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Genova, Italy

Tiseo M.,Oncologia Medica | Ippolito M.,Medicina Nucleare | Scarlattei M.,Medicina Nucleare | Spadaro P.,Oncologia Medica | And 14 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2014

Background: [18F]fluorodeoxyglucose (FDG)-PET is being evaluated as a tool for the early detection of response to various targeted agents in solid tumors. The aim of this study was to evaluate the predictive value of PET response after 2 days of erlotinib in unselected pretrated patients with stage IV NSCLC. Patients and methods: FDG-PET/CT scans were conducted at baseline and after 2 days of erlotinib, with a CT evaluation performed at baseline and after 45-60 days of therapy. PET responses were evaluated by quantitative changes on SUVmax tumor/non-tumor ratio and classified according to EORTC criteria. PET responses were compared with RECIST responses and related to progression-free (PFS) and overall (OS) survival. Erlotinib effects on glucose uptake were also studied in a panel of NSCLC cell lines. Results: Fifty-three patients were enrolled. At 2 days of erlotinib, 20 (38 %) patients showed partial metabolic response (PMR), 25 (47 %) had stable metabolic disease (SMD) and 8 (15 %) had progressive metabolic disease (PMD). All patients with PMD had confirmed RECIST progression at 45-60 days. Patients with early PMR and SMD had significantly longer PFS (p < 0.001 and p = 0.001, respectively) and OS (p = 0.001 for both) than PMD patients. Conclusions: FDG-PET assessment after 2 days of erlotinib could be useful to identify early resistent patients and to predict survival in unselected NSCLC pretreated population. © 2013 Springer-Verlag. Source

Del Bono V.,Clinica Malattie Infettive | Delfino E.,Clinica Malattie Infettive | Furfaro E.,Clinica Malattie Infettive | Mikulska M.,Clinica Malattie Infettive | And 5 more authors.
Clinical and Vaccine Immunology | Year: 2011

Microbiological diagnosis of nosocomial candidemia is negatively affected by suboptimal culture yield. Alternative methods are not fully reliable as an aid in candidemia diagnosis. Recently, the detection of (1,3)-β-D-glucan (BG) has been shown to be very promising in this setting. We carried out a prospective study on the clinical usefulness of BG detection in early diagnosis of candidemia. BG detection was performed in patients with fever unresponsive to antibacterial agents and risk factors for candidemia. BG detection was done with the Fungitell test. A total of 152 patients were included in the study; 53 were proven to have candidemia, while in 52 patients candidemia was excluded on microbiological and clinical bases. The remaining 47 patients were considered to have possible candidemia. In summary, 41 of 53 candidemia patients (77.3%), 9 of 52 patients without candidemia (17.3%), and 38 of 47 patients with possible candidemia (80.8%) were positive in the BG assay. With these results, the sensitivity and the specificity of the assay were 77% and 83%, respectively. BG levels of >160 pg/ml were highly predictive of candidemia. In 36 of 41 patients with candidemia and positive BG testing, the BG assay was performed within 48 h from when the first Candida-positive blood sample for culture was drawn, thus allowing a possible earlier start of antifungal therapy. Based on these results, the BG assay may be used as an aid in the diagnosis of nosocomial candidemia. The timing of assay performance is critical for collecting clinically useful information. However, the test results should be associated with clinical data. Copyright © 2011, American Society for Microbiology. All Rights Reserved. Source

Recchia F.,Unita Operativa di Oncologia | Candeloro G.,Unita Operativa di Oncologia | Discepoli S.,Unita Operativa di Anatomia Patologica | Grimaldi M.,Unita Operativa di Anatomia Patologica | And 3 more authors.
Experimental and Therapeutic Medicine | Year: 2010

This multicenter prospective trial assessed the outcome in 63 patients, 40 years of age or younger, with high-risk early breast cancer (HREBC), included in an ovarian protection study. The patients were treated with a luteinizing hormone-releasing hormone (LH-RH) analogue administered for 5 years, tailored chemotherapy and an aromatase inhibitor, in estrogen receptor-positive (ER+) patients. T-regulatory cells (T-regs) and vascular endothelial growth factor (VEGF) were measured at baseline and yearly. The mean age of the patients was 36years (range 26-40). Sixty-five percent had ER+ tumors, 24% had negative axillary nodes with tumors >1cm and high histological grade with lymphovascular invasion, while 76% had a mean of 3.6 positive axillary nodes (range 1-21). Serum estradiol was maintained at values <40pg/ml in all of the patients. A statistically significant decrease in VEGF (P<0.0001) and T-regs (P<0.0001), with respect to baseline values, was observed after LH-RHadministration. After a median follow-up of 110months, the 10-year progression-free and overall survival rates were 86.1 and 89.7%, respectively. These data revealed that the administration of an LH-RHanalogue to HREBCpatients, followed by chemotherapy and hormonal therapy, decreased VEGF and T-regs and improved the expected clinical outcome. Source

Silva M.A.,The Latin American and Gastrointestinal Endoscopy Training Center | Silva M.A.,University for Development | Valdivieso E.,Epidemiologia Clinica | Ramirez M.A.,The Latin American and Gastrointestinal Endoscopy Training Center | And 3 more authors.
Acta Gastroenterologica Latinoamericana | Year: 2011

Introduction. Colorectal cancer (CRC) incidence is rapidly increasing. It has been demonstrated that it can be prevented and cured when the diagnosis is made in early stages. Objective. For this reason it is necessary to apply a screening program in asymptomatic patients. Method. Since 2003, we conducted a CRC screening plan called "Mes del Colon" at Clínica Alemana Santiago. A press and local diffusion campaign was designed. Open to the community CRC talks were scheduled. An ad hoc database was designed. An informed consent was available. Patients older than 50 years and high risk patients were included. Total colonoscopy and a medical interview after the procedure were included in the plan with favorable economic conditions. Results. Since 2003, 1,158 patients were included. The 1.8% of them were excluded because of incomplete data or because they did not meet the inclusion criteria. The 54% of patients were women. Mean age was 58.4 years old and mean body mass index 25.5 kg/m2. Polipoid lesions were seen in 45% of the patients. Six (1%) of them were adenocarcinomas, 291 (57%) adenomas (98% tubular adenomas), 189 (37%) hyperplastic polyps and 25 (5%) miscellaneous lesions. In this series, the necessary number to investigate for 1 adenoma was 3.9. Conclusions. CRC prevention campaigns are needed due to the continuous increase of the incidence in our country. The detection of precursor or early lesions that are longstanding before becoming advanced cancer allows its treatment avoiding progression. Source

Deledda G.,University of Verona | Mosconi P.,Laboratorio Of Ricerca Sul Coinvolgimento Dei Cittadini In Sanita | Renzi C.,Epidemiologia Clinica | Goss C.,University of Verona
Recenti Progressi in Medicina | Year: 2012

The increasing interest in the Shared Decision Making approach is linked to an improvement of the clinical outcomes. This paper proposes an update of the literature review on Shared Decision-Making in the clinical setting in Italy, describing the areas of application, the objectives, the instruments used and the main results. Source

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