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Tortorella L, Cappuccio S, Giannarelli D, Nero C, Marchetti C, Gallotta V, Costantini B, Pasciuto T, Minucci A, Fagotti A, Scambia G. Distribution and prognostic role of BRCA status in elderly ovarian cancer patients. Gynecol Oncol 2024; 182:57-62. [PMID: 38262239 DOI: 10.1016/j.ygyno.2023.12.022] [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: 10/17/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE In the era of target therapy and personalized medicine, BRCA mutational status has a major influence on survival in ovarian cancer patients. Our aim is to verify if the poorer prognosis of elderly ovarian cancer patients can be related to the biology of the tumor beyond their own morbidities and/or suboptimal treatments. METHODS This is a retrospective single-institution study evaluating prognosis of patients with a diagnosis of ovarian cancer and known BRCA status. We collected clinical and surgical characteristics and the distribution of BRCA mutational status according to age groups. RESULTS 1840 patients were included in the analysis. The rate of BRCA mutated decreased over age-range from 49.7% in patients aged <50 years to 18.8% in ≥80 years old women. The prognostic role of BRCA status on survival is maintained when focusing on the elderly population, with improved Disease Free Survival (27.2 months vs 16.5 months for BRCA mutated and wild type respectively, p = 0.001) and Cancer Specific Survival (117.6 months vs 43.1 months for BRCA mutated and wild type respectively, p = 0.001) for BRCAmut compared to BRCAwt patients. In the multivariable analysis, among elderly women, upfront surgery and BRCA mutation are independent factors affecting survival. CONCLUSIONS Elderly patients experiment a poorer prognosis due to multiple factors that include both their medical condition and comorbidities, under-treatment and most importantly disease characteristics. We found that beyond disparities, BRCA mutation is still the strongest independent prognostic factor affecting both the risk of recurrence and death due to disease.
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Affiliation(s)
- Lucia Tortorella
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Serena Cappuccio
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics Facility G-STeP Generator Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Camilla Nero
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Claudia Marchetti
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Valerio Gallotta
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Barbara Costantini
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy; Unicamillus, International Medical University, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Tina Pasciuto
- Epidemiology and Biostatistics Facility G-STeP Generator Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy
| | - Angelo Minucci
- Genomics Core Facility, Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go A. Gemelli, 00167 Roma, Italy
| | - Anna Fagotti
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00167 Rome, Italy.
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health Sciences, Gynercologic Oncology Unit Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli 8, 00167 Rome, Italy; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00167 Rome, Italy
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Cappuccio S, Marchetti C, Altıntaş DA, Oliva R, Russo SA, Costantini B, Giannarelli D, Quagliozzi L, Scambia G, Fagotti A. Low-grade versus high-grade serous ovarian cancer: comparison of surgical outcomes after secondary cytoreductive surgery. Int J Gynecol Cancer 2023:ijgc-2023-004854. [PMID: 38135438 DOI: 10.1136/ijgc-2023-004854] [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: 12/24/2023] Open
Abstract
OBJECTIVE Retrospective series have shown secondary cytoreductive surgery improves oncological outcomes in recurrent low-grade serous ovarian cancer. We aim to compare surgical procedures and complications between patients with low-grade and high-grade recurrent serous ovarian cancer. METHODS This retrospective single-institution study includes patients with recurrent low-grade and high-grade serous ovarian cancer undergoing surgery between January 2012 to December 2021. Patients were propensity matched 1:3 for residual tumor at first surgery, presence of ascites and performance status. Complexity of surgery and postoperative complications were analyzed. RESULTS A total of 116 patients undergoing secondary cytoreductive surgery were included with 29 patients (25%) having low-grade ovarian cancer. The median age of the patients was 54 years (range: 19-85) and 57 years (range: 29-78) in low-grade and high-grade ovarian cancer, respectively (p=0.13). Stages III/IV at diagnosis were more frequent in patients with high-grade ovarian cancers (p<0.001). Peritoneal involvement was higher in low-grade compared with high-grade ovarian cancer as shown by the higher rate of diaphragmatic (41.4% vs 21.8%, p=0.05), abdominal wall (41.4% vs 18.4%, p=0.02) and pelvic (51.7% vs 21.8%, p=0.01) peritonectomy. Multiple bowel resections were higher in low-grade ovarian cancer (24.1% vs 8.0%, p=0.04), while high-grade ovarian cancer had a higher rate of nodal recurrences (73.2%% vs 37.9%, p=0.03). Overall, surgical complexity was higher in low-grade ovarian cancer (58.6% vs 36.8%; p=0.05), with higher median estimated blood loss (400 vs 200 mL; p=0.01) compared with high-grade. Complete cytoreduction was achieved in 26 patients (89.7%) with low-grade and 84 (96.6%) with high-grade (p=0.16) ovarian cancer, with no significant differences in postoperative complications. CONCLUSIONS Secondary cytoreductive surgery in low-grade serous ovarian cancer patients was associated with higher complexity, multiple bowel resections, and higher median estimated blood loss than in high-grade serous ovarian cancer. The comparable rate of postoperative complications suggests that secondary cytoreductive surgery in this group of patients is feasible in expert centers.
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Affiliation(s)
- Serena Cappuccio
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudia Marchetti
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Barbara Costantini
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UniCamillus, Rome, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics Facility, G-STeP Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorena Quagliozzi
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Grieco DL, Russo A, Anzellotti GM, Romanò B, Bongiovanni F, Dell'Anna AM, Mauti L, Cascarano L, Gallotta V, Rosà T, Varone F, Menga LS, Polidori L, D'Indinosante M, Cappuccio S, Galletta C, Tortorella L, Costantini B, Gueli Alletti S, Sollazzi L, Scambia G, Antonelli M. Lung-protective ventilation during Trendelenburg pneumoperitoneum surgery: A randomized clinical trial. J Clin Anesth 2023; 85:111037. [PMID: 36495775 DOI: 10.1016/j.jclinane.2022.111037] [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: 08/29/2022] [Revised: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Study objective To assess the effects of a protective ventilation strategy during Trendelenburg pneumoperitoneum surgery on postoperative oxygenation. DESIGNS Parallel-group, randomized trial. SETTING Operating room of a university hospital, Italy. PATIENTS Morbidly obese patients undergoing Trendelenburg pneumoperitoneum gynaecological surgery. INTERVENTIONS Participants were randomized to standard (SV: tidal volume = 10 ml/kg of predicted body weight, PEEP = 5 cmH2O) or protective (PV: tidal volume = 6 ml/kg of predicted body weight, PEEP = 10 cmH2O, recruitment maneuvers) ventilation during anesthesia. MEASUREMENTS Primary outcome was PaO2/FiO2 one hour after extubation. Secondary outcomes included day-1 PaO2/FiO2, day-2 respiratory function and intraoperative respiratory/lung mechanics, assessed through esophageal manometry, end-expiratory lung volume (EELV) measurement and pressure-volume curves. MAIN RESULTS Sixty patients were analyzed (31 in SV group, 29 in PV group). Median [IqR] tidal volume was 350 ml [300-360] in PV group and 525 [500-575] in SV group. Median PaO2/FiO2 one hour after extubation was 280 mmHg [246-364] in PV group vs. 298 [250-343] in SV group (p = 0.64). Day-1 PaO2/FiO2, day-2 forced vital capacity, FEV-1 and Tiffenau Index were not different between groups (all p > 0.10). Intraoperatively, 59% of patients showed complete airway closure during pneumoperitoneum, without difference between groups: median airway opening pressure was 17 cmH2O. In PV group, airway and transpulmonary driving pressure were lower (12 ± 5 cmH2O vs. 17 ± 7, p < 0.001; 9 ± 4 vs. 13 ± 7, p < 0.001), PaCO2 and respiratory rate were higher (48 ± 8 mmHg vs. 42 ± 12, p < 0.001; 23 ± 5 breaths/min vs. 16 ± 4, p < 0.001). Intraoperative EELV was similar between PV and SV group (1193 ± 258 ml vs. 1207 ± 368, p = 0.80); ratio of tidal volume to EELV was lower in PV group (0.45 ± 0.12 vs. 0.32 ± 0.09, p < 0.001). CONCLUSIONS In obese patients undergoing Trendelenburg pneumoperitoneum surgery, PV did not improve postoperative oxygenation nor day-2 respiratory function. PV was associated with intraoperative respiratory mechanics indicating less injurious ventilation. The high prevalence of complete airway closure may have affected study results. TRIAL REGISTRATION Prospectively registered on http://clinicaltrials.govNCT03157479 on May 17th, 2017.
