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Article ; Online: Advancing endometrial cancer management in the era of molecular classification: insights into pattern of recurrence.

De Vitis, Luigi Antonio / Multinu, Francesco

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2024 Volume 34, Issue 5, Page(s) 667–668

MeSH term(s)	Humans ; Endometrial Neoplasms/classification ; Endometrial Neoplasms/therapy ; Endometrial Neoplasms/genetics ; Endometrial Neoplasms/pathology ; Female ; Neoplasm Recurrence, Local
Language	English
Publishing date	2024-05-06
Publishing country	England
Document type	Journal Article ; Editorial
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2024-005527
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Article ; Online: Surgical morbidity of total laparoscopic hysterectomy for benign disease: Predictors of major postoperative complications.

Casarin, J / Cromi, A / Bogani, G / Multinu, F / Uccella, S / Ghezzi, F

European journal of obstetrics, gynecology, and reproductive biology

2021 Volume 263, Page(s) 210–215

Abstract: Objective: To estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo ≥ 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease.: Study design: An uncontrolled single- ... ...

Abstract	Objective: To estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo ≥ 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease. Study design: An uncontrolled single-center single-arm retrospective study. Data of consecutive patients who have undergone TLH for pathologically confirmed benign disease between January 2000 and December 2019 have been analyzed. Perioperative surgical outcomes, occurrence of postoperative complications, readmissions, and reoperations within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major (Clavien-Dindo ≥ 2) postoperative complications. Results: Over the study period 3090 patients were included in the study. Conversion to open surgery occurred in 54 (1.7%) cases. Mean operative time for TLH was 87.7 (±1.7) minutes while mean estimated blood loss was 119.5 (+7.4) mL. Overall, postoperative complications were registered in 430 (13.9%) patients, and major events were observed in 208 (6.7%) of the cases. Same-hospital readmissions and reoperations within 30-day from surgery occurred in 78 (2.5%) and 28 (0.9%) patients, respectively. At multivariable analysis, endometriosis (odds ratio: 3.51, 95%CI:1.54-8.30, p = 0.02), the need for conversion to open surgery (odds ratio: 1.26, 98%CI:1.03-12.64, p < 0.001), and the occurrence of any intraoperative complication (odds ratio: 3.10, 95%CI: 1.45-21.61, p < 0.001) were found as independent risk factors for major postoperative complications. Conclusions: Total hysterectomy performed via laparoscopy is associated with acceptable major postoperative complications rate. A huge effort should be made to minimize the occurrence of intraoperative complications and the need for conversion to open surgery. Patients undergoing TLH for endometriosis should be counselled about the increased risk of major postoperative events.
MeSH term(s)	Female ; Humans ; Hysterectomy/adverse effects ; Laparoscopy/adverse effects ; Morbidity ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies
Language	English
Publishing date	2021-06-23
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2021.06.023
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Article ; Online: Endometrial stromal tumors of the uterus: Epidemiology, pathological and biological features, treatment options and clinical outcomes.

Gadducci, Angiolo / Multinu, Francesco / De Vitis, Luigi Antonio / Cosio, Stefania / Carinelli, Silvestro / Aletti, Giovanni Damiano

Gynecologic oncology

2023 Volume 171, Page(s) 95–105

Abstract: Endometrial stromal tumors (EST) are uterine mesenchymal tumors, which histologically resemble endometrial stroma of the functioning endometrium. The majority of EST are malignant tumors classified as low-grade endometrial stromal sarcoma (LG-ESS), high- ... ...

