
| | - A Ferzi
- Oncology Unit, ASST OVEST Milanese - Presidio di Legnano, Legnano, Italy
| | - C Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - A Frassoldati
- Oncology Unit, Az Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - A Fumagalli
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - O Garrone
- Oncology Unit, A.O. S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - V Gebbia
- Oncology Unit, Osp. La Maddalena, Palermo, Italy
| | | | - N La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - M Maur
- Oncology and Haematology Department, A.O.U Policlinico di Modena, Modena, Italy
| | - A Michelotti
- Oncology Unit I, Ospedale S. Chiara, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - A Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - R Palumbo
- Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
| | - M Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy
| | - M Porpiglia
- Oncology Unit, Presidio Ospedaliero S. Anna, Torino, Italy
| | - D Sartori
- Oncology Unit, AULSS 3, Mirano, Italy
| | - C Scavelli
- Oncology Unit, Ospedale "S. Cuore di Gesù", Gallipoli, Italy
| | - A Schirone
- Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Turletti
- Oncology Unit, Ospedale Martini della ASL "Città di Torino", Torino, Italy
| | - M R Valerio
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - P Vici
- Oncology Unit, Istituto Nazionale Tumori Regina Elena - IFO, Roma, Italy
| | - A Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Clivio
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - V Torri
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | | | | |
Collapse
|
7
|
Picardo E, Mitidieri M, Gribaudo S, Marozio L, Richetto V, Arisio R, Benedetto C, Porpiglia M. Endocrine and radio-therapy during pregnancy in breast cancer patient: a case report. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.112] [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]
|
8
|
Sini V, Lunardi G, Cirillo M, Turazza M, Bighin C, Giraudi S, Levaggi A, Piccioli P, Bisagni G, Gnoni R, Stridi G, Porpiglia M, Picardo E, Ponzone R, Marenco D, Mansutti M, Puglisi F, Del Mastro L. Body mass index and circulating oestrone sulphate in women treated with adjuvant letrozole. Br J Cancer 2014; 110:1133-8. [PMID: 24448359 PMCID: PMC3950872 DOI: 10.1038/bjc.2014.2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity is an independent adverse prognostic factor in early breast cancer patients, but it is still controversial whether obesity may affect adjuvant endocrine therapy efficacy. The aim of our study (ancillary to the two clinical trials Gruppo Italiano Mammella (GIM)4 and GIM5) was to investigate whether the circulating oestrogen levels during treatment with the aromatase inhibitor letrozole are related to body mass index (BMI) in postmenopausal women with breast cancer. METHODS Plasma concentration of oestrone sulphate (ES) was evaluated by radioimmunoassay in 370 patients. Plasma samples were obtained after at least 6 weeks of letrozole therapy (steady-state time). Patients were divided into four groups according to BMI. Differences among the geometric means (by ANOVA and ANCOVA) and correlation (by Spearman's rho) between the ES levels and BMI were assessed. RESULTS Picomolar geometric mean values (95% confidence interval, n=patients) of circulating ES during letrozole were 58.6 (51.0-67.2, n=150) when BMI was <25.0 kg m(-2); 65.6 (57.8-74.6, n=154) when 25.0-29.9 kg m(-2); 59.3 (47.1-74.6, n=50) when 30.0-34.9 kg m(-2); and 43.3 (23.0-81.7, n=16) when ≥35.0 kg m(-2). No statistically significant difference in terms of ES levels among groups and no correlation with BMI were observed. CONCLUSIONS Body mass index does not seem to affect circulating oestrogen levels in letrozole-treated patients.
Collapse
Affiliation(s)
- V Sini
- 1] Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy [2] Oncology Unit, Surgical and Medical Department of Clinical Sciences, Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - G Lunardi
- Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy
| | - M Cirillo
- Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy
| | - M Turazza
- Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Via Sempreboni, 5, 37024 Negrar (Verona), Italy
| | - C Bighin
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - S Giraudi
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - A Levaggi
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - P Piccioli
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| | - G Bisagni
- Department of Oncology, Azienda Ospedaliera ASMN, viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - R Gnoni
- Department of Oncology, Azienda Ospedaliera ASMN, viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - G Stridi
- Department of Oncology, Azienda Ospedaliera ASMN, viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - M Porpiglia
- University Department of Gynecology and Obstetrics, S.Anna Hospital, Corso Spezia, 60, 10126 Turin, Italy
| | - E Picardo
- University Department of Gynecology and Obstetrics, S.Anna Hospital, Corso Spezia, 60, 10126 Turin, Italy
| | - R Ponzone
- Gynecological Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, 10060 Candiolo (Turin), Italy
| | - D Marenco
- 1] Gynecological Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, 10060 Candiolo (Turin), Italy [2] Gynecology and Obstetrics, Santa Croce Hospital, Piazza Amedeo Ferdinando, 3, 10024 Moncalieri (Turin), Italy
| | - M Mansutti
- Oncology Department, University Hospital of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - F Puglisi
- Oncology Department, University Hospital of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - L Del Mastro
- Medical Oncology Department, IRCSS AOU San Martino, IST, L.go R. Benzi, 10, 16132 Genoa, Italy
| |
Collapse
|
9
|
Gribaudo S, De Sanctis C, Durando A, Katsaros D, Porpiglia M, Richetto V, Madon E, Monetti U, Danese S. PO-1001: Ipsilateral Breast Tumour Recurrence (IBTR): Second conservative treatment with Interstitial HDR BRT. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31119-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
10
|
Lunardi G, Del Mastro L, Bighin C, Bisagni G, Driol P, Garrone O, Giraudi S, Marroni P, Piccioli P, Ponzone R, Porpiglia M, Venturini M. Effects of body mass index (BMI) on plasma levels of estrone sulfate (ES) in postmenopausal women with breast cancer (BC) during letrozole (L) treatment. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.515] [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
|
11
|