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Affiliation(s)
- Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Andrea Russo
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gian Marco Anzellotti
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Romanò
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Bongiovanni
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio M Dell'Anna
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Mauti
- Department of Internal medicine, Catholic University of The Sacred Heart, Rome, Italy; Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Cascarano
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Gallotta
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Rosà
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Varone
- Department of Internal medicine, Catholic University of The Sacred Heart, Rome, Italy; Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca S Menga
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Polidori
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco D'Indinosante
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Serena Cappuccio
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Galletta
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Tortorella
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Costantini
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liliana Sollazzi
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy; Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Salutari V, Ghizzoni V, Carbone MV, Giudice E, Cappuccio S, Fanfani F, Scambia G, Lorusso D. Genome tumor profiling in endometrial cancer and clinical relevance in endometrial cancer management: a retrospective single-center experience. Int J Gynecol Cancer 2023; 33:514-520. [PMID: 36746489 DOI: 10.1136/ijgc-2022-003997] [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: 02/08/2023] Open
Abstract
OBJECTIVE Next-generation sequencing (NGS) analysis has become an essential tool for endometrial carcinoma management. Moreover, molecular-driven therapies play an increasingly remarkable role in the era of precision oncology. This study aims to determine the clinical relevance of NGS testing in endometrial carcinoma management by analyzing the clinical benefit of NGS-driven targeted therapies. METHODS A single-center retrospective study was conducted on 25 endometrial carcinoma patients who underwent Foundation Medicine CDx assay at Fondazione Policlinico Universitario Agostino Gemelli, IRCCS (Rome, Italy). Tumor samples were analyzed by Foundation One CDx. A descriptive analysis of tumor genome profiles was performed. Assessment of clinical benefit according to RECIST 1.1 criteria was analyzed for patients who received a tailored treatment according to actionable targets identified by NGS testing. RESULTS Out of 25 endometrial carcinoma patients, 11 received targeted therapy. One patient was excluded from the clinical benefit assessment because of COVID-19-related death 1 month after starting the treatment. Eight of the remaining 10 patients benefited from targeted therapies, with an overall clinical benefit rate of 80%. A targeted agent belonging to the PI3K pathway was given to seven patients, with evidence of three partial responses (42.9%), three stable diseases (42.9%), and one progressive disease (14.2%) according to RECIST 1.1 criteria. One complete response (33.3%), one stable disease (33.3%), and one progressive disease (33.3%) were observed in the three patients treated with poly(ADP-ribose) polymerase (PARP) inhibitors according to their homologous recombination deficiency (HRD) status. CONCLUSION This study highlights the importance of characterizing the mutation profile of patient tumors through NGS. Our findings suggest a clinical benefit of using NGS-driven targeted therapies in endometrial carcinoma patients. However, this personalized approach could benefit the health system in terms of cost-effectiveness by reducing the costs of inappropriate, ineffective, and often expensive treatments.
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Affiliation(s)
- Vanda Salutari
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Viola Ghizzoni
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Vittoria Carbone
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Cappuccio
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Lorusso
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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Marchetti C, Ataseven B, Cassani C, Sassu CM, Congedo L, D'Indinosante M, Cappuccio S, Rhiem K, Hahnen E, Lucci Cordisco E, Arbustini E, Harter P, Minucci A, Scambia G, Fagotti A. Ovarian cancer onset across different BRCA mutation types: a view to a more tailored approach for BRCA mutated patients. Int J Gynecol Cancer 2023; 33:257-262. [PMID: 36581488 DOI: 10.1136/ijgc-2022-003893] [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: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the role of different specific types of germline breast cancer susceptibility BRCA mutations on the age of onset of high grade serous ovarian cancer. METHODS This was a multicenter, international, retrospective cohort of 474 patients diagnosed with recurrent or newly diagnosed high grade serous ovarian cancer, with known germline mutations in BRCA1/2 genes, treated between January 2011 and December 2020 in three academic centers in Europe. Patients were classified into four groups related to the type of BRCA1/2 genes mutation: frameshift, missense, nonsense, and splicing. Data from patients with splicing mutations were removed from the analysis because of the small numbers. The other three groups were compared. RESULTS Excluding the 29 patients with a splicing mutation, 474 patients were enrolled: 309 (65.2%) with frameshift mutations, 102 (21.5%) with nonsense mutations, and 63 (13.3%) with missense mutations. The BRCA1 gene was affected in 324 (68.4%) cases, while BRCA2 was involved in 150 (31.6%) women (p=0.06). We found a difference of more than 5 years in the age of onset of high grade serous ovarian cancer between BRCA1 and BRCA2 patients (mean 53.3 years vs 58.4 years; p=0.001), with a mean age of 55.1 years. Patients with nonsense germline mutations had the youngest age of onset, while women with frameshift mutations had the oldest age of onset of high grade serous ovarian cancer (mean 52.2 years vs mean 55.9 years), both in the BRCA1 and BRCA2 subgroups. There was no statistically significant difference in age of onset between early and advanced groups (mean 55.8 years vs 55.0 years; p=0.55). CONCLUSION Different types of germline BRCA mutations could determine different ages for onset of high grade serous ovarian cancer. If confirmed in larger series, this finding might have a clinical impact, potentially leading to a more tailored approach for risk reducing surgery for the prevention of high grade serous ovarian cancer.
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Affiliation(s)
- Claudia Marchetti
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Carolina Maria Sassu
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Luigi Congedo
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco D'Indinosante
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Serena Cappuccio
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Koln, Germany
| | - Eric Hahnen
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Koln, Germany
| | - Emanuela Lucci Cordisco
- UOC Genetica Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Medicina Genomica, Dipartimento Scienze della Vita e Sanità Pubblica, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - Eloisa Arbustini
- Center for Inherited Cardiovascular Disease, IRCCS, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | - Angelo Minucci
- Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy .,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Fagotti
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
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6
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Giudice E, Ghizzoni V, Carbone M, Salutari V, Cappuccio S, Nero C, Musacchio L, Ricci C, Ciccarone F, Camarda F, Perri M, Giannarelli D, Fanfani F, Scambia G, Lorusso D. 27P Clinical relevance of NGS analysis in endometrial cancer (EC) management. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.028] [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: 11/01/2022] Open
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Palluzzi E, Marchetti C, Cappuccio S, Avesani G, Macchia G, Gambacorta MA, Cocciolillo F, Scambia G, Fagotti A. Management of oligometastatic ovarian cancer recurrence during PARP inhibitor maintenance. Int J Gynecol Cancer 2022; 32:ijgc-2022-003543. [PMID: 35868655 DOI: 10.1136/ijgc-2022-003543] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The benefit of surgery and maintenance treatment with PARP inhibitors (PARPi) has been clearly demonstrated in ovarian cancer. Also, the efficacy and safety of stereotactic body radiotherapy has been shown in patients with metastatic, persistent, and recurrent disease. The aim of this study is to evaluate the management of oligometastatic progression during PARPi maintenance treatment. METHODS This is an observational, retrospective, single-arm study conducted from June 2017 to December 2020 in patients with recurrent ovarian cancer with oligometastatic progression under PARPi maintenance treatment and receiving surgery or stereotactic body radiotherapy for such recurrence. PARPi treatment was continued until further progression of the disease. The primary objective of the study was the median prolongation of the treatment-free interval-p (without platinum) after local treatment. RESULTS A total of 186 patients with ovarian cancer were treated with PARPi at recurrence. Of these, 30 (16%) developed oligometastatic progression. The median age was 49.5 years (range 35-73). Olaparib, niraparib and rucaparib were administered to 33%, 60%, and 7% of patients, respectively. The median prolongation of the treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy was 6 and 10 months, respectively (p=0.53). The median treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy at the time of oligometastatic progression was 32 and 29 months, respectively (p=0.44). At the time of this publication, 50% of patients are still on treatment with PARPi following progression. CONCLUSIONS Patients with recurrent ovarian cancer who have oligometastic progression during PARPi maintenance may continue to benefit from PARPi if combined with local treatment.
