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Rega D, Delrio P. How do you manage the peritoneal opening during TAMIS procedure? Tech Coloproctol 2023; 27:1135-1136. [PMID: 37555893 DOI: 10.1007/s10151-023-02851-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Affiliation(s)
- D Rega
- Colorectal Surgical Oncology, Department of Abdominal Oncology, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", 80131, Naples, Italy.
| | - P Delrio
- Colorectal Surgical Oncology, Department of Abdominal Oncology, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", 80131, Naples, Italy
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Cardone C, De Stefano A, Rosati G, Cassata A, Silvestro L, Borrelli M, Di Gennaro E, Romano C, Nappi A, Zanaletti N, Foschini F, Casaretti R, Tatangelo F, Lastoria S, Raddi M, Bilancia D, Granata V, Setola S, Petrillo A, Vitagliano C, Gargiulo P, Arenare L, Febbraro A, Martinelli E, Ciardiello F, Delrio P, Budillon A, Piccirillo MC, Avallone A. Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): an academic, multicenter, single-arm, two-stage, phase II study. ESMO Open 2023; 8:100748. [PMID: 36603521 PMCID: PMC10024144 DOI: 10.1016/j.esmoop.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Maintaining angiogenesis inhibition and switching the chemotherapy backbone represent the current second-line therapy in patients with RAS-mutant metastatic colorectal cancer (mCRC). Regorafenib, an oral multikinase inhibitor, prolonged overall survival (OS) in the chemorefractory setting. MATERIALS AND METHODS STREAM was an academic, multicenter, single-arm phase II trial, evaluating the activity of regorafenib in RAS-mutant mCRC, in terms of the rate of patients who were progression-free after 6 months from study entry (6mo-PF). Patients were pretreated with fluoropyrimidine, oxaliplatin, and bevacizumab. According to Simon's two-stage design, ≥18 patients 6mo-PF were needed in the overall population (N = 46). Secondary endpoints were safety, objective response rate (ORR), progression-free survival (PFS), and OS. Early metabolic response by [18F]2-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography ([18F]-FDG PET/CT) scan was an exploratory endpoint. EudraCT Number: 2015-001105-13. RESULTS The number of patients 6mo-PF was 8/22 at the first stage and 14/46 in the overall population. The ORR was 10.9%, disease control rate was 54.6%, median (m)PFS was 3.6 months [95% confidence interval (CI) 1.9-6.7 months], mOS was 18.9 months (95% CI 10.3-35.3 months), and mPFS2 (from study entry to subsequent-line progression) was 13.3 months (95% CI 8.4-19.7 months). Long benefiter patients (>6mo-PF) significantly more often had a single metastatic site and lung-limited disease. No unexpected toxicity was reported. Grade ≥3 events occurred in 39.1% of patients, with hand-foot syndrome (13%), fatigue, and hyperbilirubinemia (6.5%) occurring mostly. Baseline metabolic assessment was associated with OS in the multivariate analysis, while early metabolic response was not associated with clinical outcomes. CONCLUSIONS The study did not meet its primary endpoint. However, regorafenib was well tolerated and did not preclude subsequent treatments. Patients with good prognostic features (single metastatic site and lung-limited disease) reported clinical benefit with regorafenib. The exploratory metabolic analysis suggests that baseline [18F]-FDG PET/CT might be useful to select patients with a favorable outcome. A chemotherapy-free interval with regorafenib was associated with durable disease control in a selected group of patients with favorable clinical characteristics.
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Affiliation(s)
- C Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/clacardone
| | - A De Stefano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/alfdestefano
| | - G Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - A Cassata
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - L Silvestro
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Borrelli
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - E Di Gennaro
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Romano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Nappi
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - N Zanaletti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - F Foschini
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - R Casaretti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - F Tatangelo
- Pathology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - S Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Raddi
- Nuclear Medicine Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - D Bilancia
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - V Granata
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - S Setola
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Petrillo
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - C Vitagliano
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - P Gargiulo
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Febbraro
- Hospital Sacro Cuore di Gesu, Fatebenefratelli, Benevento, Italy
| | - E Martinelli
- Medical Oncology, Precision Medicine Department, University of Campania Luigi Vanvitelli, Naples, Italy. https://twitter.com/grikamartinelli
| | - F Ciardiello
- Medical Oncology, Precision Medicine Department, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Delrio
- Colorectal Oncological Surgery, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Budillon
- Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy. https://twitter.com/AlfredoBudillon
| | - M C Piccirillo
- Clinical Trial Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
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Cardone C, Piccirillo M, Rosati G, De Stefano A, Romano C, Nappi A, Zanaletti N, Foschini F, Cassata A, Casaretti R, Silvestro L, Tatangelo F, Lastoria S, Raddi M, Bilancia D, Febbraro A, Martinelli E, Ciardiello F, Delrio P, Perrone F, Budillon A, Avallone A. P-68 Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): An academic, multicenter, single-arm, two-stage, phase 2 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Granata V, Fusco R, Venanzio Setola S, Sassaroli C, De Franciscis S, Delrio P, Danti G, Grazzini G, Faggioni L, Gabelloni M, Ottaiano A, Greggi S, Patrone R, Palaia R, Petrillo A, Izzo F. Radiological assessment of peritoneal carcinomatosis: a primer for resident. Eur Rev Med Pharmacol Sci 2022; 26:2875-2890. [PMID: 35503632 DOI: 10.26355/eurrev_202204_28619] [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: 06/14/2023]
Abstract
The imaging has critical responsibility in the assessment of peritoneal lesions along with estimating the overall extent. Valuing disease burden is crucial for selection of combining cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy (HIPEC) treatment. An approach that combines the strength of several imaging tools and increases diagnostic accuracy, should be chosen, even if the preferred imaging tool in patients with suspected Peritoneal Carcinomatosis (PC) is CT. The outcomes of PC are mainly correlated to tumor spread, localization, and lesion size. Accurate assessment of these features is critical for prognosis and treatment planning. These data can be evaluated by Peritoneal Cancer Index (PCI), a quantitative index suggested by Harman and Sugarbaker. Additionally, precise predictive biomarkers should be established to predict PC in patients at risk. The radiomics analysis could predict PC throughout the evaluation of cancers heterogeneity.