Lunardi G, Lastraioli S, Bruzzi P, Pronzato P, Bisagni G, Ponzone R, Porpiglia M, Russo S, Del Mastro L, Venturini M. Single-nucleotide polymorphisms (SNPs) of CYP19A1 and plasma levels of estrone sulfate (ES) in postmenopausal women with breast cancer (BC) during letrozole (L) treatment. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2606] [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
|
12
|
Lunardi G, Del Mastro L, Serra M, Driol P, Boni C, Cognetti F, Ponzone R, Porpiglia M, Venturini M, Pronzato P. Plasma levels of estrone sulfate (ES) in postmenopausal women with breast cancer (BC) during letrozole (L) treatment: Association with single nucleotide polymorphisms (SNPs) of CYP19A1. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
555 Background: The CYP19A1 gene encodes aromatase, a key enzyme for estrogen biosynthesis. We investigated the association between four CYP19A1 SNPs, affecting different circulating estrogen levels (rs10046 C>T, rs4646 G>T, rs749292 C>T, rs727479 T>G), and suppression of plasma ES levels induced by 6 weeks (time needed to reach L steady-state concentrations) of L (25 mg/d). Methods: Patients were enrolled into a prospective, italian multi-centre trial (GIM5) testing the correlation of CYP19A1 SNPs with the efficacy of L adjuvant therapy, after 5 years of tamoxifen, in postmenopausal early BC patients. Blood samples for hormone measurements were obtained immediately before starting L (baseline) and following 6 wks of treatment. SNPs were identified from DNA obtained from peripheral blood cells by Hexaprimer Amplification Refractory Mutation System PCR (H-ARMS-PCR). Plasma ES levels were evaluated by Radio Immuno Assay (RIA). Results: SNPs and hormone levels were evaluated in at least 129 patients. SNPs of CYP19A1 were associated with different baseline plasma ES levels. Mean inhibition of aromatase activity induced by L ranges from 71% to 79%, as a function of the SNPs. After 6 weeks of L no difference in ES levels was observed between patients with different SNPs (Table). Conclusions: L therapy induces a higher aromatase suppression in patients with SNPs associated with higher baseline plasma ES levels. The difference in ES levels associated with genetic variation at the CYP19A1 locus disappeared after L therapy. [Table: see text] [Table: see text]
Collapse
Affiliation(s)
- G. Lunardi
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - L. Del Mastro
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - M. Serra
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - P. Driol
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - C. Boni
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - F. Cognetti
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - R. Ponzone
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - M. Porpiglia
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - M. Venturini
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| | - P. Pronzato
- National Institute for Cancer Research, Genova, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Regina Elena Institute, Roma, Italy; IRCC, Candiolo, Italy; S. Anna Hospital, Torino, Italy; Sacro Cuore Hospital, Negrar, Italy
| |
Collapse
|
13
|
Sozzani P, Arisio R, Porpiglia M, Benedetto C. Is Sialyl Lewis x antigen expression a prognostic factor in patients with breast cancer? Int J Surg Pathol 2008; 16:365-74. [PMID: 18977761 DOI: 10.1177/1066896908324668] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sialyl Lewis x (sLex) carbohydrate antigen acts as an adhesion molecule expressed on the surface of cancer cells and is the most important ligand of the selectins present on endothelial cells. sLex expression was correlated to the metastatic potential of breast cancer. The aim of the present work was to evaluate the prognostic value of sLex in a series of breast carcinomas with long-term follow-up. A total of 127 consecutive patients with primary breast cancer were enrolled and followed for a median of 140 months. Tumor grade, mitotic index, histotype, vascular invasion, and tumor extension and sLex were recorded and used in multivariate analysis. sLex antigen was expressed in 37 specimens (21%). Survival was similar for sLex-positive and sLex-negative tumors (62% vs 60%) for overall survival and for disease-free survival (59% vs 56%). Expression of sLex antigen in breast cancer is not associated with breast cancer survival.
Collapse
Affiliation(s)
- Prisca Sozzani
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy.
| | | | | | | |
Collapse
|
14
|
Zheng Y, Katsaros D, Shan SJC, de la Longrais IR, Porpiglia M, Scorilas A, Kim NW, Wolfert RL, Simon I, Li L, Feng Z, Diamandis EP. A multiparametric panel for ovarian cancer diagnosis, prognosis, and response to chemotherapy. Clin Cancer Res 2008; 13:6984-92. [PMID: 18056174 DOI: 10.1158/1078-0432.ccr-07-1409] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Our goal was to examine a panel of 11 biochemical variables, measured in cytosolic extracts of ovarian tissues (normal, benign, and malignant) by quantitative ELISAs for their ability to diagnose, prognose, and predict response to chemotherapy of ovarian cancer patients. EXPERIMENTAL DESIGN Eleven proteins were measured (9 kallikreins, B7-H4, and CA125) in cytosolic extracts of 259 ovarian tumor tissues, 50 tissues from benign conditions, 35 normal tissues, and 44 tissues from nonovarian tumors that metastasized to the ovary. Odds ratios and hazard ratios and their 95% confidence interval were calculated. Time-dependent receiver operating characteristic curves for censored survival data were used to evaluate the performance of the biomarkers. Resampling was used to validate the performance. RESULTS Most biomarkers effectively separated cancer from noncancer groups. A composite marker provided an area under the curve of 0.97 (95% confidence interval, 0.95-0.99) for discriminating normal and cancer groups. Univariately, hK5 and hK6 were positively associated with progression. After adjusting for clinical variables in multivariate analysis, both hK10 and hK11 significantly predicted time to progression. Increasing levels of hK13 were associated with chemotherapy response, and the predictive power of hK13 to chemotherapy response was improved by a panel of five biomarkers. CONCLUSIONS The evidence shows that a group of kallikreins and multiparametric combinations with other biomarkers and clinical variables can significantly assist with ovarian cancer classification, prognosis, and response to platinum-based chemotherapy. In particular, we developed a multiparametric strategy for predicting ovarian cancer response to chemotherapy, comprising several biomarkers and clinical features.
