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T Maggino

Publications and source records attributed to T Maggino.

At least 37 records · Page 2Linked to original sources
PubMed1997

Serum CA125 assay at the time of relapse has no prognostic relevance in patients undergoing chemotherapy for recurrent ovarian cancer: a multicenter Italian study.

The present retrospective study assessed the prognostic value of serum CA125 assay at relapse in 73 patients with recurrent epithelial ovarian cancer. At the time of relapse, serum CA125 levels ranged from 7 to 7000 U ml-1. The 25%, 50% and 75% quantiles of CA125 levels were 76, 178 and 339 U ml-1, respectively. Antigen values were >35 U ml-1 in 67 (91.8%) of the 73 patients. Median time to recurrence was 16 months (range, 4-62 months). Serum CA125 levels at relapse were not related to site of recurrence, time to recurrence, FIGO stage, histologic type, tumor grade and residual disease after initial surgery. Sixty patients received salvage chemotherapy at relapse. In these patients survival after recurrence was significantly related to time to recurrence (< or = 6 months vs < 6 months, P = 0.0371; < or =12 months vs >12 months, P = 0.0014; < or =16 months vs >16 months, P = 0.0001), but not to CA125 level at relapse (at any cut-off value for the antigen: 35, 76, 178 and 339 U ml-1), site of recurrence, FIGO stage, histologic type, tumor grade and residual disease after initial surgery. In conclusion, time to recurrence was the only variable predictive of further survival in patients undergoing salvage chemotherapy for recurrent ovarian cancer, whereas serum CA125 level at relapse had no prognostic relevance.

Journal Article↗
PubMed1996

Uterine leiomyosarcoma: analysis of treatment failures and survival.

The objective of this retrospective multicenter study was to assess the rates, times, and sites of recurrences of 126 patients with uterine leiomyosarcomas. Surgery was the initial therapy for all patients. Median follow-up of survivors was 50 months (range, 3-168 months). Of the 90 patients with stage I-II disease, 26 received postoperative irradiation and/or chemotherapy. Thirty-five (38.9%) patients developed recurrent disease after a median time of 16 months (range, 2-102 months). Recurrence was pelvic in 5 (14.3%) patients, distant in 23 (65.7%), and pelvic plus distant in 7 (20.0%). The overall recurrence rate was similar in patients who received adjuvant treatment and in those who did not. None of the 15 patients who underwent pelvic irradiation developed local recurrences, but 5 of them failed in distant sites. Of the 16 patients with stage III leiomyosarcomas, 2 died of intercurrent disease within 1 month from surgery and 11 received postoperative irradiation and/or chemotherapy. Thirteen patients developed recurrent tumor after a median time of 8 months (range, 1-21 months). Recurrence was pelvic in 3, distant in 4, and pelvic plus distant in 6 patients. Of the 20 patients with stage IV leiomyosarcomas, after surgery 6 were clinically free of disease (group A) and 14 had clinically evaluable residual disease (group B). With regard to group A, 3 patients received postoperative irradiation and/or chemotherapy. Five patients developed recurrent disease after a median time of 11 months (range, 8-16 months). Recurrence was distant in 3 patients and pelvic plus distant in 2. With regard to group B, 11 patients underwent postoperative chemotherapy. Eleven patients died after a median time of 6 months (range, 1-15 months), and 3 are still alive with clinical evidence of disease after 4, 5, and 8 months, respectively, from surgery. Cox model showed that stage (P = 0.0001), mitotic count (P = 0.0002), and age (P = 0.0048) were independent prognostic variables for disease-free survival. In conclusion, uterine leiomyosarcomas have an aggressive clinical behavior, with a propensity to recur both locally and moreover at distant sites. Tumor stage is the strongest prognostic variable. Only patients with early-stage disease have a chance of surviving, whereas the treatment of patients with advanced or recurrent disease is palliative.

Adult↗
PubMed1996

The relationship between postoperative decline of serum CA 125 levels and size of residual disease after initial surgery in patients with advanced ovarian cancer: a CTF study.