Abstract	Endometrial stromal tumors (EST) are uterine mesenchymal tumors, which histologically resemble endometrial stroma of the functioning endometrium. The majority of EST are malignant tumors classified as low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and undifferentiated uterine sarcoma (UUS). Overall, ESTs are rare malignancies, with an annual incidence of approximately 0.30 per 100'000 women, mainly affecting peri- or postmenopausal women. The most common genetic alteration identified in LG-ESS is the JAZF1-SUZ12 rearrangement, while t(10;17)(q23,p13) translocation and BCOR gene abnormalities characterize two major subtypes of HG-ESS. The absence of specific genetic abnormalities is the actual hallmark of UUS. Unlike HG-ESSs, LG-ESSs usually express estrogen and progesterone receptors. Total hysterectomy without morcellation and bilateral salpingo-oophorectomy (BSO) is the first-line treatment of early-stage LG-ESS. Ovarian preservation, fertility-sparing treatment, and adjuvant hormonal therapy ± radiotherapy may be an option in selected cases. In advanced or recurrent LG-ESS, surgical cytoreduction followed by hormonal treatment, or vice versa, are acceptable treatments. The standard treatment for apparently early-stage HG-ESS and UUS is total hysterectomy without morcellation with BSO. Ovarian preservation and adjuvant chemotherapy ± radiotherapy may be an option. In advanced or recurrent HG-ESS, surgical cytoreduction and neoadjuvant or adjuvant chemotherapy can be considered. Alternative treatments, including biological agents and immunotherapy, are under investigation. LG-ESSs are indolent tumor with a 5-year overall survival (OS) of 80-100% and present as stage I-II at diagnosis in two third of patients. HG-ESSs carry a poor prognosis, with a median OS ranging from 11 to 24 months, and 70% of patients are in stage III-IV at presentation. UUS median OS ranges from 12 to 23 months and, at diagnosis, 70% of patients are in stage III-IV. The aim of this review is to assess the clinical, pathological, and biological features and the therapeutic options for malignant ESTs.
MeSH term(s)	Humans ; Female ; Endometrial Stromal Tumors/epidemiology ; Endometrial Stromal Tumors/genetics ; Endometrial Stromal Tumors/therapy ; Sarcoma, Endometrial Stromal/epidemiology ; Sarcoma, Endometrial Stromal/genetics ; Sarcoma, Endometrial Stromal/therapy ; Endometrial Neoplasms/epidemiology ; Endometrial Neoplasms/genetics ; Endometrial Neoplasms/therapy ; Uterus/pathology ; Endometrium/pathology
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2023.02.009
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Article ; Online: Letter to the editor-The new FIGO staging system for endometrial cancer: Is the paradigm shift clinically feasible?

Betella, Ilaria / De Vitis, Luigi Antonio / Calidona, Carmelo / Multinu, Francesco / Colombo, Nicoletta

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2023 Volume 164, Issue 1, Page(s) 364–365

MeSH term(s)	Female ; Humans ; Endometrial Neoplasms/pathology ; Neoplasm Staging ; Prognosis
Language	English
Publishing date	2023-12-06
Publishing country	United States
Document type	Letter
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.15265
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Zs.A 355: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 183: Show issues

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Article ; Online: Poly (ADP-ribose) polymerase inhibitors (PARPi) in ovarian cancer: lessons learned and future directions.

Caruso, Giuseppe / Tomao, Federica / Parma, Gabriella / Lapresa, Mariateresa / Multinu, Francesco / Palaia, Innocenza / Aletti, Giovanni / Colombo, Nicoletta

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2023 Volume 33, Issue 4, Page(s) 431–443

Abstract: Poly (ADP-ribose) polymerase inhibitors (PARPi) represent a new standard of care in the upfront treatment of advanced epithelial ovarian cancer to the point that the vast majority of patients now receive a PARPi, alone or in combination with the anti- ... ...

