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PubMed | Plastic Surgery Unit, Breast Surgery Unit, Fondazione T. Campanella, Oncologic Surgery and 10 more.
Type: | Journal: Annals of surgical oncology | Year: 2015

The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin with temporary permeabilization induced by locally administered electric pulses. Preliminary experience with ECT in BC patients is encouraging.A total of 125 patients with BC skin metastases who underwent ECT between 2010 and 2013 were enrolled onto a multicenter retrospective cohort study. The treatment was administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to Common Terminology Criteria for Adverse Events 4.0. Cox regression analysis was used to identify predictive factors.Response was evaluable in 113 patients for 214 tumors (median 1 per patient, range 1-3). The overall response rate after 2 months was 90.2 %, while the complete response (CR) rate was 58.4 %. In multivariate analysis, small tumor size (P < 0.001), absence of visceral metastases (P = 0.001), estrogen receptor positivity (P = 0.016), and low Ki-67 index (P = 0.024) were significantly associated with CR. In the first 48 h, 10.4 % of patients reported severe skin pain. Dermatologic toxicity included grade 3 skin ulceration (8.0 %) and grade 2 skin hyperpigmentation (8.8 %). Tumor 1-year local progression-free survival was 86.2 % (95 % confidence interval 79.3-93.8) and 96.4 % (95 % confidence interval 91.6-100) in the subgroup of those with CR.In this study, small tumor size, absence of visceral metastases, estrogen receptor positivity, and low Ki-67 index were predictors of CR after ECT. Patients who experienced CR had durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC.


Clemente S.,Instituto Of Ricovero E Cura A Carattere Scientifico | Nigro R.,Azienda Sanitaria Locale Rieti | Oliviero C.,Instituto Of Ricovero E Cura A Carattere Scientifico | Marchioni C.,Azienda Sanitaria Locale Rieti | And 9 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2015

The increasing use of moderate (<35 fractions) and extreme (<5 fractions) hypofractionated radiation therapy in prostate cancer is yielding favorable results, both in terms of maintained biochemical response and toxicity. Several hypofractionation (HF) schemes for the treatment of prostate cancer are available, although there is considerable variability in the techniques used to manage intra-/interfraction motion and deliver radiation doses. We performed a review of the published studies on HF regimens as a topic of interest for the Stereotactic Ablative Radiotherapy working group, which is part of the Italian Association of Medical Physics. Aspects of organ motion management (imaging for contouring, target volume definition, and rectum/bladder preparation) and treatment delivery (prostate localization, image guided radiation therapy strategy and frequency) were evaluated and categorized to assess outcome relative to disease control and toxicity. Despite the heterogeneity of the data, some interesting trends that emerged from the review might be useful in identifying an optimum HF strategy. © 2015 Elsevier Inc.


PubMed | Humanitas Clinical and Research Center, Ospedale sacro Cuore don Calabria, Regina Elena Cancer Institute, Azienda USL Toscana Centro and 6 more.
Type: Journal Article | Journal: Medical physics | Year: 2016

Small radiation fields (<30 mm) are typically involved in stereotactic body radiation therapy procedures. Output factor measurements are subjected to large uncertainties. The signal ratio (SR) readings, defined as the ratio of central axis reading, respectively, in the actual field size and in the reference field size, were evaluated in several centers and a common mathematical description of the SR curve was investigated.A couple of new unshielded stereotactic diodes (Razor, IBA) was tested under eight different TrueBeams using 10 MV flattering filter free beams with high dose rate (2400 MU/min). Small fields, ranging from 6 to 50 mm, were analyzed in terms of profiles and central axis point measurements. SRs were normalized to 30 mm field and were calculated as a function of nominal field size (NFS) and effective field size (EFS). From SRs acquired using Razor1 (four centers), a theoretical equation was extrapolated. Three centers with Razor2 were used to test the mathematical relationship. Finally, the two diodes were directly compared in the last center.The EFS was systematically smaller than NFS (p < 0.01) for all field size ranges, with mean difference of 0.9 0.5 mm. The SR fits using the NFS and EFS had, respectively, REFS measurements were confirmed to be mandatory when comparing SRs over different centers. An equation establishing a functional relation between SRs and the EFS was obtained and tested for the new Razor diode.