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Affiliation(s)
- Eleonora Palluzzi
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Claudia Marchetti
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Cappuccio
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Gabriella Macchia
- Dipartimento Servizi e Laboratori, Direzione Scientifica, Gemelli Molise Hospital, Radiotherapy Unit, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maria Antonietta Gambacorta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Fabrizio Cocciolillo
- Nuclear Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Nero C, Pasciuto T, Cappuccio S, Corrado G, Pelligra S, Zannoni GF, Santoro A, Piermattei A, Minucci A, Lorusso D, Fanfani F, Scambia G. Further refining 2020 ESGO/ESTRO/ESP molecular risk classes in patients with early-stage endometrial cancer: A propensity score-matched analysis. Cancer 2022; 128:2898-2907. [PMID: 35617463 PMCID: PMC9541547 DOI: 10.1002/cncr.34331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/12/2022]
Abstract
Background The integration of molecular features with clinicopathological findings in endometrial cancer classification seems to be able to significantly refine risk assessment. Nevertheless, clinical management remains challenging, and different therapeutic options are available for each class. Further prognostic characterization of the subgroups within each risk class could be helpful in the decision‐making process. Methods This study evaluated the role of the 2020 European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy and Oncology (ESTRO)/European Society of Pathology (ESP) risk assessment system and the three prognostic profiles adopted in the PORTEC‐4a trial in predicting disease‐free and overall survival in a retrospective study cohort of patients with early‐stage endometrial cancer. Patients were selected according to a 1:2 propensity score matching analysis. Moreover, the sequencing of 29 genes was undertaken for tumor samples. Results The study included 137 patients. No differences in disease‐free or overall survival at 5 years were observed among the 2020 ESGO/ESTRO/ESP risk classes without molecular features (p = .766 and p = .176, respectively). Once molecular features were integrated, the probability of overall survival was significantly different (p = .011). When the three prognostic profiles were applied, the probability of recurrence had a p value of .097, and significant differences were observed in overall survival (p = .004). Among patients experiencing recurrence, 17.6% showed mutations in BRCA1/2, RAD50, BRIP1, and XRCC2, whereas 22.5% had PD‐L1–positive expression and an MUTYH mutation. Conclusions Further stratification within each risk class according to the most relevant prognostic features could better define the prognosis of patients with early‐stage endometrial cancer. Nearly half of the patients who experienced recurrence showed a targetable molecular alteration for which dedicated trials should be encouraged. The 2020 molecular integrated risk assessment is of crucial importance for better defining the prognosis of patients with early‐stage endometrial cancer. Nevertheless, further stratification within each risk class according to the most relevant prognostic features could better define the biological behavior of the disease and thus allow better tailoring of adjuvant treatment.
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Affiliation(s)
- Camilla Nero
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tina Pasciuto
- Research Core Facility Data Collection- Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serena Cappuccio
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Pelligra
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Università Cattolica del Sacro Cuore, Rome, Italy.,Gineco-Patologia e Patologia Mammaria unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Santoro
- Gineco-Patologia e Patologia Mammaria unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessia Piermattei
- Gineco-Patologia e Patologia Mammaria unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angelo Minucci
- Diagnostica Molecolare e Genomica unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Dipartimento per le Scienze della Salute della Donna del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Gill SE, Garzon S, Multinu F, Hokenstad AN, Casarin J, Cappuccio S, McGree ME, Weaver AL, Cliby WA, Keeney GL, Mariani A. Ultrastaging of 'negative' pelvic lymph nodes in patients with low- and intermediate-risk endometrioid endometrial cancer who developed non-vaginal recurrences. Int J Gynecol Cancer 2021; 31:1541-1548. [PMID: 34706876 DOI: 10.1136/ijgc-2021-002924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/05/2021] [Accepted: 10/13/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Evidence on micrometastases and isolated tumor cells as factors associated with non-vaginal recurrence in low- and intermediate-risk endometrial cancer is limited. The goal of our study was to investigate risk factors for non-vaginal recurrence in low- and intermediate-risk endometrial cancer. METHODS Records of all patients with endometrial cancer surgically managed at the Mayo Clinic before sentinel lymph node implementation (1999-2008) were reviewed. We identified all patients with endometrioid low-risk (International Federation of Gynecology and Obstetrics (FIGO) stage I, grade 1 or 2 with myometrial invasion <50% and negative peritoneal cytology) or intermediate-risk (FIGO stage I, grade 1 or 2 with myometrial invasion ≥50% or grade 3 with myometrial invasion <50% and negative peritoneal cytology) endometrial cancer at definitive pathology after pelvic and para-aortic lymph node assessment. All pelvic lymph nodes of patients with non-vaginal recurrence (any recurrence excluding isolated vaginal cuff recurrences) underwent ultrastaging. RESULTS Among 1303 women, we identified 321 patients with low-risk (n=236) or intermediate-risk (n=85) endometrial cancer (median age 65.4 years; 266 (82.9%) stage IA; 55 (17.1%) stage IB). Of the total of 321, 13 patients developed non-vaginal recurrence (Kaplan-Meier rate 4.7% by 60 months; 95% CI 2.1% to 7.2%): 11 hematogenous/peritoneal and two para-aortic and distant lymphatic. Myometrial invasion and lymphovascular space invasion were univariately associated with non-vaginal recurrence. In these patients, the original hematoxylin/eosin slides review confirmed all 646 pelvic and para-aortic removed lymph nodes as negative. The ultrastaging of 463 pelvic lymph nodes did not identify any occult metastases (prevalence 0%; 95% CI 0% to 22.8% considering 13 patients; 95% CI 0% to 0.8% considering 463 pelvic lymph nodes). CONCLUSION There were no occult metastases in pelvic lymph nodes of patients with low- or intermediate-risk endometrial cancer with non-vaginal recurrence. Myometrial invasion and lymphovascular space invasion appear to be associated with non-vaginal recurrence.
