AOU Citta Della Salute e Della Science

Città della Pieve, Italy

AOU Citta Della Salute e Della Science

Città della Pieve, Italy
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Ronco G.,AOU Citta della salute e della Science
Epidemiologia e prevenzione | Year: 2015

Italian national guidelines recommend regional implementation of organized screening programmes for cervical cancer. As we have been doing since 1998, we collected aggregated tables of data from Italian organized cervical screening programmes in order to centrally compute process indicators. Data on women invited during 2011 and 2012 and screened up to April of the subsequent year were considered. In 2012, the target population of Italian organized screening programmes included 14,497,207 women, corresponding to 87.3% of Italian women aged 25-64 years. Compliance to invitation was 41.2%in 2011 and 40.8%in 2012, with a strong decreasing North-South trend. However, it should be considered that many women are screened outside any organized programmes. In 2012, of the women screened, 3.5% were referred for repeat cytology and 71.1% of them complied; 2.4% of screened women were referred to colposcopy. Compliance with colposcopy referral was 85.3%among women referred because of ASC-US or more severe cytology and 90.4% among those referred because of HSIL or more severe cytology. The positive predictive value (PPV) of referral because of ASC-US or more severe cytology for CIN2 or more severe histology was 16.9%. The unadjusted detection rate of CIN2 or more severe histology was 3.4 per 1,000 screened women (3.6 standardized on the Italian population, truncated 25-64). CIN2 or more severe histology was detected in 64.6% of colposcopies classified as grade 2 or higher. Of all colposcopies during which a CIN2 or more severe histology was obtained, 33.6% were classified as grade 2 or higher. Follow-up only was recommended to 81.7% of women with CIN1. Excision by radio-frequency device was the most common treatment for women with CIN2 (52.8%) and CIN3 (57.0%). However 0.4% of all CIN2 and 2.3% of all CIN3 had hysterectomy.

Ronco G.,AOU Citta della salute e della Science
Epidemiologia e prevenzione | Year: 2015

Pilot HPV-based cervical screening programmes have recently started in Italy, partly on the strength of a large randomized trial. The Ministry of Health recommended that regions shift toward HPV-based screening in early 2013 and provided guidelines for its application (stand-alone HPV testing by validated methods, cytological triage of HPV positives, beginning at age 30-35, 5-year intervals). A first survey on the 2012 activity was conducted in 2013. In 2012, 19 Italian organized cervical screening programmes from 10 regional programmes invited 311,856 women (8.0%of all women invited for cervical screening in 2012 in Italy) for HPV-based screening; 41.5% complied, with a decreasing North-South trend. Among screened women, 7.9% (range 4.3%-13.9%) were HPV positive, decreasing to 6.6% (range 4.0%-12.4%) when considering women aged 35-64 years. Among HPV positive women, 34.8%(with high variability between programmes: range 11.1%-59.3%) were judged to have ASC-US or more severe cytology (5.3%ASC-US, 26.6%L-SIL, 5.2% H-SIL). Out of all screened women, those referred to colposcopy based on HPV and cytology results were 2.9% (range 0.6%-4.8%), whereas they were 2.0% when considering only women aged 35-64 years.

Senore C.,AOU Citta della Salute e della Science | Bellisario C.,AOU Citta della Salute e della Science | Segnan N.,AOU Citta della Salute e della Science
Best Practice and Research: Clinical Gastroenterology | Year: 2017

