Franca Forni

Publications (5)11.41 Total impact

• Article: Squamous cell carcinoma antigen in patients with locally advanced cervical carcinoma undergoing preoperative radiochemotherapy: association with pathological response to treatment and clinical outcome.

  Gabriella Ferrandina, Gabriella Macchia, Francesco Legge, Francesco Deodato, Franca Forni, Cinzia Digesù, Vito Carone, Alessio G Morganti, Giovanni Scambia
  [show abstract] [hide abstract]
  ABSTRACT: We investigated the role of squamous cell carcinoma (SCC) at presentation (pre-SCC) and after treatment (post-SCC) as predictor of pathological response and outcome in locally advanced cervical cancer (LACC) patients undergoing preoperative chemoradiation. One hundred and twenty-three consecutive LACC patients underwent preoperative chemoradiation including cisplatin and 5-fluorouracil plus external radiotherapy to the whole pelvic region. Clinical responders underwent radical surgery. SCC levels were expressed in nanograms/milliliter. Ninety-five of 123 (77.2%) and 15/113 (13.3%) cases were classified as having high pre-SCC and high post-SCC levels. Complete pathological response was documented in 51 cases (41.5%), while persistence of microscopic foci was shown in 40 cases (32.5%). In the univariate analysis, FIGO (International Federation of Gynecology and Obstetrics) stage, clinical response to treatment and post-SCC levels were associated with pathological response to chemoradiation. In the multivariate analysis, only clinical response to treatment and post-SCC levels retained an independent role as predictors of pathological response to treatment. Cases with high post-SCC status had a shorter disease-free survival than cases with low post-SCC levels (p = 0.028). In the multivariate analysis, lack of a pathological complete response/persistence of microscopic foci to treatment retained an independent negative prognostic role for disease-free survival. Post-SCC identifies LACC patients with a poor chance of pathological response to chemoradiation and an unfavorable outcome.
  Oncology 02/2008; 74(1-2):42-9. · 2.27 Impact Factor
• Article: Squamous cell carcinoma antigen in follow-up of cervical cancer treated with radiotherapy: evaluation of cost-effectiveness.

  Franca Forni, Gabriella Ferrandina, Francesco Deodato, Gabriella Macchia, Alessio G Morganti, Daniela Smaniotto, Stefano Luzi, Giuseppe D'Agostino, Vincenzo Valentini, Numa Cellini, Bruno Giardina, Giovanni Scambia
  [show abstract] [hide abstract]
  ABSTRACT: The squamous cell carcinoma (SCC) antigen is still considered the most accurate serologic tumor marker in cervical carcinoma. We assessed the contribution of the SCC assay to the detection of recurrences in patients treated with radiotherapy. The pattern of recurrence and follow-up data were prospectively recorded for 135 patients. Of the 135 patients, 103 (76.3%) had primary cervical carcinoma and 32 (23.7%) had already experienced disease recurrence that had been successfully treated with surgery (n = 2), surgery plus radiotherapy (n = 2), radiotherapy (n = 5), or concomitant chemoradiotherapy (n = 23). The follow-up evaluations (chest X-ray, abdominopelvic magnetic resonance imaging, gynecologic examination with colposcopy, Papanicolaou smear, and SCC assay) were performed at 6-month intervals; the evaluation was done earlier if recurrent disease was suspected. The median follow-up time was 29 months (range, 6-131). The SCC serum levels were assayed, and a cost analysis was done. A total of 481 SCC determinations were performed. Of the 135 patients, 43 (31.8%) experienced disease recurrence. The SCC levels were higher in those with recurrent disease than in the disease-free patients. Elevation of SCC was documented in 34 (79.1% sensitivity) of 43 recurrences before symptoms appeared. Of the 38 patients with serum SCC elevation, 34 developed a recurrence (positive predictive value, 89.5%). Of the 97 patients with negative SCC serum levels, 88 had negative findings at the clinicoradiologic evaluation (negative predictive value, 90.7%). A simplified approach (SCC plus gynecologic examination) was evaluated. Compared with the complete follow-up program, the rate of missed recurrence was 2.2%. The total projected cost per patient for 5 years of follow-up for the simplified procedure was approximately 12.2-fold lower than the standard approach. Our results have shown that a simplified diagnostic approach, including the SCC assay and gynecologic examination, can detect a high rate of recurrence from cervical cancer, with a very favorable cost-effective profile.
  International Journal of Radiation OncologyBiologyPhysics 12/2007; 69(4):1145-9. · 4.11 Impact Factor
• Article: Chemoradiation of unresectable pancreatic carcinoma: impact of pretreatment hemoglobin level on patterns of failure.