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Affiliation(s)
- Sarah E Gill
- Division of Gynecologic Oncology, Nancy N and J C Lewis Cancer and Research Pavilion, Savannah, Georgia, USA
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Francesco Multinu
- Division of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alexis N Hokenstad
- Department of Obstetrics and Gynecology, Billings Clinic Cancer Center, Billings, Montana, USA
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Serena Cappuccio
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michaela E McGree
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - William A Cliby
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gary L Keeney
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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10
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Palluzzi E, Marchetti C, Cappuccio S, Avesani G, Nardangeli A, Scambia G, Fagotti A. 752P PARP-inhibitors beyond progression: A new way to manage oligometastatic ovarian cancer recurrence. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1194] [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: 12/01/2022] Open
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11
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Grassi T, Harris FR, Smadbeck JB, Murphy SJ, Block MS, Multinu F, Schaefer Klein JL, Zhang P, Karagouga G, Liu MC, Larish A, Lemens MA, Sommerfield MKS, Cappuccio S, Cheville JC, Vasmatzis G, Mariani A. Personalized tumor-specific DNA junctions to detect circulating tumor in patients with endometrial cancer. PLoS One 2021; 16:e0252390. [PMID: 34111149 PMCID: PMC8192008 DOI: 10.1371/journal.pone.0252390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION There are no reliable blood biomarkers for monitoring endometrial cancer patients in the current clinical practice. Circulating tumor DNA (ctDNA) is emerging as a promising non-invasive method to measure tumor burden, define prognosis and monitor disease status in many solid cancers. In this pilot study, we investigated if unique tumor-specific DNA junctions can be used to detect ctDNA levels in patients with endometrial cancer. METHODS Chromosomal rearrangements in primary tumors of eleven patients with high-grade or advanced stage endometrial cancer were determined by whole-genome Mate-Pair sequencing. Identified unique tumor-specific junctions were evaluated in pre- and six-week post-surgery patient plasma using individualized quantitative polymerase chain reaction (qPCR) assays. The relationship between clinicopathological features and detection of ctDNA was investigated. RESULTS CtDNA was detected in 60% (6/10) of cases pre-surgery and in 27% (3/11) post-surgery. The detection of ctDNA pre-surgery was consistent with clinical indicators of aggressive disease such as advanced stage (80% - 4/5), lymphatic spread of disease (100% - 3/3), serous histology (80% - 4/5), deep myometrial invasion (100% - 3/3), lympho-vascular space invasion (75% - 3/4). All patients in which ctDNA was detected post-surgically had type II endometrial cancer. DISCUSSION This pilot study demonstrates the feasibility of using personalized tumor-specific junction panels for detecting ctDNA in the plasma of endometrial cancer patients. Larger studies and longer follow-up are needed to validate the potential association between pre-surgical ctDNA detection and the presence of cancers with aggressive pathologic tumor characteristics or advanced stage observed in this study.
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Affiliation(s)
- Tommaso Grassi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Faye R. Harris
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - James B. Smadbeck
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Stephen J. Murphy
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew S. Block
- Department of Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Francesco Multinu
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
- Department of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Piyan Zhang
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Giannoula Karagouga
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Minetta C. Liu
- Department of Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Alyssa Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
| | - Maureen A. Lemens
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
| | | | - Serena Cappuccio
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
- Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - John C. Cheville
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - George Vasmatzis
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
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12
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Cappuccio S, Li Y, Song C, Liu E, Glaser G, Casarin J, Grassi T, Butler K, Magtibay P, Magrina JF, Scambia G, Mariani A, Langstraat C. The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: trends, enabling factors, cost, and safety. Int J Gynecol Cancer 2021; 31:686-693. [PMID: 33727220 DOI: 10.1136/ijgc-2020-002192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety. METHODS In this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression. RESULTS We identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%. CONCLUSIONS A significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs.
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Affiliation(s)
- Serena Cappuccio
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Yanli Li
- Global Health Economics and Outcomes Research, Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Chao Song
- Global Health Economics and Outcomes Research, Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Emeline Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Gretchen Glaser
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tommaso Grassi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristina Butler
- Department of Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | - Paul Magtibay
- Department of Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Giovanni Scambia
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Gallotta V, Jeong SY, Conte C, Trozzi R, Cappuccio S, Moroni R, Ferrandina G, Scambia G, Kim TJ, Fagotti A. Minimally invasive surgical staging for early stage ovarian cancer: A long-term follow up. Eur J Surg Oncol 2021; 47:1698-1704. [PMID: 33573854 DOI: 10.1016/j.ejso.2021.01.033] [Citation(s) in RCA: 7] [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: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The standard treatment for epithelial early stage ovarian cancer (eEOC) includes laparotomic surgical staging, according to ESGO-ESMO guidelines. In the last decade, many investigators have assessed the safety and feasibility of minimally invasive surgery (MIS) staging in properly selected patients. However, survival data related to different surgical approaches (open versus MIS) are extremely limited. The aim of this study is to analyze the long-term oncological outcomes in eEOC patients treated with MIS. MATERIALS AND METHODS This is a multicenter observational retrospective study conducted in two tertiary oncological centers. We selected all consecutive women who underwent a laparoscopic or robotic staging for eEOC. RESULTS From January 2008 to December 2016, 254 eEOC patients underwent a MIS staging (188 laparoscopic staging and 66 robotic staging). Overall, 18.1% of patients were upstaged due to pathological findings. A total of 203 (79.9%) patients received platinum-based adjuvant chemotherapy. After a median follow-up of 61 months (range 13-118), 39 (15.3%) patients experienced recurrence. The 5-years progression free survival (PFS) and overall survival rates were 84.0% and 93.8%, respectively. In the univariate analysis, favorable variables influencing PFS were young age (≤45 years), non-serous histotype, tumor grade 1-2, and FIGO stage IA/IB. In the multivariate analysis, only grade 3 was shown to keep its negative independent prognostic value (HR = 3.47; p = 0.004), whereas FIGO stage ≥ IC showed a trend toward significance (HR = 1.75; p = 0.099). CONCLUSION This retrospective study represents the longest follow-up of eEOC patients managed by MIS. The MIS is a valuable therapeutic option in appropriately selected patients, although a randomized controlled trial is needed.
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Affiliation(s)
- Valerio Gallotta
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Soo Young Jeong
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Carmine Conte
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Rita Trozzi
- Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Serena Cappuccio
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Rossana Moroni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Giovanni Scambia
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea.
| | - Anna Fagotti
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
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Tortorella L, Restaino S, Zannoni GF, Vizzielli G, Chiantera V, Cappuccio S, Gioè A, La Fera E, Dinoi G, Angelico G, Scambia G, Fanfani F. Substantial lymph-vascular space invasion (LVSI) as predictor of distant relapse and poor prognosis in low-risk early-stage endometrial cancer. J Gynecol Oncol 2021; 32:e11. [PMID: 33470061 PMCID: PMC7930448 DOI: 10.3802/jgo.2021.32.e11] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/08/2020] [Accepted: 12/05/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this study is to analyze the prognostic role of lymph-vascular space invasion (LVSI), evaluated in a semi-quantitative fashion on prognosis of early stage, low risk endometrial cancer (EC). METHODS We enrolled patients who underwent surgery for endometrial cancer between 2003 and 2018 in two referral cancer center. All patients had endometrioid EC, G1-G2, with myometrial invasion <50%, and no lymph-node involvement. LVSI was analyzed in a semi-quantitative way, according to a 3-tiered scoring system in absent, focal and substantial. RESULTS Among 524 patients, any positive LVSI was found in 57 patients (10.9%) with focal LVSI (n=35, 6.7%) and substantial LVSI (n=22, 4.2%). Substantial LVSI was associated to higher rate of G2 (p<0.001), myometrial infiltration (p=0.002) and greater tumor dimensions (p=0.014). Patients with substantial LVSI were more likely to receive adjuvant treatment (6.6% vs. 52.6%, p<0.001). The 5-year OS was 99.5% in patients with absent LVSI and 70.6% in those with substantial LVSI (p<0.001). The 5-year disease free survival (DFS) was 93.6% in patients with absent LVSI and 56.5% in those with substantial LVSI (p<0.001). The rate of distant failures increased from 1.8% for absent LVSI to 22.7% for substantial LVSI (p=0.002). In univariate analysis substantial LVSI was the strongest predictor of poor overall survival (hazard ratio [HR]=11.9, p=0.001). Multivariate analysis showed that substantial LVSI was an independent predictive factor of both recurrence (HR=5.88, p=0.001) and distant failure (HR=10.6, p=0.006). CONCLUSIONS Substantial LVSI represents the strongest independent risk factor for decreased survival and distant relapse, indicating a role for potential hematogenous dissemination.