Collapse
Affiliation(s)
- Yingye Zheng
- The Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Boccardo F, Rubagotti A, Aldrighetti D, Buzzi F, Cruciani G, Farris A, Mustacchi G, Porpiglia M, Schieppati G, Sismondi P. O-54 Switching to an aromatase inhibitor provides mortality benefit in early breast-carcinoma: Pooled analysis of 2 consecutive trials. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71744-5] [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: 10/22/2022] Open
|
16
|
Boccardo F, Rubagotti A, Aldrighetti D, Buzzi F, Cruciani G, Farris A, Mustacchi G, Porpiglia M, Schieppati G, Sismondi P. Switching to an aromatase inhibitor provides mortality benefit in early breast carcinoma. Cancer 2007; 109:1060-7. [PMID: 17295293 DOI: 10.1002/cncr.22513] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 11/11/2022]
Abstract
BACKGROUND The superiority of new generation aromatase inhibitors over tamoxifen in the adjuvant treatment of early breast carcinoma has emerged from several randomized trials. However, until now not all previous studies have shown a mortality benefit. METHODS A pooled analysis of 2 prospective multicentric trials, sharing the same study design and nearly identical inclusion criteria, was performed. In both trials, women treated previously with tamoxifen for 2 or 3 years were randomly assigned to either continuing tamoxifen for an additional 2 or 3 years or to having their treatment switched to aminoglutethimide or anastrozole for a comparable time period. Mortality was analyzed according to allocated treatment and other patient and tumor variables. RESULTS In all, 828 postmenopausal women, mostly with estrogen receptor (ER)-positive and node-positive tumors who had been monitored for a median time of 78 months (range, 6-141 months) were analyzed. Of these women, 415 were randomly selected to continue tamoxifen and 413 switched to aminoglutethimide or anastrozole. All-cause mortality and breast cancer-specific mortality were significantly improved by the switch: all-cause mortality: hazard ratio (HR) = 0.61 (0.42-0.88) P = .007; breast cancer-specific mortality: HR = 0.61 (0.39-0.94) P = .025. No increase was recorded in breast cancer-unrelated mortality in women after switching. Multivariate analysis showed that patient age, tumor size, allocated treatment, and nodal status, in that order, were independent mortality predictors. CONCLUSIONS Switching to an aromatase inhibitor after 2 or 3 years of tamoxifen therapy significantly improves survival compared with continuing 2 or 3 years of additional tamoxifen treatment.
Collapse
|
17
|
Boccardo F, Rubagotti A, Guglielmini P, Fini A, Paladini G, Mesiti M, Rinaldini M, Scali S, Porpiglia M, Benedetto C, Restuccia N, Buzzi F, Franchi R, Massidda B, Distante V, Amadori D, Sismondi P. Switching to anastrozole versus continued tamoxifen treatment of early breast cancer. Updated results of the Italian tamoxifen anastrozole (ITA) trial. Ann Oncol 2006; 17 Suppl 7:vii10-4. [PMID: 16760270 DOI: 10.1093/annonc/mdl941] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [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: 12/27/2022] Open
Abstract
BACKGROUND Tamoxifen, for many years the 'gold standard' in the adjuvant setting for the management of endocrine sensitive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy due to the development of resistance. This provided the rationale for a switching trial with anastrozole, the updated results of which are reported here. PATIENTS AND METHODS This trial investigated the efficacy of switching to anastrozole for women already receiving tamoxifen. After 2-3 years of tamoxifen treatment, postmenopausal, node-positive, ER-positive patients were randomized to receive either anastrozole 1 mg/day or to continue tamoxifen, 20 mg/day, giving a total duration of 5-years treatment. The primary end point was disease-free survival and secondary endpoints were event-free survival, overall survival and safety. RESULTS A total of 448 patients were enrolled. At a median follow-up time of 64 months (range 12-93), 63 events had been reported in the tamoxifen group compared with 39 in the anastrozole group [HR 0.57 (95% CI 0.38-0.85) P = 0.005]. Relapse-free and overall survival were also longer in the anastrozole group [HR 0.56 (95% CI 0.35-0.89) P = 0.01 and 0.56 (95% CI 0.28-1.15) P = 0.1]. However, the latter difference was not statistically significant. Overall more patients in the anastrozole group experienced at least one adverse event (209 versus 151: P = 0.000). However, numbers of patients experiencing serious adverse events were comparable (37 versus 40, respectively: P = 0.7). CONCLUSIONS Switching to anastrozole after the first 2-3 years of treatment was confirmed to improve event-free and relapse-free survival of postmenopausal, node-positive, ER-positive early breast cancer patients already receiving adjuvant tamoxifen.