This retrospective study assessed 46 patients with advanced ovarian cancer who had elevated preoperative serum CA 125 (>35 U/ml) and who had another serum CA 125 assay 6-9 days after surgery. Preoperative CA 125 levels were similar in patients with residual disease below 20 mm and in those with larger residuum. The postoperative decline of serum CA 125 was significantly higher in patients with small residual disease at any preoperative serum CA 125 value. By taking 60% as the cutoff of CA 125 decline, the diagnostic accuracy of this parameter in discriminating between patients with residual disease below or above 20 mm improved progressively when we considered patients with increasing preoperative antigen values. However, even in the subset of patients with preoperative serum CA 125 above 400 U/ml, 2 of the 20 patients with less than 20 mm residual disease had a percentage reduction of antigen levels lower than 60%, whereas 5 of the 10 patients with larger than 20 mm residuum had a CA 125 decline higher than 60%. Therefore, we believe that the perioperative changes of CA 125 levels have a limited clinical relevance in the management of patients with ovarian cancer.

Adult↗
PubMed1996

Endometrial stromal sarcoma: analysis of treatment failures and survival.

The objective of this retrospective multicenter study was to assess the rates, times, and sites of recurrences of 26 patients with low-grade endometrial stromal sarcomas (ESS) (<10 mitoses per 10 high-power fields (HPF) and 40 patients with high-grade ESS (>10 mitoses/10 HPF). Surgery was the initial therapy for all patients. Postoperative treatment was given without well-defined protocols. The median follow-up of survivors was 92 months (range, 4-167). Low-grade ESS: Of the 20 patients with disease confined to the uterus, 5 (25.0%) developed pelvic recurrence after a median of 36 months (range, 4-108). Of the 6 patients with disease outside the uterus, only one recurred in the pelvis after 93 months. High-grade ESS: Of the 20 patients with disease confined to the uterus, 11 (55.0%) developed recurrent disease after a median of 5 months (range, 2-76). The relapse occurred in the pelvis in 3 patients, in upper abdomen in 3, in upper abdomen and extraabdominal sites in 1, and in the pelvis and upper abdomen or extraabdominal sites in 4. Of the 12 patients with extrauterine disease confined to the pelvis, 9 (75.0%) developed recurrent disease after a median of 12 months (range, 1-49). The relapse occurred in the pelvis in 3 patients, in extraabdominal sites in 3, and in the pelvis and upper abdomen or extraabdominal sites in 3. Of the 8 patients with extrauterine disease outside the pelvis, 7 died of disease and 1 is currently alive with progressive disease after 24 months. The disease-free survival was significantly better for low-grade than that for high-grade ESS (P = 0.0001). By log-rank test the disease-free survival of high-grade ESS patients was related to stage (P = 0.0466) and mitotic count (P = 0.0014), but not to age. Cox model showed that mitotic count was the only independent prognostic variable for high-grade ESS (P = 0.006). In conclusion, low-grade and high-grade ESS have a completely different biological aggressiveness and clinical behavior.

Adult↗
PubMed1996

Transdermal estroprogestins versus transdermal estrogen plus oral dihydrogesterone replacement in menopause.

We studied 18 early (6 to 36 months) postmenopausal patients with a mean age of 51 years (47-53), who had never undergone hormone replacement therapy before and had no contraindications to hormone replacement. All cases of menopause were spontaneous. The treatment consisted in the continuous transdermal administration of 17-beta-estradiol (50 microg/daily) by skin patch to be replaced every 84 hours. The patients were further treated with a two-week progestogen administration every fortnight. This consisted of transdermal norethisterone acetate (0.25 mg/daily) combined with estradiol in the same patch in the first year, and oral dihydrogesterone (10 mg/daily) in the second year, without wash-out period. Before treatment (T0), and at the 12th (T1) and 24th (T2) month we measured the body mass index, the arterial blood pressure (AP), lipoproteins, coagulation parameters and bone metabolism parameters. The systolic pressure presented mean values (+/-SD) equal to 128.5+/-10.2 mmHg (T0), 131.1+/-7.4 mmHg (T1) and 130.4+/-7.5 mmHg (T2). Diastolic pressure values showed mean value ranging from 85.4+/-8.7 mmHg (T0) to 83.9+/-5.3 (T1) and 83.4+/-5.8 mmHg (T2). The detailed analysis of values of triglycerides, HDL cholesterol, apolipoprotein A1, apolipoprotein B and coagulation parameters at different times of therapy showed no statistically significant changes. With regard to bone metabolism, no statistically significant changes from baseline values were observed in parathormone, alkaline phosphatase, calcitonin, urinary calcium/creatinine ratio, and bone mineral content expressed by the bone density.