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Affiliation(s)
- Lucia Tortorella
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Stefano Restaino
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Gian Franco Zannoni
- Dipartimento della salute della Donna, del Bambino e di Sanità Pubblica, Area Anatomia Patologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Dipartimento Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italia
| | - Giuseppe Vizzielli
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Vito Chiantera
- Dipartimento di Ginecologia Oncologica, Università di Palermo, Palermo, Italia
| | - Serena Cappuccio
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Alessandro Gioè
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Eleonora La Fera
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Giorgia Dinoi
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Giuseppe Angelico
- Dipartimento della salute della Donna, del Bambino e di Sanità Pubblica, Area Anatomia Patologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Giovanni Scambia
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Dipartimento Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italia.
| | - Francesco Fanfani
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Dipartimento Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italia
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15
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Turco LC, Ferrandina G, Vargiu V, Cappuccio S, Fagotti A, Sallustio G, Scambia G, Cosentino F. Extreme complications related to bevacizumab use in the treatment of ovarian cancer: a case series from a III level referral centre and review of the literature. Ann Transl Med 2020; 8:1687. [PMID: 33490199 PMCID: PMC7812204 DOI: 10.21037/atm-20-4448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In patients undergoing debulking surgery for ovarian cancer (OC), bevacizumab-combined chemotherapy has been reported to be associated with an increased incidence of adverse events (AEs). Reports in the literature have noted the overall morbidity of bevacizumab to be between 3.7% and 9%. The aim of this study is to report uncommon and unusual manifestations of morbidity in surgical cases performed at our third level referral centers for gynecologic oncology. Additionally, we review the rare and severe bevacizumab-related complications that have been described in the literature. We defined as "extreme", the particularly rare and/or severe complications up to determining a life-threatening condition or death, which are related to the use of bevacizumab. A case-series of extreme complications registered at our institutions were reported. In addition, a literature search of the PubMed, MEDLINE and EMBASE electronic databases was performed for this review. The studies collected included: 8 randomized controlled trials (RCT) and 5 prospective observational, 1 prospective phase-IV, 10 prospective phase-II, 2 prospective phase-I, and 20 retrospective studies, as well as 9 case reports. Bevacizumab was administered as primary treatment in adjuvant and neo-adjuvant setting in 16 and 5 studies respectively, as treatment for recurrence in 36 trials, and for secondary cytoreductive surgery (SCS) in 3 studies. The overall population administered with bevacizumab numbered 7,096 women. Extreme complications were observed in 591 patients, with a morbidity rate of the 8.3%. Overall, central nervous system (CNS), cardiovascular, gastrointestinal (GI) and primary infectious complications were seen in 22 patients (0.3%), 261 patients (3.7%), 159 patients (2.2%), and 8 patients (0.13%), respectively. Hemorrhagic and wound complications occurred in 18 women (0.25%), and 112 women (1.6%), respectively. Extreme complications related to the use of bevacizumab are rare, and often go unrecognized. The recognition and immediate management of such rare and life-threatening complications in patients treated at third level referral centers could significantly improve patient survival.
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Affiliation(s)
- Luigi Carlo Turco
- Mater Olbia Hospital, Gynaecology and Breast Unit, Olbia.,Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Gabriella Ferrandina
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Virginia Vargiu
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Serena Cappuccio
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Anna Fagotti
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giuseppina Sallustio
- Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Radiology and Diagnostic Imaging, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Giovanni Scambia
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
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16
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Grassi T, Mariani A, Cibula D, Soliman PT, Suman VJ, Weaver AL, Pedra Nobre S, Weigelt B, Glaser GE, Cappuccio S, Abu-Rustum NR. A prospective multicenter international single-arm observational study on the oncological safety of the sentinel lymph node algorithm in stage I intermediate-risk endometrial cancer (SELECT, SEntinel Lymph node Endometrial Cancer Trial). Int J Gynecol Cancer 2020; 30:1627-1632. [PMID: 32699021 DOI: 10.1136/ijgc-2020-001698] [Citation(s) in RCA: 9] [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] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the primary treatment of apparent uterine-confined endometrial carcinoma, pelvic ± para-aortic lymphadenectomy has been considered the standard of care. Although some retrospective data suggest that the sentinel lymph node algorithm without complete lymphadenectomy can be used without jeopardizing oncologic outcome, prospective data are lacking. PRIMARY OBJECTIVES To assess the 36 month incidence of pelvic/non-vaginal recurrence in women with pathologically confirmed stage I intermediate-risk endometrioid endometrial carcinoma who have bilateral negative pelvic sentinel lymph nodes. STUDY HYPOTHESIS We hypothesize that patients with stage I, intermediate-risk endometrioid endometrial carcinoma who have bilateral negative pelvic sentinel lymph nodes will demonstrate a pelvic/non-vaginal recurrence rate comparable to historical estimate of stage I, intermediate-risk endometrioid endometrial carcinoma patients (estimated 2.5%). TRIAL DESIGN This prospective multicenter single-arm observational study will follow women with stage I, intermediate risk endometrioid endometrial adenocarcinoma who have undergone successful hysterectomy, bilateral salpingo-oophorectomy, and bilateral sentinel lymph node biopsies, for recurrence. All patients will undergo lymphatic mapping using indocynanine green and will either receive no adjuvant treatment or vaginal brachytherapy only. Patients will be followed for 36 months. MAJOR INCLUSION/EXCLUSION CRITERIA Patients will be enrolled in the study cohort if all the following criteria are met: (i) at time of surgery: hysterectomy with bilateral adnexectomy, and successful bilateral pelvic sentinel lymph node mapping; (ii) on final pathology: pathologic stage I, intermediate-risk endometrioid endometrial carcinoma (grade 1 or grade 2 with ≥50% myometrial invasion, or grade 3 with <50% myometrial invasion), negative pelvic peritoneal cytology, and bilateral sentinel lymph nodes negative for malignancy; (iii) recommended adjuvant treatment: vaginal brachytherapy or no adjuvant treatment. PRIMARY ENDPOINT Incidence of pelvic/non-vaginal recurrence at 36 months. SAMPLE SIZE 182 patients for study cohort ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Accrual will be completed in 2023 with results reported in 2026. TRIAL REGISTRATION NCT04291612.