Collapse
Affiliation(s)
- F Boccardo
- The National Cancer Research Institute and the University of Genoa, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Boccardo F, Rubagotti A, Puntoni M, Guglielmini P, Amoroso D, Fini A, Paladini G, Mesiti M, Romeo D, Rinaldini M, Scali S, Porpiglia M, Benedetto C, Restuccia N, Buzzi F, Franchi R, Massidda B, Distante V, Amadori D, Sismondi P. Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: preliminary results of the Italian Tamoxifen Anastrozole Trial. J Clin Oncol 2005; 23:5138-47. [PMID: 16009955 DOI: 10.1200/jco.2005.04.120] [Citation(s) in RCA: 329] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Tamoxifen, which is actually the gold standard adjuvant treatment in estrogen receptor-positive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy because of the development of resistance. Therefore new approaches are required. PATIENTS AND METHODS We conducted a prospective randomized trial to test the efficacy of switching postmenopausal patients who were already receiving tamoxifen to the aromatase inhibitor anastrozole. After 2 to 3 years of tamoxifen treatment, patients were randomly assigned either to receive anastrozole 1 mg/d or to continue receiving tamoxifen 20 mg/d, for a total duration of treatment of 5 years. Disease-free survival was the primary end point. Event-free survival, overall survival, and safety were secondary end points. RESULTS Four hundred forty-eight patients were enrolled. All women had node-positive, estrogen receptor-positive tumors. At a median follow-up time of 36 months, 45 events had been reported in the tamoxifen group compared with 17 events in the anastrozole group (P = .0002). Disease-free and local recurrence-free survival were also significantly longer in the anastrozole group (hazard ratio [HR] = 0.35; 95% CI, 0.18 to 0.68; P = .001 and HR = 0.15; 95% CI, 0.03 to 0.65; P = .003, respectively). Overall, more adverse events were recorded in the anastrozole group compared with the tamoxifen group (203 v 150, respectively; P = .04). However, more events were life threatening or required hospitalization in the tamoxifen group than in the anastrozole group (33 of 150 events v 28 of 203 events, P = .04). CONCLUSION Switching to anastrozole after the first 2 to 3 years of treatment is well tolerated and significantly improves event-free and recurrence-free survival in postmenopausal patients with early breast cancer.
Collapse
|
19
|
Boccardo FM, Rubagotti A, Puntoni M, Guglielmini P, Porpiglia M, Mesiti M, Rinaldini M, Paladini G, Distante V, Franchi R. Switching to anastrozole (ANA) vs continued tamoxifen (TAM) treatment of early breast cancer (EBC). Updated results of the Italian tamoxifen anastrozole (ITA) trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.526] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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)
- F. M. Boccardo
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - A. Rubagotti
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - M. Puntoni
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - P. Guglielmini
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - M. Porpiglia
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - M. Mesiti
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - M. Rinaldini
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - G. Paladini
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - V. Distante
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| | - R. Franchi
- Univ of Genoa - Nat Cancer Rsrch Inst, Genova, Italy; S. Anna Hosp, Turin, Italy; Univ of Messina, Messina, Italy; S. Donato Hosp Arezzo, Arezzo, Italy; S. Orsola-Malpighi Hosp, Bologna, Italy; Univ of Florence, Florence, Italy; Civic Hosp, Casalpusterlengo, Italy
| |
Collapse
|
20
|
Fracchioli S, Bellino R, Arisio R, Mingrone K, Durando A, Giardina G, Katsaros D, Massobrio M, Porpiglia M, Vicelli R. Ductal carcinoma in situ (DCIS): USC/Van Nuys Prognostic Index (VNPI) and the impact of micropapillary histotype. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.662] [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)
- S. Fracchioli
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - R. Bellino
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - R. Arisio
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - K. Mingrone
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - A. Durando
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - G. Giardina
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - D. Katsaros
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - M. Massobrio
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - M. Porpiglia
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| | - R. Vicelli
- University of Turin, Turin, Italy; S. Anna Hospital, Turin, Italy
| |
Collapse
|
21
|
Porpiglia M, Vicelli R, Durando A, Fracchioli S, Puopolo M, Katsaros D, Bellino R, Benedetto C. [Biologic therapy and epithelial ovarian cancer]. Minerva Ginecol 2004; 56:91-104. [PMID: 14973413] [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: 04/29/2023]
Abstract
The identification of new molecular prognostic and predictive factors for ovarian cancer may contribute in deciding individual therapeutic strategies; on the other hand, there has been growing interest in new biologic therapies to correct molecular or genic lesions of neoplastic cells (genic therapy), or to activate the specific immune response (immunological therapy). Chemotherapy collateral toxic effects, as myelotoxicity, should be reduced through transfection of genes that modulate drug resistance in stem cells. The data at present available suggest then the potential role of these new treatments, are more specific and less toxic than current therapies; however, other biological-molecular studies are required to obtain the clinical applications of the results: Aim of this study is to provide a review of the most interesting data in ovarian cancer biologic therapy.
Collapse
Affiliation(s)
- M Porpiglia
- Cattedra C, Dipartimento di Discipline, Ginecologiche e Ostetriche, Day Hospital Oncologico Universitario, Azienda Ospedaliera OIRM-S. Anna, Torino, Italy
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Fracchioli S, Porpiglia M, Arisio R, Voglino G, Katsaros D. Oral squamous carcinoma in a patient with cervix cancer: use of human papillomavirus analysis to differentiate synchronous versus metastatic tumor. Gynecol Oncol 2003; 89:522-5. [PMID: 12798722 DOI: 10.1016/s0090-8258(03)00129-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer usually spreads by direct infiltration and disseminates by lymphatic and hematogenous pathways. The common sites of distant metastases are the lungs, liver, and bones. Other rare metastatic sites have been previously described including only one case of oral cavity metastasis. CASE We present here the second case of a patient with apparent oral cavity metastasis from cervical cancer. By cloning specific human papilloma virus (HPV) genomic regions, the two lesions showed HPV genomic sequences from different viruses (18 and 33, for the uterine cervix and the oral cavity, respectively), thus indicating the oral lesion as a synchronous second primary tumor. CONCLUSION The use of molecular markers to distinguish between a secondary and a primary lesion is recommendable in cervical cancer, particularly when reporting rare site metastases.
