Alberto Lapini - Academia.edu (original) (raw)
Papers by Alberto Lapini
Journal of endourology / Endourological Society, May 8, 2016
Objectives To evaluate the variation of interpretation of the same bladder urothelium image in di... more Objectives To evaluate the variation of interpretation of the same bladder urothelium image in different Storz Professional Image Enhancement System (SPIES) modalities. SPIES contains a White light (WL), Spectra A (SA), Spectra B (SB), Clara and Chroma (CC) modality. Materials & methods An App for the i-PAD retina was developed to study evaluation of images. A total of 80 images from 20 bladder areas acquired in four modalities were included. 73 participants completed the study. Images were analyzed on differences in delineated tumor margin variation, perceived quality of the image and delineation time. Results A separation between high agreement (n=14), and low agreement (n=6) images was found. In high agreement images, no difference in root mean square (RMS) was found between modalities. In low agreement images, WL (26.5 pix) and SA (33.4 pix) had a higher RMS than CC (18 pix) and SB (21.4 pix). The quality of SPIES modalities images was rated significantly higher. Delineation tim...
Urologia, Jan 20, 2015
Clinical practice and adherence to the diagnosis and treatment of NMIBC guidelines: a report of a... more Clinical practice and adherence to the diagnosis and treatment of NMIBC guidelines: a report of a recognition based clinical cases studyFor non-muscle invasive bladder cancer, a disease with a considerable epidemiological and socio-economic impact, the introduction of the Guidelines has always evoked as a tool for the resolution of long-standing disputes in terms of diagnosis and therapy. Check the degree of routine clinical practice adherence to the Recommendations is for this disease, more than for other uro-oncology pathology, an urgent need felt by the urological community. To assess the level of Guidelines adherence's, and study issues related to the paths of diagnosis and treatment of non-muscle invasive bladder cancer, and identifying the processes actually implemented in daily clinical practice, a series of case studies has submitted to a group of experts. The acknowledgement study allowed testing the impact of the current Evidence Based Medicine Recommendations in the e...
Applied Immunohistochemistry & Molecular Morphology, 2012
We tested a selected series of patients with single urothelial high-grade pT1 stage (pT1 HG) or u... more We tested a selected series of patients with single urothelial high-grade pT1 stage (pT1 HG) or urothelial carcinoma in situ (CIS) with a set of immunohistochemical markers to elaborate a risk score for progression. We retrospectively reviewed all first diagnoses of single, <3 cm, urothelial papillary carcinoma pT1 HG or isolated CIS between 2006 and 2009. Galectin-3, CD44, E-cadherin, CD138, p16, survivin, HYAL-1, and topoisomerase-II α were used. A grading score 0 or 1 for each immunohistochemical staining was assigned to obtain a total score for assessing the progression. The median "progression score" was selected as cutoff value for statistical analysis. Overall, 23 patients (19 pT1 HG and 4 CIS) were included in the study. After a median follow-up of 21 months (range, 12 to 34 mo), 9 patients (39.1%) showed disease recurrence whereas 4 patients (17.4%) showed tumor progression. Topoisomerase-II α, p16, survivin, galectin-3, and CD138 were significantly associated with progression. Progression score ranged from 0 (best prognosis) to 7 (worst prognosis). Using a score ≥5 as a threshold, specificity was 78.9%, sensitivity 100%, positive predictive value 50%, and negative predictive value 100%. ROC area (a 95% confidence interval, 0.807-1.000; P<0.001). This immunohistochemistry-based progression score using a threshold ≥5, might help the clinician to focus on patients with HG pT1 or extended CIS at high risk for disease progression. These patients might benefit from a more intensive follow-up program or early cystectomy.
Case Reports in Urology, 2013
is report illustrates the case of a patient who su ered an iatrogenic complete injury of both ure... more is report illustrates the case of a patient who su ered an iatrogenic complete injury of both ureters a er a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetra uoroethylene covered nitinol stents. To our knowledge, we describe the rst application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity.
