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F. Peccatori

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University College Cork

Kocaeli University

Natela Shanidze

Smith Kettlewell Eye Research Institute

Columbia University

Prof Henry Ademola Adeola

University of Cape Town

Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart)

The University of Sydney

Antonio Cámara

Universidad de Jaén

Université Paris Nanterre

Università degli studi di Modena e Reggio Emilia

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Papers by F. Peccatori

Obstetrical, Fetal and Postnatal Effects of Gestational Antiblastic Chemotherapy: How to Counsel Cancer Patients

International Journal of Immunopathology and Pharmacology, 2012

At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregn... more At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregnancy increases, numbers are growing. If chemotherapy cannot be postponed, both doctors and patients face complex medical and ethical issues. There is a conflict between optimal maternal therapy and fetal wellbeing. Treatment during the first trimester increases the risk of congenital malformations, spontaneous abortions and fetal death. Second and third trimester exposure is less risky, but it can cause intrauterine growth retardation and low birth weight. Other effects on pregnancy after the first trimester include premature birth, stillbirth, impaired functional development, myocardial toxicity and myelosuppression. Counseling and management of these cases are difficult, because literature is mostly represented by case reports or retrospective series while randomized prospective studies or guidelines are lacking. Moreover, personal experience is often scanty due to the rarity of the co...

Cancer and fertility preservation: international recommendations from an expert meeting

BMC medicine, Jan 4, 2016

In the last years, thanks to the improvement in the prognosis of cancer patients, a growing atten... more In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should...

Prolonged treatment with rituximab in patients with follicular lymphoma significantly increases event-free survival and response duration compared with the standard weekly x 4 schedule

Blood, 2004

The potential benefits of extended rituximab treatment have been investigated in a randomized tri... more The potential benefits of extended rituximab treatment have been investigated in a randomized trial comparing the standard schedule with prolonged treatment in 202 patients with newly diagnosed or refractory/relapsed follicular lymphoma (FL). All patients received standard treatment (rituximab 375 mg/m 2 weekly ؋ 4). In 185 evaluable patients, the overall response rate was 67% in chemotherapynaive patients and 46% in pretreated cases (P < .01). Patients responding or with stable disease at week 12 (n ‫؍‬ 151) were randomized to no further treatment or prolonged rituximab administration (375 mg/m 2 every 2 months for 4 times). At a median follow-up of 35 months, the median event-free survival (EFS) was 12 months in the no further treatment versus 23 months in the prolonged treatment arm (P ‫؍‬ .02), the difference being particularly notable in chemotherapy-naive patients (19 vs 36 months; P ‫؍‬ .009) and in patients responding to induction treatment (16 vs 36 months; P ‫؍‬ .004). The number of t(14;18)-positive cells in peripheral blood (P ‫؍‬ .0035) and in bone marrow (P ‫؍‬ .0052) at baseline was pre-dictive for clinical response. Circulating normal B lymphocytes and immunoglobulin M (IgM) plasma levels decreased for a significantly longer time after prolonged treatment, but the incidence of adverse events was not increased. In patients with FL, the administration of 4 additional doses of rituximab at 8-week intervals significantly improves the EFS. (Blood.

Fertility preservation in women with borderline ovarian tumours

Cancer Treatment Reviews, 2016

Background: To evaluate the effect of clinicopathologic factors on the prognosis and fertility ou... more Background: To evaluate the effect of clinicopathologic factors on the prognosis and fertility outcomes of BOT patients. Methods: We performed a retrospective analysis of BOT patients who underwent surgical procedures in West China Second University Hospital from 2008 to 2015. The DFS outcomes, potential prognostic factors and fertility outcomes were evaluated. Results: 448 patients were included; 52 recurrences were observed. 92 patients undergoing FSS achieved pregnancy. No significant differences in fertility outcomes were found between the staging and unstaged surgery groups. Staging surgery was not an independent prognostic factor for DFS. Laparoscopy resulted in better prognosis than laparotomy in patients with stage I tumours and a desire for fertility preservation. Conclusion: Patients with BOT fail to benefit from surgical staging. Laparoscopy is recommended for patients with stage I disease who desire to preserve fertility. Physicians should pay more attention to risk of recurrence in patients who want to preserve fertility.

Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

New England Journal of Medicine, 2015

BACKGROUND Data on the long-term outcome of children who are exposed to maternal cancer with or w... more BACKGROUND Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking. METHODS In this multicenter case-control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months. RESULTS A total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P = 0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P = 0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings. CONCLUSIONS Prenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment.