Abstract	Poly (ADP-ribose) polymerase inhibitors (PARPi) represent a new standard of care in the upfront treatment of advanced epithelial ovarian cancer to the point that the vast majority of patients now receive a PARPi, alone or in combination with the anti-angiogenic bevacizumab, as part of their first-line maintenance therapy. The clinical benefit of PARPi is well established; however, much has changed since their introduction and several relevant questions have been raised and remain unresolved in the post-PARPi era. The decision-making process regarding the most appropriate first-line maintenance therapy could be challenging in clinical practice, especially in the homologous recombination-proficient setting, and several other factors need to be considered apart from the mutational status. Concerns regarding post-PARPi progression treatment have emerged, highlighting an unmet need to define a valid algorithm strategy. PARPi may not only compromise the response to further platinum due to cross-resistance mechanisms but the impact on subsequent non-platinum chemotherapy and surgery also remains unclear. Definitive results on the role of PARPi rechallenge are awaited, especially in the case of oligoprogression managed with locoregional treatment. Moreover, the updated overall survival data from the recurrent setting warrant caution in using PARPi as single agents for unselected patients. Several PARPi combination regimens are emerging for overcoming PARPi resistance and may become our new therapeutic armamentarium. This review discusses a set of clinically relevant issues in the PARPi era and provides a glimpse of future challenges and opportunities in ovarian cancer treatment.
MeSH term(s)	Humans ; Female ; Poly(ADP-ribose) Polymerase Inhibitors ; Ribose/therapeutic use ; Ovarian Neoplasms/drug therapy ; Carcinoma, Ovarian Epithelial/drug therapy ; Bevacizumab/therapeutic use
Chemical Substances	Poly(ADP-ribose) Polymerase Inhibitors ; Ribose (681HV46001) ; Bevacizumab (2S9ZZM9Q9V)
Language	English
Publishing date	2023-04-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2022-004149
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Article ; Online: Systemic therapy de-escalation in advanced ovarian cancer: a new era on the horizon?

Caruso, Giuseppe / Coleman, Robert L / Aletti, Giovanni / Multinu, Francesco / Botticelli, Andrea / Palaia, Innocenza / Cliby, William / Colombo, Nicoletta

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2023 Volume 33, Issue 9, Page(s) 1448–1457

Abstract: Poly(ADP-ribose) polymerase inhibitors (PARPi) have sculpted the current landscape of advanced ovarian cancer treatment. With the advent of targeted maintenance therapies, improved survival rates have led to a timely interest in exploring de-intensified ... ...

Abstract	Poly(ADP-ribose) polymerase inhibitors (PARPi) have sculpted the current landscape of advanced ovarian cancer treatment. With the advent of targeted maintenance therapies, improved survival rates have led to a timely interest in exploring de-intensified strategies with the goal of improving quality of life without compromising oncologic outcomes. The emerging concept of systemic treatment de-escalation would represent a new frontier in personalizing therapy in ovarian cancer. PARPi are so effective that properly selected patients treated with these agents might require less chemotherapy to achieve the same oncologic outcomes. The fundamental key is to limit de-escalation to a narrow subpopulation with favorable prognostic factors, such as patients with
MeSH term(s)	Female ; Humans ; Carcinoma, Ovarian Epithelial ; Neoadjuvant Therapy ; Ovarian Neoplasms/drug therapy ; Poly(ADP-ribose) Polymerase Inhibitors ; Quality of Life
Chemical Substances	Poly(ADP-ribose) Polymerase Inhibitors
Language	English
Publishing date	2023-09-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2023-004740
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Zs.A 3198: Show issues

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Article: Advancing Tailored Treatments: A Predictive Nomogram, Based on Ultrasound and Laboratory Data, for Assessing Nodal Involvement in Endometrial Cancer Patients.

Pino, Ida / Gozzini, Elisa / Radice, Davide / Boveri, Sara / Iacobone, Anna Daniela / Vidal Urbinati, Ailyn Mariela / Multinu, Francesco / Gullo, Giuseppe / Cucinella, Gaspare / Franchi, Dorella

Journal of clinical medicine

2024 Volume 13, Issue 2

Abstract: Assessing lymph node metastasis is crucial in determining the optimal therapeutic approach for endometrial cancer (EC). Considering the impact of lymphadenectomy, there is an urgent need for a cost-effective and easily applicable method to evaluate the ... ...