Scilletta R.,University of Catania | Pagano D.,University of Palermo | Spada M.,University of Palermo | Mongiovi S.,Humanitas Centro Catanese Of Oncologia | And 5 more authors.
Journal of Surgical Research | Year: 2014

Background The aim of this study was to identify the incidence of surgical site infections (SSIs) and postoperative complications, as defined by the Clavien-Dindo classification, after hepatic resection for metastatic colorectal cancer in patients with and without associated neoadjuvant chemotherapy. Methods A total of 181 patients were studied retrospectively. Patients were divided into two groups: The first group comprised patients with associated neoadjuvant chemotherapeutic treatment for liver metastases with a latency time <8 wk and the second group comprised patients without associated neoadjuvant chemotherapy. Results Variables of duration of liver surgery, length of total hospital stay, and length of postoperative hospital stay seem to be correlated with SSIs and postoperative complications, P < 0.005 and P < 0.0001, respectively. Duration of surgery is a risk factor for SSIs, with an odds ratio of 1.15, and for complications according to the Clavien-Dindo classification, with an odds ratio of 1.35. Conclusions Neoadjuvant chemotherapy was not a significant risk factor for SSIs, whereas the total length of hospital stay, length of postoperative hospital stay, and duration of surgery were independent predictors of SSIs and complications according to the Clavien-Dindo classification. © 2014 Elsevier Inc. All rights reserved.


Caruso F.,Humanitas Centro Catanese Of Oncologia | Ferrara M.,Humanitas Centro Catanese Of Oncologia | Castiglione G.,Humanitas Centro Catanese Of Oncologia | Cannata I.,Humanitas Centro Catanese Of Oncologia | And 6 more authors.
European Journal of Surgical Oncology | Year: 2011

Aim: To evaluate the effectiveness of therapeutic mammoplasty with frozen section in achieving negative surgical margins in a single-stage surgery for breast cancer. Methods: Fifty patients affected by early stage breast cancer treated by therapeutic mammaplasties were retrospectively reviewed in this study. Fifty-two therapeutic mammaplasties were accomplished. After resection the specimen was sent to pathologist for examination with frozen section. Tumour positive margins were defined as presence of cancerous cells at ≤ 2 mm from the edge of the specimen. In case of positive margins a second large re-excision was accomplished intra-operatively. All patients were followed every 4 months for the first 2 years and twice a year subsequently. Results: Fifty-two procedures were evaluated (median follow-up of 72.6 months). The overall survival rate was 98% we had a single case of local recurrent disease (1.9%) that progressed to metastatic disease and patient's death. Frozen section as a diagnostic tool for identification of positive margins has been tested. In conclusion we report a sensitivity of 0.83 and a specificity of 0.93; the predictive positive value was 0.62 and the negative predictive value was 0.97, for a final accuracy of 0.94. Conclusion: Frozen section coupled to oncoplastic resections allows a proper control of local disease and can minimize any second surgical look for margins revision.© 2011 Elsevier Ltd. All rights reserved.


Rizza L.,University of Catania | D'Agostino A.,Humanitas Centro Catanese Of Oncologia | Girlando A.,Humanitas Centro Catanese Of Oncologia | Puglia C.,University of Catania
Journal of Pharmacy and Pharmacology | Year: 2010

Objectives: Radiotherapy may cause severe skin changes that significantly interfere with the patient's quality of life and reduce radiotherapy effectiveness. Many skin care instructions and various topical agents are recommended to help patients in the management of radiation skin reactions, but evidence to support the value of the topical treatments of the irradiated skin is lacking. In the present study we investigated the effects of topical agents used as supportive care to minimise radiation-induced skin disease using an instrumental method. Methods: Subjects who were undergoing a planned course of radiation therapy after breast-conserving surgery were randomised to treatment (using one of two topical agents) or non-treatment (control) groups and monitored over 8 weeks. The intensity of skin erythema was evaluated once per week by non-invasive instrumental reflectance spectrophotometry in comparison with a visual scoring system. Key findings: Examination of the erythema time course by a sensitive spectrophotometric reflectance method showed a significant increase of skin reactions in the non-treated group after the second week of treatment and maximal alterations between the fourth and sixth week. Conclusions: From the results obtained, we observed that application of topical agents used in radio-induced skin disease were able to significantly reduce the erythema extent compared to the non-treated group. © 2010 Royal Pharmaceutical Society of Great Britain.


PubMed | University of Catania and Humanitas Centro Catanese Of Oncologia
Type: Journal Article | Journal: Updates in surgery | Year: 2015

The aim of this study was to assess the safety, effectiveness and advantages of a new surgical technique for the extraction of endometrial polyps after in-office hysteroscopic polipectomy. Between November 2009 and September 2013, 140 pre- and post-menopausal women with a sonographic diagnosis of endometrial polyps underwent polypectomy in-office hysteroscopy, followed by lesion removal using classical surgical instruments or the new REP-b technique. A total of 70 women underwent endometrial polyp removal using the new surgical technique REP-b (GROUP A), and 70 women received endometrial polyp removal using classical surgical instruments (GROUP B). The extraction time Tr, calculated as the time from the introduction of the basket into the operative hysteroscopic sheath to the complete removal of the previously sectioned polyp, in GROUP A (REP-b technique) was significantly lower compared with GROUP B (control group). The median Tr for GROUP A was 29.50s versus the median Tr for GROUP B of 54.00s (P<0.01). The use of the REP-b technique improves the outcome of the operation and reduces the extraction time for the removal of endocavitary uterine lesions.


