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Fausto Chiesa

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Papers by Fausto Chiesa

Inactivation of the putative suppressor gene DOK1 by promoter hypermethylation in primary human cancers

by Ishraq Hussain and Fausto Chiesa

International journal of cancer. Journal international du cancer, 2011

The DOK1 gene is a putative tumour suppressor gene located on the human chromosome 2p13 which is ... more The DOK1 gene is a putative tumour suppressor gene located on the human chromosome 2p13 which is frequently rearranged in leukaemia and other human tumours. We previously reported that the DOK1 gene can be mutated and its expression down-regulated in human malignancies. However, the mechanism underlying DOK1 silencing remains largely unknown. We show here that unscheduled silencing of DOK1 expression through aberrant hypermethylation is a frequent event in a variety of human malignancies. DOK1 was found to be silenced in nine head and neck cancer (HNC) cell lines studied and DOK1 CpG hypermethylation correlated with loss of gene expression in these cells. DOK1 expression could be restored via demethylating treatment using 5-aza-2'deoxycytidine. In addition, transduction of cancer cell lines with DOK1 impaired their proliferation, consistent with the critical role of epigenetic silencing of DOK1 in the development and maintenance of malignant cells. We further observed that DOK1...

Surgery versus combined therapies for cancer of the anterior floor of the mouth

Head & Neck Surgery, 1983

cancer of the anterior floor of the mouth. Most of the tumors were advanced: 39 were treated with... more cancer of the anterior floor of the mouth. Most of the tumors were advanced: 39 were treated with simple resection, and 36 underwent combined treatment, consisting of surgery associated with either chemotherapy or surgery. Three-and five-year observed survival rates of the whole series were good (41% and 25%, respectively), considering the tumor stage of these patients, but the determined survival rates were particularly high (56% and 46%, respectively). No real advantage was found in the use of multiple planned sequential therapies over surgery alone, and deaths from intercurrent diseases seemed to be more frequent in the patients who underwent combined therapies. We conclude that for patients in poor general condition, such as those with carcinomas of the anterior floor of the mouth, aggressive and complex treatments should be considered with caution in controlled clinical trials.

Linee Guida sul Cancro della Laringe

sioechcf.it

La corretta programmazione dell'iter diagnostico e terapeutico non può prescindere da un'approfon... more La corretta programmazione dell'iter diagnostico e terapeutico non può prescindere da un'approfondita conoscenza della storia naturale di una neoplasia. La storia naturale dei carcinomi squamocellulari della laringe è caratterizzata dalla crescita locale e dalla diffusione regionale e negli stadi avanzati, a distanza. I carcinomi della laringe che si sviluppano nel piano glottico inizialmente si presentano, nella maggior parte dei casi, come lesioni leucoplasiche e/o eritroplasiche ed hanno un sviluppo superficiale, seguendo le barriere anatomiche. Naturalmente anche lesioni pre-neoplastiche ed aree di cheratosi senza displasia possono manifestarsi clinicamente con aree leucoplasiche e/o eritroplasiche che differiscono chiaramente per il loro pattern di crescita. Dirimente è l'esame istologico della lesione. Negli ultimi decenni il miglioramento della preservazione d'organo e delle sue funzioni grazie a tecniche chirurgiche conservative della laringe (per via endoscopica con laser CO2 o a cielo aperto), e a trattamento non chirurgico di chemio-radioterapia, non si è tradotto in un significativo incremento della sopravvivenza a causa della comparsa di metastasi a distanza e secondi tumori.

Effects of benzydamine on the oral mucositis during antineoplastic radiotherapy and/or intra-arterial chemotherapy

International journal of tissue reactions

In view of the good results obtained with benzydamine against oral radio-chemomucositis in a prev... more In view of the good results obtained with benzydamine against oral radio-chemomucositis in a previous trial, a double-blind/placebo study was undertaken in order to ascertain the possible oral histoprotective effect of benzydamine mouthwash during the intra-arterial polychemotherapy and/or radiotherapy for neoplasms of the head and neck. Statistical comparison of the results obtained in these two groups, treated with benzydamine and placebo mouthwash, revealed a marked difference in the clinical evolution of iatrogenic tissue damage. The benzydamine topical application was more effective than placebo in the control of mucositis symptoms and signs produced by radiotherapy and/or intra-arterial antineoplastic chemotherapy.