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Affiliation(s)
- V Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
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Granata V, Grassi R, Fusco R, Izzo F, Brunese L, Delrio P, Avallone A, Pecori B, Petrillo A. Current status on response to treatment in locally advanced rectal cancer: what the radiologist should know. Eur Rev Med Pharmacol Sci 2021; 24:12050-12062. [PMID: 33336723 DOI: 10.26355/eurrev_202012_23994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The assessment of tumor response, after neoadjuvant radiochemotherapy (nCRT), allows stratifying the patient in order to consider the proper therapeutical management. Histopathology analysis of the surgical specimen is considered the gold standard to assess tumour response and the definition of a complete cancer response is related to the clinical and endoscopic features, by direct evaluation of the rectal wall. However, imaging studies, especially Magnetic Resonance Imaging (MRI) have provided additional parameters, as the evaluation of nodal or mesorectal status. MRI provides a radiological tumour regression grade (mrTRG) that is correlated with the pathologic tumor regression grade (pTRG). Functional MRI parameters have additional impending in early prediction of the efficacy of therapy and can be valuable in drug development processes. Some of functional methodologies are already part of clinical practice: diffusion-weighted MRI (DW-MRI) and perfusion imaging (dynamic contrast enhanced MRI [DCE-MRI]). Other technologies, such as radiomics with MRI are still in the experimental phase. An adequate radiological report describing the restaging of rectal cancer after nCRT should be a "structured report" to improve communication in a multidisciplinary team.
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Affiliation(s)
- V Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
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Granata V, Fusco R, Venanzio Setola S, Mattace Raso M, Avallone A, De Stefano A, Nasti G, Palaia R, Delrio P, Petrillo A, Izzo F. Liver radiologic findings of chemotherapy-induced toxicity in liver colorectal metastases patients. Eur Rev Med Pharmacol Sci 2020; 23:9697-9706. [PMID: 31799635 DOI: 10.26355/eurrev_201911_19531] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There are a number of chemotherapy-effects that should be assessed with liver imaging since they have an influence on surgical morbidity. Chemotherapy-related complications, steatosis, chemotherapy-associated steatohepatitis (CASH), and SOS might impair the hepatic parenchyma, thus reducing the functionality and influencing the outcome following resection. The main role of a radiologist is to provide an accurate diagnosis of the lesion. With constant advances in medicine, a radiologist's role should extend beyond just reporting the data of tumor, providing additional information that may greatly improve patient care. Radiologists should assess both chemotherapy effects on the hepatic metastasis itself, as well as chemo-induced focal and diffuse modifications of non-tumor hepatic parenchyma, since it is important to avoid impaired hepatic function after hepatic resection.
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Affiliation(s)
- V Granata
- Division of Radiology, Division of Abdominal Oncology, Division of Hepatobiliary Surgical Oncology; "Istituto Nazionale Tumori - IRCCS, Fondazione G. Pascale", Naples, Italy.
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Reddavid R, Di Candido F, Ortenzi M, Elmore U, Rega D, Ricceri F, Delrio P, Borghi F, Guerrieri M, Spinelli A, Degiuli M, Cancer S.C.C. SC. Resection of the splenic flexure is the optimal treatment for cancer of the left colonic angle. A nationwide retrospective study of the Italian society of surgical oncology - colorectal cancer network (SICO-CCN) collaborative group. European Journal of Surgical Oncology 2020. [DOI: 10.1016/j.ejso.2020.06.055] [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]
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Milone M, Degiuli M, Allaix ME, Ammirati CA, Anania G, Barberis A, Belli A, Bianchi PP, Bianco F, Bombardini C, Burati M, Cavaliere D, Coco C, Coratti A, De Luca R, De Manzoni G, De Nardi P, De Rosa M, Delrio P, Di Cataldo A, Di Leo A, Donini A, Elmore U, Fontana A, Gallo G, Gentilli S, Giannessi S, Giuliani G, Graziosi L, Guerrieri M, Li Destri G, Longhin R, Manigrasso M, Mineccia M, Monni M, Morino M, Ortenzi M, Pecchini F, Pedrazzani C, Piccoli M, Pollesel S, Pucciarelli S, Reddavid R, Rega D, Rigamonti M, Rizzo G, Robustelli V, Rondelli F, Rosati R, Roviello F, Santarelli M, Saraceno F, Scabini S, Sica GS, Sileri P, Simone M, Siragusa L, Sofia S, Solaini L, Tribuzi A, Trompetto M, Turri G, Urso EDL, Vertaldi S, Vignali A, Zuin M, Zuolo M, D'Ugo D, De Palma GD. Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study. Eur J Surg Oncol 2020; 46:1683-1688. [PMID: 32220542 DOI: 10.1016/j.ejso.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
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Affiliation(s)
- M Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
| | - M Degiuli
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - M E Allaix
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - C A Ammirati
- Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy
| | - G Anania
- Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy
| | - A Barberis
- Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy
| | - A Belli
- Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - P P Bianchi
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - F Bianco
- Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - C Bombardini
- Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy
| | - M Burati
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - D Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - C Coco
- Department of General Surgery, Sacred Heart Catholic University, Rome, Italy
| | - A Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - R De Luca
- Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy
| | - G De Manzoni
- Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy
| | - P De Nardi
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - M De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - P Delrio
- Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - A Di Cataldo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - A Di Leo
- Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy
| | - A Donini
- Department of General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - U Elmore
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - A Fontana
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - S Gentilli
- Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy
| | - S Giannessi
- Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy
| | - G Giuliani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - L Graziosi
- Department of General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - G Li Destri
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - R Longhin
- Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy
| | - M Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - M Mineccia
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - M Monni
- Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - F Pecchini
- Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy
| | - C Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy
| | - M Piccoli
- Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy
| | - S Pollesel
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
| | - S Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - R Reddavid
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - D Rega
- Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - M Rigamonti
- Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy
| | - G Rizzo
- Department of General Surgery, Sacred Heart Catholic University, Rome, Italy
| | - V Robustelli
- Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy
| | - F Rondelli
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - R Rosati
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - F Roviello
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
| | - M Santarelli
- Division of General and Emergency Surgery, Molinette Hospital, Turin, Italy
| | - F Saraceno
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Scabini
- Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy
| | - G S Sica
- Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M Simone
- Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy
| | - L Siragusa
- Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy
| | - S Sofia
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy
| | - L Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - A Tribuzi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy
| | - E D L Urso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - S Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - A Vignali
- Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy
| | - M Zuin
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - M Zuolo
- Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy
| | - D D'Ugo
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G D De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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9
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Ursini C, Omodeo Salè E, Fresegna A, Ciervo A, Jemos C, Maiello R, Buresti G, Colosio C, Rubino F, Mandić-Rajčević S, Chiarella P, Carbonari D, Delrio P, Maiolino P, Marchetti P, Boccia R, Iavicoli S, Cavallo D. Antineoplastic drug occupational exposure: a new integrated approach to evaluate exposure and early genotoxic and cytotoxic effects by no-invasive Buccal Micronucleus Cytome Assay biomarker. Toxicol Lett 2019; 316:20-26. [DOI: 10.1016/j.toxlet.2019.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
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10
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Pucciarelli S, Del Bianco P, Pace U, Bianco F, Restivo A, Maretto I, Selvaggi F, Zorcolo L, De Franciscis S, Asteria C, Urso EDL, Cuicchi D, Pellino G, Morpurgo E, La Torre G, Jovine E, Belluco C, La Torre F, Amato A, Chiappa A, Infantino A, Barina A, Spolverato G, Rega D, Kilmartin D, De Salvo GL, Delrio P. Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer. Br J Surg 2019; 106:1147-1155. [PMID: 31233220 DOI: 10.1002/bjs.11222] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. METHODS This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. RESULTS Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. CONCLUSION Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov).
