Marta D'Alonzo

Università degli Studi di Torino, Torino, Piedmont, Italy

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Publications (5)12.5 Total impact

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    ABSTRACT: Uterine fibroids are the most common benign tumors of the female genital tract. The management of symptomatic fibroids has traditionally been surgical; however, alternative pharmacological approaches have been proposed to control symptoms. To date, gonadotropin-releasing hormone analogs are the only available drugs for the preoperative treatment of fibroids. However, the US Food and Drug Administration recently authorized ulipristal acetate (UPA), an oral selective progesterone-receptor modulator, for the same indication. UPA is a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms of uterine fibroids in women of reproductive age. According to clinical data, UPA shows several advantages: it is faster than leuprolide in reducing the fibroid-associated bleeding, it significantly improves hemoglobin and hematocrit levels in anemic patients, and it grants a significant reduction in the size of fibroids, which lasts for at least 6 months after the end of the treatment. Furthermore, UPA displays a better tolerability profile when compared to leuprolide; in fact, it keeps estradiol levels at mid follicular phase range, thereby reducing the incidence of hot flushes and exerting no impact on bone turnover. On the grounds of this evidence, the administration of 5 mg/day ulipristal acetate for 3 months is suggested for different patient categories and allows for planning a treatment strategy tailored to meet an individual patient's needs.
    Drug Design, Development and Therapy 02/2014; 8:285-292. DOI:10.2147/DDDT.S54565 · 3.03 Impact Factor
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    ABSTRACT: PURPOSE OF THE STUDY: A retrospective analysis on 1407 patients with invasive ductal carcinoma (IDC) and 243 invasive lobular carcinoma (ILC) was performed in order to compare the histological features, the immunohistochemical characteristics, the surgical treatment and the clinical outcome in the two groups. RESULTS: ILC seems to be more likely multifocal, estrogen receptor positive, HER-2 negative and to have a lower proliferative index compared to IDC. ILC, when treated with conservative surgery, required more frequently re-excision and/or mastectomy because of positive resection margins. No difference was observed in terms of 5-year disease free survival and local relapse free survival between the two groups, in the whole series and in the subgroup of patients treated with breast-conserving treatment. CONCLUSION: ILC can be safely treated with conservative surgery but a more accurate preoperative evaluation of tumor size and multifocality could be advocated, in order to reduce the re-excision rate.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 03/2013; DOI:10.1016/j.ejso.2013.02.007 · 2.89 Impact Factor
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    ABSTRACT: Nipple-areola sparing mastectomy (NSM) is increasingly used in patients with non-locally advanced breast carcinoma. Literature data on the preoperative assessment of the nipple-areola complex (NAC) are inconsistent. Out of 1359 patients submitted to total mastectomy between 2001 and 2010, we selected 61 patients whose pre-operative mammogram (MX) was available (MX group) and 39 patients who underwent preoperative breast magnetic resonance imaging (magnetic resonance imaging (MRI) group). The rate of NAC involvement, the value of MX and MRI to predict NAC involvement and the performance of the Schecter's and Loewn's algorithms for the prediction of NAC involvement were evaluated. In the combined MX and MRI groups, NAC involvement was found in 14% of the cases. At univariate analysis, tumour stage (p value: 0.03), central tumour location (p value: 0.004), presence of NAC retraction (p value: 0.001) and tumour-NAC distance (p value: 0.006) were associated with NAC involvement, but only the latter parameter retained statistical significance at multivariate analysis (p value: 0.05). Tumour-NAC distance was a key predictor of NAC involvement, with a negative predictive value of 94% for MX and of 100% for MRI when the cut-off was set at 10mm. Overall, the performance of Schecter's and Loewn's algorithms was respectively lower and similar as compared to the original series. Occult tumour involvement of the NAC is detected in a minority of breast cancer patients submitted to mastectomy. A tumour-NAC distance ⩾10mm by MRI may help select patients candidate to NSM.
    European journal of cancer (Oxford, England: 1990) 05/2012; 48(15):2311-8. DOI:10.1016/j.ejca.2012.04.017 · 4.82 Impact Factor
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    ABSTRACT: The objective of this study is to investigate if changes in cognitive functions can be recognised in patients undergoing chemotherapy for breast cancer. Forty women with breast cancer and without depression underwent cognitive evaluation before and after 6 months of chemotherapy; emotional evaluation was performed before and after 1, 3 and 6 months of chemotherapy. Self-reported cognitive deficit evaluation was included. Global cognitive functioning before starting chemotherapy was good. After 6 months of treatment there was a significant decline in some cognitive functions, particularly involving the attention subdomain. Objective cognitive deficit resulted independent from the emotional status. On the contrary, self-perceived mental dysfunction was unrelated to the objective cognitive decline, but it was associated with depression and anxiety. Breast cancer chemotherapy can induce domain-specific cognitive dysfunction. Patients' self-perception of mental decline is unrelated to objective cognitive deficit. Breast cancer patients negatively judge their cognitive performances if they have a negative emotional functioning.
    European Journal of Cancer Care 12/2011; 21(4):485-92. DOI:10.1111/j.1365-2354.2011.01320.x · 1.76 Impact Factor
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    ABSTRACT: PURPOSE For selected cases, nipple-sparing mastectomy may represent the optimal surgical option oncologically and cosmetically. However, the radiological criteria predicting the tumoural involvement of the nipple-areola complex (NAC) are not yet exhaustively defined. The purpose of the study was to assess the role of Dynamic Contrast-Enhanced MRI (DCE-MRI) in the evaluation of NAC in patients with breast cancer undergoing mastectomy. METHOD AND MATERIALS The series included the 26 patients with biopsy-proven breast cancer undergoing MRI and treated by mastectomy between January 2009 and January 2010 in our Institution. DCE-MRI were performed by 1.5T equipment, 8-channel coil and 3D high-resolution dynamic sequence (parallel imaging technique, axial/sagittal plane, in plane resolution <1mm). The MRI tumour distance from the NAC was measured on axial and sagittal MIP reconstruction by two radiologists blind to pathology; the smallest distance was considered. The subareolar tissue was removed and specimens were separately evaluated by the pathologist. The MRI measurements were then correlated with pathology. DCE-MRI Sensitivity, Specificity, Accuracy, Positive (PPV) and Negative (NPV) Predictive Values were calculated for evidence of carcinoma within 1cm and 2cm to the NAC. RESULTS At pathology tumoural NAC involvement was identified in 12 patients. By considering evidence of carcinoma within 1cm to the NAC, DCE-MRI Sensitivity, Specificity, Accuracy, PPV and NPV were 91% (11/12), 85% (12/14), 88% (23/26), 85% (11/13) and 92% (12/13) respectively (p=.0002). By considering evidence of carcinoma within 2cm to the NAC, DCE-MRI Sensitivity, Specificity, Accuracy, PPV and NPV were 91% (11/12), 64% (9/14), 77% (20/26), 68% (11/16) and 90% (9/10) respectively (p=.005); the three additional false positives occured in patients with multicentric cancer. CONCLUSION Preoperative DCE-MRI reliably predicts the tumoural involvement of NAC. Our results suggest that DCE-MRI evidence of carcinoma within 1cm to NAC may reduce the false positive cases. The study is still ongoing in order to confirm our data in a larger series of patients. CLINICAL RELEVANCE/APPLICATION Algorithms for prediction of NAC tumoural involvement are mainly based on mammography. Diagnostic performance of DCE-MRI may lead to a revision of radiological criteria currently used.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 11/2010