Collapse
Affiliation(s)
- S Fracchioli
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, University of Turin, Turin, Italy
| | | | | | | | | |
Collapse
|
23
|
Porpiglia M, Genta F, Vicelli R, De Nicola B, Ferraris F, Piccinno R, Benedetto C. [The role of aromatase inhibitors in the treatment of breast neoplasms. An evaluation of clinical efficacy and the tolerability profile]. Minerva Ginecol 2002; 54:115-31. [PMID: 12032450] [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: 02/25/2023]
Abstract
Constant acquisitions regarding endocrine pathogenesis and the biology of breast neoplasms have led to the evolution of hormone manipulation as a therapeutic option in patients suffering from this disease. There has been a shift from ablative surgical procedures to the use of drugs offering greater clinical efficacy and an improved tolerability profile. Since the late 1970s tamoxifen has been regarded as the gold standard for hormone treatment in hormone-responsive breast neoplasm, but promising new endocrine agents are now being compared in random trials. Of these, the latest generation of aromatase inhibitors appears to gather the widest consensus on the basis of the results published to date. This article aims to review this new category of drugs, illustrating their rationale of use, the results obtained in the treatment of breast neoplasm and the main studies in which they are currently being investigated.
Collapse
Affiliation(s)
- M Porpiglia
- Dipartimento di Discipline Ginecologiche, Università degli Studi, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
24
|
Grio R, Malara D, Curti A, Porpiglia M. [Abnormal uterine bleeding during climacteric. Correlation between transvaginal ultrasonography, hysteroscopy and histology]. Minerva Ginecol 1999; 51:125-7. [PMID: 10379148] [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: 02/12/2023]
Abstract
BACKGROUND AND AIMS The authors evaluated the accuracy of ultrasonographic findings compared to hysteroscopic and histological results in the diagnosis of anomalous uterine bleeding in menopause. METHODS Forty-eight women suffering from the above pathology and attending the Preventive Gynecology outpatient clinic of Department C of the Gynecology and Obstetrics faculty at Turin University during the period between September 1996 and July 1997, underwent first ultasonography using a transvaginal probe and then outpatient hysteroscopy with endometrial biopsy. RESULTS A total overlap between the ultrasonographic image, hysteroscopic results and histological diagnosis was only obtained in the group of menopausal patients. CONCLUSIONS In line with the data reported in the literature, the authors imposed a cut-off endometrial thickness of 4 mm above which further diagnostic tests were performed using hysteroscopy with targeted biopsy.
Collapse
Affiliation(s)
- R Grio
- Dipartimento di Scienze Ginecologiche Ostetriche, Università degli Studi, Torino
| | | | | | | |
Collapse
|
25
|
Grio R, Cellura A, Porpiglia M, Geranio R, Piacentino R. [Sexuality in menopause. Importance of adequate replacement therapy]. Minerva Ginecol 1999; 51:59-62. [PMID: 10352535] [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: 02/12/2023]
Abstract
BACKGROUND AND AIMS The harmful repercussions of estrogen deficiency in menopause on the female organism are also responsible for reduced libido and uncomfortable trophic disorders of the genitourinary tract leading to reduced vaginal lubrication and severe alterations affecting sexual function, as well as for the more commonplace vasomotor phenomena and psychoemotive changes. METHODS The authors treated 102 menopausal patients who presented reduced libido and orgasmic difficulties, as well as other menopausal problems, with 17-beta estradiol+noretisterone acetate using a transdermal route. The main advantage offered by the transdermal route is that conjugated estrogens "bypass" the liver and reach the target organs in an unmodified manner. This treatment is well tolerated by almost all patients, even those suffering from slight gastroenteric and hepatic problems. RESULTS AND CONCLUSIONS This study showed the good tolerability and almost complete innocuousness of the drug used. None of the patients receiving replacement therapy reported any collateral effects worthy of note or the onset of malignant lesions of the breast or pelvic organs. The results obtained show that the use of 17-beta estradiol+noretisterone acetate can effectively modify menopausal symptoms, improving both quality of life and sexual function.
Collapse
Affiliation(s)
- R Grio
- Dipartimento di Scienze Ginecologiche Ostetriche, Università degli Studi, Torino
| | | | | | | | | |
Collapse
|
26
|
Porpiglia M, Piacentino R, Cellura A, Malara D, Geranio R, Grio R. [Abnormal uterine hemorrhage in climacteric. Medical management]. Minerva Ginecol 1998; 50:475-9. [PMID: 9882988] [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: 02/09/2023]
Abstract
Following a review of the literature, the authors examine the drugs which are currently used to treat anomalous uterine bleeding during menopause, illustrating their aims and justifying the rationale underlying their use. They conclude by stating that a satisfactory treatment often does not exist, but it is the task of the specialist to gauge the level and sequence of treatments in order to achieve the hoped-for result.
Collapse
Affiliation(s)
- M Porpiglia
- Dipartimento di Scienze Ginecologiche Ostetriche, Università degli Studi, Torino
| | | | | | | | | | | |
Collapse
|
27
|
Porpiglia M, Piacentino R, Cellura A, Malara D, Geranio R, Grio R. [Abnormal uterine hemorrhage in the climacteric. Diagnostic approach]. Minerva Ginecol 1998; 50:429-33. [PMID: 9866954] [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: 02/09/2023]
Abstract
Having made a detailed list of the invasive and non-invasive diagnostic techniques used to evaluate anomalous uterine bleeding in menopause, the authors conclude by affirming that hysteroscopy undoubtedly represents the most reliable diagnostic technique and that echography should be the preferred first diagnostic step since it allows the adnexa to be examined and is less invasive and cheaper.