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Affiliation(s)
- S Pucciarelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - P Del Bianco
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - U Pace
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - F Bianco
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - A Restivo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - I Maretto
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - F Selvaggi
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L Zorcolo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - S De Franciscis
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - C Asteria
- Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy
| | - E D L Urso
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - D Cuicchi
- General Surgery Unit, Department of Alimentary Tract, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Pellino
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - E Morpurgo
- Department of Surgery, Regional Centre for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - G La Torre
- Abdominal Surgical Oncology, Department of Surgery, IRCCS, Centro di Riferimento oncologico della Basilicata, Rionero in Vulture, Italy
| | - E Jovine
- General Surgery and Emergency, Maggiore Hospital, Azienda Sanitaria Locale di Bologna, Bologna, Italy
| | - C Belluco
- Department of Surgical Oncology, Centro di Riferimento Oncologico -IRCCS, National Cancer Institute, Aviano, Italy
| | - F La Torre
- Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - A Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, Italy
| | - A Chiappa
- Innovative Techniques in Surgery Unit, European Institute of Oncology, University of Milan, Milan, Italy
| | - A Infantino
- Surgical Unit, Department of General Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Italy
| | - A Barina
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - G Spolverato
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - D Rega
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - D Kilmartin
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - P Delrio
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
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Rega D, Scala D, Pace U, Bucci AF, Patrone R, Rocca A, Delrio P. Closure of the defect after TAMIS for rectal tumor: which methods. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.269] [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: 11/26/2022] Open
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Budillon A, Delrio P, Pecori B, Tatangelo F, Di Gennaro E, Romano C, D'Angelo V, Marone P, Granata C, Cavalacanti E, De Stefano A, Pace U, Bianco F, Petrillo A, Lastoria S, Botti G, Muto P, Perrone F, Piccirillo M, Avallone A. Phase I/II study of valproic acid (VPA) and short-course radiotherapy (SCRT) plus capecitabine (CAP) as preoperative treatment in low-moderate risk rectal cancer (V-shoRT-R3). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Avallone A, Delrio P, Nasti G, Cassata A, Silvestro L, De Stefano A, Lastoria S, Casaretti R, Romano C, Ottaiano A, Di gennaro E, Nappi A, Maiolino P, Cavalcanti E, Petrillo A, Tatangelo F, Giannarelli D, Galon J, Ascierto P, Budillon A. Preoperative nivolumab in patients(pts) with locally advanced colon cancer (T3 or T4): A window-of-opportunity study (NICOLE). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Avallone A, Nasti G, Rosati G, Carlomagno C, Romano C, Bilancia D, De Stefano A, Silvestro L, Ottaiano A, Cassata A, Bianco F, Izzo F, Delrio P, De Gennaro E, Casaretti R, Tafuto S, Albino V, Pace U, Lastoria S, Gallo C, Budillon A, Piccirillo M. Survival analysis of a multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Placido S, Nuzzo F, Perrone F, Carlomagno C, Noviello A, Delrio P, di Palma E, Pini MT, Cerato PL, Bianco C. The First Breast Cancer Screening Program in Southern Italy: Preliminary Results from Three Municipalities of the Naples Province. Tumori 2018; 81:7-12. [PMID: 7754547 DOI: 10.1177/030089169508100103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background It has been demonstrated that breast cancer screening induces a 30% reduction of specific mortality. In May 1990, we started a pilot screening program to assess the feasibility of carrying out such a program in Campania (southern Italy). Herein we report the results of the first round of the program from three municipalities (Giugliano, Mugnano and Qualiano) that lie within the local health district no. 23, close to the city of Naples. Methods Women between the ages of 50 and 69 years were sent a personalized letter inviting them to attend the screening test; those not responding were sent a second invitation. The screening test consisted of clinical examination followed by two-view mammography. Second–level diagnostic tools were sonography, fine needle aspiration (manual, echo-guided and stereotaxic) and surgical biopsy. Results Out of 5,732 women invited for the first round, 1,813 (31.6%) attended the screening. Attendance rate was higher among younger women. Ninety-one women were positive at the screening test and underwent further examination (recall rate, 5.0%). Among them, 19 had surgical biopsy (biopsy rate, 1.0%) that led to breast cancer diagnosis in 11 cases. The benign/malignant biopsy rate was 0.73. Detection rate was 6.07 × 1,000 screened women and varied among age categories, increasing within the 60–69 subgroup; detection rate/expected incidence ratio in the overall group was 4.5 and also increased within the older age category. Seven out of 11 cancers were at UICC stage 0-I. Among 327 self-referring women, 38 were positive (recall rate, 11.6%), and 14 underwent biopsy (biopsy rate, 4.3%), which showed cancer in 7 cases (benign/malignant biopsy rate, 1.0). In addition, 2 inflammatory cancers were diagnosed without surgical biopsy. Thus 9 cancer cases were detected in this group. Self-referring women differed from responding women in that they had a higher frequency of symptoms or familiar history of cancer, and a higher educational level and awareness of preventive medicine. Clinical examination added no diagnostic advantage in the responding group but did not significantly worsen the recall rate. In the self-referring group, one case of inflammatory cancer was missed by mammography and diagnosed by clinical examination. Conclusion The early results (recall rate = 5%, detection rate/expected incidence ratio = 4.5, benign/malignant biopsy rate = 0.73, advanced cancers = 36.4%) are encouraging and indicate the validity of the program. Strategies to improve attendance rate are planned.