  Alessio G Morganti, Franca Forni, Gabriella Macchia, Vincenzo Valentini, Daniela Smaniotto, Lucio Trodella, Mario Balducci, Numa Cellini
  [show abstract] [hide abstract]
  ABSTRACT: To evaluate, in patients with locally advanced pancreatic carcinoma undergoing concomitant chemoradiation, the impact of pretreatment hemoglobin (Hb) concentration on the outcome in terms of clinical response, local control, metastasis-free survival, disease-free survival, and overall survival. 30 patients undergoing concomitant chemoradiation (5-fluorouracil [5-FU], 1,000 mg/m(2)/day, continuous i.v. infusion days 1-4 of radiotherapy) and external beam radiotherapy (50.4-59.4 Gy) were divided into two groups based on pretreatment median Hb value (11.5 g/dl). The potential prognostic factors examined besides Hb concentration were: tumor site (head vs body-tail), sex (female vs male), cN (cN0 vs nC1), dose of external beam radiotherapy (50.4 Gy vs 59.4 Gy), presence of jaundice at diagnosis (yes vs no), weight loss at diagnosis (> or = 5 kg vs < 5 kg), epigastric-lumbar pain at diagnosis (yes vs no), maximum tumor diameter (< 40 mm vs > or = 40 mm). Pretreatment Hb ranged between 9.6 and 15.0 g/dl. No statistically significant differences were observed as for clinical response and local control between patients with an Hb < or = 11.5 g/dl and those with an Hb > 11.5 g/dl. Metastasis-free survival was 5.1 months in patients with an Hb < or = 11.5 g/dl and 10.7 months in patients with an Hb > 11.5 g/dl (p = 0,010). Median actuarial disease-free survival was 5.1 and 10.2 months in patients with an Hb < or = 11.5 and > 11.5 g/dl, respectively (p = 0.026). Median actuarial overall survival was 7.5 and 10.3 months in patients with an Hb < or = 11.5 and > 11.5 g/dl; respectively (p = 0.039). On multivariate analysis, Hb concentration at diagnosis was the only factor prognostically correlated with metastasis-free survival (p = 0.026), disease-free survival (p = 0.032), and overall survival (p = 0.048). In a group of patients with locally advanced pancreatic carcinoma treated with chemoradiation, a significant correlation was observed between pretreatment Hb levels and metastasis-free survival, disease-free survival, and overall survival.
  Strahlentherapie und Onkologie 02/2003; 179(2):87-92. · 3.56 Impact Factor
• Article: Biological factors and therapeutic modulation in pancreatic carcinoma radiotherapy.

  Numa Cellini, Alessio G Morganti, Gabriella Macchia, Daniela Smaniotto, Stefano Luzi, Gian Carlo Mattiucci, Franca Forni, Vincenzo Valentini
  [show abstract] [hide abstract]
  ABSTRACT: The prognosis of pancreatic carcinoma is dismal. Its main reason can be attributed to the difficult early diagnosis. In fact, at diagnosis most patients show advanced disease. In recent years, studies on the biomolecular characteristics of this disease have been conducted. The obtained results have favored the understanding of the basic mechanisms of the biologic aggressiveness and the resistance to chemoradiation of pancreatic carcinoma. They include the frequent oncogene activation as well as the similarly frequent suppressor gene inhibition. Based on this new knowledge, novel therapeutic strategies have been identified and treatments of targeting the ras oncoprotein or mutated p53, metalloproteinase inhibitors and tyrosine kinase receptor inhibitors (trastuzumab and cetuximab) together with antiangiogenic therapies are under experimentation.
  Rays 27(3):215-7.
• Article: Multiple tumor marker elevation in androgen ablation-refractory prostate cancer with long-term response to metronomic chemotherapy: a case report.

  Mariangela Massaccesi, Franca Forni, Pasquale Spagnuolo, Gabriella Macchia, Samantha Mignogna, Maria De Ninno, Numa Cellini, Bruno Giardina, Arnaldo Carbone, Alessio G Morganti
  [show abstract] [hide abstract]
  ABSTRACT: Outcomes in hormone-refractory prostate cancer are very poor. The time from progression to death is only 12-19 months. We present the case of a 69-year-old man with hormone-refractory prostate cancer and bone metastases treated with metronomic chemotherapy (cyclophosphamide based). He had had a colon adenocarcinoma ten years before. The atypical features of this case were an unusually long-lasting response to metronomic chemotherapy and an increase in serum levels of some non-prostate-specific tumor markers (CEA and CA 19-9) that was not related to a relapse of colon cancer. We hypothesize a potential role of hypoxia inducing CA 19-9 and CEA expression in tumor cells, which may predict the development of progressive resistance to antiangiogenic therapies.
  The International journal of biological markers 25(4):243-7. · 1.48 Impact Factor