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Introduction: In the Emilia-Romagna region of Italy, a unique Hub and Spoke model was adopted to recognize BRCA-related breast cancer (BC) patients. Characteristics and outcomes of tumors identified by this model will be presented., Methods: This multicenter retrospective cohort study involved patients diagnosed with BRCA-related BC identified in the Emilia-Romagna region between January 2000 and December 2013. Seven provinces collected data on patient and tumor characteristics; clinical and gene testing information were also registered. Comparisons between BRCA1 and BRCA2 BC were performed. To balance different variants to identify significant predictors of survival, an inverse probability of treatment weighting (IPTW) analysis on Cox regression was conducted., Results: From 2000 to 2013, 284 BRCA-related BC were registered (171 BRCA1, 110 BRCA2, and 3 BRCA1 and BRCA2). BRCA1 were diagnosed at an earlier stage compared to BRCA2 (50.1 % vs 30 %, respectively, in stage I, P = 0.0015). BRCA2 patients underwent more up-front surgery (85 % vs. 74.9 %, P = 0.049) and less chemotherapy (69.1 % vs 88.9 %, P = 0.004) than BRCA1 patients. At 11.8 years median follow-up, BRCA1 patients developed more second contralateral BC (P = 0.09), while BRCA2 had more visceral relapses (P = 0.013). No differences in overall survival (OS) between BRCA1 and BRCA2 patients (P = 0.07) were found. An advantage in OS was independently seen for patients who underwent contralateral prophylactic mastectomy (P = 0.0001) and oophorectomy (P < 0.0001)., Conclusions: In conclusion, adopting a homogeneous regional framework provides important information about prevention and treatment strategies of BRCA-related BC and suggests using maximal surgery to improve OS., Competing Interests: Declaration of competing interest LC: speaker honoraria from Astra Zeneca, Pfizer, Novartis, Gilead, MSD; advisory role for Astra Zeneca, Pfizer, MSD, Amgen, Roche; GC, MV: no conflict of interest to disclose; AT: speaker honoraria from Lilly, Novartis, Pfizer, AstraZeneca, MSD, Seagen, Gilead, Daiichi Sankyo; EB: travel grants from Lilly, Novartis, Pfizer, MSD, AstraZeneca, Gilead, Daiichi Sankyo; FT: no conflict of interest to disclose; AM: Honoraria: Eli-Lilly, Pfizer, Macrogenics, Seagen, and Daiichi Sankyo; institutional research funding: Roche, Eli-Lilly; UDG: Advisory Board: MSD, Bristol Myers Squibb, Janssen, Astellas, Sanofi, Bayer, Pfizer, Ipsen, Novartis, and Pharmamar. Institutional Research grants: AstraZeneca, Sanofi, and Roche; GB, VA: no conflict of interest to disclose; CZ: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events by Roche, Eisai, Novartis, Astrazeneca, Pfizer, Pharmamar, Tesaro, Pierre Fabre, Ist. Gentili, Teva, Seagen, Eli Lilly, Celgene, MSD, GSK, Amgen, Daichii, Support for attending meetings and/or travel by Roche, Novartis, Pfizer, Pharmamar, Tesaro, Pierre Fabre, Ist. Gentili, Celgene, Participation on a Data Safety Monitoring Board or Advisory Board by Roche, Eisai, Novartis, Astrazeneca, Pfizer, Pharmamar, Amgen, Tesaro, QuintilesIms, Eli Lilly, Celgene, MSD, GSK, Daichii, Other financial or non-financial interests by Roche, Novartis, Astrazeneca, Pfizer, Amgen, Tesaro, QuintilesIms, MSD, GSK, Daichii. LC, MD: no conflict of interest to disclose., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Objective: BRCA carriers are recommended to undergo prophylactic risk-reducing salpingo-oophorectomy (RRSO). Possible adverse health impacts of RRSO, particularly when done before natural menopause, can reduce the long-term satisfaction with this risk-reducing strategy. The aim of this study was to prospectively evaluate the level of satisfaction of women undergoing RRSO, also in relation to some specific characteristics at RRSO., Methods: A prospective cohort study was performed in the Modena Family Cancer Clinic of the University Hospital of Modena (Italy). All BRCA1/2 confirmed mutation carriers who decided to undergo RRSO were recruited between 2016 and 2019., Results: Fifty-five women (29 BRCA1 and 26 BRCA2) (mean age: 50.4 ± 7.7 years [range 35-79]) were included with a mean follow-up after RRSO of 660.9 days (1.8 years) (range 35-1,688 days) (median: 549 days). No intraepithelial (Serous Tubal Intraepithelial Carcinoma)/invasive cancers were found (0%) at RRSO. No vasomotor symptoms at 1 month after surgery were reported by 11/22 (50%) premenopausal women at RRSO. All women (100%) with new "RRSO-caused" vasomotor symptoms with no previous breast cancer initiated postmenopausal hormone therapy. At the final follow-up the satisfaction rate (0-100 visual analog scale points) of the participants was 96.4 ± 8.6 points (range 62-100). To the question "Would you undergo RRSO again if it was proposed today? (0-100 visual analog scale points)" the answer was 99.4 ± 3.2 points (range 79-100). These scores were in general very high and did not change in the different groups according to pre/postmenopausal status at RRSO, cancer survivors versus healthy women at RRSO, BRCA status, hormone therapy users/nonusers after RRSO, "RRSO-caused" symptoms versus not RRSO-caused (P > 0.05)., Conclusions: Findings from this prospective study suggest that satisfaction with RRSO is very high and little dependent on the participants' characteristics at surgery. Women at high risk for ovarian cancer are very satisfied with their choice of risk-reduction strategy., Competing Interests: Financial disclosure/conflicts of interest: A.T. has received funding from Eli Lilly and Roche. F.F. has received funding from Loli Pharma International and Zambongroup SRL. The other authors have nothing to disclose., (Copyright © 2021 by The North American Menopause Society.)