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Affiliation(s)
- S de Placido
- Cattedra di Oncologia Medica, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, Italy
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Avallone A, Nasti G, Rosati G, Carlomagno C, Romano C, Bilancia D, De Stefano A, Ottaiano A, Cassata A, Silvestro L, Tafuto S, Bianco F, Delrio P, Izzo F, Di Gennaro E, Lastoria S, Gallo C, Perrone F, Budillon A, Piccirillo M. A multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with mFOLFOX/OXXEL in patients with metastatic colorectal cancer (mCRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barina A, De Paoli A, Delrio P, Guerrieri M, Muratore A, Bianco F, Vespa D, Asteria C, Morpurgo E, Restivo A, Coco C, Pace U, Belluco C, Aschele C, Lonardi S, Valentini V, Mantello G, Maretto I, Del Bianco P, Perin A, Pucciarelli S. Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study. Tech Coloproctol 2017; 21:633-640. [PMID: 28755256 DOI: 10.1007/s10151-017-1665-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rectum-sparing approaches appear to be appropriate in rectal cancer patients with a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The aim of the present study is to evaluate the effectiveness of rectum-sparing approaches at 2 years after the completion of neoadjuvant treatment. STUDY DESIGN Patients with rectal adenocarcinoma eligible to receive neoadjuvant therapy will be prospectively enrolled. Patients will be restaged 7-8 weeks after the completion of neoadjuvant therapy and those with mCR (defined as absence of mass, small mucosal irregularity no more than 2 cm in diameter at endoscopy and no metastatic nodes at MRI) or cCR will be enrolled in the trial. Patients with mCR will undergo local excision, while patients with cCR will either undergo local excision or watch and wait policy. The main end point of the study is to determine the percentage of rectum preservation at 2 years in the enrolled patients. CONCLUSION This protocol is the first prospective trial that investigates the role of both local excision and watch and wait approaches in patients treated with neoadjuvant therapy for rectal cancer. The trial is registered at clinicaltrials.gov (NCT02710812).
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Affiliation(s)
- A Barina
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy.
| | - A De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - P Delrio
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - M Guerrieri
- Surgery Clinic, Marche Polytechnic University, Ancona, Italy
| | - A Muratore
- E. Agnelli Hospital, Pinerolo, TO, Italy
| | - F Bianco
- Abdominal Surgical Oncology Unit, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - D Vespa
- General Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - C Asteria
- Department of Surgery and Orthopaedics, General Surgery Units of Asola, Mantua, Italy
| | - E Morpurgo
- Department of Surgery, Regional Center for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - A Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - C Coco
- Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
| | - U Pace
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - C Belluco
- Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - C Aschele
- Medical Oncology Unit, S. Andrea Hospital, La Spezia, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - V Valentini
- Institute of Radiotherapy, Catholic University of Rome, Rome, Italy
| | - G Mantello
- Department of Radiotherapy, Ospedali Riuniti, Ancona, Italy
| | - I Maretto
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| | | | - A Perin
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| | - S Pucciarelli
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
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Bianco F, De Franciscis S, Belli A, Falato A, Fusco R, Altomare DF, Amato A, Asteria CR, Avallone A, Binda GA, Boccia L, Buzzo P, Carvello M, Coco C, Delrio P, De Nardi P, Di Lena M, Failla A, La Torre F, La Torre M, Lemma M, Luffarelli P, Manca G, Maretto I, Marino F, Muratore A, Pascariello A, Pucciarelli S, Rega D, Ripetti V, Rizzo G, Serventi A, Spinelli A, Tatangelo F, Urso EDL, Romano GM. T1 colon cancer in the era of screening: risk factors and treatment. Tech Coloproctol 2017; 21:139-147. [DOI: 10.1007/s10151-017-1586-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023]
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Cardone E, Napolitano M, Rega D, Tatangelo F, Scala D, Delrio P. Peripheral myeloid-derived suppressor and t-regulatory pd-1 positive cells predict response to neoadjuvant short-course radiotherapy in rectal cancer patients. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.010] [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: 10/21/2022] Open
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Scala D, Pace U, Rega D, Ruffolo F, Sassaroli C, Cardone E, Delrio P. Transanal video-assisted surgery: Indications, technical options and results. The experience of a colorectal cancer surgical division. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.019] [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: 10/21/2022] Open
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Pace U, Ruffolo F, Rega D, Scala D, Sassaroli C, Niglio A, Delrio P. Laparoscopic extralevator APR and perineal reconstruction with a biomesh. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rega D, Scala D, Pace U, Niglio A, Ruffolo F, Pannullo M, Sassaroli C, Delrio P. 15. TAMIS for rectal tumors: Advancements of a new approach. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.021] [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: 10/21/2022] Open
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Rega D, Pace U, Niglio A, Scala D, Sassaroli C, Ruffolo F, Pannullo M, Delrio P. 337. Carcinoma of the splenic flexure: What surgical treatment. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.233] [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: 10/21/2022] Open