20-alpha-Dihydroprogesterone↗
PubMed1995

Serum half-life of CA 125 during early chemotherapy as an independent prognostic variable for patients with advanced epithelial ovarian cancer: results of a multicentric Italian study.

This retrospective multicentric study assessed the prognostic value of the serum CA 125 assay and the common clinicopathological variables in 225 patients with advanced epithelial ovarian cancer. All of these patients had serum CA 125 > or = 35 U/ml before the first cycle of chemotherapy and had had serial antigen determinations during early chemotherapy. By univariate analysis pathological complete response rate was significantly related to stage, size of residual disease after first surgery, serum CA 125 before the first cycle and before the third cycle of chemotherapy, and serum CA 125 half-life. Multiple logistic regression showed that residual disease (P = 0.002), serum CA 125 half-life (P = 0.004), serum CA 125 before the third cycle (P = 0.004), and serum CA 125 before the first cycle (P = 0.03) retained a significant value in predicting second-look findings. By log-rank test survival was significantly related to stage, residual disease, tumor grade, serum CA 125 before the third cycle, and serum CA 125 half-life. Cox proportional hazard model showed that residual disease (P = 0.0001), serum CA 125 half-life (P = 0.007), and tumor grade (P = 0.01) retained a significant value in predicting survival. In conclusion, serum CA 125 half-life during early chemotherapy was an independent prognostic factor for both the achievement of a pathological complete response and the survival of patients with advanced epithelial ovarian cancer.

Adult↗
PubMed1995

Gynaecological aspects of primary Sjogren's syndrome.

UNLABELLED: Female patients affected with Sjogren's Syndrome (SS) frequently describe symptoms such as vaginal dryness and dyspareunia; however, only a few controlled studies have regarded clinical involvement of the female external genitalia. OBJECTIVE: The present study was undertaken in order to: (1) Evaluate the involvement of external genitalia in a large number of female patients affected with primary SS (pSS) by semi-quantitative methods covering subjective symptoms and clinical evaluation. (2) Compare pSS patients with a matched healthy control group (pre- and post-menopausal women were separately studied). (3) Correlate the gynaecological involvement with salivary and lacrimal abnormalities in pSS patients. METHODS: We evaluated 36 patients with primary SS (18 pre- and 18 post-menopausal women) and 43 healthy controls using a questionnaire regarding vulvar and vaginal dryness and a complete gynaecological examination. Subsequently, three scores related to vulvar and cervical status plus a global score were obtained. In primary SS patients, salivary and lacrimal involvement was also evaluated. RESULTS: Dyspareunia was present in 61% and vaginal dryness in 55% of SS patients versus 39% and 33% of healthy controls. No significant differences regarding gynaecological scores were found between SS patients and controls, in both pre- and post-menopausal women, nor correlation was observed between gynaecological and lacrimal or salivary involvement. CONCLUSIONS: Our data suggest that although SS patients frequently complain of dyspareunia and vaginal dryness they do not greatly differ from healthy subjects in regard to some major gynaecological aspects.

Adult↗
PubMed1995

An analysis of approaches to the treatment of endometrial cancer in western Europe: a CTF study.

The role of this research is to define the clinical-therapeutic approach to endometrial cancer currently being followed in some of the most important centres of reference for gynaecological cancer in Western Europe. Data was collected by means of a questionnaire, concerning specific diagnostic and therapeutic options, sent to 115 leading centres for gynaecological oncology in Western Europe, and 82 responses were received. The analysis of the management of this neoplasia in Western European countries shows significant differences regarding some particular clinical conditions. Only 24.4% of the interviewed centres stated that they perform lymphadenectomy routinely, whereas it is most commonly reserved for specific pathological conditions. The presence of lymph node spread is generally considered to be the most important prognostic element, and currently, radiotherapy of the pelvis appears to be the treatment of choice either as the sole postsurgical therapy (57%) or in combination with systemic treatment. An adjuvant treatment in stage I lymph node-negative patients is adopted in the large majority of the centres (70.5%) when poorly differentiated cancer (46%) and/or deep myometrial invasion (33.3%) are present. In this condition, radiotherapy appears to be the therapy of choice. Histotype and grading are generally recognised as important risk factors and result in treatment modification; the high percentage of primary surgical modifications is considerable (63.4%) in stage I grade 3 cancers that primarily require lymphadenectomy or recourse to radical hysterectomy. The results of our study indicate that there is no leading therapy in the advanced stages of endometrial cancers, but each therapeutic modality is adopted to more or less the same extent.