Collapse
Affiliation(s)
- M Porpiglia
- Cattedra C, Dipartimento di Scienze Ginecologiche Ostetriche, Università degli Studi, Torino
| | | | | | | | | | | |
Collapse
|
28
|
Grio R, Curti A, Piacentino R, Cellura A, Malara D, Geranio R, Porpiglia M. [Anomalous uterine hemorrhages in the climacteric. Their etiopathogenesis]. Minerva Ginecol 1998; 50:383-8. [PMID: 9842207] [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: 02/09/2023]
Abstract
Anomalous uterine bleeding accounts for approximately two-thirds of the causes of outpatient gynecological check-ups for women in menopause. The high incidence of this pathology raises considerable problems from a clinical and social point of view. In this paper the authors outline the main causes of both organic and functional bleeding.
Collapse
Affiliation(s)
- R Grio
- Dipartimento di Scienze Ginecologiche Ostetriche, Università degli Studi, Torino
| | | | | | | | | | | | | |
Collapse
|
29
|
Grio R, Cellura A, Porpiglia M, Geranio R, Piacentino R. [Menopause. Hormone substitution therapy and prevention of cardiovascular risk]. Minerva Ginecol 1998; 50:329-31. [PMID: 9808958] [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: 02/09/2023]
Abstract
BACKGROUND AND AIMS Cardiovascular disease is the major cause of death in over 60-year-old women. The mean age of onset is about 10 years later in women compared to men, a difference which can be explained by the end of physiological estrogen production in menopause. METHODS The authors treated a group of 68 menopausal patients with HRT for a period of 5 years. RESULTS A series of positive effects emerged from the study which were potentially capable of preventing ischemic cardiopathy. CONCLUSIONS The authors reached the conclusion that--owing to its beneficial effects on lipid and glucose metabolism, as well as on coagulation factors and arterial pressure--HRT is able to prevent cardiovascular disease, reducing the risk of infarction by between 20 and 50%.
Collapse
Affiliation(s)
- R Grio
- Dipartimento di Scienze Ginecologiche Ostetriche, Università degli Studi, Torino
| | | | | | | | | |
Collapse
|
30
|
Grio R, Cellura A, Geranio R, Porpiglia M, Piacentino R. [Clinical efficacy of tamoxifen in the treatment of premenstrual mastodynia]. Minerva Ginecol 1998; 50:101-3. [PMID: 9595924] [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: 02/07/2023]
Abstract
BACKGROUND Premenstrual syndrome (PMS), which was first described by Frank in 1931, is a clinical condition that is not easy to classify in terms of either symptoms or from a diagnostic and therapeutic point of view. AIMS The aim of this study was to evaluate the efficacy of tamoxifen, an antiestrogen drug, using a double-blind study with placebo in the treatment of mastodynia, one of the most frequent symptoms of PMS, given that an absolute or relative increase in estrogens is one of the most controversial etiopathogenetic hypotheses. METHODS The study included a group of 88 outpatients aged between 22 and 40 with regular menstrual cycles and intense mastodynia. Before commencing therapy, a detailed medical history was compiled for each subject and all underwent a gynecological and breast examination, hematochemical and instrumental tests (scan and mammography) in order to rule out other PMS-related organic pathologies. The patients were randomly divided into two groups of 44: one group received tamoxifen at a dose of 10 mg by mouth from day 5 to day 24 of the menstrual cycle, whilst a placebo was administered to the other group using the same dosage scheme. All women underwent a thorough control examination at the end of treatment and two months after the end of treatment. RESULTS At the end of treatment 90% of patients reported a complete resolution of symptoms, whilst 10% only showed a slight improvement. In the control group, 86% showed a transitory reduction in symptoms and 13% did not report any improvement. CONCLUSIONS On the basis of the results obtained, the authors affirm the validity and efficacy of tamoxifen in the treatment of mastodynia in PMS owing to both its innocuity and its atoxity.
Collapse
Affiliation(s)
- R Grio
- Dipartimento di Discipline, Ginecologiche ed Ostetriche, Università degli Studi, Torino
| | | | | | | | | |
Collapse
|
31
|
Grio R, Geranio R, Porpiglia M, Leidi L, Piacentino R. [Use of a GnRH analogue (leuprorelin) in the therapy of endometriosis]. Minerva Ginecol 1997; 49:417-419. [PMID: 9446077] [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: 05/22/2023]
Abstract
BACKGROUND Endometriosis is undoubtedly an extremely complex disease from both a diagnostic and therapeutic point of view. The finding that the continuous administration of GnRH analogs suppresses gonadotropin release by the hupophysis, thus blocking ovary function, has promoted researchers to use these drugs in the treatment of endometriosis. AIM Having reviewed the data reported in the literature, the authors selected from the numerous drugs used to resolve implants (oestroprogestogens, danazol, progestogens, clomiphene citrata, GnRH analogs), a GnRH analog with a depot action known as leuprorelin (D-Leu6-Pro9-NH-Ethylamide). MATERIALS AND METHOD This drug was administered to 98 patients suffering from endometriosis at a dose of one intramuscular phial every 30 days for six months. RESULTS AND CONCLUSIONS The results obtained (complete resolution of disease in 610.2% of cases, partial remission in 30.6% of cases, transient improvement in 9.2% of cases owing to reduced patient compliance, percentage of pregnancies after treatment 12%), allow the authors to conclude that the use of a GnRH antagonist, like leuprorelin, owing to its efficacy and good tolerability, represents a valid alternative to oestroprogestogens and Danazol in the treatment of implants and the symptoms of endometriosis.