Introduction: Chemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes., Patients and Methods: We conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected., Results: Seventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%., Conclusions: Secondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: To examine the surgical treatment and clinical outcome of elderly and very elderly advanced epithelial ovarian cancer patients., Methods: We retrospectively analyzed FIGO stage IIIC-IV ovarian cancer patients, divided in elderly (Group A, >65 and <75 years) and very elderly patients (Group B, ≥ 75 years) treated by primary debulking surgery (PDS) or by interval debulking surgery (IDS) at the Catholic University at Rome and Campobasso, Italy., Results: 164 patients were included: 123 (Group A) and 41 (Group B). Complete cytoreduction was achieved in 60 patients (60.6%) in Group A and in 20 patients (62.5%) in Group B (p = 0.75). In the remaining cases, optimal cytoreduction was performed (39 cases (39.4%) in Group A and 12 (37.5%) in Group B; p = 0.75). In Group A complete/optimal debulking was achieved in 53 patients (53.5%) at PDS and in 46 patients (46.5%) at IDS (p = 0.55). In the Group B a higher rate of patients was debulked at IDS with respect to PDS (10 (31.3%) vs. 22 patients (68.7%); p = 0.02). In Group A patients debulked at PDS showed better DFS (p = 0.007) and OS (p = 0.003) with respect to patients submitted to successful IDS, whereas in group B we did not observed any survival difference according to time of cytoreduction., Conclusions: Our data suggest that elderly and very elderly patients may tolerate radical and ultra-radical surgery. These patients should be managed in a gynecologic oncology unit, with prudent but complete approach., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: The efficacy of postoperative radiotherapy (RT) in the treatment of early-stage endometrial carcinoma (EC) is still under debate. This study was aimed to review the outcome and adverse effects in patients treated for EC with postoperative RT at a single center., Methods: A total of 883 patients with pathological stages I to II EC were retrospectively analyzed. Surgery consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy, or vaginal hysteroannessiectomy in 532 patients (60.2%) with pelvic lymphadenectomy in 351 patients (39.8%). Seven hundred forty-seven patients (84.6%) underwent whole pelvic RT (WPRT) and 136 (15.4%) combined WPRT and vaginal brachytherapy (BT) boost., Results: At a median follow-up of 9 years (range, 1.2-27.6 years), we observed 10.6% disease relapse. Forty-seven patients experienced local recurrence (LR), and 38 patients experienced distant metastases (DMs). At univariate analysis, age at diagnosis (P < 0.0001), stage (P < 0.04), and histological subtype (P < 0.0001) resulted in significant prognostic factors. At multivariate analysis, histotype emerged as an independent relapse predictor (P = 0.0001). Acute WPRT-related toxicity was mild; diarrhea was the most common adverse effect (19.8%). We recorded long-term adverse effects in 7.8% of the patients., Conclusions: Our study showed that patients with early-stage EC have a good outcome in overall survival and disease-free survival. In our experience, standard surgery (including hysterectomy and bilateral salpingo-oophorectomy followed by WPRT with or without BT) showed an acceptable toxicity profile.

In Italy, which is rabies-free, the national Law No. 281 [Legge Nazionale 14 agosto 1991. No. 281: Legge Quadro in materia di animali di affezione e prevenzione del randagismo. Gazz. Uff. Rep. Ital. no 203 del 30 agosto 1991: p. 3] on the management of pets and on the control of feral cats has introduced the no-kill policy for this species. Thus, "trap-neuter-release" (TNR) programs have been carried out for >10 years. In this paper we present data on registered colonies and censused cats in Rome from 1991 to 2000; the results of the neutering campaign from 1991 to 2000; and a survey, on 103 cat colonies, on the effects of demographic control of urban feral-cat colonies in the city of Rome, carried out by the local Veterinary Public Services (VPS) in collaboration with the associations of cat care-takers. In 10 years almost 8000 were neutered and reintroduced in their original colony. The spay/neuter campaigns brought about a general decrease in cat number but the percentage of cat immigration (due to abandonment and spontaneous arrival) is around 21%. This suggests that all these efforts without an effective education of people to control the reproduction of house cats (as a prevention for abandonment) are a waste of money, time and energy.

The large use of new gynaecological technologies such as the operative laparoscopy, requires both efficacy and efficiency evaluation. The aim of this work is to compare costs of the surgical treatment of ovarian cysts between two groups of patients--35 patients undergone to laparotomic cystectomy (age: mean 27.5) and 34 operated by laparoscopic technique (age: mean 27). The analysis of the costs, related to three steps of health care (pre-operative, operative, post-operative) shows that the laparoscopic cystectomy results the more efficient intervention (L. 6,244,808 vs L. 8,310,002). This economic analysis may offer a planning tool for health care to hospital managers and represent an efficiency evaluation criterion of surgical techniques employed by the gynaecologists.