Applied Immunohistochemistry & Molecular Morphology, 2012
We herein report an uncommon case of renal metastasis from the lung in a 72-year-old man who 2 ye... more We herein report an uncommon case of renal metastasis from the lung in a 72-year-old man who 2 years before underwent surgical treatment for a pulmonary adenocarcinoma. During follow-up, a computed tomography scan revealed the presence of a solid mass located in the right kidney. Histopathologic and immunohistochemical examination of the enucleated lesion demonstrated the renal localization of an adenocarcinoma of the lung. Clinically recognized renal metastatic lesions from pulmonary cancer are a rare finding with only 35 cases reported to date in the English literature, and renal localization of adenocarcinoma of the lung is extraordinarily uncommon. Together with suggestive clinical data and negativity for markers of adenocarcinomas of different origin, thyroid transcription factor-1, when positive, is considered to be the most reliable marker for the differential diagnosis.
Urology, Oct 1, 1994
Second stage reconfiguration of Carney I neobladder with intact ileal loop was performed in 3 pat... more Second stage reconfiguration of Carney I neobladder with intact ileal loop was performed in 3 patients due to poor functional results and associated complications requiring reintervention. Neobladder capacity increased from a mean volume of 240 to 593 mL, maximum endoluminal pressure decreased from a mean value of 86 to 29 mm water, and night-time incontinence uniformly disappeared. Loop detubularization and reconfiguration, therefore, results in marked improvement of the clinical and urodynamic characteristics of Camey I ileal neobiadder.
European Urology Supplements, 2007
Radical prostatectomy is considered the treatment of choice for tumors localized within the prost... more Radical prostatectomy is considered the treatment of choice for tumors localized within the prostate gland. This surgical procedure is usually performed using the retrograde technique as described by Walsh and co-workers. In recent years, the antegrade approach, originally described by Campbell was newly discovered due to the advent of laparoscopic radical prostatectomy. The aim of this study is to present the functional results of antegrade open radical prostatectomy, specifically reporting on the incidence of recovery of continence and potency.
European Journal of Surgical Oncology, Apr 23, 2015
European Journal of Surgical Oncology, Apr 23, 2015
Cancer, Sep 28, 2011
BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active a... more BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active against many tyrosine kinase receptors involving crucial pathways in both healthy tissues and malignant tissues. Because its use in clinical practice is quite recent, many of its possible side effects remain unknown. In this report, the authors describe the incidence of new-onset hyperparathyroidism in a cohort of patients with metastatic renal cell carcinoma who received treatment with sunitinib. METHODS: Twenty-six patients who received first-line sunitinib for metastatic renal cell carcinoma were enrolled in this study for a mineral and parathyroid function assessment. Plasma levels of intact parathyroid hormone; serum levels of calcium, phosphorus, 25-hydroxyvitamin D 3 , and 1,25-dihydrovitamin D 3 ; and urinary 24-hour calcium and phosphorus excretion all were measured in each patient. Biochemical evaluations were performed before the beginning of treatment and at the end of each sunitinib treatment period. RESULTS: Eighteen of 26 patients (69.2%) developed hyperparathyroidism with normal serum calcium levels, and 6 of them developed hypophosphatemia. Patients presented with a mean elevation of parathyroid hormone after 2.2 cycles of sunitinib. The levels of 25-OH vitamin D 3 were stable over the course of treatment, whereas 1,25-OH vitamin D 3 levels were increased in 5 hyperparathyroid patients. Those who presenting with elevated parathyroid hormone levels had low or undetectable urinary calcium levels. Parathyroid hormone elevation usually persisted but did not progress during long-term therapy with sunitinib. Permanent treatment interruption resulted in a resolution of hyperparathyroidism. CONCLUSIONS: Hyperparathyroidism developed in an high percentage of patients on sunitinib. Therefore, the authors concluded that sunitinib may affect parathyroid function and bone mineral homeostasis, possibly resulting in abnormal bone remodeling. Cancer 2012;118:3165-72
Cancer, Sep 28, 2011
BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active a... more BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active against many tyrosine kinase receptors involving crucial pathways in both healthy tissues and malignant tissues. Because its use in clinical practice is quite recent, many of its possible side effects remain unknown. In this report, the authors describe the incidence of new-onset hyperparathyroidism in a cohort of patients with metastatic renal cell carcinoma who received treatment with sunitinib. METHODS: Twenty-six patients who received first-line sunitinib for metastatic renal cell carcinoma were enrolled in this study for a mineral and parathyroid function assessment. Plasma levels of intact parathyroid hormone; serum levels of calcium, phosphorus, 25-hydroxyvitamin D 3 , and 1,25-dihydrovitamin D 3 ; and urinary 24-hour calcium and phosphorus excretion all were measured in each patient. Biochemical evaluations were performed before the beginning of treatment and at the end of each sunitinib treatment period. RESULTS: Eighteen of 26 patients (69.2%) developed hyperparathyroidism with normal serum calcium levels, and 6 of them developed hypophosphatemia. Patients presented with a mean elevation of parathyroid hormone after 2.2 cycles of sunitinib. The levels of 25-OH vitamin D 3 were stable over the course of treatment, whereas 1,25-OH vitamin D 3 levels were increased in 5 hyperparathyroid patients. Those who presenting with elevated parathyroid hormone levels had low or undetectable urinary calcium levels. Parathyroid hormone elevation usually persisted but did not progress during long-term therapy with sunitinib. Permanent treatment interruption resulted in a resolution of hyperparathyroidism. CONCLUSIONS: Hyperparathyroidism developed in an high percentage of patients on sunitinib. Therefore, the authors concluded that sunitinib may affect parathyroid function and bone mineral homeostasis, possibly resulting in abnormal bone remodeling. Cancer 2012;118:3165-72
Archivio Italiano Di Urologia Andrologia Organo Ufficiale Di Societa Italiana Di Ecografia Urologica E Nefrologica Associazione Ricerche in Urologia, Sep 1, 2012
To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyoli... more To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyolipomas (AML). We retrospectively analyzed a prospectively derived database of 707 patients with kidney tumor, who were treated with conservative surgery, between January 1995 and September 2009. Overall, 31 patients had a histopathologic diagnosis of renal AML and of those, 3 patients had a diagnosis of unilateral or bilateral renal mass, with at least one clinically suggestive of giant AML (maximal tumor diameter > or = 9 cm), either central or perihilar. These patients were the subjects of the analysis. Nephron sparing surgery (NSS) was performed as tumor enucleation (TE), carried out by a blunt dissection, using the natural cleavage plane between the tumor and the normal parenchyma. Preoperative tumor size ranged between 9.0 and 15.0 centimetres. At surgery, after kidney capsule incision, TE was done in all cases. In critical surgical steps, in case of difficult visualization of the correct enucleation plane, a sharp dissection a few millimetres away from the tumor was adopted. Warm ischemia time (WIT) was always below 20 minutes. Intraoperative blood loss was negligible. Unsignificant postoperative creatinine variation was recorded in all cases. No intra- and post-operative complications occurred. At last follow up visit, no tumor recurrence at the enucleation site was reported. TE technique can be considered a viable and effective treatment option for this very rare pathologic condition, since it provides a maximal glomerular preservation and minimizes WIT and intra- and postoperative complications.
Archivio Italiano Di Urologia Andrologia Organo Ufficiale Di Societa Italiana Di Ecografia Urologica E Nefrologica Associazione Ricerche in Urologia, Sep 1, 2012
To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyoli... more To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyolipomas (AML). We retrospectively analyzed a prospectively derived database of 707 patients with kidney tumor, who were treated with conservative surgery, between January 1995 and September 2009. Overall, 31 patients had a histopathologic diagnosis of renal AML and of those, 3 patients had a diagnosis of unilateral or bilateral renal mass, with at least one clinically suggestive of giant AML (maximal tumor diameter > or = 9 cm), either central or perihilar. These patients were the subjects of the analysis. Nephron sparing surgery (NSS) was performed as tumor enucleation (TE), carried out by a blunt dissection, using the natural cleavage plane between the tumor and the normal parenchyma. Preoperative tumor size ranged between 9.0 and 15.0 centimetres. At surgery, after kidney capsule incision, TE was done in all cases. In critical surgical steps, in case of difficult visualization of the correct enucleation plane, a sharp dissection a few millimetres away from the tumor was adopted. Warm ischemia time (WIT) was always below 20 minutes. Intraoperative blood loss was negligible. Unsignificant postoperative creatinine variation was recorded in all cases. No intra- and post-operative complications occurred. At last follow up visit, no tumor recurrence at the enucleation site was reported. TE technique can be considered a viable and effective treatment option for this very rare pathologic condition, since it provides a maximal glomerular preservation and minimizes WIT and intra- and postoperative complications.