Collapse
Affiliation(s)
- R Grio
- Dipartimento di Discipline, Ginecologiche e Ostetriche, Università degli Studi, Torino
| | | | | | | | | |
Collapse
|
32
|
Piacentino R, Porpiglia M, Giannotta MR, Grio R. [Dysspermia due to inflammation. The evaluation of sperm cultures]. Minerva Ginecol 1995; 47:327-9. [PMID: 8559444] [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: 01/31/2023]
Abstract
The study evaluates 160 cases of positive spermioculture taken from 522 sterile individuals examined by the authors at the Couple Sterility Outpatient unit in Department A of the Institute of Gynecology and Obstetrics at Turin University during the period between January 1984 and December 1993. The germs responsible for infection were assayed in order to evaluate the strains which showed the highest incidence every year. Whereas there was no significant change in the absolute number of cases of sterility over the period, the number of cases caused by infection increased significantly during the second five-year period. It was found that the germs predominantly implicated in the genesis of male sterility formed part of the so-called mixed flora group, responsible in women for syndromes of often asymptomatic bacterial vaginosis which are not identified and consequently not treated.
Collapse
Affiliation(s)
- R Piacentino
- Cattedra A, Istituto di Ginecologia e Ostetricia, Università degli Studi di Torino
| | | | | | | |
Collapse
|
33
|
Grio R, Porpiglia M, Vetro E, Uligini R, Piacentino R, Minì D, Marchino GL. Asymptomatic bacteriuria in pregnancy: a diagnostic and therapeutic approach. Panminerva Med 1994; 36:195-7. [PMID: 7603738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pregnancy is a predisposing factor for urinary tract infection and pregnant women suffering from this pathology are exposed to dangerous risks which may condition maternal wellbeing and fetal prognosis. The apparently paradoxal finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to those with manifest infections may be explained by the fact that the latter are adequately treated, whereas asymptomatic bacteriuria, which is difficult to diagnose, may continue in a subtle form for the entire duration of pregnancy. This emphasises the importance of the early diagnosis of infection using a protocol based on urine tests and urine culture and the adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of maternal and fetal complications (acute pyelonephritis, increased fetal morbidity and mortality). The choice of the antibiotic to be used must be made on the basis of the urine culture test, the stage of gestation, maternal clinical data and the characteristics of the antibiotic itself (pharmacokinetics, maternal and fetal toxicity). With regard to the treatment protocol, the "single-dose" protocol is currently preferred. After negative urine culture tests, all patients must carry out a complete urine test each month with hormonal and echographic monitoring of the fetoplacental unit.
Collapse
Affiliation(s)
- R Grio
- Department of Gynecology and Obstetrics, University of Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
34
|
Grio R, Porpiglia M, Vetro E, Uligini R, Piacentino R, Minì D, Marchino GL. Asymptomatic bacteriuria in pregnancy: maternal and fetal complications. Panminerva Med 1994; 36:198-200. [PMID: 7603739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
From an analysis of the data reported in the literature it is clear that pregnancy is a predisposing factor for urinary tract infection and that pregnant women with this pathology are exposed to dangerous risks which may influence maternal wellbeing and fetal prognosis. Authors do not concur on the specific risks to the mother and fetus, one reason being that the statistics reported to date reveal discrepancies relating to the presence of disorders prior to pregnancy and the environmental, working and socio-hygienic conditions of the populations studied. The apparently paradoxical finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to manifest forms can be attributed to the fact that the latter are treated with adequate therapies whereas asymptomatic bacteriuria, which is difficult to diagnose, may persist throughout pregnancy. This underlines the importance of early diagnosis using a protocol which entails the execution of serial urine tests and urine cultures and adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of urinary tract infections and materno-fetal complications. Non-treated asymptomatic bacteriuria in fact represents a considerable risk factor since it may lead to the onset of acute pyelonephritis in approximately 5% of pregnant women and may increase the risk of fetal mortality.
Collapse
Affiliation(s)
- R Grio
- Institute of Gynecology and Obstetrics, University of Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
35
|
Grio R, Porpiglia M, Piacentino R, Marchino GL. [Intramuscular beta-interferon in the treatment of cervical intraepithelial neoplasia (CIN) associated with human papilloma virus (HPV) infection]. Minerva Ginecol 1994; 46:579-82. [PMID: 7838417] [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: 01/27/2023]
Abstract
In an attempt to find less aggressive and more efficacious tools for the treatment of cervical neoplasia (CIN) associated with genital HPV infection, the authors have examined a therapeutic approach based on the strengthening of natural defences. For this purpose, a group of 10 patients diagnosed with CIN associated with HPV infection received beta-IFN therapy at a dose of 300,000 UI/die i.m. for 7 days, continuing the same dose on alternate days for 2 weeks. At the end of the follow-up results were satisfactory especially if compared with those from a control group of 9 patients. These results appear to indicate beta-IFN as the treatment of choice in HPV infections in young women wishing to have children in order to preserve the anatomic and functional integrity of the lower genetical tract.
Collapse
Affiliation(s)
- R Grio
- Istituto di Ginecologica e Ostetrica, Cattedra A, Università degli Studi di Torino
| | | | | | | |
Collapse
|
36
|
Grio R, Porpiglia M. Obesity: internal medicine, obstetric and gynecological problems related to overweight. Panminerva Med 1994; 36:138-41. [PMID: 7877828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Obesity is the major nutritional problem affecting industrialised society. According to a recent ISTAT survey, 41% of men and 19% of women in the Italian population suffer from obesity. Obesity is a complex pathological entity with a multiform and often indeterminable etiology. Studies of natural and adopted children and twins suggest that a clear hereditary, constitutional predisposing factor is present in obesity which interacts with environmental conditions. The genetic factor is also suggested by the statistical finding that if neither parent is obese, then only 7-10% of their children will be obese, whereas if one parent is obese, 40-50% of children will probably become obese, and if both parents are obese as many as 70-80% of children will be obese. The risks related to obesity can be broadly categorised as mechanical and metabolic. The former include arthrosis, osteoporosis, degenerative diseases affecting the joints and bone matrix, muscular hypotrophy and respiratory deficits. The major metabolic risks include hypercholesterolemia, altered glycoregulation and hyperuricemia. From an obstetric point of view, apart from the fact that obesity is often associated with sterility, excess weight can often lead to sometimes dramatic complications during pregnancy, involving major risks for both mother and fetus. From a gynecological point of view the links between obesity, tumours and menopause are well known.