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Affiliation(s)
- Tommaso Grassi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.,Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vera J Suman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Silvana Pedra Nobre
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Serena Cappuccio
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA .,Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York, United States
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17
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Bogani G, Cappuccio S, Casarin J, Narasimhulu DMM, Cilby WA, Glaser GE, Weaver AL, McGree ME, Keeney GL, Weroha J, Petersen IA, Mariani A. Role of adjuvant therapy in stage IIIC2 endometrial cancer. Int J Gynecol Cancer 2020; 30:1169-1176. [PMID: 32646864 DOI: 10.1136/ijgc-2020-001446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The role of the different types of adjuvant treatments in endometrial cancer with para-aortic node metastases is unclear. The aim of this study was to report oncologic outcomes after adjuvant therapy in patients with stage IIIC2 endometrial cancer. METHODS This retrospective single-institution study assessed patients with stage IIIC2 endometrial cancer who underwent primary surgery from January 1984 to December 2014. All patients had hysterectomy (±salpingo-oophorectomy) plus lymphadenectomy (para-aortic nodes, ±pelvic nodes). We included all patients with stage III endometrial cancer and documented para-aortic lymph node metastases (International Federation of Obstetrics and Gynecologists stage IIIC2). We excluded patients who did not provide consent, who had synchronous cancer, or who underwent neoadjuvant chemotherapy. Follow-up was restricted to the first 5 years post-operatively. Cox proportional hazards models, with age as the time scale, was used to evaluate associations of risk factors with disease-free survival and overall survival. RESULTS Among 105 patients with documented adjuvant therapy, external beam radiotherapy was administered to 25 patients (24%), chemotherapy to 24 (23%), and a combination (chemotherapy and external beam radiotherapy) to 56 (53%) patients. Most patients receiving chemotherapy and external beam radiotherapy (80%) had chemotherapy first. The majority of relapses had a distant component (31/46, 67%) and only one patient had an isolated para-aortic recurrence. Non-endometrioid subtypes had poorer disease-free survival (HR 2.57; 95% CI 1.38 to 4.78) and poorer overall survival (HR 2.00; 95% CI 1.09 to 3.65) compared with endometrioid. Among patients with endometrioid histology (n=60), chemotherapy and external beam radiotherapy improved disease-free survival (HR 0.22; 95% CI 0.07 to 0.71) and overall survival (HR 0.28; 95% CI 0.09 to 0.89) compared with chemotherapy or external beam radiotherapy alone. Combination therapy did not improve prognosis for patients with non-endometrioid histology (n=45). CONCLUSIONS In our cohort of patients with stage IIIC2 endometrioid endometrial cancer, those receiving chemotherapy and external beam radiotherapy had improved survival compared with patients receiving chemotherapy or external beam radiotherapy alone. However, the prognosis of patients with non-endometrioid endometrial cancer remained poor, regardless of the adjuvant therapy administered. Distant recurrences were the most common sites of failure.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Serena Cappuccio
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | | | - William A Cilby
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gretchen E Glaser
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gary L Keeney
- Division of Anatomic Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - John Weroha
- Division of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrea Mariani
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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18
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Cappuccio S, Marinucci B, Bove V, Turco LC, Cosentino F, Scambia G, Costamagna G, Boškoski I. Rare Case of Endoscopic Treatment for Bevacizumab-Related Gastric Perforation in a Patient with Ovarian Cancer. Chemotherapy 2020; 65:54-57. [PMID: 32615577 DOI: 10.1159/000508556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
Antiangiogenic chemotherapy is a common treatment option for patients with advanced ovarian cancer (OC) and has been proven to be effective and generally safe. Nevertheless, in rare cases, these drugs can give serious complications such as gastrointestinal perforations that can be even mortal or very difficult to treat and can heavily impact the clinical management. We present a rare case of bevacizumab-induced gastric perforation in a patient with advanced OC occurred during bevacizumab-including chemotherapy in an adjuvant setting. Surgical treatment was not possible due to the frailty of the clinical condition of the patient and the gastric perforation was successfully treated with endoscopic suturing.
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Affiliation(s)
- Serena Cappuccio
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Benito Marinucci
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Carlo Turco
- Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy.,Gynecologic Oncology, Gemelli Molise Spa, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Cosentino
- Gynecologic Oncology, Gemelli Molise Spa, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giovanni Scambia
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Guido Costamagna
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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19
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Narasimhulu DM, Cope A, Riaz IB, Petersen I, Cliby W, Langstraat C, Glaser G, Kumar A, Cappuccio S, Murad MH, West C, Mariani A. External beam radiotherapy versus vaginal brachytherapy in patients with stage II endometrial cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2020; 30:797-805. [DOI: 10.1136/ijgc-2020-001199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe choice of adjuvant treatment for women with stage II endometrial cancer is challenging, given the known increase in morbidity with external beam radiation compared with vaginal brachytherapy, and the lack of consensus on its benefits. We summarized the evidence on survival and recurrence for stage II endometrial cancer, defined as cervical stromal invasion, after adjuvant postoperative external beam radiotherapy and vaginal brachytherapy.MethodsWe searched the MEDLINE, EMBASE, CENTRAL, and Scopus databases from inception to January 2019 to identify studies that compared adjuvant postoperative external beam radiotherapy with or without vaginal brachytherapy and vaginal brachytherapy alone in stage II endometrial cancer. Our primary outcome was the locoregional recurrence rate, defined as recurrence in the pelvis or vagina. Secondary outcomes included the rate of recurrence at any site, distant recurrence rate, vaginal recurrence rate, pelvic recurrence rate, and 5 year overall survival. Study selection, assessment, and data abstraction were performed by an independent set of reviewers. Random effects models were used to synthesize quantitative data.ResultsWe included 15 cohort studies reporting data on 1070 women. Most women with stage II endometrial cancer (848/1070, 79.3%) were treated with external beam radiotherapy with or without vaginal brachytherapy. Subgroup analysis was stratified by whether >90% of the women included underwent pelvic lymph node assessment (sampling or full dissection). Locoregional recurrence (pelvic and vaginal recurrence) was significantly reduced with external beam radiotherapy with or without vaginal brachytherapy compared with vaginal brachytherapy alone (14 studies (n=1057); odds ratio (OR) 0.33 (95% confidence interval (CI) 0.16 to 0.68); I2=5%) regardless of pelvic lymph node assessment. Most women (81.8%) who recurred locoregionally had a least one uterine risk factor (grade 3 tumor, myometrial invasion >50%, or lymphovascular invasion). There was no difference in overall survival with external beam radiotherapy with or without vaginal brachytherapy compared with vaginal brachytherapy alone (five studies (n=463); OR 0.78 (95% CI 0.34 to 1.80); I2=48%).ConclusionsExternal beam radiotherapy with or without vaginal brachytherapy decreased the locoregional recurrence threefold for stage II endometrial cancer, regardless of pelvic lymph node assessment. Most women who suffered recurrence locoregionally had a least one high risk factor. Vaginal brachytherapy alone may be sufficient therapy for node negative stage II endometrial cancer without uterine risk factors, while those with uterine risk factors should be considered for external beam radiotherapy with or without vaginal brachytherapy to improve locoregional control.
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20
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Casarin J, Song C, Multinu F, Cappuccio S, Liu E, Butler KA, Glaser GE, Cliby WA, Langstraat CL, Ghezzi F, Fu AZ, Mariani A. Implementing robotic surgery for uterine cancer in the United States: Better outcomes without increased costs. Gynecol Oncol 2020; 156:451-458. [DOI: 10.1016/j.ygyno.2019.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022]
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Casarin J, Multinu F, Tortorella L, Cappuccio S, Weaver AL, Ghezzi F, Cliby W, Kumar A, Langstraat C, Glaser G, Mariani A. Sentinel lymph node biopsy for robotic-assisted endometrial cancer staging: further improvement of perioperative outcomes. Int J Gynecol Cancer 2019; 30:41-47. [DOI: 10.1136/ijgc-2019-000672] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/30/2022] Open
Abstract
ObjectivesIt is unclear if sentinel lymph node biopsy is associated with improved surgical outcomes compared with lymphadenectomy in patients with endometrial cancer. In this study we aimed to compare peri-operative surgical outcomes and treatment-related morbidity in patients who underwent robotic-assisted sentinel lymph node biopsy versus systematic pelvic lymphadenectomy or hysterectomy alone for apparent early-stage endometrial cancer.MethodsRecords were reviewed of consecutive patients with International Federation of Gynecology and Obstetrics stages I–III endometrial cancer undergoing robotic-assisted staging from January 1, 2009, through June 30, 2016. For the purpose of this analysis we focused on the actual patients who had sentinel node biopsy only (ie, excluding those who had an associated lymphadenectomy either for failed mapping or during the learning curve). We also excluded patients who had para-aortic lymph node dissection from the lymphadenectomy group. Perioperative and 30-day surgical outcomes were compared between patients who underwent sentinel lymph node assessment and those who had pelvic lymphadenectomy or hysterectomy alone, respectively. Inverse probability of treatment weighting derived from propensity scores was used to minimize allocation bias in the comparison of outcomes between groups.ResultsA total of 621 patients were analyzed: 188 (30.3%) with sentinel lymph node biopsy, 198 (31.9%) with pelvic lymphadenectomy, and 235 (37.8%) with hysterectomy alone. Inverse probability of treatment weights analysis balanced for baseline characteristics (age, body mass index, American Society of Anesthesiologists score, Charlson co-morbidity index, parity, prior cesarean section, and previous abdominal operation) showed no significant differences in intra-operative and post-operative complications, re-admissions, and re-operations between the groups. Compared with pelvic lymphadenectomy, the sentinel lymph node biopsy group had a shorter mean operative time (138.0 vs 222.8 min, p<0.001) and less median blood loss (50 vs 100 mL, p<0.001). Sentinel lymph node biopsy also was not associated with worse morbidity compared with hysterectomy alone.ConclusionsIntroduction of sentinel lymph node biopsy reduces operative times and improves peri-operative surgical outcomes of robotic-assisted staging for apparent early-stage endometrial cancer without worsening the morbidity of hysterectomy alone.