Electron Beam Intraoperative Radiotherapy (ELIOT) in Pregnant Women with Breast Cancer: From in Vivo Dosimetry to Clinical Practice

Breast Care, 2017

Background: The aim of this study was to confirm our preliminary results with in vivo dosimetry i... more Background: The aim of this study was to confirm our preliminary results with in vivo dosimetry in non-pregnant breast cancer patients receiving electron beam intraoperative radiotherapy (ELIOT) and to report on the first treatment in a pregnant woman. Patients and Methods: Following our previous experience, 5 non-pregnant patients receiving ELIOT to the tumor bed after breast-conserving surgery (BCS) were studied with thermoluminescent dosimeters positioned in the subdiaphragmatic region, within the uterus, and in the ovarian region. In December 2011, the first pregnant breast cancer patient underwent BCS and ELIOT (21 Gy at 90% isodose) during the 15th week of gestation. Results: The mean dose to the subdiaphragmatic external region in the 5 non-pregnant patients was 5.57 mGy, while pelvic measurements were below 1 mGy. The actual dosimetry of the pregnant patient showed a mean subdiaphragmatic dose of 4.34 mGy, a mean suprapubic dose of 1.64 mGy, and mean ovarian doses of 1.48 mG...

Antiblastic Treatment and Haematological Malignancies during Pregnancy: A Crucial Decision

International Journal of Immunopathology and Pharmacology, 2012

Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues rel... more Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues related to the curability of the maternal disease, the need of a prompt treatment and the potential toxicity of chemotherapy for the fetus. Here we report the results of a systematic literature search about the management of the most frequent hematological malignancies that may occur during pregnancy, focusing on specific issues related to gestational age at diagnosis, fetal toxicity and efficacy on the maternal side. The standard approach in non-pregnant women is illustrated as reference.

Effects of in-utero exposure to chemotherapy on fetal brain growth

International Journal of Gynecologic Cancer, 2019

ObjectiveChildren exposed to chemotherapy in the prenatal period demonstrate normal neurocognitiv... more ObjectiveChildren exposed to chemotherapy in the prenatal period demonstrate normal neurocognitive development at 3 years but concerns regarding fetal brain growth remain high considering its vulnerability to external stimuli. Our aim was to evaluate the impact of in-utero chemotherapy exposure on brain growth and its effects on neurodevelopmental outcome.MethodsThe protocol was approved by the local ethics committee. Brain regional volumes at term postmenstrual age were measured by MRI in children exposed to in-utero chemotherapy and compared with normal MRI controls. Brain segmentation was performed by Advanced Normalization Tools (ANTs)-based transformations of the Neonatal Brain Atlas (ALBERT). Neurodevelopmental assessment (Bayley-III scales) was performed at 18 months corrected age in both exposed infants and in a group of healthy controls. Multiple linear regressions and false discovery rate correction for multiple comparisons were performed.ResultsTwenty-one newborns prenata...

Abstract OT1-01-06: POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13)

Ongoing Clinical Trials, 2019

Thalidomide in multiple myeloma, myelodysplastic syndromes and histiocytosis. Analysis of clinical results and of surrogate angiogenesis markers

Annals of Oncology, 2001

Background: Thalidomide, as a single agent, has been recently found to induce a clinical response... more Background: Thalidomide, as a single agent, has been recently found to induce a clinical response in one third of refractory or relapsed myeloma patients. Although it has been reported that thalidomide significantly inhibits angiogenesis, it is still unclear whether its clinical effect is mediated, at least in part, by its anti-angiogenic properties. Patients and methods: We evaluated thalidomide as a single agent in myeloma, myelodysplastic syndromes (MDS) and histiocytosis, i.e. hematological diseases characterized by increased angiogenesis, and measured prospectively a number of surrogate angiogenesis markers. Results: Clinical responses were observed in 7 of 17 mye-loma and 2 of 5 MDS patients. The histiocytosis patient had a partial response. At the time of the best clinical response, plasma levels of angiogenic growth factors, vascular endothelial growth factor (VEGF) and basic-fibroblast growth factor (b-FGF), were significantly decreased, and flow cytometry indicated a decrease of activated endothelial cells in the bone marrow of responding MDS patients. Conclusions: These observations confirm thalidomide efficacy in myeloma, suggest a possible use in MDS and histiocytosis and may contribute to the prediction of clinical response and to understanding the mechanism of thalidomide's action.

