Biomedical subjects

Angiolo Gadducci

Publications and source records attributed to Angiolo Gadducci.

24 records · Page 2Linked to original sources

PubMedDate not supplied

The management of malignant nondysgerminomatous ovarian germ cell tumors.

Nondysgerminomatous ovarian germ cell tumors are always unilateral and predominantly occur in children, adolescents and young women. Conservative surgery should be the standard approach for most patients regardless of tumor stage. The role of adjuvant chemotherapy in stage I disease is questionable. Platinum-based chemotherapy is the standard postoperative treatment for all patients with advanced nondysgerminomatous ovarian germ cell malignancies. In immature teratoma patients with peritoneal spreading, chemotherapy is not required for grade 0 or 1 implants, is of uncertain significance for grade 2 lesions, but is warranted for grade 3 implants. In recent series, in which most patients received conservative surgery often followed by platinum-based chemotherapy, 5-year survival rates range from 82% to 100%. There have been several cases reported of normal babies delivered following treatment of ovarian germ cell tumors. In women previously treated conservatively for these malignancies, miscarriages are in the expected range whereas the malformation rate seems to be slightly higher than in the general population. In conclusion, the current therapeutic strategies are able to save the large majority of patients with nondysgerminomatous ovarian germ cell tumors and to preserve their reproductive potential.

Adolescent↗

PubMedDate not supplied

Vascular endothelial growth factor (VEGF) expression in primary tumors and peritoneal metastases from patients with advanced ovarian carcinoma.

BACKGROUND: Several experimental and clinical data suggest that vascular endothelial growth factor (VEGF) is involved in ovarian carcinogenesis. However, there are no conclusive data about the prognostic value of tissue VEGF expression in this malignancy. The aim of the present investigation was to compare VEGF immunostaining in primary tumors and peritoneal metastases from patients with advanced ovarian carcinoma and to assess whether this parameter has a predictive or prognostic relevance. MATERIALS AND METHODS: The investigation was conducted on 45 patients who underwent initial surgery followed by platinum-based or paclitaxel/platinum-based chemotherapy for advanced ovarian carcinoma. Both primary tumors and peritoneal metastases were immunohistochemically analyzed for VEGF expression. Intense staining score was assigned if more than 75% of the cells stained positive. RESULTS: Intense VEGF immunostaining was detected in 14 and 36 (31.1% versus 80.0%, p < 0.0001), respectively, of primary tumors and peritoneal metastases. Twenty-six (57.8%) patients showed an increased VEGF immunostaining in metastatic lesions compared with primary tumors. VEGF immunostaining in primary tumors, VEGF immunostaining in peritoneal metastases and change in VEGF immunostaining from the primary tumor to peritoneal metastatic lesion were related neither to the response to chemotherapy nor to progression-free survival. CONCLUSION: In patients with advanced ovarian carcinoma, intense VEGF immunostaining was more often detected in peritoneal metastases than in primary tumors. VEGF immunostaining in primary as well as in metastatic lesions correlated neither with the response to chemotherapy nor with the clinical outcome. Therefore the immunohistochemical detection of VEGF in tissue samples collected during primary surgery failed to have a predictive or prognostic relevance for patients with advanced ovarian carcinoma.

Adult↗

PubMedDate not supplied

Chemotherapy with epirubicin and paclitaxel for breast cancer during pregnancy: case report and review of the literature.

BACKGROUND: Breast cancer diagnosed during pregnancy is a challenging clinical situation. Little data are currently available about chemotherapy in pregnant women with this malignancy. CASE REPORT: We report the case of a 36-year-old pregnant woman with a T2N1M0 breast cancer who received sequential chemotherapy including epirubicin (120 mg/m2 every three weeks for four cycles) and paclitaxel (175 mg/m2 every three weeks for three cycles) from the 14th to the 32nd week of gestation. The patient delivered a normal female baby by caesarean section at the 36th week. The immunohistochemical examination of the placenta showed a diffuse, strong P-glycoprotein expression. Thirty-six months after the delivery, the mother was disease-free and the infant showed normal development and growth. DISCUSSION: Sequential chemotherapy including epirubicin and paclitaxel should be taken into consideration as adjuvant treatment for pregnant women with high-risk breast cancer. The strong placental expression of P-glycoprotein may play a major role in limiting fetal exposure to anthracyclines and taxanes.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMedDate not supplied

Neutropenic enterocolitis in an advanced epithelial ovarian cancer patient treated with paclitaxel/platinum-based chemotherapy: a case report and review of the literature.

