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Mauro Signorelli,Andrea Alberto Lissoni,Elena De Ponti,Tommaso Grassi,Serena Ponti,Robert Fruscio 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4
Objective: Evaluation of the impact of sequential chemoradiotherapy in high risk endometrial cancer (EC). Methods: Two hundred fifty-four women with stage IB grade 3, II and III EC (2009 FIGO staging), were included in this retrospective study. Results: Stage I, II, and III was 24%, 28.7%, and 47.3%, respectively. Grade 3 tumor was 53.2% and 71.3% had deep myometrial invasion. One hundred sixty-five women (65%) underwent pelvic (+/– aortic) lymphadenectomy and 58 (22.8%) had nodal metastases. Ninety-eight women (38.6%) underwent radiotherapy, 59 (23.2%) chemotherapy, 42 (16.5%) sequential chemoradiotherapy, and 55 (21.7%) were only observed. After a median follow-up of 101 months, 78 women (30.7%) relapsed and 91 women (35.8%) died. Sequential chemoradiotherapy improved survival rates in women who did not undergo nodal evaluation (disease-free survival [DFS], p=0.040; overall survival [OS], p=0.024) or pelvic (+/– aortic) lymphadenectomy (DFS, p=0.008; OS, p=0.021). Sequential chemoradiotherapy improved both DFS (p=0.015) and OS (p=0.014) in stage III, while only a trend was found for DFS (p=0.210) and OS (p=0.102) in stage I–II EC. In the multivariate analysis, only age (≤65 years) and sequential chemoradiotherapy were statistically related to the prognosis. Conclusion: Sequential chemoradiotherapy improves survival rates in high risk EC compared with chemotherapy or radiotherapy alone, in particular in stage III.
Giorgio Bogani,Elena Tagliabue,Mauro Signorelli,Antonino Ditto,Fabio Martinelli,Valentina Chiappa,Lavinia Mosca,Ilaria Sabatucci,Umberto Leone Roberti Maggiore,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.3
Objective: To test the applicability of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Memorial Sloan Kettering (MSK) criteria in predicting complete cytoreduction (CC) in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer (ROC). Methods: Data of consecutive patients undergoing SCS were reviewed. The Arbeitsgemeinschaft Gynäkologische Onkologie OVARian cancer study group (AGO-OVAR) and MSK criteria were retrospectively applied. Nomograms, based on AGO criteria, MSK criteria and both AGO and MSK criteria were built in order to assess the probability to achieve CC at SCS. Results: Overall, 194 patients met the inclusion criteria. CC was achieved in 161 (82.9%) patients. According to the AGO-OVAR criteria, we observed that CC was achieved in 87.0% of patients with positive AGO score. However, 45 out of 71 (63.4%) patients who did not fulfilled the AGO score had CC. Similarly, CC was achieved in 87.1%, 61.9% and 66.7% of patients for whom SCS was recommended, had to be considered and was not recommended, respectively. In order to evaluate the predictive value of the AGO-OVAR and MSK criteria we built 2 separate nomograms (c-index: 0.5900 and 0.5989, respectively) to test the probability to achieve CC at SCS. Additionally, we built a nomogram using both the aforementioned criteria (c-index: 0.5857). Conclusion: The AGO and MSK criteria help identifying patients deserving SCS. However, these criteria might be strict, thus prohibiting a beneficial treatment in patients who do not met these criteria. Further studies are needed to clarify factors predicting CC at SCS.
A critical assessment on the role of sentinel node mapping in endometrial cancer
Giorgio Bogani,Antonino Ditto,Fabio Martinelli,Mauro Signorelli,Stefania Perotto,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4
Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.
Gynecologic oncology at the time of COVID-19 outbreak
Giorgio Bogani,Claudia Brusadelli,Rocco Guerrisi,Salvatore Lopez,Mauro Signorelli,Antonino Ditto,Francesco Raspagliesi 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4
The World Health Organization (WHO) classified the novel coronavirus (i.e., coronavirusdisease 2019 [COVID-19]) as a global public health emergency. COVID-19 threatens tocurtail patient access to evidence-based treatment. Medicine is changing, basically due tothe limited available resources. In the field of gynecologic oncology, we have to re-designour treatments' paradigm. During COVID-19 pandemic outbreak, the highest priority is toachieve the maximum benefit from less demanding procedures. Extensive procedures shouldbe avoided, in order to reduce hospitalization and postoperative events that might increasethe in-hospital spread of the virus. There are ongoing concerns on the use of laparoscopicprocedures, related to the possible contamination of the staff working in the operation room. Other minimally invasive techniques, including, vaginal surgery as well as robotic-assistedand isobaric procedures would be preferred over laparoscopy. A fair allocation of resources isparamount adequate treatments.