Tumori, 2005
Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clin... more Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clinicopathological features and outcomes. We identified all patients diagnosed with testicular GCTs at our Institute between 1988 and 2004 who developed relapse > or = 24 months after completion of primary therapy. A retrospective case-note review was performed to extract clinical, pathological, treatment and outcome data. Six patients (1.25%) developed late relapse. All patients presented with stage I disease and were classified as "good risk" according to the International Germ Cell Consensus Classification. Mean time to late relapse was 48 months. Markers at late relapse were normal in all patients. Relapse was confined to retroperitoneal sites in five patients and located in the mediastinum in one patient. Five patients were managed by chemotherapy alone while one underwent combined treatment with surgery followed by chemotherapy. All patients obtained a complete response and all remained free from recurrence with a mean follow-up of 115 months. The incidence of late relapse in this small series is low. Chemonaive patients with late relapse were successfully salvaged with chemotherapy alone or surgical excision followed by cisplatin-based chemotherapy. The optimal duration of follow-up in patients with testicular GCTs is not known and practice varies widely. At our Institute we advise lifelong follow-up of all patients with malignant GCTs of the testis.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia
Tumor enucleation consists of excising the tumor by blunt dissection following the natural cleava... more Tumor enucleation consists of excising the tumor by blunt dissection following the natural cleavage plane between the peritumoral pseudocapsule and the renal parenchyma without removing a visible rim of healthy renal tissue. In the very recent years, the urological current opinion have changed from a wide skepticism against tumor enucleation to a wider level of acceptance based on the lack of correlation between the width of the resection margin and the risk of disease progression/local recurrence and on larger retrospective series on tumor enucleation with longer follow up. The aim of the present review is to report the technique of tumor enucleation, discuss some technical aspects that can vary between centers and to summarize the oncological and surgical results of this technique for the conservative treatment of RCC in the last 10 years; finally, to briefly present the pathological findings on pseudocapsule and surgical margins prospectively evaluated after tumor enucleation.
Anti Cancer Drugs, 2007
The purpose of the study was to evaluate objective response rate, survival and toxicity of the co... more The purpose of the study was to evaluate objective response rate, survival and toxicity of the combination of gemcitabine-docetaxel administered on a biweekly schedule as first-line treatment in advanced/relapsed or metastatic urothelial carcinoma. Treatment consisted of the sequenced administration of gemcitabine 1500 mg/m(2) and docetaxel 60 mg/m(2) (2 h intravenous infusion) on days 1, 14 of a 28-day cycle for 6 months. A total of 33 patients, 22 men and 11 women, were enrolled, aged 41-75 years (median 64 years). The majority of patients had a good performance status (94%; status<2). Thirteen patients had locally advanced disease (39%) and 20 metastasic disease (41%). A total of 178 treatment cycles were administered with a median number of 5.4 cycles for a patients (range 2-8). Toxicity was primarily hematologic with the most frequent grade >2 being neutropenia (11%), with three episodes of febrile neutropenia. Anemia and thrombocytopenia were milder and had a lower incidence. The most frequent nonhematological toxicities were alopecia, followed by asthenia. Cardiac and pulmonary toxicity was minimal. No toxic deaths were recorded during study and follow-up. Overall response rate was 53.1%, including four complete responses (12.5%) and 13 partial responses (40.6%), whereas six patients (18.8%) had disease stabilization. Median time to progression was 10.2 months (95% confidence interval: 5.1-13.7), with a median survival of 14.8 months (95% confidence interval: 9.4-20.2) after an observation of 30 months (range 4-30+). The results of this study suggested that combination therapy with gemcitabine and docetaxel administered twice a week is particularly active and well tolerated as first-line treatment in advanced and/or metastatic urothelial carcinoma. Once data are confirmed in a larger study and longer follow-up, the favorable toxicity profile of this regimen may offer an interesting alternative to the cisplatin-based regimen.