BACKGROUND: Literature data show that neutropenic enterocolitis is a rare but severe complication that can occur in cancer patients treated with chemotherapy and especially with taxanes. CASE REPORT: A 60-year-old woman with stage Illc epithelial ovarian cancer developed neutropenic fever, abdominal pain, severe diarrhoea, nausea, vomiting and oral mucositis one week after the first postoperative cycle of paclitaxel (175 mg/m2 3-hour infusion) plus carboplatin-based chemotherapy. Abdominal X-ray showed diffuse dilatation of the ileal and colonic loops with air/fluid. The patient soon recovered after intensive supportive care. For the second cycle the dose of paclitaxel was reduced by 20%, but nine days later the patient again developed severe neutropenia with fever, abdominal colicky pain, diarrhoea and vomiting. The culture of blood samples collected on admission was found to be positive for Escherichia coli, whereas stools resulted negative for both enteric rods and Clostridium difficile toxin. The patient recovered with intensive supportive care, and chemotherapy was continued with single-agent carboplatin. DISCUSSION: The increasing use of paclitaxel in first-line as well as in the salvage treatment of epithelial ovarian cancer could increase the occurrence of neutropenic enterocolitis in patients with this malignancy. The importance of symptoms such as neutropenic fever, abdominal pain and tenderness and severe diarrhoea should be stressed in patients who receive taxane-based chemotherapy, and intensive supportive care management should be started immediately.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

P53 gene status in patients with advanced serous epithelial ovarian cancer in relation to response to paclitaxel- plus platinum-based chemotherapy and long-term clinical outcome.

BACKGROUND: The aim of this retrospective study was to assess whether p53 gene status has any predictive or prognostic relevance in patients with advanced, poorly-differentiated serous epithelial ovarian cancer treated with paclitaxel- plus platinum-based chemotherapy. MATERIALS AND METHODS: The study was conducted on 46 patients who underwent surgery followed by paclitaxel- plus carboplatin-based chemotherapy. The tumor tissue samples were analyzed for p53 gene mutations. The median follow-up of survivors was 50.3 months. RESULTS: Twenty-three patients (50%) showed p53 mutations at exons 5 to 9. Sixteen (34.8%) patients had a polymorphism at codon 72 in exon 4 (SNP codon 72): 10 were Pro/Pro homozygous and 6 Pro/Arg heterozygous. Four polymorphic patients had a second mutation at exons 5 to 9. An inverse correlation was evidenced between the SNP codon 72 and mutations at exons 5 to 9, with the latter more frequently found in wild-type (Arg/Arg) codon 72 (19/30 versus 4/16, 63.3% versus 25.0%; p=0.03) cases. A clear trend for a higher response rate and longer progression-free and overall survival was observed in wild-type p53 and Pro/Pro polymorphic patients as compared to patients with mutant p53. CONCLUSION: The addition of paclitaxel to carboplatin does not appear to overcome the negative predictive and prognostic significance of p53 gene mutations in serous ovarian cancer. Nevertheless, the comprehensive analysis of p53 genotype, including the SNP codon 72, warrants further investigation in order to envisage individual responsiveness to cancer therapy.

Adult↗

PubMedDate not supplied

Intratumoral microvessel density in advanced epithelial ovarian cancer and its use as a prognostic variable.

BACKGROUND: The aim of this retrospective study was to assess whether the intratumoral microvessel density (IMD) in primary tumour specimens had any impact on the clinical outcome of patients with advanced epithelial ovarian cancer treated in two Italian departments of gynaecological oncology. MATERIALS AND METHODS: The study was conducted on 101 patients who underwent initial surgery followed by platinum-based chemotherapy (37) or paclitaxel/platinum-based chemotherapy (64) for International Federation of Gynecology and Obstetrics (FIGO) stage III-IV epithelial ovarian cancer. The median follow-up of survivors from initial surgery was 65 months (range, 27 to 132 months). Paraffin-embedded sections of primary tumour specimens were analysed for IMD by immunohistochemistry using anti-CD34 antibodies. RESULTS: Progression-free survival and overall survival were significantly better in patients with IMD > or =40 microvessels/field compared with those with lower IMD (p = 0.0105 and p = 0.0065, respectively). Cox model showed that IMD was the strongest independent prognostic variable for both progression-free survival (p = 0.0267) and overall survival (p = 0.0189). CONCLUSION: An elevated IMD was associated with a significantly better progression-free survival and overall survival in patients with stage III-IV epithelial ovarian cancer who underwent initial surgery followed by chemotherapy, mainly consisting of a paclitaxel/platinum-based regimen.

Antineoplastic Combined Chemotherapy Protocols↗