PubMed | Humanitas Centro Catanese Of Oncologia
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

1133 Background: Chemotherapy is the most aggressive medical option for metastatic breast cancer patients. However, treatment is frequently associated to severe hematological toxicity that compels a chemotherapy-rest. Hormone-sensitive metastatic breast cancer patients could benefit in these cases from a monthly intramuscular injection of fulvestrant, a pure estrogen receptors antagonist.Since November 2005 to December 2007 we tested objective responses, clinical benefit, and safety of once-a-month fulvestrant 250 mg as therapy after disease progression or for maintenance of heavily pretreated hormone-sensitive breast cancer patients.Among 121 enrolled patients, 101 of them were evaluable: 98 females and 3 males, ECOG performance status (PS) 0-3, median age 59 years (range 27-87), HER-2/neu overexpression in 16%, bone plus visceral disease in 73% of cases. All the patients were pretreated with at least 2 endocrine therapy lines and a median of 3 chemotherapy regimens (range 1-8). Fulvestrant was administered for a median duration of 6 months (range 3-26). We observed 14 partial responses and 50 disease stabilizations lasting at least 6 months, with a clinical benefit rate of 64%. Despite the disease progression several patients could slowly remove the chemotherapy toxicity, improve their quality of life, and receive further antiblastic drugs. A PS improvement was often observed in elderly patients (more than 70 years), compared with the younger women (less than 50 years), probably due to either major chemotherapy toxicities with following recovery in the elderly or more frequent HER2/neu overexpression with aggressive disease in the younger patients. Tumor markers reduction didnt always correlate with therapy activity, that probably reflects the progressive drug steady state reachable after 3 to 6 months of treatment. Safety of fulvestrant was excellent. We recorded only a systemic intolerance reaction leading to treatment interruption and very unusual symptoms of muscle pain in the injecton site.Fulvestrant is an effective and optimally tolerated therapy for metastatic breast cancer and heavily pretreated patients who need a chemotherapy-rest for toxicity recovery. No significant financial relationships to disclose.


PubMed | Humanitas Centro Catanese Of Oncologia
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

e11028 Background: Trastuzumab is a monoclonal antibody developed to target HER 2 receptor inhibit tumour cells proliferation that overexpress HER 2.Trastuzumab is active and is viable in breast cancer in neoadjuvant, adjuvant or metastatic setting. The most serious adverse event of trastuzumab is cardiotoxicity. We evaluate different cardiologic toxicity in patients with breast cancer treated with trastuzumab in metastatic or adiuvant setting.Jan 2006 - Dec 2010 were treated, 84 patients with metastatic breast cancer (MBC). While Aug 2006 - Dec 2010 were admitted 140 patients affected by breast cancer treated in adjuvant setting of whom 110 able to be assessed. MBC sample: 84 patients (2M/82 F) median age 54 (range 27-86 yy). 77 patients underwent surgery for primary tumor. 70 have received also complementary radiotherapy and 62 patients have received adjuvant chemotherapy with antracyclines and 14 chemotherapy without antracyclines. In the metastatic setting patients have started trastuzumab following - in median of 37 months (range 6-192 months) - adjuvant chemotherapy and were treated for 23 months (range 3-49 months) in concomitant regimen with taxanes, vinorelbine or platinum-derived in 3 median lines (1-10 lines). In adjuvant setting sample (n = 110), the median age was 53 years (range 23-83 yy). The whole group underwent surgery and received adjuvant anthracyclines, 47 also taxanes, 89 adjuvant radiotherapy, followed by one year of trastuzumab after a time of 1-3 months. Cardiotoxicity has been assessed every 3 months, by Echocardiography and % LVEF.6 pts affected by MBC (7,1%) had hearth failure, class III of NYHA, 3 patients have discontinued trastuzumab treatment for 2 months. In adjuvant setting severe cardiotoxicity leading to stop therapy was recorded in 8 patients (7,2%), class III of NYHA, while 13 patients have discontinued treatment for LVEF droop for 1or 2 month.Trastuzumab in general has an acceptable cardiologic toxicity. However, weve noticed that cardiologic safety is lower in adjuvant setting than in MBC, probably because - in adjuvant administration - antracyclines and other adjuvant therapy are closer.

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