European Urology Supplements, 2011
European Urology Supplements, 2011
Journal of endourology / Endourological Society, May 8, 2016
Objectives To evaluate the variation of interpretation of the same bladder urothelium image in di... more Objectives To evaluate the variation of interpretation of the same bladder urothelium image in different Storz Professional Image Enhancement System (SPIES) modalities. SPIES contains a White light (WL), Spectra A (SA), Spectra B (SB), Clara and Chroma (CC) modality. Materials & methods An App for the i-PAD retina was developed to study evaluation of images. A total of 80 images from 20 bladder areas acquired in four modalities were included. 73 participants completed the study. Images were analyzed on differences in delineated tumor margin variation, perceived quality of the image and delineation time. Results A separation between high agreement (n=14), and low agreement (n=6) images was found. In high agreement images, no difference in root mean square (RMS) was found between modalities. In low agreement images, WL (26.5 pix) and SA (33.4 pix) had a higher RMS than CC (18 pix) and SB (21.4 pix). The quality of SPIES modalities images was rated significantly higher. Delineation tim...
Urologia, Jan 20, 2015
Clinical practice and adherence to the diagnosis and treatment of NMIBC guidelines: a report of a... more Clinical practice and adherence to the diagnosis and treatment of NMIBC guidelines: a report of a recognition based clinical cases studyFor non-muscle invasive bladder cancer, a disease with a considerable epidemiological and socio-economic impact, the introduction of the Guidelines has always evoked as a tool for the resolution of long-standing disputes in terms of diagnosis and therapy. Check the degree of routine clinical practice adherence to the Recommendations is for this disease, more than for other uro-oncology pathology, an urgent need felt by the urological community. To assess the level of Guidelines adherence's, and study issues related to the paths of diagnosis and treatment of non-muscle invasive bladder cancer, and identifying the processes actually implemented in daily clinical practice, a series of case studies has submitted to a group of experts. The acknowledgement study allowed testing the impact of the current Evidence Based Medicine Recommendations in the e...
Applied Immunohistochemistry & Molecular Morphology, 2012
We tested a selected series of patients with single urothelial high-grade pT1 stage (pT1 HG) or u... more We tested a selected series of patients with single urothelial high-grade pT1 stage (pT1 HG) or urothelial carcinoma in situ (CIS) with a set of immunohistochemical markers to elaborate a risk score for progression. We retrospectively reviewed all first diagnoses of single, <3 cm, urothelial papillary carcinoma pT1 HG or isolated CIS between 2006 and 2009. Galectin-3, CD44, E-cadherin, CD138, p16, survivin, HYAL-1, and topoisomerase-II α were used. A grading score 0 or 1 for each immunohistochemical staining was assigned to obtain a total score for assessing the progression. The median "progression score" was selected as cutoff value for statistical analysis. Overall, 23 patients (19 pT1 HG and 4 CIS) were included in the study. After a median follow-up of 21 months (range, 12 to 34 mo), 9 patients (39.1%) showed disease recurrence whereas 4 patients (17.4%) showed tumor progression. Topoisomerase-II α, p16, survivin, galectin-3, and CD138 were significantly associated with progression. Progression score ranged from 0 (best prognosis) to 7 (worst prognosis). Using a score ≥5 as a threshold, specificity was 78.9%, sensitivity 100%, positive predictive value 50%, and negative predictive value 100%. ROC area (a 95% confidence interval, 0.807-1.000; P<0.001). This immunohistochemistry-based progression score using a threshold ≥5, might help the clinician to focus on patients with HG pT1 or extended CIS at high risk for disease progression. These patients might benefit from a more intensive follow-up program or early cystectomy.
Case Reports in Urology, 2013
is report illustrates the case of a patient who su ered an iatrogenic complete injury of both ure... more is report illustrates the case of a patient who su ered an iatrogenic complete injury of both ureters a er a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetra uoroethylene covered nitinol stents. To our knowledge, we describe the rst application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity.