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Antonio A, Piccirillo M, Nasti G, Rosati G, Chiara C, Romano C, Bilancia D, De Stefano A, Ottaiano A, Cassata A, Bianco F, Delrio P, Izzo F, Di Gennaro E, Caracò C, Iaffaioli R, Lastoria S, Gallo C, Budillon A, Perrone F. A multicentre, randomized phase 3 study on the optimization of the combination of bevacizumab with FOLFOX/OXXEL in the treatment of patients with metastatic colorectal cancer (mCRC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D, Delrio P. Transanal minimal invasive surgery for rectal lesions: should the defect be closed? Colorectal Dis 2015; 17:397-402. [PMID: 25512176 DOI: 10.1111/codi.12866] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/20/2014] [Indexed: 02/08/2023]
Abstract
AIM Transanal minimal invasive surgery (TAMIS) of rectal lesions is increasingly being used, but the technique is not yet standardized. The aims of this study were to evaluate peri-operative complications and long-term functional outcome of the technique and to analyse whether or not the rectal defect needs to be closed. METHOD Consecutive patients undergoing TAMIS using the SILS port (Covidien) and standard laparoscopic instruments were studied. RESULTS Seventy-five patients (68% male) of mean age 67 (± 15) years underwent single-port transanal surgery at three different centres for 37 benign lesions and 38 low-risk cancers located at a mean of 6.4 ± 2.3 cm from the anal verge. The median operating time was 77 (25-245) min including a median time for resection of 36 (15-75) min and for closure of the rectal defect of 38 (9-105) min. The defect was closed in 53% using interrupted (75%) or a running suture (25%). Intra-operative complications occurred in six (8%) patients and postoperative morbidity was 19% with only one patient requiring reoperation for Grade IIIb local infection. There was no difference in the incidence of complications whether the rectal defect was closed or left open. Patients were discharged after 3.4 (1-21) days. At a median follow-up of 12.8 (2-29) months, the continence was normal (Vaizey score of 1.5; 0-16). CONCLUSION Transanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1 year continence is not compromised.
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Affiliation(s)
- D Hahnloser
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland; Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
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Scala D, Rega D, Ruffolo F, Pace U, Sassaroli C, Cardone E, Grimaldi A, Caraco' C, Mozzillo N, Delrio P. Electrochemotherapy for rectal cancer after neoadjuvant radiotherapy: A case report. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.037] [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: 10/24/2022] Open
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Sassaroli C, Scala D, Rega D, Pace U, Ruffolo F, Cassata A, Delrio P. 428. Proactive HIPEC treatment of pelvic T4 locally advanced cancer and recurrent pelvic colorectal cancer: Preliminary results. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sassaroli C, Scala D, Rega D, Ruffolo F, Pace U, Cassata A, Delrio P. 247. Pelvic resection: Indications, technical considerations and outcomes of a single center series. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Martines C, Cordio S, Aprile G, Galiano A, Lonardi S, Rosati G, Avallone A, Pini S, Leo S, Lutrino S, Uccello M, Delrio P, Franco S, Bordonaro R. Safety and Efficacy of Preoperative Chemoradiotherapy (Crt) in Locally Advanced Rectal Cancers (Larc): a Retrospective Italian Survey of 389 Elderly Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- U Pace
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori - "Fondazione Giovanni Pascale" IRCCS, Naples, Italy
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Cardone E, Apice G, Rega D, Montesarchio L, Scala D, Granata C, Vallone P, Fiore F, Mori S, Delrio P. Salvage vacuum therapy after failed reconstruction of abdominal wall for extensive resection in recurrent uterine sarcoma. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.078] [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: 10/26/2022] Open
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Rega D, Montesarchio L, Cardone E, Ulloa Severino B, Pace U, Scala D, Ruffolo F, Sassaroli C, Delrio P. Transanal minimally invasive surgery (TAMIS) for local excision of rectal tumors. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.049] [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: 10/26/2022] Open
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Nasti G, Piccirillo MC, Izzo F, Ottaiano A, Albino V, Delrio P, Romano C, Giordano P, Lastoria S, Caracò C, de Lutio di Castelguidone E, Palaia R, Daniele G, Aloj L, Romano G, Iaffaioli RV. Neoadjuvant FOLFIRI+bevacizumab in patients with resectable liver metastases from colorectal cancer: a phase 2 trial. Br J Cancer 2013; 108:1566-70. [PMID: 23558891 PMCID: PMC3668480 DOI: 10.1038/bjc.2013.140] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Preoperative treatment of resectable liver metastases from colorectal cancer (CRC) is a matter of debate. The aim of this study was to assess the feasibility and activity of bevacizumab plus FOLFIRI in this setting. Methods: Patients aged 18–75 years, PS 0–1, with resectable liver-confined metastases from CRC were eligible. They received bevacizumab 5 mg kg−1 followed by irinotecan 180 mg m−2, leucovorin 200 mg m−2, 5-fluorouracil 400 mg m−2 bolus and 5-fluorouracil 2400 mg m−2 46-h infusion, biweekly, for 7 cycles. Bevacizumab was stopped at cycle 6. A single-stage, single-arm phase 2 study design was applied with 1-year progression-free rate as the primary end point, and 39 patients required. Results: From October 2007 to December 2009, 39 patients were enrolled in a single institution. Objective response rate was 66.7% (95% exact CI: 49.8–80.9). Of these, 37 patients (94.9%) underwent surgery, with a R0 rate of 84.6%. Five patients had a pathological complete remission (14%). Out of 37 patients, 16 (43.2%) had at least one surgical complication (most frequently biloma). At 1 year of follow-up, 24 patients were alive and free from disease progression (61.6%, 95% CI: 44.6–76.6). Median PFS and OS were 14 (95% CI: 11–24) and 38 (95% CI: 28–NA) months, respectively. Conclusion: Preoperative treatment of patients with resectable liver metastases from CRC with bevacizumab plus FOLFIRI is feasible, but further studies are needed to define its clinical relevance.