Age Factors↗
PubMed1994

Prospective multicenter study on CA 125 in postmenopausal pelvic masses.

The purpose of this study was to determine the diagnostic value of CA 125 in comparison with transabdominal ultrasound (US) in the evaluation of postmenopausal women with pelvic mass to detect malignant epithelial ovarian tumors. Postmenopausal patients with pelvic mass were studied with gynecologic examination, US and CA 125 determination. Three hundred eighty-eight patients were entered in the study. According to stratification based on US (probably benign, equivocal, possibly malignant) and CA 125 (< 35 U/ml, negative; between 35 and 65 U/ml, borderline; > 65 U/ml, positive), 290 patients were considered eligible for surgery. Specificity, sensitivity, positive and negative predictive value, and accuracy of US and CA 125 were calculated with respect to histological examination. Out of 290 operated patients, 134 had a benign ovarian pathology, 34 had extraovarian benign pathology, 106 had an ovarian malignancy, and 16 presented with an extraovarian malignant pathology. The results according to ovarian malignant pathology were as follows. CA 125 (> 65 U/ml): Specificity, 92.5%; sensitivity, 71.7%; accuracy, 83.3%. CA 125 (> 35 U/ml): Specificity, 82.0%; sensitivity, 78.3%; accuracy, 80.4%. US: Specificity, 77.6%; sensitivity, 84.9%; accuracy, 80.3%. Combination of US and CA 125 (> 65 U/ml): Specificity, 96.1%; sensitivity, 91.7%; accuracy, 94.3%. Determination of CA 125 is a highly specific method in predicting ovarian cancer in postmenopausal women with a pelvic mass. The association with US significantly improves the overall accuracy and may support therapeutical decision making by distinguishing between a significant percentage of women most likely to benefit from prompt intervention and women who may be managed following minor surgical diagnostic approach, such as fine-needle aspiration.

Adult↗
PubMed1994

[Maternal anemia and fetal outcome. Authors's experience].

A physiological pregnancy in which the only pathological datum proved to be a computerised NST at the 40th week of pregnancy is reported. The NST trace showed evidence of fetal distress: absence of acceleration, short term reduced variability and deceleration of the fetal beat. On the basis of further traces, constantly pathological, and of the echographic evaluation of the fetal "outcome", with a biophysical profile which revealed oligohydramnios and absence of active fetal movement, Cesarean Section was undertaken, resulting in the birth of a baby girl of 3180 g, 50 cms, with Apgar 8/10. The clinical interest in this case arises from the total lack of pathological anamnestic data in the pregnancy, except, at a more accurate evaluation, anemia due to martial shortcoming of modest entity in the 1st and in the 2nd trimesters, worsening in the course of the 3rd after an episode of cystopyelitis. The message of the clinical case described is that immediate and careful evaluation of NST must be integrated in every case with obstetric anamneses, echographic and hormonal parameters, without a careful interpretation of routine hematochemical parameters.

Adult↗
PubMed1994

Times and sites of relapses after negative second look in advanced epithelial ovarian cancer.

In the present work the Authors analyse the role and significance of second-look laparotomy in the management of epithelial ovarian cancer. Eighty-three patients with advanced epithelial ovarian cancer (stage III-IV) followed at the Institutes of Gynecology of Padua and Pisa Universities underwent a negative second-look at a median time of 6 months after first surgery. The incidence of relapse after the negative second-look was 45.8% and the mean time of relapse was 27.4 months. Advanced surgical-pathological stage, the presence of residual disease > 2 cm and serous histotype are risk factors for relapse after a negative second-look. These data confirm that, because of its poor prognostic value, a negative second-look laparotomy should not influence the choice of second line chemotherapy and, consequently is no longer routinely performed in our Institutes.

Adult↗
PubMed1993

Histopathological characterization in carcinoma of the endometrium. Comparison between biopsy and pathological examination of specimen.

On the basis of a case series of 577 patients affected by carcinoma of the endometrium treated during the period 1963-1989 in the Gynecologic Institute of the Padua University, the present work examines the reliability of endometrial biopsy aiming at the correct histopathologic diagnosis, through comparison with the subsequent histologic examination of the surgical specimen. It is shown how simple biopsy alone allows for correct diagnosis of histotype in 91.6% of cases of adenocarcinoma, while the reliability of such an examination is reduced, respectively, to 30.7% in adenoacanthoma and to 37.5% in adenosquamous histotypes.