Contraception is as important as fertility preservation in young women with cancer

The Lancet, 2015

Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in cancer women: Systematic review and meta-analysis of randomized trials

Cancer Treatment Reviews, 2014

Background: The role of temporary ovarian suppression with gonadotropin-releasing hormone analogu... more Background: The role of temporary ovarian suppression with gonadotropin-releasing hormone analogues (GnRHa) in the prevention of chemotherapy-induced premature ovarian failure (POF) is still controversial. We conducted a systematic review and meta-analysis of randomized trials evaluating the efficacy of GnRHa, given before and during chemotherapy, in the prevention of POF in premenopausal cancer patients. Methods: Studies were retrieved by searching PubMed, Web of Knowledge database and the proceedings of major conferences. We calculated Odds Ratios (OR) and 95% confidence intervals (CIs) for POF from each trial and obtained pooled estimates through the random effects model as suggested by DerSimonian and Laird. Results: Nine studies were included in the meta-analysis with 225 events of POF occurring in 765 analyzed patients. The pooled OR estimate indicates a highly significant reduction in the risk of POF (OR = 0.43; 95% CI: 0.22-0.84; p = 0.013) in patients receiving GnRHa. There was statistically significant heterogeneity among studies (I 2 = 55.8%; p = 0.012). There was no evidence of publication bias. Subgroups analyses showed that the protective effect of GnRHa against POF was similar in subgroups of patients defined by age and timing of POF assessment, while it was present in breast cancer but unclear in ovarian cancer and lymphoma patients. Conclusions: Our pooled analysis of randomized studies shows that the temporary ovarian suppression induced by GnRHa significantly reduces the risk of chemotherapy-induced POF in young cancer patients.

Totally implantable central venous access port infections in patients with digestive cancer: Incidence and risk factors

American Journal of Infection Control, 2012

Background and Objectives: Vascular access has great importance in the treatment of patients subm... more Background and Objectives: Vascular access has great importance in the treatment of patients submitted to prolonged chemotherapy. Purpose of this study is to assess the efficacy and safety of the percutaneous insertion and use of totally implantable central venous access ports (TICVAP). Methods: During a 10-year period, 700 TICVAP were inserted into cancer patients for chemotherapy. Early and late complications and their management were recorded and analyzed. Results: Of the 700 catheters implanted, 126 (18%) presented one or more types of early and late complication. Removal of 262 catheters was performed, of which 216 (82.4%) were elective indications due to the termination of the treatment and 46 (17.6%) resulted from complications that could not be controlled using clinical measures. In 280 patients (40%), the catheter remained functional until the patient's death, and 158 patients (22.5%) are still making use of their catheters for clinical treatment. Conclusions: The low rate of complications according to this study confirms the safety and convenience of the percutaneous insertion and use of TICVAP in patients undergoing prolonged chemotherapy regimens and explains the increasing use of these devices in current medical oncology practice.

Is Electron Beam Intraoperative Radiotherapy (ELIOT) Safe in Pregnant Women with Early Breast Cancer? In Vivo Dosimetry to Assess Fetal Dose

Annals of Surgical Oncology, 2009

Safety of pregnancy following breast cancer diagnosis: A meta-analysis of 14 studies

European Journal of Cancer, 2011

BackgroundDue to the rising trend of delaying pregnancy to later in life, more women are diagnose... more BackgroundDue to the rising trend of delaying pregnancy to later in life, more women are diagnosed with breast cancer before completing their families. Therefore, enquiry into the feasibility and safety of pregnancy following breast cancer diagnosis is on the rise. Available evidence suggests that women with a history of breast cancer are frequently advised against future conception for fear that

ESO-ESMO 4rd International Consensus Guidelines for Breast Cancer in Young Women (BCY4)

Annals of Oncology

The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in ... more The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were identified as well. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).

Pegfilgrastim support effectively increases the relative dose intensitity (RDI) of modified CHLVVP/ABVVP regimen in patients with advanced Hodgkin disease (HD)

Pregnancy after breast cancer: Patients' characteristics and pregnancy outcomes

Primary Ovarian Small Cell Carcinoma: Four More Cases

Gynecologic Oncology, 1993

GnRH analogue for chemotherapy-induced ovarian damage: too early to say?

Fertility and Sterility, 2009

We read with interest the paper by Badawy et al. (1), reporting the beneficial effect of gosereli... more We read with interest the paper by Badawy et al. (1), reporting the beneficial effect of goserelin for the prevention of chemotherapy induced amenorrhea and ovarian failure in young breast cancer patients undergoing cytotoxic treatment. Even if we acknowledge the study design and the stringent criteria used for the evaluation of ovarian function recovery after chemotherapy, we have some concerns that we would like to share with the authors and the readers.