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Affiliation(s)
- G Nasti
- Medical Oncology, Abdominal Department, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, 80131 Napoli, Italy
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Cardone E, Rega D, Scala D, Tammaro P, Sassaroli C, Mori S, Montesarchio L, Pace U, Delrio P. Options for pelvic floor reconstruction after extralevator abdomin-operineal resection (APR): Myocutaneous flap or porcine dermal collagen implant. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Rega D, Cardone E, Montesarchio L, Tammaro P, Pace U, Ruffolo F, De Franciscis S, Belli A, Bianco F, Delrio P. Transanal minimally invasive surgery with single-port laparoscopy for rectal tumors. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Avallone A, Di Gennaro E, Aloj L, Delrio P, Pecori B, Tatangelo F, Petrillo A, Iaffaioli V, Lastoria S, Budillon A. Neoadjuvant Multidisciplinary Phase II Study (BRANCH) of an Early Bevacizumab Schedule Plus Chemo-Radiation Therapy in Rectal Cancer: Efficacy, Safety, and Biomarkers. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cardone E, Delrio P, Avallone A, Pecori B, Budillon A, De Gennaro E, Lastoria S, Tatangelo F, Marone P, Petrillo A, Romano C, Sassaroli C, Bianco F, Cremona F, Romano G. Circulating endothelial cells and FDG-PET as markers for early prediction of response to neoadjuvant chemoradiation and bevacizumab for locally advanced rectal cancer. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Avallone A, Delrio P, Gennaro ED, Pecori B, Caracò C, Tatangelo F, Sandomenico C, Petrillo A, Budillon A, Comella P. 6117 Circulating endothelial cells (CECs) and FDG-PET for early prediction of response in high-risk locally advanced rectal cancer (HR-LARC) patients (pts) treated with two different schedules of bevacizumab (BEV) in combination with preoperative chemo-radiotherapy (CT-RT). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71212-1] [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: 10/20/2022] Open
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Avallone A, Delrio P, Di Gennaro E, Pecori B, Aloi L, Tatangelo F, Petrillo A, Budillon A, Caracò C, Sandomenico C, Comella P. Evaluation of two different schedules of bevacizumab (BEV) with oxaliplatin (OXA), raltitrexed (TOM), levo-folinic acid (LFA), and 5-fluorouracil (5-FU) during preoperative (preop) pelvic RT in high-risk locally advanced rectal cancer (HR-LARC) patients (pts). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14546 Background: OXA, RTX, 5FU, and LFA during preop pelvic RT produced a high rate of complete (TRG1) or subtotal (TRG2) tumor regression in HR-LARC. BEV might enhance response to chemoradiotherapy (CH-RT), but scheduling of BEV could be critical. Therefore, we added BEV to CH-RT in two different schedules to evaluate their feasibility and activity. According to the Simon's two-stage design, assuming a hypothesis of a 50% TRG1 (α=0.05, β=0.20), at least 6/16 TRG1 should be obtained to continue pts accrual in every schedule. Methods: Inclusion criteria were: cT4, cN+, cT3(<5 cm from the anal verge and/or +ve CRM), resectable M1. Pts received 3 biweekly courses(c) of OXA (100 mg/m2)/TOM (2.5 mg/m2) on day 1, and 5FU (800 mg/m2)/LFA(250 mg/m2) on day 2 during pelvic RT (45 Gy). BEV (5 mg/kg) was given biweekly from day -14 for 4 c in schedule A, and from day -4 for 2 c in schedule B. Toxicity was graded with NCI-CTCv3. Changes of circulating endothelial cells (CECs)assessed by flow cytometry in 17 (7 A; 10 B) pts, and glucose metabolism evaluated by FDG-PET in 27 (15 A; 12 B) pts after 1st c of CT were used as surrogate markers of tumor response. The Mann-Whitney test assessed the differences in CECs and FDG-PET related to schedules. TME was planned 8 wks after CH- RT. Results: Until now, 28 pts (16 A; 12 B) were treated: M/F=19/9; median age 57 (range, 43–74) yrs. All but one pt (A) completed the planned CH-RT. Grade 3/4 neutropenia was the most common toxicity with schedule A (7 pts, 44%), while it never occurred with schedule B. No treatment-related or postop death occurred. CECs were more decreased by schedule B than by schedule A (median, -78% vs -29%, p< 0.05). Glucose metabolism was also more reduced by schedule B (median, -78% vs -50%, p < 0.05). All but one pt (refusal) of schedule A, and 7 pts of schedule B proceeded to TME. With schedule A, 2 pts obtained a TRG1, 8 pts a TRG2, 3 pts a TRG3 and 2 pts a TRG4. With schedule B, 4 pts obtained a TRG1 and 3 pts a TRG2. Conclusions: These data suggest the relevance of BEV scheduling during preop CT-RT to optimize safety and efficacy of the combination treatment. Updated results on the whole study population will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- A. Avallone
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - P. Delrio
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - E. Di Gennaro
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - B. Pecori
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - L. Aloi
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - F. Tatangelo
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - A. Petrillo
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - A. Budillon
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - C. Caracò
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - C. Sandomenico
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
| | - P. Comella
- National Cancer Institute, Naples, Italy; National Cancer Institute, Naples, Italy
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Fattopace A, Canonico S, Guida A, Scala D, Ruffolo F, Cremona F, Pecori B, Guida C, Avallone A, Di Marzo M, Tatangelo F, Petrillo A, Marone P, Delrio P. Preoperative radiotherapy "short course" in rectal cancer in elder patient: low impact on tumor regression. BMC Geriatr 2009. [PMCID: PMC4290845 DOI: 10.1186/1471-2318-9-s1-a25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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41
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Avallone A, Delrio P, Guida C, Tatangelo F, Petrillo A, Sandomenico C, Costanzo R, Parisi V, Comella G, Comella P. 3027 POSTER High rate of TRG1–2, and prolonged RFS with OXA/TOM and FU/LFA during preoperative pelvic RT in patients with poor prognosis locally-advanced rectal cancer (LARC). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70955-2] [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: 11/25/2022] Open