Background: During the last decades data from different studies reported modifications of the topographic distribution of colorectal cancers (CRCs), with an increased frequency of tumours in proximal colonic segments. Given the documented link between adenomas and CRC, a proximal migration of adenomas over time could be expected as well. Aim: To evaluate available evidence about the prevalence of adenomas and of sessile serrated polyps across colonic segments, the changing trends in their distribution across the colon and the diagnostic performance of screening tests currently adopted in population based screening programs for lesions located in different colonic segments. Methods: Literature search on PubMed, Embase, and Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects with reference to preferred reporting items for systematic reviews and meta-analysis (PRISMA), considering all adult human studies in English, published between January 2000 and February 2017. Results: Cross-sectional analysis of endoscopy and pathology data-bases are consistently showing a trend toward an increase with age of the proportion of adenomas located in the proximal colon.Several observational studies analysed the site distribution of adenomas, testing the hypothesis of a proximal shift of these lesions, and most of them reported an increase in the proportion of right-sided adenomas over time, although a similar trend was not confirmed by others. Also the quality of the retrieved evidence was low. Both endoscopy and FIT are showing a different level of sensitivity for lesions arising in different colonic segments, depending also on screenees characteristics. Conclusion: Available evidence is supporting the hypothesis of an increase in the proportion of right-sided adenomas with age, while a similar increase has not been reported for SSP/A, at least among subjects aged 50 or older. The trend toward a proximalization of colorectal adenomas over time, reported by some authors, likely results from improved diagnostic performances and/or the process of population ageing. © 2017.

Benevolo G.,AOU Citta della Salute e della Science | Nicolosi M.,AOU Citta della Salute e della Science | Santambrogio E.,AOU Citta della Salute e della Science | Vitolo U.,AOU Citta della Salute e della Science
Expert Review of Hematology | Year: 2017

Introduction: Waldenström’s macroglobulinemia (WM) is a rare, incurable B-cell lymphoma, with a median survival of 5–10 years in symptomatic patients. There is no consensus on the standard of care and several agents are currently used in these patients. Areas covered: In this article, we will review the use of standard therapies and new drugs investigated such as monoclonal antibodies, proteasome inhibitors, immunomodulatory agents, Bruton’s tyrosine kinase inhibitors and novel agents in early-stage development. Expert commentary: RCD (Rituximab/Cyclophosphamide/Dexamethasone) is an effective and safe treatment in first line in WM. BR (Bendamustine/Rituximab) or BRD (Bortezomib/Rituximab/Dexamethasone) provide durable responses, and are still indicated in most patients. Ibrutinib is a new option and it was approved as primary therapy and for relapse. Carfilzomib based therapy represents an emerging option for proteasome-inhibitor based therapy for WM. Despite encouraging results, WM remains an incurable disease; therefore, new treatment options are needed. For this reason, continued participation in clinical trials should be encouraged. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

PubMed | Center for Diagnostic Imaging, Oncological Center for Gastrointestinal Neoplasm, Radiation Oncology, University of Turin and 2 more.
Type: Journal Article | Journal: Medical oncology (Northwood, London, England) | Year: 2016

To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by (18)FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing (18)FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose-volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (=-1.852; 95% CI -3.205/-0.500; p=0.009), V10 (=-2.153; 95% CI -4.263/-0.721; p=0.002), V20 (=-2.081; 95% CI -4.880/-0.112; p=0.003), V30 (=-1.971; 95% CI -4.748/-0.090; p=0.023) and IBM V10 (=-0.073; 95% CI -0.106/-0.023; p=0.016). ANC nadir found to be significantly associated with LSBM V10 (=-1.878; 95% CI -4.799/-0.643; p=0.025), V20 (=-1.765; 95% CI -4.050/-0.613; p=0.030) and IBM V10 (=-0.039; 95% CI -0.066/-0.010; p=0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (=-0.056; 95% CI -2.748/-0.187; p=0.060), V40 (=-0.059; 95% CI -3.112/-0.150; p=0.060) and IBM V30 (=-0.028; 95% CI -0.074/-0.023; p=0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. (18)FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.

PubMed | University of Turin and AOU Citta della Salute e della Science
Type: Journal Article | Journal: La Radiologia medica | Year: 2016