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22
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Tortorella L, Casarin J, Multinu F, Cappuccio S, McGree ME, Weaver AL, Langstraat CL, Keeney GL, Kumar A, Melis GB, Angioni S, Scambia G, Mariani A, Glaser GE. Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer: predictors of unsuccessful mapping. Gynecol Oncol 2019; 155:34-38. [DOI: 10.1016/j.ygyno.2019.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/27/2022]
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23
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Multinu F, Casarin J, Cappuccio S, Keeney GL, Glaser GE, Cliby WA, Weaver AL, McGree ME, Angioni S, Faa G, Leitao MM, Abu-Rustum NR, Mariani A. Ultrastaging of negative pelvic lymph nodes to decrease the true prevalence of isolated paraaortic dissemination in endometrial cancer. Gynecol Oncol 2019; 154:60-64. [PMID: 31126637 DOI: 10.1016/j.ygyno.2019.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study aimed to determine the prevalence of occult pelvic lymph node metastasis in patients with endometrial cancer (EC) with isolated paraaortic dissemination who underwent pelvic and paraaortic lymphadenectomy. METHODS From 2004 to 2008, patients undergoing surgery for EC at our institution were prospectively treated according to a validated surgical algorithm relying on intraoperative frozen section. For the current study, we re-reviewed pathologic slides obtained at the time of diagnosis and performed ultrastaging of all negative pelvic lymph nodes to assess the prevalence of occult pelvic lymph node metastasis. RESULTS Of 466 patients at risk for lymphatic dissemination, 394 (84.5%) underwent both pelvic and paraaortic lymphadenectomy. Of them, 10 (2.5%) had isolated paraaortic metastasis. Pathologic review of hematoxylin-eosin-stained slides identified 1 patient with micrometastasis in 1 of 18 pelvic lymph nodes removed. Ultrastaging of 296 pelvic lymph nodes removed from the 9 other patients (median [range], 32 [20-50] nodes per patient) identified 2 additional cases (1 with micrometastasis and 1 with isolated tumor cells), for a total of 3/10 patients (30%) having occult pelvic dissemination. CONCLUSIONS Ultrastaging and pathologic review of negative pelvic lymph nodes of patients with presumed isolated paraaortic metastasis can identify occult pelvic dissemination and reduce the prevalence of true isolated paraaortic disease. In the era of the sentinel lymph node (SLN) algorithm for EC staging, which incorporates ultrastaging of the SLNs removed, these findings demonstrate that use of the SLN algorithm can further mitigate the concern of missing cases of isolated paraaortic dissemination.
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Affiliation(s)
- Francesco Multinu
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America; Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; Department of Gynecology, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Jvan Casarin
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Serena Cappuccio
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Gary L Keeney
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Gretchen E Glaser
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - William A Cliby
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America
| | - Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gavino Faa
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Mario M Leitao
- Division of Gynecology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Division of Gynecology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Andrea Mariani
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America.
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Giudice MT, D’Indinosante M, Cappuccio S, Gallotta V, Fagotti A, Scambia G, Petrillo M. Secondary cytoreduction in ovarian cancer: who really benefits? Arch Gynecol Obstet 2018; 298:873-879. [DOI: 10.1007/s00404-018-4915-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/20/2018] [Indexed: 01/06/2023]
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Uccella S, Mele MC, Quagliozzi L, Rinninella E, Nero C, Cappuccio S, Cintoni M, Gasbarrini A, Scambia G, Fagotti A. Assessment of preoperative nutritional status using BIA-derived phase angle (PhA) in patients with advanced ovarian cancer: Correlation with the extent of cytoreduction and complications. Gynecol Oncol 2018; 149:263-269. [DOI: 10.1016/j.ygyno.2018.03.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 01/07/2023]
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Tinelli G, Cappuccio S, Parente E, Fagotti A, Gallotta V, Conte C, Costantini B, Gueli Alletti S, Scambia G, Vizzielli G. Resectability and Vascular Management of Retroperitoneal Gynecological Malignancies: A Large Single-institution Case-Series. Anticancer Res 2017; 37:6899-6906. [PMID: 29187471 DOI: 10.21873/anticanres.12153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To report on morbidity and oncological outcomes in a consecutive series of gynecological malignancies involving the vascular district. PATIENTS AND METHODS We retrospectively evaluated a consecutive series between 1/2015 and 1/2017 with suspicious gynecological malignancies involving the vascular district. Peri-operative data and survival rates were computed. RESULTS Eight-hundred-four women with gynecological malignancies were admitted for major oncologic surgery during the study period, and among them, 50 cases (6.2%) showed vascular involvement. Twenty-seven and 23 patients were submitted to minor and major vascular procedures, respectively. R0 resection was achieved in 44 patients. There were no perioperative mortalities. Major postoperative complications occurred in 6 patients (12.0%). The 2-year disease free survival (DFS) was 67% if R0 resection was achieved. In patients with positive pathological margins (n=2), the 2-year DFS was 33%. CONCLUSION Vascular procedures can be safely performed with a proper pre-operative planning and may not be an impediment to major gynecological oncological surgery.
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Affiliation(s)
- Giovanni Tinelli
- Division of Vascular Surgery, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Serena Cappuccio
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Ezio Parente
- Division of Vascular Surgery, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Anna Fagotti
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Valerio Gallotta
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Carmine Conte
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Barbara Costantini
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
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Fanfani F, Restaino S, Ercoli A, Chiantera V, Fagotti A, Gallotta V, Monterossi G, Cappuccio S, Scambia G. Robotic versus laparoscopic surgery in gynecology: which should we use? Minerva Ginecol 2016; 68:423-430. [PMID: 26633042] [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: 06/05/2023]
Abstract
This review of the literature aims at assessing the safety and effectiveness of robotic versus laparoscopic surgery in benign and malignant gynecological diseases. Robotic-assisted laparoscopy is already widely used in the United States and Europe for the main gynecological procedure - hysterectomy - and has proved feasible and comfortable for other benign and malignant gynecological procedures. However, the clinical effectiveness and safety of robotic surgery compared with standard laparoscopy have not been undoubtedly established. We reviewed the literature by searching in the Ovid/MEDLINE, PubMed, Cochrane Library, and Google Scholar databases for all the articles published from January 1995 to September 2015. More rigorous experimental studies are needed, that compare robotic-assisted surgery and laparoscopic surgery for gynecological diseases. However, current data seem to encourage the use of minimally-invasive surgery to treat benign and malignant gynecological diseases.