Obstetrical, Fetal and Postnatal Effects of Gestational Antiblastic Chemotherapy: How to Counsel Cancer Patients

International Journal of Immunopathology and Pharmacology, 2012

At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregn... more At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregnancy increases, numbers are growing. If chemotherapy cannot be postponed, both doctors and patients face complex medical and ethical issues. There is a conflict between optimal maternal therapy and fetal wellbeing. Treatment during the first trimester increases the risk of congenital malformations, spontaneous abortions and fetal death. Second and third trimester exposure is less risky, but it can cause intrauterine growth retardation and low birth weight. Other effects on pregnancy after the first trimester include premature birth, stillbirth, impaired functional development, myocardial toxicity and myelosuppression. Counseling and management of these cases are difficult, because literature is mostly represented by case reports or retrospective series while randomized prospective studies or guidelines are lacking. Moreover, personal experience is often scanty due to the rarity of the co...

Cancer and fertility preservation: international recommendations from an expert meeting

BMC medicine, Jan 4, 2016

In the last years, thanks to the improvement in the prognosis of cancer patients, a growing atten... more In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should...

Prolonged treatment with rituximab in patients with follicular lymphoma significantly increases event-free survival and response duration compared with the standard weekly x 4 schedule

Blood, 2004

The potential benefits of extended rituximab treatment have been investigated in a randomized tri... more The potential benefits of extended rituximab treatment have been investigated in a randomized trial comparing the standard schedule with prolonged treatment in 202 patients with newly diagnosed or refractory/relapsed follicular lymphoma (FL). All patients received standard treatment (rituximab 375 mg/m 2 weekly ؋ 4). In 185 evaluable patients, the overall response rate was 67% in chemotherapynaive patients and 46% in pretreated cases (P < .01). Patients responding or with stable disease at week 12 (n ‫؍‬ 151) were randomized to no further treatment or prolonged rituximab administration (375 mg/m 2 every 2 months for 4 times). At a median follow-up of 35 months, the median event-free survival (EFS) was 12 months in the no further treatment versus 23 months in the prolonged treatment arm (P ‫؍‬ .02), the difference being particularly notable in chemotherapy-naive patients (19 vs 36 months; P ‫؍‬ .009) and in patients responding to induction treatment (16 vs 36 months; P ‫؍‬ .004). The number of t(14;18)-positive cells in peripheral blood (P ‫؍‬ .0035) and in bone marrow (P ‫؍‬ .0052) at baseline was pre-dictive for clinical response. Circulating normal B lymphocytes and immunoglobulin M (IgM) plasma levels decreased for a significantly longer time after prolonged treatment, but the incidence of adverse events was not increased. In patients with FL, the administration of 4 additional doses of rituximab at 8-week intervals significantly improves the EFS. (Blood.

Fertility preservation in women with borderline ovarian tumours

Cancer Treatment Reviews, 2016

Background: To evaluate the effect of clinicopathologic factors on the prognosis and fertility ou... more Background: To evaluate the effect of clinicopathologic factors on the prognosis and fertility outcomes of BOT patients. Methods: We performed a retrospective analysis of BOT patients who underwent surgical procedures in West China Second University Hospital from 2008 to 2015. The DFS outcomes, potential prognostic factors and fertility outcomes were evaluated. Results: 448 patients were included; 52 recurrences were observed. 92 patients undergoing FSS achieved pregnancy. No significant differences in fertility outcomes were found between the staging and unstaged surgery groups. Staging surgery was not an independent prognostic factor for DFS. Laparoscopy resulted in better prognosis than laparotomy in patients with stage I tumours and a desire for fertility preservation. Conclusion: Patients with BOT fail to benefit from surgical staging. Laparoscopy is recommended for patients with stage I disease who desire to preserve fertility. Physicians should pay more attention to risk of recurrence in patients who want to preserve fertility.

Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

New England Journal of Medicine, 2015

BACKGROUND Data on the long-term outcome of children who are exposed to maternal cancer with or w... more BACKGROUND Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking. METHODS In this multicenter case-control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months. RESULTS A total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P = 0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P = 0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings. CONCLUSIONS Prenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment.