Abstract	Assessing lymph node metastasis is crucial in determining the optimal therapeutic approach for endometrial cancer (EC). Considering the impact of lymphadenectomy, there is an urgent need for a cost-effective and easily applicable method to evaluate the risk of lymph node metastasis in cases of sentinel lymph node (SLN) biopsy failure. This retrospective monocentric study enrolled EC patients, who underwent surgical staging with nodal assessment. Data concerning demographic, clinicopathological, ultrasound, and surgical characteristics were collected from medical records. Ultrasound examinations were conducted in accordance with the IETA statement. We identified 425 patients, and, after applying exclusion criteria, the analysis included 313 women. Parameters incorporated into the nomogram were selected via univariate and multivariable analyses, including platelet count, myometrial infiltration, minimal tumor-free margin, and CA 125. The nomogram exhibited good accuracy in predicting lymph node involvement, with an AUC of 0.88. Using a cutoff of 10% likelihood of nodal involvement, the nomogram displayed a low false-negative rate of 0.04 (95% CI 0.00-0.19) in the training set. The adaptability of this straightforward model renders it suitable for implementation across diverse clinical settings, aiding gynecological oncologists in preoperative patient evaluations and facilitating the design of personalized treatments. However, external validation is mandatory for confirming diagnostic accuracy.
Language	English
Publishing date	2024-01-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13020496
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Article: Management of bladder endometriosis with combined transurethral and laparoscopic approach. Follow-up of pain control, quality of life, and sexual function at 12 months after surgery.

Pontis, A / Nappi, L / Sedda, F / Multinu, F / Litta, P / Angioni, S

Clinical and experimental obstetrics & gynecology

2018 Volume 43, Issue 6, Page(s) 836–839

Abstract: To describe the pre-surgical and post-surgical outcomes at one year in terms of recurrence of lower urinary tract symptoms, quality of life, and sexual function of a transurethral and laparoscopic combined approach in the treatment of bladder ... ...

Abstract	To describe the pre-surgical and post-surgical outcomes at one year in terms of recurrence of lower urinary tract symptoms, quality of life, and sexual function of a transurethral and laparoscopic combined approach in the treatment of bladder endometriosis. The au- thors performed a prospective observational study of 16 women affected by symptomatic bladder endometriosis at the University Hos- pitals of Cagliari, Padua, and Foggia. In all patients bladder nodule was excised with a transurethral and laparoscopic combined approach technique. Intensity of lower urinary tract symptoms (VAS score) were assessed pre- and post-operatively at one, six, and 12 months after surgery; quality of life (SF-36) and sexual functions (FSFI) were collected preoperatively and one year postoperatively. Operative time was 120.18 ± 15.77 minutes and mean blood loss was 65.12 ± 44.74. No intraoperative and postoperative complications and conversion laparotomy occurred. Intensity of lower urinary tract symptoms evaluated with VAS score were significantly lower after one, six, and 12 months postsurgery vs. presurgery (p < 0.001). The authors observed a significantly improvement in the quality of life and sexual functions in all patients at one year after surgery. This surgical approach is safe and simple in the treatment of bladder en- dometriosis, with low risks and optimal resolution of symptoms, and improvement of quality of life and sexual function.
MeSH term(s)	Adult ; Conversion to Open Surgery ; Cystoscopy/methods ; Dyspareunia ; Endometriosis/surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/methods ; Middle Aged ; Operative Time ; Pain ; Pain Management ; Postoperative Complications/epidemiology ; Prospective Studies ; Quality of Life ; Sexual Health ; Treatment Outcome ; Urinary Bladder Diseases/surgery ; Young Adult
Language	English
Publishing date	2018-06-22
Publishing country	China
Document type	Journal Article
ZDB-ID	754459-5
ISSN	0390-6663
ISSN	0390-6663
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Zs.A 1678: Show issues

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Article ; Online: Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review.

Buonomo, Barbara / Multinu, Francesco / Casarin, Jvan / Betella, Ilaria / Zanagnolo, Vanna / Aletti, Giovanni / Peccatori, Fedro

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2021 Volume 31, Issue 3, Page(s) 360–370

Abstract: Ovarian transposition aims to minimize ovarian exposure and damage during pelvic radiotherapy. One or both ovaries are separated from the uterus and mobilized away from the area where the radiation will be administered. A review of the available ... ...