Applied Immunohistochemistry & Molecular Morphology, 2012
We herein report an uncommon case of renal metastasis from the lung in a 72-year-old man who 2 ye... more We herein report an uncommon case of renal metastasis from the lung in a 72-year-old man who 2 years before underwent surgical treatment for a pulmonary adenocarcinoma. During follow-up, a computed tomography scan revealed the presence of a solid mass located in the right kidney. Histopathologic and immunohistochemical examination of the enucleated lesion demonstrated the renal localization of an adenocarcinoma of the lung. Clinically recognized renal metastatic lesions from pulmonary cancer are a rare finding with only 35 cases reported to date in the English literature, and renal localization of adenocarcinoma of the lung is extraordinarily uncommon. Together with suggestive clinical data and negativity for markers of adenocarcinomas of different origin, thyroid transcription factor-1, when positive, is considered to be the most reliable marker for the differential diagnosis.
Urology, Oct 1, 1994
Second stage reconfiguration of Carney I neobladder with intact ileal loop was performed in 3 pat... more Second stage reconfiguration of Carney I neobladder with intact ileal loop was performed in 3 patients due to poor functional results and associated complications requiring reintervention. Neobladder capacity increased from a mean volume of 240 to 593 mL, maximum endoluminal pressure decreased from a mean value of 86 to 29 mm water, and night-time incontinence uniformly disappeared. Loop detubularization and reconfiguration, therefore, results in marked improvement of the clinical and urodynamic characteristics of Camey I ileal neobiadder.
European Urology Supplements, 2007
Radical prostatectomy is considered the treatment of choice for tumors localized within the prost... more Radical prostatectomy is considered the treatment of choice for tumors localized within the prostate gland. This surgical procedure is usually performed using the retrograde technique as described by Walsh and co-workers. In recent years, the antegrade approach, originally described by Campbell was newly discovered due to the advent of laparoscopic radical prostatectomy. The aim of this study is to present the functional results of antegrade open radical prostatectomy, specifically reporting on the incidence of recovery of continence and potency.
European Journal of Surgical Oncology, Apr 23, 2015
European Journal of Surgical Oncology, Apr 23, 2015
Cancer, Sep 28, 2011
BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active a... more BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active against many tyrosine kinase receptors involving crucial pathways in both healthy tissues and malignant tissues. Because its use in clinical practice is quite recent, many of its possible side effects remain unknown. In this report, the authors describe the incidence of new-onset hyperparathyroidism in a cohort of patients with metastatic renal cell carcinoma who received treatment with sunitinib. METHODS: Twenty-six patients who received first-line sunitinib for metastatic renal cell carcinoma were enrolled in this study for a mineral and parathyroid function assessment. Plasma levels of intact parathyroid hormone; serum levels of calcium, phosphorus, 25-hydroxyvitamin D 3 , and 1,25-dihydrovitamin D 3 ; and urinary 24-hour calcium and phosphorus excretion all were measured in each patient. Biochemical evaluations were performed before the beginning of treatment and at the end of each sunitinib treatment period. RESULTS: Eighteen of 26 patients (69.2%) developed hyperparathyroidism with normal serum calcium levels, and 6 of them developed hypophosphatemia. Patients presented with a mean elevation of parathyroid hormone after 2.2 cycles of sunitinib. The levels of 25-OH vitamin D 3 were stable over the course of treatment, whereas 1,25-OH vitamin D 3 levels were increased in 5 hyperparathyroid patients. Those who presenting with elevated parathyroid hormone levels had low or undetectable urinary calcium levels. Parathyroid hormone elevation usually persisted but did not progress during long-term therapy with sunitinib. Permanent treatment interruption resulted in a resolution of hyperparathyroidism. CONCLUSIONS: Hyperparathyroidism developed in an high percentage of patients on sunitinib. Therefore, the authors concluded that sunitinib may affect parathyroid function and bone mineral homeostasis, possibly resulting in abnormal bone remodeling. Cancer 2012;118:3165-72
Cancer, Sep 28, 2011
BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active a... more BACKGROUND: Sunitinib malate is an orally bioavailable tyrosine kinase inhibitor that is active against many tyrosine kinase receptors involving crucial pathways in both healthy tissues and malignant tissues. Because its use in clinical practice is quite recent, many of its possible side effects remain unknown. In this report, the authors describe the incidence of new-onset hyperparathyroidism in a cohort of patients with metastatic renal cell carcinoma who received treatment with sunitinib. METHODS: Twenty-six patients who received first-line sunitinib for metastatic renal cell carcinoma were enrolled in this study for a mineral and parathyroid function assessment. Plasma levels of intact parathyroid hormone; serum levels of calcium, phosphorus, 25-hydroxyvitamin D 3 , and 1,25-dihydrovitamin D 3 ; and urinary 24-hour calcium and phosphorus excretion all were measured in each patient. Biochemical evaluations were performed before the beginning of treatment and at the end of each sunitinib treatment period. RESULTS: Eighteen of 26 patients (69.2%) developed hyperparathyroidism with normal serum calcium levels, and 6 of them developed hypophosphatemia. Patients presented with a mean elevation of parathyroid hormone after 2.2 cycles of sunitinib. The levels of 25-OH vitamin D 3 were stable over the course of treatment, whereas 1,25-OH vitamin D 3 levels were increased in 5 hyperparathyroid patients. Those who presenting with elevated parathyroid hormone levels had low or undetectable urinary calcium levels. Parathyroid hormone elevation usually persisted but did not progress during long-term therapy with sunitinib. Permanent treatment interruption resulted in a resolution of hyperparathyroidism. CONCLUSIONS: Hyperparathyroidism developed in an high percentage of patients on sunitinib. Therefore, the authors concluded that sunitinib may affect parathyroid function and bone mineral homeostasis, possibly resulting in abnormal bone remodeling. Cancer 2012;118:3165-72
Archivio Italiano Di Urologia Andrologia Organo Ufficiale Di Societa Italiana Di Ecografia Urologica E Nefrologica Associazione Ricerche in Urologia, Sep 1, 2012
To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyoli... more To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyolipomas (AML). We retrospectively analyzed a prospectively derived database of 707 patients with kidney tumor, who were treated with conservative surgery, between January 1995 and September 2009. Overall, 31 patients had a histopathologic diagnosis of renal AML and of those, 3 patients had a diagnosis of unilateral or bilateral renal mass, with at least one clinically suggestive of giant AML (maximal tumor diameter > or = 9 cm), either central or perihilar. These patients were the subjects of the analysis. Nephron sparing surgery (NSS) was performed as tumor enucleation (TE), carried out by a blunt dissection, using the natural cleavage plane between the tumor and the normal parenchyma. Preoperative tumor size ranged between 9.0 and 15.0 centimetres. At surgery, after kidney capsule incision, TE was done in all cases. In critical surgical steps, in case of difficult visualization of the correct enucleation plane, a sharp dissection a few millimetres away from the tumor was adopted. Warm ischemia time (WIT) was always below 20 minutes. Intraoperative blood loss was negligible. Unsignificant postoperative creatinine variation was recorded in all cases. No intra- and post-operative complications occurred. At last follow up visit, no tumor recurrence at the enucleation site was reported. TE technique can be considered a viable and effective treatment option for this very rare pathologic condition, since it provides a maximal glomerular preservation and minimizes WIT and intra- and postoperative complications.
Archivio Italiano Di Urologia Andrologia Organo Ufficiale Di Societa Italiana Di Ecografia Urologica E Nefrologica Associazione Ricerche in Urologia, Sep 1, 2012
To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyoli... more To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyolipomas (AML). We retrospectively analyzed a prospectively derived database of 707 patients with kidney tumor, who were treated with conservative surgery, between January 1995 and September 2009. Overall, 31 patients had a histopathologic diagnosis of renal AML and of those, 3 patients had a diagnosis of unilateral or bilateral renal mass, with at least one clinically suggestive of giant AML (maximal tumor diameter > or = 9 cm), either central or perihilar. These patients were the subjects of the analysis. Nephron sparing surgery (NSS) was performed as tumor enucleation (TE), carried out by a blunt dissection, using the natural cleavage plane between the tumor and the normal parenchyma. Preoperative tumor size ranged between 9.0 and 15.0 centimetres. At surgery, after kidney capsule incision, TE was done in all cases. In critical surgical steps, in case of difficult visualization of the correct enucleation plane, a sharp dissection a few millimetres away from the tumor was adopted. Warm ischemia time (WIT) was always below 20 minutes. Intraoperative blood loss was negligible. Unsignificant postoperative creatinine variation was recorded in all cases. No intra- and post-operative complications occurred. At last follow up visit, no tumor recurrence at the enucleation site was reported. TE technique can be considered a viable and effective treatment option for this very rare pathologic condition, since it provides a maximal glomerular preservation and minimizes WIT and intra- and postoperative complications.