Electron Beam Intraoperative Radiotherapy (ELIOT) in Pregnant Women with Breast Cancer: From in Vivo Dosimetry to Clinical Practice

Breast Care, 2017

Background: The aim of this study was to confirm our preliminary results with in vivo dosimetry i... more Background: The aim of this study was to confirm our preliminary results with in vivo dosimetry in non-pregnant breast cancer patients receiving electron beam intraoperative radiotherapy (ELIOT) and to report on the first treatment in a pregnant woman. Patients and Methods: Following our previous experience, 5 non-pregnant patients receiving ELIOT to the tumor bed after breast-conserving surgery (BCS) were studied with thermoluminescent dosimeters positioned in the subdiaphragmatic region, within the uterus, and in the ovarian region. In December 2011, the first pregnant breast cancer patient underwent BCS and ELIOT (21 Gy at 90% isodose) during the 15th week of gestation. Results: The mean dose to the subdiaphragmatic external region in the 5 non-pregnant patients was 5.57 mGy, while pelvic measurements were below 1 mGy. The actual dosimetry of the pregnant patient showed a mean subdiaphragmatic dose of 4.34 mGy, a mean suprapubic dose of 1.64 mGy, and mean ovarian doses of 1.48 mG...

Antiblastic Treatment and Haematological Malignancies during Pregnancy: A Crucial Decision

International Journal of Immunopathology and Pharmacology, 2012

Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues rel... more Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues related to the curability of the maternal disease, the need of a prompt treatment and the potential toxicity of chemotherapy for the fetus. Here we report the results of a systematic literature search about the management of the most frequent hematological malignancies that may occur during pregnancy, focusing on specific issues related to gestational age at diagnosis, fetal toxicity and efficacy on the maternal side. The standard approach in non-pregnant women is illustrated as reference.

Effects of in-utero exposure to chemotherapy on fetal brain growth

International Journal of Gynecologic Cancer, 2019

ObjectiveChildren exposed to chemotherapy in the prenatal period demonstrate normal neurocognitiv... more ObjectiveChildren exposed to chemotherapy in the prenatal period demonstrate normal neurocognitive development at 3 years but concerns regarding fetal brain growth remain high considering its vulnerability to external stimuli. Our aim was to evaluate the impact of in-utero chemotherapy exposure on brain growth and its effects on neurodevelopmental outcome.MethodsThe protocol was approved by the local ethics committee. Brain regional volumes at term postmenstrual age were measured by MRI in children exposed to in-utero chemotherapy and compared with normal MRI controls. Brain segmentation was performed by Advanced Normalization Tools (ANTs)-based transformations of the Neonatal Brain Atlas (ALBERT). Neurodevelopmental assessment (Bayley-III scales) was performed at 18 months corrected age in both exposed infants and in a group of healthy controls. Multiple linear regressions and false discovery rate correction for multiple comparisons were performed.ResultsTwenty-one newborns prenata...

Abstract OT1-01-06: POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13)

Ongoing Clinical Trials, 2019

Thalidomide in multiple myeloma, myelodysplastic syndromes and histiocytosis. Analysis of clinical results and of surrogate angiogenesis markers

Annals of Oncology, 2001

Background: Thalidomide, as a single agent, has been recently found to induce a clinical response... more Background: Thalidomide, as a single agent, has been recently found to induce a clinical response in one third of refractory or relapsed myeloma patients. Although it has been reported that thalidomide significantly inhibits angiogenesis, it is still unclear whether its clinical effect is mediated, at least in part, by its anti-angiogenic properties. Patients and methods: We evaluated thalidomide as a single agent in myeloma, myelodysplastic syndromes (MDS) and histiocytosis, i.e. hematological diseases characterized by increased angiogenesis, and measured prospectively a number of surrogate angiogenesis markers. Results: Clinical responses were observed in 7 of 17 mye-loma and 2 of 5 MDS patients. The histiocytosis patient had a partial response. At the time of the best clinical response, plasma levels of angiogenic growth factors, vascular endothelial growth factor (VEGF) and basic-fibroblast growth factor (b-FGF), were significantly decreased, and flow cytometry indicated a decrease of activated endothelial cells in the bone marrow of responding MDS patients. Conclusions: These observations confirm thalidomide efficacy in myeloma, suggest a possible use in MDS and histiocytosis and may contribute to the prediction of clinical response and to understanding the mechanism of thalidomide's action.