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Affiliation(s)
- Francesco Fanfani
- Gynecologic Oncology Unit, Department of Medicine and Aging Sciences, "G. D'Annunzio" University, Chieti, Italy -
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Fanfani F, Restaino S, Rossitto C, Gueli Alletti S, Costantini B, Monterossi G, Cappuccio S, Perrone E, Scambia G. Total Laparoscopic (S-LPS) versus TELELAP ALF-X Robotic-Assisted Hysterectomy: A Case-Control Study. J Minim Invasive Gynecol 2016; 23:933-8. [PMID: 27247263 DOI: 10.1016/j.jmig.2016.05.008] [Citation(s) in RCA: 20] [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: 04/05/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE To compare the feasibility and safety of the TELELAP ALF-X system and standard laparoscopy for total hysterectomy to treat patients with benign and early malignant gynecologic disease. DESIGN Single-institution retrospective case-control study (Canadian Task Force classification II-2). SETTING Catholic University of the Sacred Heart, Rome, Italy. PATIENTS Between October 2013 and May 2015, 203 women underwent TELELAP-ALF X (group 1) or standard laparoscopic (group 2) total hysterectomy and were enrolled. INTERVENTIONS Total standard laparoscopy vs TELELAP ALF-X robot-assisted hysterectomy for benign and early malignant gynecologic disease. MEASUREMENTS AND MAIN RESULTS In group 1, the median age was 55 years (range, 40-79 years), median body mass index (BMI) was 25 kg/m(2) (range, 17-38 kg/m(2)), and 51 patients (58%) had undergone previous abdominal surgery. In the control group, the median age was 55 years (range, 34-90 years), median BMI was 25 kg/m(2) (range, 17-41 kg/m(2)), and 31 patients (27%) had previous abdominal surgery. The median operative time was 147 minutes (range, 58-320 minutes) in group 1 and 80 minutes (range, 22-300 minutes) in group 2 (p = .055). The median estimated blood loss was 57 mL (range, 0-600 mL) in group 1 and 99 mL (range, 0-400 mL) in group 2, with no significant differences between the 2 groups (p = .963). Procedures were successfully performed without conversion in 94.3% of cases in the group 1 and in all cases in group 2. Early postoperative pain was significantly lower in group 2. CONCLUSION TELELAP ALF-X hysterectomy in patients with benign and early malignant gynecologic disease is feasible and safe, and can be considered a valid option for these patients.
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Affiliation(s)
- Francesco Fanfani
- Department of Medicine and Aging Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy
| | - Cristiano Rossitto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Serena Cappuccio
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Perrone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Emoli A, Cappuccio S, Marche B, Musarò A, Scoppettuolo G, Pittiruti M. [The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC)]. Assist Inferm Ric 2015; 33:82-9. [PMID: 25002059 DOI: 10.1702/1539.16813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC). INTRODUCTION The insertion of a peripherally inserted central venous catheter (PICC) is not without risks. AIM The Italian Group for the Study of Long-Term Central Venous Access Devices (GAVeCeLT) has developed a protocol (SIP: Safe Implantation of PICCs) with the aim of minimizing the risks which may be associated with the placement of PICCs. METHODS The protocol is based on recommendations available in the literature and on the main clinical practice guidelines. RESULTS The SIP protocol, a bundle of evidence-based recommendations, it is is easy to use, inexpensive, and cost-effective. CONCLUSIONS If routinely used and carefully inplemented, it greatly reduces complications such as failure of venipuncture, accidental arterial puncture, damage of median nerve, infection and catheter related venous thrombosis.
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Di Salvatore M, Lo Giudice L, Rossi E, Santonocito C, Nazzicone G, Rodriquenz MG, Cappuccio S, Inno A, Fuso P, Orlandi A, Strippoli A, Capoluongo E, Astone A, Cassano A, Barone C. Association of IL-8 and eNOS polymorphisms with clinical outcomes in bevacizumab-treated breast cancer patients: an exploratory analysis. Clin Transl Oncol 2015; 18:40-6. [PMID: 26141413 DOI: 10.1007/s12094-015-1334-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 02/08/2015] [Accepted: 06/20/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of bevacizumab in metastatic breast cancer is controversial. Identification of predictive biomarkers could help to select patients who really benefit from it. We evaluated the association of angiogenesis-related gene polymorphisms with the treatment outcome of bevacizumab in metastatic breast cancer patients. PATIENTS AND METHODS eNOS-786T/C and -894G/T, IL-8-251T/A genomic polymorphisms were assessed in 31 metastatic breast cancer patients treated with bevacizumab plus chemotherapy in the first-line setting. Testing for association between each polymorphism and treatment outcome was performed. RESULTS Patients with IL-8 251 AA genotype showed a significantly lower progression-free survival in each combination comparison: "TT" vs "AA" (13 vs 8 months; p = 0.008); TT vs TA vs AA (13 vs 11 vs 8 months; p = 0.02); TT vs TA +AA (13 vs 11 months; p = 0.01); TT + TA vs AA (12 vs 8 months; p = 0.01) and a lower overall survival when compared with TT +TA genotype (26 vs 51 months, p = 0.04). Patients carrying eNOS 894 TT genotype showed a statistically significant lower progression-free survival than patients with GG genotype (11.5 vs 26.5 months; p = 0.04) with no differences in the overall survival. No association with response rate was found with any of the polymorphisms analyzed. CONCLUSION These findings suggest that IL-8 251T/A and eNOS-894 G/T polymorphisms might have a role in predicting treatment outcome of bevacizumab in metastatic breast cancer. Our results are hypothesis generating and need to be confirmed in larger clinical trials.
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Affiliation(s)
- M Di Salvatore
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.
| | - L Lo Giudice
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - E Rossi
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - C Santonocito
- Laboratory of Clinical Molecular Biology, Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - G Nazzicone
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - M G Rodriquenz
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - S Cappuccio
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Inno
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.,Medical Oncology, Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 5, 37024, Negrar, VR, Italy
| | - P Fuso
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Orlandi
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Strippoli
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - E Capoluongo
- Laboratory of Clinical Molecular Biology, Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Astone
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Cassano
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - C Barone
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
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Monaco M, Mondello B, Galletti G, Cappuccio S, Monici D, Nunnari F, Micali E, Vasta I, Monaco F, Pavia R. [Surgical treatment of hydatid cysts]. G Chir 2004; 25:224-6. [PMID: 15558983] [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: 05/01/2023]
Abstract
Hydatidosis represents a form of helminthic zoonosis with a stronger medical, social and economic impact. It is endemic in some areas of the world including Mediterranean countries, and therefore Italy. The disease is often diagnosed in an advanced phase, due to the poor symptomatology in the early stages. The best treatment is surgery. Emergency surgery is similar to elective surgery, though in some cases is preferable only a drainage procedure until the stabilization of the genreal and local conditions of the patient allow a radical intervention. The Authors report on their five year experience of surgical treatment of compliated pulmonar hydatidosis pointing out that exeresis must be aimed at preserving pulmonar function as much as possible.
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Affiliation(s)
- M Monaco
- Azienda Ospedaliera Universitaria "G. Martino", Dipartimento di Scienze Cardiovascolari e Toraciche, Cattedra ed U.O.C. di Chirurgia Toracica, Università degli Studi di Messina
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Biondo G, Cappuccio S, Cucinotta E. [Sulpiride and experimental gastric lesions]. Boll Soc Ital Biol Sper 1980; 56:2594-7. [PMID: 7470305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Authors have conducted some research on the action of Sulpiride in animals which had been previously obliged to search into the gastric lesion caused by the compulsion. According to them above drug determines a reduction of the quantity of animals affected from gastric lesion and attenuates in other animals the entity of the gastric lesion.
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Biondo G, Cappuccio S, Cucinotta E. [Hyperbaric therapy and experimental peritonitis]. Boll Soc Ital Biol Sper 1980; 56:2304-8. [PMID: 7225237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The AA, report about the action explicate by the hyperbaric treatment on the evolution of the experimental peritonitises from hurt of the digestive tube. In their opinion the AA, a hyperbaric daily treatment of an hour at two ATA exercises a protection about evolution of the peritoneal syndrome.
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Bernardo ND, Cappuccio S, Ferlazzo F. [Treatment of postphlebitic ulcers of the lower limb by electroacupuncture]. Minerva Med 1978; 69:2979-87. [PMID: 309567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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