Stereotactic ablative radiotherapy (SABR) is a safe treatment approach for hepatocellular carcinoma (HCC) with comparable effectiveness to other local therapies. Only scant information is available concerning the role of SABR prior to liver transplantation (LT) for HCC. We present a consecutive case series investigating the role of SABR as a bridge or downstaging option in HCC patients subsequently submitted to LT.Between September 2012 and May 2014, 8 patients for a total of 13 lesions underwent SABR prior to LT. Inclusion criteria were a pathological or radiological diagnosis of HCC, lesion size 6cm or lesion number 3 with a total diameter 6cm, no extrahepatic metastases, Child-Pugh class A-B, ECOG performance status 1. Patients were prescribed 36-48Gy in 3-5 fractions (8Gy5 fractions or 16Gy3 fractions), in 3-5 consecutive days according to clinical and dosimetric decision making. Radiological response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Pathological response was assessed through the rate of tumor necrosis relative to the total tumor volume. Acute and late toxicities were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4 (CTCAE v 4.0).Among the 13 pathologically evaluated lesions, 8 (61.5%) lesions had a complete response 2 (15.3%) had a minimal pathological response and other 2 (15.3%) showed stable disease. The remaining lesion had a significant pathological response. Maximum detected toxicity included a G2 GGT increase in two patients (at 1 and 3months respectively). One patient developed a non-classic RILD with a fivefold increase in transaminase enzymes level and a shift in Child-Pugh category from B7 to C10 due to bilirubin increase. Only one modification in the surgical strategy was needed during LT.SABR proved to be a safe and effective local therapy prior to LT in HCC patients. Prospective controlled clinical trials are needed to evaluate its efficacy compared to other local therapies in this setting.

PubMed | Breast Unit, Medical Oncology, Candiolo Cancer Institute IRCCS, A.O.U. Citta della Salute e della Science and 3 more.
Type: | Journal: SpringerPlus | Year: 2016

This retrospective multicenter analysis was aimed to evaluate clinical activity and tolerability of eribulin in pretreated metastatic breast cancer patients in clinical practice. Patients treated with eribulin from January 2012 to July 2013 were enrolled in the observational study from 10 italian hospitals. Tumor and toxicity evaluation were performed according to Agenzia Italiana Farmaco. One-hundred and thirteen patients were included in the study. Median age 62years old. 71.7% of the patients had visceral involvement and the majority had a burden of disease involving two or more organs with a median number of 2 (1-6). The median number of previous chemotherapy regimens for advanced disease was 3 (1-10). Median number of eribulin cycles was 4 (1-27). Overall response rate was 24% (95% CI 16.0-31.8). Clinical benefit rate, was 35.4% (95% CI 26.6-44.2). At a median follow-up of 29.6months (8.3-41.9) the median progression free survival was 3.3months (0.6-26.7; 95% CI 2.4-4.2), and the median overall survival 11.6months (0.6-33.3; 95% CI 8.7-14.5). No correlation was recorded between subtypes in terms of ORR and CBR. Toxicity was manageable. Main common grade 3-4 toxicities were neutropenia (19.4%), febrile neutropenia (0.9%), asthenia (3.5%), abnormal liver function test (1.8%), stomatitis (0.9%). Our results confirm that treatment with eribulin is feasible and safe in real-world patients.

PubMed | Gastroenterology Unit, S Maria Del Prato Hospital, Nuovo Regina Margherita Hospital, University of Bologna and 10 more.
Type: Journal Article | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2016

The provision of high-quality colonoscopy can be assessed by evaluating technical aspects of the procedure and, at individual center level, by comparing structural indicators and institutional policies for managing peri-procedural issues with guideline recommendations.To assess the colonoscopy quality (CQ) in Italy at center level.Gastroenterologists participating in a nationwide colonoscopy education initiative provided information on structural indicators of their centers and on institutional policies by answering 10 multiple-choice clinical scenarios. Practice variation across centers and compliance with guidelines were analyzed.Data from 282 Italian centers were evaluated. Overall, a significant proportion of centers did not meet CQ standards as concerns endoscopy facilities and equipments (e.g., dedicated recovery room, dirty-to-clean path, reporting software). CQ assurance programs were implemented in only 25% of centers. Concerning peri-procedural issues, main discrepancies with guidelines were recorded in the underuse of split-dose preparation (routinely adopted by 18% of centers), the routine request of coagulation tests prior to colonoscopy (30%), the routine interruption of aspirin for polypectomy (18%), and the adoption of 3-year surveillance for low-risk adenoma (49%).Present survey shows a significant variation in the CQ of endoscopy centers in Italy on many items of colonoscopy practice that should be targeted for future interventions.