Contraception is as important as fertility preservation in young women with cancer

The Lancet, 2015

Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in cancer women: Systematic review and meta-analysis of randomized trials

Cancer Treatment Reviews, 2014

Background: The role of temporary ovarian suppression with gonadotropin-releasing hormone analogu... more Background: The role of temporary ovarian suppression with gonadotropin-releasing hormone analogues (GnRHa) in the prevention of chemotherapy-induced premature ovarian failure (POF) is still controversial. We conducted a systematic review and meta-analysis of randomized trials evaluating the efficacy of GnRHa, given before and during chemotherapy, in the prevention of POF in premenopausal cancer patients. Methods: Studies were retrieved by searching PubMed, Web of Knowledge database and the proceedings of major conferences. We calculated Odds Ratios (OR) and 95% confidence intervals (CIs) for POF from each trial and obtained pooled estimates through the random effects model as suggested by DerSimonian and Laird. Results: Nine studies were included in the meta-analysis with 225 events of POF occurring in 765 analyzed patients. The pooled OR estimate indicates a highly significant reduction in the risk of POF (OR = 0.43; 95% CI: 0.22-0.84; p = 0.013) in patients receiving GnRHa. There was statistically significant heterogeneity among studies (I 2 = 55.8%; p = 0.012). There was no evidence of publication bias. Subgroups analyses showed that the protective effect of GnRHa against POF was similar in subgroups of patients defined by age and timing of POF assessment, while it was present in breast cancer but unclear in ovarian cancer and lymphoma patients. Conclusions: Our pooled analysis of randomized studies shows that the temporary ovarian suppression induced by GnRHa significantly reduces the risk of chemotherapy-induced POF in young cancer patients.

Totally implantable central venous access port infections in patients with digestive cancer: Incidence and risk factors

American Journal of Infection Control, 2012

Background and Objectives: Vascular access has great importance in the treatment of patients subm... more Background and Objectives: Vascular access has great importance in the treatment of patients submitted to prolonged chemotherapy. Purpose of this study is to assess the efficacy and safety of the percutaneous insertion and use of totally implantable central venous access ports (TICVAP). Methods: During a 10-year period, 700 TICVAP were inserted into cancer patients for chemotherapy. Early and late complications and their management were recorded and analyzed. Results: Of the 700 catheters implanted, 126 (18%) presented one or more types of early and late complication. Removal of 262 catheters was performed, of which 216 (82.4%) were elective indications due to the termination of the treatment and 46 (17.6%) resulted from complications that could not be controlled using clinical measures. In 280 patients (40%), the catheter remained functional until the patient's death, and 158 patients (22.5%) are still making use of their catheters for clinical treatment. Conclusions: The low rate of complications according to this study confirms the safety and convenience of the percutaneous insertion and use of TICVAP in patients undergoing prolonged chemotherapy regimens and explains the increasing use of these devices in current medical oncology practice.

Is Electron Beam Intraoperative Radiotherapy (ELIOT) Safe in Pregnant Women with Early Breast Cancer? In Vivo Dosimetry to Assess Fetal Dose

Annals of Surgical Oncology, 2009

Safety of pregnancy following breast cancer diagnosis: A meta-analysis of 14 studies

European Journal of Cancer, 2011

BackgroundDue to the rising trend of delaying pregnancy to later in life, more women are diagnose... more BackgroundDue to the rising trend of delaying pregnancy to later in life, more women are diagnosed with breast cancer before completing their families. Therefore, enquiry into the feasibility and safety of pregnancy following breast cancer diagnosis is on the rise. Available evidence suggests that women with a history of breast cancer are frequently advised against future conception for fear that

ESO-ESMO 4rd International Consensus Guidelines for Breast Cancer in Young Women (BCY4)

Annals of Oncology

The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in ... more The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were identified as well. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).

Pegfilgrastim support effectively increases the relative dose intensitity (RDI) of modified CHLVVP/ABVVP regimen in patients with advanced Hodgkin disease (HD)

Pregnancy after breast cancer: Patients' characteristics and pregnancy outcomes

Primary Ovarian Small Cell Carcinoma: Four More Cases

Gynecologic Oncology, 1993

GnRH analogue for chemotherapy-induced ovarian damage: too early to say?

Fertility and Sterility, 2009

We read with interest the paper by Badawy et al. (1), reporting the beneficial effect of gosereli... more We read with interest the paper by Badawy et al. (1), reporting the beneficial effect of goserelin for the prevention of chemotherapy induced amenorrhea and ovarian failure in young breast cancer patients undergoing cytotoxic treatment. Even if we acknowledge the study design and the stringent criteria used for the evaluation of ovarian function recovery after chemotherapy, we have some concerns that we would like to share with the authors and the readers.