Abstract	Ovarian transposition aims to minimize ovarian exposure and damage during pelvic radiotherapy. One or both ovaries are separated from the uterus and mobilized away from the area where the radiation will be administered. A review of the available literature was conducted to evaluate the efficacy and safety of ovarian transposition among pre-menopausal women diagnosed with cervical cancer and eligible for pelvic radiotherapy. Outcomes evaluated were ovarian function preservation and complication rates. We also searched for information on pregnancy/live birth rates after ovarian transposition. Our search yielded a total of 635 manuscripts, of which 33 were considered eligible. A total of 28 full texts were selected for the current review, including 1377 patients who underwent ovarian transposition. The median or mean follow-up ranged between 7 and 87 months. Ovarian function preservation after ovarian transposition and pelvic radiotherapy, with or without chemotherapy, was 61.7% (431/699 patients), ranging from 16.6% to 100%. A total of 12 studies reported on 117 complications, accounting for 8.5%. Ovarian metastases were described in 5 (0.4%). Data about fertility preservation after ovarian transposition are scarce and definitive conclusions cannot be drawn. Based on the available data, ovarian transposition could be performed on young patients with tumors smaller than 4 cm, and it should be avoided in those with bulky tumors. A risk/benefit assessment should be carefully evaluated by a multidisciplinary team, and the decision regarding ovarian transposition should be always guided by the values and informed preferences of the patient.
MeSH term(s)	Adult ; Female ; Fertility Preservation/methods ; Humans ; Middle Aged ; Organ Sparing Treatments/methods ; Ovary/surgery ; Premenopause ; Primary Ovarian Insufficiency/prevention & control ; Radiation Oncology/methods ; Uterine Cervical Neoplasms/radiotherapy
Language	English
Publishing date	2021-02-26
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2020-001774
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Article ; Online: Clear cell carcinoma of the ovary: Epidemiology, pathological and biological features, treatment options and clinical outcomes.

Gadducci, Angiolo / Multinu, Francesco / Cosio, Stefania / Carinelli, Silvestro / Ghioni, Mariacristina / Aletti, Giovanni Damiano

Gynecologic oncology

2021 Volume 162, Issue 3, Page(s) 741–750

Abstract: Clear cell carcinoma of the ovary is a rare and distinct histotype of epithelial ovarian carcinomas. Women diagnosed with clear cell carcinomas are usually younger and diagnosed at earlier stages than those with the most common high-grade serous ... ...

Abstract	Clear cell carcinoma of the ovary is a rare and distinct histotype of epithelial ovarian carcinomas. Women diagnosed with clear cell carcinomas are usually younger and diagnosed at earlier stages than those with the most common high-grade serous histology. Endometriosis is considered a main risk factor for the development of clear cell carcinoma of the ovary, and it can be considered a precursor of of this tumor, as it is identified in more than 50% of patients with clear cell carcinoma. Different molecular pathways and alterations heve been identified in ovarian clear cell carcinoma, including the most common mutations of AT-rich interaction domain 1A [ARID1A] and phosphatidylinositol-4,5-bisphosphate 3-kinase [PIK3] catalytic subunit alpha [PIK3CA]. The prognosis of patients at early stage is favorable, while patients with advanced or recurrent disease experience a poor oncologic outcomes. Despite a lower rate of responses due to an intrinsic chemoresistance, the treatment strategy for advanced disease resembles the treatment of high-grade serous carcinoma, which includes aggressive cytoreductive surgery and platinum-based chemotherapy. For this reason, the role of adjuvant chemotherapy in patients with stage I disease undergoing complete surgical staging is still under debate. Alternative treatments, including biological agents that target different pathways constitute the most promising treatment strategies, and well-designed, collaborative international trials should be designed in order to improve the oncologic outcomes and the quality of life of patients with this aggressive disease.
MeSH term(s)	Adenocarcinoma, Clear Cell/diagnosis ; Adenocarcinoma, Clear Cell/epidemiology ; Adenocarcinoma, Clear Cell/pathology ; Adenocarcinoma, Clear Cell/therapy ; Biological Factors/therapeutic use ; Chemotherapy, Adjuvant/methods ; Cytoreduction Surgical Procedures ; Endometriosis/complications ; Female ; Humans ; Neoplasm Staging ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/epidemiology ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/therapy ; Salpingo-oophorectomy/methods
Chemical Substances	Biological Factors
Language	English
Publishing date	2021-07-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2021.06.033
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