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42
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Avallone A, Delrio P, Guida C, Tatangelo F, Petrillo A, Lastoria S, Parisi V, Comella G, Budillon A, Comella P. High rate of TRG1–2 and prolonged RFS with OXA/TOM and FU/LFA during preoperative pelvic RT in patients with poor prognosis locally advanced rectal cancer (LARC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14500 Background: We have previously reported that 3 cycles of Oxaliplatin (OXA), Raltitrexed (TOM) and 5-Fluorouracile (FU) + levo-folinic acid (LFA) during pelvic RT had an acceptable toxicity and produced a complete (TRG1, 42%) or subtotal (TRG2, 29%) pathologic tumor regression in 71% of 31 pts with poor prognosis LARC (Avallone et al, Br J Cancer 2006). Here we report an expanded experience on such treatment. Methods: We enrolled 62 eligible pts (M, 33; F, 29), with median age of 58 (27–79) yrs, and adenocarcinoma of the extraperitoneal rectum, with at least one of the following characteristics: cT4 (N pts), cN+ (N), cT3N0 with tumor location = 5 cm from the anal verge and/or CRM +ve (assessed by MRI) (N). Pts received 3 biweekly courses of OXA 100 mg/sqm + TOM 2.5 mg/sqm on day 1, and LFA 250 mg/sqm + FU 900 mg/sqm (31 pts) or 800 mg/sqm (31 pts) on day 2, and concomitant pelvic RT (1.8 Gy/day, total dose 45 Gy). TME was planned 8 weeks after the end of treatment. Pathologic response was evaluated by tumor regression grading (TRG) according to Mandard’s modified classification. Pts with cT4, pN+ and pCRM +ve received also 4 months of weekly FU/FA. Results: All pts received full dose of RT, and 98% of the planned CT cycles. Neutropenia was the most common grade = 3 toxicity (40%), while grade 3 diarrhea was seen in 19% of pts with FU 900 mg/sqm, and in only 6% of pts with FU 800 mg/sqm. All but 2 pts had a TME with R0 resection, and no treatment-related or perioperative death occurred. Median number of sampled lymph nodes was 36 (range, 10–80). 28 (45%) pts obtained a TRG1, and 17 (27%) pts a TRG2. Activity of the treatment was similar in all risk groups, regardless of FU dosage. 1 pt suffered a local recurrence (after 9 months), and 3 pts had distant metastases (after 22, 33, and 47 months). After a median follow-up of 34 (range 6–54) months, all pts are alive, and the estimated 34-month RFS was 95%. All pts achieving a TRG1, and all but one with TRG2 (pCRM +ve), were recurrence-free. Conclusions: These data confirm the feasibility and activity of the whole treatment. A slight reduction of FU dosage appeared to improve the safety of this combination. Currently, we are now evaluating the addition of bevacizumab 5 mg/kg every 2 weeks before and during this concurrent treatment. No significant financial relationships to disclose.
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Affiliation(s)
- A. Avallone
- National Tumour Institute Naples, Naples, Italy
| | - P. Delrio
- National Tumour Institute Naples, Naples, Italy
| | - C. Guida
- National Tumour Institute Naples, Naples, Italy
| | | | - A. Petrillo
- National Tumour Institute Naples, Naples, Italy
| | - S. Lastoria
- National Tumour Institute Naples, Naples, Italy
| | - V. Parisi
- National Tumour Institute Naples, Naples, Italy
| | - G. Comella
- National Tumour Institute Naples, Naples, Italy
| | - A. Budillon
- National Tumour Institute Naples, Naples, Italy
| | - P. Comella
- National Tumour Institute Naples, Naples, Italy
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Papa ML, Capasso F, Pudore L, Torre S, Mango S, Russo V, Delrio P, Palaia R, Ruffolo F, d'Eufemia MD, De Lucia D, Napolitano M, Di Micco P, Parisi V. Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer. Exp Oncol 2007; 29:111-5. [PMID: 17704742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor progression. However, none of activation coagulation markers has any predictive value for the occurrence of the thrombotic events in one individual patient. Current clotting methods can't reveal the overall dynamic clot formation; in contrast thromboelastographic methods specifically assess overall coagulation kinetics and its strength in whole blood. AIM Objective of study was to evaluate if the activation of coagulation as eventually revealed by ROTEM thromboelastometry could assess an hypercoagulable state in surgical neoplastic patients. PATIENTS AND METHODS Fifty consecutive patients with carcinoma of the digestive tract in preoperative period (23 M, 27 F aging 61.5 (45-79 years) and 147 healthy subjects (71 M, 76 F) were studied. A recent thromboelastometric method based on thrombelastography after Hartert was employed. Measurements were performed on ROTEM Coagulation Analyzer. The continuous coagulation data from 50 min course were transformed into dynamic velocity profiles of WB clot formation. RESULTS Standard parameters (CT, CFT, MCF) of cancer patients were similar to controls. CT (in cancer patients): females 50 s (38.3-58.7), males 50 s (42-71.2) vs 51 s (42-59), p = 0.1210 / 53 s (42-74.8), p = 0.1975 (in controls). CFT (in cancer patients): females 72 s (32- 92.4), males 80 s (50.2- 128.7) vs 78 s (62-100), p = 0.0128 / 80 s (59-124.4), p = 0.9384 (in controls). MCF (in cancer patients): females 70 mm (59.9-82.5), males 63 mm (56-73.7) vs 69 mm (59-95.8), p = 0.9911 / 69 mm (53.6-90), p = 0.0135 (in controls). Females showed a higher MaxVel when compared to males. The MaxVel was increased in cancer patients: females 19 mm /100 s (14.3-49.5) males 18 mm / 100 s (11-27) vs 15 mm 100 s (11.8-22), p < 0.001 / 13 mm / 100 s (10-21.8), p < 0.001 in controls. The t-MaxVel was shortened in cancer patients: females 65s (48.6-112.8), males 81s (50.1-135.9) vs 115s (56.8-166), p < 0.001 / 115 s (59.8-180.8), p = 0.0002 in controls. The AUC was increased in cancer patients: females 6451 mm 100(5511-8148), males 5984 mm 100 (5119-6899) vs 5778 mm 100 (4998-6655), p < 0.001 / 5662 mm 100 (4704-6385), p = 0.0105. CONCLUSION Unlike other assays measuring variations in a single component during coagulation, the thrombelastographic method records a profile of real-time continuous WB clot formation, and may provide extensive informations on haemostasis in neoplastic patients before surgery.