PubMed | Presidio, Humanitas Research Hospital, Endoscopy Unit, AOU Citta della Salute e della Science and 2 more.
Type: | Journal: Gut | Year: 2016

Miss rate of polyps has been shown to be substantially lower with full-spectrum endoscopy (FUSE) compared with standard forward-viewing (SFV) colonoscopy in a tandem study at per polyp analysis. However, there is uncertainty on whether FUSE is also associated with a higher detection rate of colorectal neoplasia, especially advanced lesions, in per patient analysis.Consecutive subjects undergoing colonoscopy following a positive faecal immunochemical test (FIT) by experienced endoscopists and performed in the context of a regional colorectal cancer population-screening programme were randomised between colonoscopy with either FUSE or SFV colonoscopy in seven Italian centres. Randomisation was stratified by gender, age group and screening history. Primary outcomes included detection rates of advanced adenomas (A-ADR), adenomas (ADR) and sessile-serrated polyps (SSPDR).Of 741 eligible subjects, 658 were randomised to either FUSE (n=328) or SFV (n=330) colonoscopy and included in the analysis. Overall, 293/658 and 143/658 subjects had at least one adenoma (ADR 44.5%) and advanced adenoma (A-ADR 21.7%), respectively, while SSP was the most advanced lesion in 18 cases (SSPDR 2.7%). ADR and A-ADR were 43.6% and 19.5% in the FUSE arm, and 45.5% and 23.9% in the SFV arm, with no difference for both ADR (OR for FUSE: 0.96, 95% CI 0.81 to 1.14) and A-ADR (OR for FUSE: 0.82, 95% CI 0.61 to 1.09). No difference in SSPDR or multiplicity was detected between the two arms. In the per polyp analysis, the mean number of adenomas and proximal adenomas per patient was 0.811.25 and 0.470.93 in the FUSE arm, and 0.851.33 and 0.480.96 in the SFV colonoscopy arm (p=NS for both comparisons).No statistically significant difference in ADR and A-ADR between FUSE and SFV colonoscopy was detected in a per patient analysis in FIT-positive patients.ISRCTN10357435.

PubMed | University of Bari, University of Udine, Hematology, Ematologia CTMO Ospedale Roberto Binaghi Cagliari and 5 more.
Type: Journal Article | Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation | Year: 2016

Patients with acute myeloid leukemia (AML) during induction chemotherapy and those who receive allogeneic hematopoietic stem cell transplantation (HSCT) are at higher risk of invasive fungal infections (IFI). In the present study, we investigated whether the risk of IFI in AML patients receiving HSCT might be affected by the antifungal prophylaxis with posaconazole administered during the induction/salvage chemotherapy treatment. Between August 2001 and April 2015, 130 patients with AML received itraconazole/fluconazole (group A) and 99 received posaconazole (group B) as antifungal prophylaxis after induction/salvage chemotherapy at 7 Italian centers and all patients received fluconazole as antifungal prophylaxis after HSCT. The median duration of antifungal prophylaxis after induction/salvage chemotherapy was significantly longer for patients in group A than for those in group B (24 days versus 20 days, P=.019). The 1-year cumulative incidence of proven/probable IFI after HSCT was 14% and 4% in group A and group B, respectively (P=.012). Fungal-free survival and overall survival at 1 year after HSCT were 66% and 70% in group A, and 75% and 77% in group B (P=.139 and P=.302), respectively. Multivariate logistic analysis identified the use of alternative donors (matched unrelated donor: odds ratio [OR], 3.25; haploidentical/partially matched related donor: OR, 3.19), antifungal prophylaxis with itraconazole/fluconazole (OR, 3.82), and reduced-intensity conditioning (OR, 4.92) as independent risk factors for the development of IFI after HSCT. In summary, the present study suggests that the protective effects of posaconazole during induction/salvage chemotherapy for AML patients may have long-lasting benefits and eventually contribute to reduce the risk of IFI when patients undergo allogeneic HSCT.

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