Marta D'Alonzo

Università degli Studi di Torino, Torino, Piedmont, Italy

Are you Marta D'Alonzo?

Claim your profile

Publications (11)20.24 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The surgical option which should be reserved for patients with BRCA1/2 mutation and breast cancer diagnosis is still debated. Several aspects should be considered before the surgical decision-making: the risk of ipsilateral breast recurrence (IBR), the risk of contralateral breast cancer (CBC), the potential survival benefit of prophylactic mastectomy, and the possible risk factors that could either increase or decrease the risk for IBR or CBC. Results: Breast conservative treatment (BCT) doesn't increase the risk for IBR in BRCA mutation carriers compared to non-carriers in short term follow-up; however, an increased risk for IBR in carriers was observed in studies with long follow-up. In spite of the increased risk for IBR in patients who underwent BCT than patients with mastectomy, no significant difference in breast- cancer specific or overall survival was observed by local treatment type at 15 years. Patients with BRCA mutation had a higher risk for contralateral breast cancer (CBC) compared with non carriers and BRCA1-mutation carriers had an increased risk for CBC compared to BRCA2-mutation carriers. Bilateral mastectomy is intended to prevent CBC in BRCA mutation carriers, however, no difference in survival was found if a contralateral prophylactic mastectomy was performed or not. For higher-risk groups of BRCA mutated patients, a more-aggressive surgical approach may be preferable, but there are some aspects that should be considered in the surgical decision-making process. The use of adjuvant chemotherapy and performing oophorectomy are associated with a decreased risk for IBR. When considering the risk for CBC, three risk factors were associated with significantly decreased risk: the use of adjuvant tamoxifen, performing oophorectomy and older age at first breast cancer diagnosis. As a result, we could identify a group of patients that might benefit from a more aggressive surgical approach (unilateral mastectomy or unilateral therapeutic mastectomy with concomitant contralateral prophylactic mastectomy). For women with BRCA mutations candidate to mastectomy, preservation of the nipple-areola complex (NAC) may be highly important due to the generally younger age at time of surgery. Concerning the oncological safety, nipple sparing mastectomy (NSM) is an acceptable option, with no evidence of compromise to oncological safety at short-term follow-up. Conclusion: The evaluation of surgical treatment in breast cancer patients with BRCA 1/2 mu- tation, should include several issues namely the current evidence of adequate oncological safety of breast conservative treatment (BCT) in BRCA mutated patients, the increased risk for CBC espe- cially in BRCA1 carriers; the feasibility on NSM with a greater patient's satisfaction for cosmetic results with no evidence of compromised oncological safety and finally the awareness that breast radiotherapy might increase the risk of complications in a possible subsequent mastectomy with immediate breast reconstruction.
    No preview · Article · Jan 2016
  • [Show abstract] [Hide abstract]
    ABSTRACT: Breast Cancer (BC) is the most commonly diagnosed invasive cancer among women, in developed countries BC occurs in one out of eight women during her lifetime. Many factors determine a woman's risk of breast cancer, outside of genetic risk factors, it is important to identify high risk women: several mathematical models to provide a better overall determination of risk have been proposed. Over the last decades great efforts have been made in search of cancer preventive strategies such as chemoprevention therapy and risk-reduction surgery. Risk-reduction agents are recommended for high risk breast cancer women aged ≥35 years old. Tamoxifen is presently deemed to be the preventive agent of choice in most high-risk women. The absence of effects on the endometrium and the reduced incidence of venous thromboembolic events compared with tamoxifen, however, suggest that Raloxifen would be preferable for use in some postmenopausal women. Prophylactic surgery has been widely investigated, bilateral risk-reducing mastectomy decreased the risk of developing breast cancer by approximately 90% in moderate- and high-risk women and in known BRCA1/2 mutation carriers. In this review we try to summarize the recent achievement on breast cancer high risk women identification and to illustrate an update on recent evidences on preventive breast cancer strategies analyzing the risk-benefit balance of any preventive choice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Jul 2015 · Maturitas
  • [Show abstract] [Hide abstract]
    ABSTRACT: Different treatments (surgery, radiotherapy, chemotherapy) for gynaecological cancers may cause ovarian failure or increase menopausal symptoms. There is a widespread reluctance among physicians to prescribe hormone replacement therapy (HRT) to the survivors of gynaecological cancer. This review analyses the use of HRT and of alternative therapies in such women. Squamous cervical cancer is not estrogen dependent and thus HRT is not contraindicated. While a cautious approach to hormone-dependent cancer is warranted, for women treated for non-hormone-related tumours alternative treatments for menopausal symptoms should be given due consideration, as any reluctance to prescribe HRT for them has neither a biological nor a clinical basis. In studies of HRT for survivors of endometrial and ovarian cancer, for instance, no evidence of increased risk was found, although no definitive conclusions can yet be formulated. The positive effect of HRT on quality of life seems to outweigh the unfounded suspicion of an increased risk of recurrence of non-hormone-related tumours. Effective non-hormonal alternatives for vasomotor symptoms are selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Jul 2015 · Maturitas
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fertility issues should be discussed with young women before the start of any anticancer treatment. The study is aimed to investigate the attitude on fertility among Italian oncologists and breast surgeons dealing with BCa, and to report the consensus achieved on specific statements. One hundred and sixty-two panelists anonymously expressed an opinion through a web-based platform on 19 statements based on the Delphi method. Ninety-one percent of oncologists considered important to discuss with patients about fertility issues and 83% believed estrogens could stimulate the growth of hidden cancer cells in ER(+) tumors. Difficulties in accessing fertility preservation procedures were mainly due to patients' reluctance, but also to lack of coordination with the assisted reproduction specialists. No full consensus was reached on the prognostic role of pregnancy after BCa. Fifty-four percent of oncologists declared that pregnancy does not affect oncologic prognosis. Treatment with GnRHa during chemotherapy was considered the only mean for preserving ovarian function. Fertility preservation in BCa patients is a well-accepted practice among Italian oncologists. A poor knowledge of this specific issue emerged from the survey, even if a certain degree of agreement was observed on most fertility-related issues.
    No preview · Article · May 2015 · Gynecological Endocrinology
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2014 · Drug Design, Development and Therapy
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Mar 2013 · European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · May 2012 · European journal of cancer (Oxford, England: 1990)
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Dec 2011 · European Journal of Cancer Care
  • [Show abstract] [Hide abstract]
    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.
    No preview · Conference Paper · Nov 2010

  • No preview · Article · · Giornale Italiano di Ostetricia e Ginecologia

  • No preview · Article · · Giornale Italiano di Ostetricia e Ginecologia