Tumori, 2005
Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clin... more Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clinicopathological features and outcomes. We identified all patients diagnosed with testicular GCTs at our Institute between 1988 and 2004 who developed relapse > or = 24 months after completion of primary therapy. A retrospective case-note review was performed to extract clinical, pathological, treatment and outcome data. Six patients (1.25%) developed late relapse. All patients presented with stage I disease and were classified as "good risk" according to the International Germ Cell Consensus Classification. Mean time to late relapse was 48 months. Markers at late relapse were normal in all patients. Relapse was confined to retroperitoneal sites in five patients and located in the mediastinum in one patient. Five patients were managed by chemotherapy alone while one underwent combined treatment with surgery followed by chemotherapy. All patients obtained a complete response and all remained free from recurrence with a mean follow-up of 115 months. The incidence of late relapse in this small series is low. Chemonaive patients with late relapse were successfully salvaged with chemotherapy alone or surgical excision followed by cisplatin-based chemotherapy. The optimal duration of follow-up in patients with testicular GCTs is not known and practice varies widely. At our Institute we advise lifelong follow-up of all patients with malignant GCTs of the testis.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia
Tumor enucleation consists of excising the tumor by blunt dissection following the natural cleava... more Tumor enucleation consists of excising the tumor by blunt dissection following the natural cleavage plane between the peritumoral pseudocapsule and the renal parenchyma without removing a visible rim of healthy renal tissue. In the very recent years, the urological current opinion have changed from a wide skepticism against tumor enucleation to a wider level of acceptance based on the lack of correlation between the width of the resection margin and the risk of disease progression/local recurrence and on larger retrospective series on tumor enucleation with longer follow up. The aim of the present review is to report the technique of tumor enucleation, discuss some technical aspects that can vary between centers and to summarize the oncological and surgical results of this technique for the conservative treatment of RCC in the last 10 years; finally, to briefly present the pathological findings on pseudocapsule and surgical margins prospectively evaluated after tumor enucleation.
Anti Cancer Drugs, 2007
The purpose of the study was to evaluate objective response rate, survival and toxicity of the co... more The purpose of the study was to evaluate objective response rate, survival and toxicity of the combination of gemcitabine-docetaxel administered on a biweekly schedule as first-line treatment in advanced/relapsed or metastatic urothelial carcinoma. Treatment consisted of the sequenced administration of gemcitabine 1500 mg/m(2) and docetaxel 60 mg/m(2) (2 h intravenous infusion) on days 1, 14 of a 28-day cycle for 6 months. A total of 33 patients, 22 men and 11 women, were enrolled, aged 41-75 years (median 64 years). The majority of patients had a good performance status (94%; status<2). Thirteen patients had locally advanced disease (39%) and 20 metastasic disease (41%). A total of 178 treatment cycles were administered with a median number of 5.4 cycles for a patients (range 2-8). Toxicity was primarily hematologic with the most frequent grade >2 being neutropenia (11%), with three episodes of febrile neutropenia. Anemia and thrombocytopenia were milder and had a lower incidence. The most frequent nonhematological toxicities were alopecia, followed by asthenia. Cardiac and pulmonary toxicity was minimal. No toxic deaths were recorded during study and follow-up. Overall response rate was 53.1%, including four complete responses (12.5%) and 13 partial responses (40.6%), whereas six patients (18.8%) had disease stabilization. Median time to progression was 10.2 months (95% confidence interval: 5.1-13.7), with a median survival of 14.8 months (95% confidence interval: 9.4-20.2) after an observation of 30 months (range 4-30+). The results of this study suggested that combination therapy with gemcitabine and docetaxel administered twice a week is particularly active and well tolerated as first-line treatment in advanced and/or metastatic urothelial carcinoma. Once data are confirmed in a larger study and longer follow-up, the favorable toxicity profile of this regimen may offer an interesting alternative to the cisplatin-based regimen.
European Urology Supplements, 2011
European Urology Supplements, 2011