Collapse
Affiliation(s)
- R Grio
- Chair A, Institute of Gynecology and Obstetrics, University of Turin, Italy
| | | |
Collapse
|
37
|
Grio R, Porpiglia M. Efficacy of Fat Mobilisation System (FMS) in the treatment of obesity and its utility in the resolution of gynecological problems related to overweight. Panminerva Med 1994; 36:142-8. [PMID: 7877829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In industrialised countries the problem of overweight affects more than 50% of the adult population. Knowledge acquired over the past years has replaced the principally esthetic concept of obesity with the notion of a multifactorial pathology, the outcome of an imbalance in the individual's energy balance caused by an excessive food intake as well as an inadequate energy consumption. The Fat Mobilisation System (FMS), which is able to activate a fat clearance process following cold local application, has proved a valuable and well tolerated tool capable of influencing the entire system responsible for obesity. A group of 109 patients of both sexes, aged between 15 and 71 years old, with problems of overweight and/or figure faults linked to the localised accumulation of fat, underwent out-patient treatment in the form of bandaging with elasticated bandages soaked in active solution able to lower body temperature by 2-3 degrees C. The results were satisfactory in all cases. In particular, a group of 24 women (10 of a childbearing age, 7 in premenopause and 7 in menopause), in whom overweight was associated with gynecological problems, were evaluated by Department A of the Department of Gynecology and Obstetrics at the University of Turin. An improvement in gynecological symptoms was achieved in parallel to weight loss in all patients.
Collapse
Affiliation(s)
- R Grio
- Chair A, Institute of Gynecology and Obstetrics, University of Turin, Italy
| | | |
Collapse
|
38
|
Piacentino R, Giobbe C, Giannotta MR, Porpiglia M, Minì D, Grio R. [Ovarian hyperstimulation syndrome (OHS): borderlines between physiology and pathology]. Minerva Ginecol 1994; 46:413-416. [PMID: 7970077] [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: 05/22/2023]
Abstract
The use of gonadotropins in therapy has led to the appearance of a complication due to hyperstimulation, referred to as "syndrome due to ovarian hypertension" (SOH). There are three clinical stages of SOH: slight, moderate and severe, caused by a pathogenetic mechanism which is thought to involve the action of prostaglandins and the renin-angiotensin system leading to an alteration in capillary permeability with increased ovarian diameter. SOH can be prevented using a protocol to evaluate clinical conditions during therapy mainly based on hormone assays and echographic monitoring. SOH can be predicted but not prevented, thus making it important to commence immediate treatment for in-patients so as to restore the volume of blood and the blood protein load in the most severe cases.
Collapse
Affiliation(s)
- R Piacentino
- Istituto di Ginecologia e Ostetricia, Università degli studi di Torino
| | | | | | | | | | | |
Collapse
|
39
|
Grio R, Mazza O, Cellura A, Porpiglia M, Borgarino S, Piacentino R, Caccuri D, Marchino GL, Fuda G. [Pathologic conditions related to sterilization in the female]. Minerva Ginecol 1990; 42:403-4. [PMID: 2290597] [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: 12/31/2022]
Affiliation(s)
- R Grio
- Clinica Ostetrica e Ginecologia, Cattedra A, Università di Torino
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Porpiglia M, Cellura A, Caccuri D, Borgarino S, Fuda G, Piacentino R, Marchino GL, Grio R. [Urinary tract infection during pregnancy]. Minerva Ginecol 1990; 42:263-5. [PMID: 2381557] [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: 12/31/2022]
Abstract
Infections of the urinary tract are particularly frequent in pregnancy (3-10%). Immediate treatment of all symptomatic forms and screening for asymptomatic forms are vital to prevent damage to mother and fetus.
Collapse
Affiliation(s)
- M Porpiglia
- Istituto di Ginecologia ed Ostetricia, Cattedra A, Università degli Studi di Torino
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Grio R, Giobbe C, Cellula A, Zaccheo F, Porpiglia M, Malara D, Marchino GL, Mazza O, Fuda G, Tamburrano F. [Inflammation of the uterine corpus: endometritis]. Minerva Ginecol 1990; 42:99-102. [PMID: 2359511] [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: 12/31/2022]
Abstract
In industrialised countries endometritis is a problem which represents an increasing risk to personal health and to society. In almost all cases the inflammatory process which affects the uterine mucosa forms part of a more generalised infection which involves the entire internal genital system (PID). The most important problem associated with pelvic phlogosis is increased sterility, a greater number of ectopic pregnancies and chronic pelvic pain. In order to treat the symptoms of genito-pelvic infection, an early diagnosis and adequate medical therapy are indispensable. In this event it may be possible to prevent invalidating effects on fertility and chronic pelvic pain.
Collapse
Affiliation(s)
- R Grio
- Università degli Studi di Torino
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Grio R, Cellura A, Zaccheo F, Giobbe C, Malara D, Porpiglia M, Russo P, Marchino GL. [Perinatal mortality in placental insufficiency]. Minerva Ginecol 1989; 41:589-91. [PMID: 2626203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The review of 55 cases of placental failure and the results obtained reveal a 54% mortality rate.
Collapse
|