Adenocarcinoma↗
PubMed1993

The role of the endocrine factors and obesity in hormone-dependent gynecological neoplasias.

Between September 1990 and February 1992, we studied 70 women of post-menopausal age, of whom 33 were affected by hormone-dependent gynecologic tumors and 37 by other pathologies, measuring estrogens, androgens, SHBG and also measuring excess fat and its distribution. The aim of our research was to ascertain what relation there was between adipose tissue, taking account central or peripheric localization, the levels of sex steroids and the onset of endometrial and breast cancer. In the group of tumor patients, we found a quantity of fat mass greater than in the control group (p < 0.05); there was, beside, in the first group, an inverse proportional correlation between the SHBG levels and BMI, and between SHBG and the fat mass (P < 0.05). We also observed an inverse relation between the levels of testosterone and SHBG (P < 0.05). These findings confirm the role that the adipose tissue and androgens would have on the globulin production, which in turn would reflect on the percentage of potentially active steroids in endometrial and mammary tissues. We also wished to ascertain if the distribution of fatty tissue (prevalently abdominal or prevalently gluteo-femoral) could have different endocrine-metabolic consequences. We found a directly proportional relation between an index of central obesity, the T/L Ratio, and the levels of DHA-S (P < 0.05), but the significance of this relation is not clear, inasmuch as DHA-S is one of the least active of the androgens.(ABSTRACT TRUNCATED AT 250 WORDS)

17-alpha-Hydroxyprogesterone↗
PubMed1993

The role of insulin and renin in the pathogenesis of hormone-dependent neoplasias. a). Insulin.

Weight increase is frequently observed in women of menopausal age and the androgens secreted at the ovarian level are converted into estrogens at adipose tissue level, because of the presence of specific enzymes, the aromatases. Insulin and the androgens reduce the synthesis of Sex Hormone Binding Globulin (SHBG) at the hepatic level, thus increasing the amount of free steroids able to act at the level of the hormone-dependent tissues. Besides, the insulin stimulates androgenic synthesis at the level of the ovarian stroma in postmenopausal women. In this research, we studied 83 postmenopausal women, 41 with hormone-dependent pathologies and 42 affected by other pathologies, and we observed that women affected by breast and endometrial neoplasias presented a reduced tolerance to glucose, a higher level of circulating androgens, a large quantity of fatty tissue and a SHBG concentration inversely proportional to insulin level. These results suggest that the ovarian synthesis of androgens increase in women in postmenopausal age affected by hormone-dependent pathologies, and that insulin may play a part in the pathogenesis of such neoplasias.

Androstenedione↗
PubMed1993

The role of insulin and renin in the pathogenesis of hormone-dependent neoplasias. b). Renin.

Recently, a prorenin-renin-angiotensin system which could be correlated to the reproductive function, although independent from the renal renin-angiotensin complex, has been observed also at ovarian level. It had been supposed that the renin itself by influencing the metabolism of steroid hormones is responsible for the pathogenesis of hormone-dependent neoplasias, endometrial and breast carcinoma. This would lead to the consideration of hypertension as a primary risk factor for such pathologies and not only as secondary to obesity. This research has not, however, revealed significant relations between the plasmatic concentration of renin and the hormone variation responsible for the pathogenesis of hormone-dependent neoplasias.

Adipose Tissue↗
PubMed1993

Endometrial cancer treatment today.

The Authors stress the role of surgery in the clinical management of endometrial cancer. The half Century case-series of Padua Gynaecologic Institute is considered.

Combined Modality Therapy↗
PubMed1992

Carcinoma of the vulva: critical analysis of survival and treatment of recurrences.

Prognostic variables in vulvar cancer include: stage, lymph nodal status, tumour diameter, vascular space invasion, depth of invasion. Treatment must in the cost/benefit balance, be adequate to these prognostic variables and surgery is today the cornerstone in vulvar cancer management. In early stages it is possible to control the disease with personalized radical non-mutilant operations limiting the high incidence of complications of the past, without endangering the 5-year survival rate. The risk of relapses is related to some factors such as site of tumour growth, depth of tumoural infiltration, lymphnode involvement and vascular space involvement. Relapses appear earlier in the groin than in the primitive sites and cases with more than 3 effected nodes have a higher incidence of recurrences in any site. Survival in related to localization and time of relapses. The treatment of recurrence is personalized for different sites, almost always surgical, in local recurrences.

Carcinoma↗