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Affiliation(s)
- M L Papa
- Laboratory of Haemostasis and Thrombosis, San Giovanni Bosco Hospital of Naples, Naples, Italy
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Avallone A, Delrio P, Guida C, Tatangelo F, Petrillo A, Marone P, Cascini LG, Morrica B, Lastoria S, Parisi V, Budillon A, Comella P. Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I-II study. Br J Cancer 2006; 94:1809-15. [PMID: 16736001 PMCID: PMC2361331 DOI: 10.1038/sj.bjc.6603195] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oxaliplatin (OXA), raltitrexed (RTX), 5-fluorouracil (FU) and folinic acid (FA) have shown activity in metastatic colorectal cancer, radioenhancing effect and synergism when combined. We evaluated a chemotherapy (CT) combination of OXA, RTX and FU/FA during preoperative radiotherapy (RT) in locally advanced rectal cancer (LARC) patients. Fifty-one patients with LARC at high risk of recurrence (T4, N+ or T3N0 ⩽5 cm from anal verge and/or circumferential resection margin ⩽5 mm) received three biweekly courses of CT during pelvic RT (45 Gy). Surgery was planned 8 weeks after CT-RT. Recommended doses (RDs) determined during phase I were utilised in the subsequent phase II trial, where the rate of tumour regression grade (TRG) 1 or 2 was the main end point. No toxic deaths occurred, and severe toxicity was easily managed. In phase II, RDs delivered in 31 patients were OXA 100 mg m−2 and RTX 2.5 mg m−2 on day 1, and FU 900 mg m−2 and LFA 250 mg m−2 on day 2. Main severe toxicities by patients were grade 4 neutropenia (23%) and grade 3 diarrhoea (19%). In 71% (95% confidence limits, 52–86%) of patients, TRG1 (13) or TRG2 (9) was obtained. All patients are alive and recurrence-free after a median follow-up of 29 months. Combination of OXA, RTX and FU/FA with pelvic RT has an acceptable toxicity and a high clinical activity in LARC and should be studied further in patients at high risk of recurrence.
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Affiliation(s)
- A Avallone
- Department of Medical Oncology, National Tumour Institute, Naples, Italy.
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Avallone A, Lastoria D, Delrio P, Guida C, Tatangelo F, Marone P, Petrillo A, Budillon A, Cascini G, Comella P. High pathological response rate with neoadjuvant oxaliplatin (OXA), raltitrexed (TOM), 5-fluorouracil (FU) and levo-folinic acid (LFA) + RT in poor-risk locally advanced rectal cancer (LARC): Results of a phase II study with dynamic evaluation by FDG-PET scan. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3584] [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)
| | | | - P. Delrio
- National Tumor Institute, Naples, Italy
| | - C. Guida
- National Tumor Institute, Naples, Italy
| | | | - P. Marone
- National Tumor Institute, Naples, Italy
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Delrio P, Fazioli F, Di Marzo M, Avallone A, Elmo M, Pecori B, Ravo V, Idà DN, Bianchi P, Cremona F, De Rosa V, Parisi V. Combined multistep approach in a locally advanced rectal cancer with sacral invasion: case report. Suppl Tumori 2005; 4:S7. [PMID: 16437870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Composite pelvic resection with sacrectomy may provide good local control in case of locally advanced rectal cancer infiltrating the sacral bone. A combined multidisciplinary approach including chemotherapy and radiotherapy is here presented for a case of rectal tumor invading the sacrum.
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Affiliation(s)
- P Delrio
- Colorectal Cancer Cooperative Team, Istituto Nazionale dei Tumori, Napoli
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47
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Palaia R, Delrio P, Albino V, Scala D, Cremona F, Pignata S, Parisi V. [Evolution of the treatment of locoregional recurrences of gastric carcinoma]. Suppl Tumori 2005; 4:S76. [PMID: 16437914] [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: 05/06/2023]
Affiliation(s)
- R Palaia
- Oncologia Chirurgica C, Istituto Nazionale dei Tumori, Napoli
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Delrio P, Avallone A, Guida C, Lastoria S, Tatangelo F, Cascini GM, Marone P, Petrillo A, Budillon A, Di Marzo M, Palaia R, Albino V, De Rosa V, Parisi V. Multidisciplinary approach to locally advanced rectal cancer: results of a single institution trial. Suppl Tumori 2005; 4:S8. [PMID: 16437871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Locally advanced rectal cancer carries out a dismail prognosis despite optimal surgery in terms of local and distant relapses. Neoadjuvant chemoradiation offers good results with tumor downstaging and downsizing and leads to more radical surgery with conservative intent. Selection of patients and an intensive chemotherapy may improve long term results. Our experience with a combined polichemotherapy and radiotherapy for low advanced rectal cancer is presented.
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Affiliation(s)
- P Delrio
- Colorectal Cancer Cooperative Team, Istituto Nazionale dei Tumori, Napoli
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Guida C, Delrio P, Avallone A, Ravo V, Elmo M, Pecori B, Silvestro G, Di marzo M, Lastoria S, Cascini G, Tempesta A, Morrica B. High pathological response rates with a novel preoperative chemoradiaton regimen in locally advanced rectal cancer: Preliminary results and dynamic evaluation by PET. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Avallone A, Delrio P, Ravo E, Marone P, Lastoria S, Petrillo A, Tatangelo F, Budillon A, Carreca I, Comella P. Neoadjuvant oxaliplatin (OXA), raltitrexed (TOM), 5- fluorouracil (FU) and folinic acid (FA) + radiotherapy followed by optimal surgery in locally advanced rectal cancer (LARC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Avallone
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - P. Delrio
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - E. Ravo
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - P. Marone
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - S. Lastoria
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - A. Petrillo
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - F. Tatangelo
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - A. Budillon
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - I. Carreca
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
| | - P. Comella
- INT Pascale, naples, Italy; Università degli studi di Palermo, palermo, Italy
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