Small sized phyllodes tumor of the breast

European Journal of Surgical Oncology

From 1970 to 1988, 106 women (aged 13-63 years) suffering from phyllodes tumor of the breast unde... more From 1970 to 1988, 106 women (aged 13-63 years) suffering from phyllodes tumor of the breast underwent surgery at the Day Hospital in the Istituto Nazionale Tumori, Milan. Treatment consisted of enucleation in 57, enucleoresection in 42 and wide resection in seven. Ninety-two cases (86.8%) were benign, 12 (11.3%) borderline and two malignant. All the borderline and malignant tumors were submitted to wider resection as inpatients. The 12 borderline cases underwent wide resection while a subcutaneous mastectomy was performed in the two malignant cases. A mean follow-up of 49 months was carried out on 85 patients (range 1-186). The relapses, all in the benign group (6 cases; 6.52%), were much lower than reported by other authors (20-33%). This may be related to neoplasia size (less than 40 mm in 85.3%) and not to type of limited surgery. Although limited surgery was performed in 93.4% of cases (pre-operative diagnosis being unknown) the number of relapses was so low that re-operation w...

Outpatient surgical treatment of lip carcinomas: Immediate and long-term results

Tumori

From 1977 to 1987, outpatient surgery was performed under local anesthesia on 131 patients with s... more From 1977 to 1987, outpatient surgery was performed under local anesthesia on 131 patients with squamous cell carcinoma of the lip without regional lymph nodes at the Day Hospital of the Istituto Nazionale Tumori (INT) Milan. Radical surgery was achieved in 117 cases (89.3%), independently of the size of the neoplasm. Of the 7 patients in whom radical surgery was not achieved at first operation, 3 were reoperated on as outpatients, 2 were hospitalized and reoperated, and 2 underwent X-ray treatment. Finally, in the remaining 7 patients radical surgery was not obtained or was near the borderline of the neoplasm. Complications (diastasis and/or suppuration) arose in 4.6% of the cases. During the follow-up (mean duration, 30 months) 7 patients developed a relapse and 2 manifested regional metastasis. Twenty-three patients developed a second tumor (13 on the lip, 3 in the lung, and 7 in other areas). These results prove that day hospital surgery of T1-T2 lip squamous carcinoma is feasib...

Papillary carcinoma in thyroglossal duct remnants

by GIBELLI Bianca and Fausto Chiesa

European Archives of Oto-Rhino-Laryngology, 1991

About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world lit... more About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk&#39;s operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed.

Percorsi diagnostici e terapeutici per le neoplasie di cavo orale, faringe, laringe, ghiandole salivari, tiroide

by GIBELLI Bianca and Fausto Chiesa

Compartmental surgery in tongue tumours: description of a new surgical technique

by GIBELLI Bianca and Fausto Chiesa

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2009

The aim of curative surgical oncology is to remove the primary tumour with a wide margin of norma... more The aim of curative surgical oncology is to remove the primary tumour with a wide margin of normal tissue. What constitutes a sufficiently wide margin particularly in oral cancer is fundamentally unclear. The currently accepted standard is to remove the primary lesion with a 1.5-2 cm circumferential macroscopic margin. In the last ten years, anatomical considerations in the approach to primary, advanced and untreated tumours of the tongue led us to develop and improve a new surgical approach to their demolition and reconstruction. From July 1999 to July 2009, at the European Institute of Oncology in Milano, Italy, 155 patients were treated, while defining and refining the concept of compartmental tongue surgery (CTS) and its main components: 1) anatomical approach to the disease that requires removal of the primary lesion and all of the potential pathways of progression--muscular, lymphatic and vascular; 2) identification of a distinct territory at risk of metastatic representation ...

US-guided transcutaneous tru-cut biopsy of laryngo-hypopharyngeal lesions

by Elvio Fiori and Fausto Chiesa

European Radiology, 2010

Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous tru-cu... more Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous tru-cut biopsy (USGTCB) in selected patients (with stenosis of airways or difficult intubation or contraindication to general anaesthesia) with untreated or previously treated suspicious laryngo-hypopharyngeal masses. Methods: Biopsies were performed with a free-hand technique by a single radiologist. Thirty-six USGTCBs were scheduled in 34 patients (24 males, 10 females; age range 47-95 years). Two USGTCBs were not performed, as lesions were not detectable: therefore, 16 USGTCBs were performed for an untreated mass suspicious for malignancy and 18 were performed for a mass suspicious for recurrence after radiotherapy alone, or associated with endoscopic laser surgery or chemotherapy. Results: USGTCB diagnosed 25 squamous cell carcinomas (73.5%) and nine benign lesions (26.5%); no false positives and two false negatives were reported, both in patients previously treated with radiotherapy. The sensitivity, specificity, positive and negative predictive value of the technique was 92.5%, 100%, 100% and 77.7% respectively, with no major complications. Conclusion: Although biopsy under microlaryngoscopy remains the "gold-standard" technique, USGTCB is feasible, carries the advantages of avoiding general anaesthesia, is suitable for outpatients and is cost-effective. If applied to selected patients, it could be considered for the histological diagnosis of both primary and recurrent laryngo-hypopharyngeal masses.

Ultrasound-guided transcutaneous Tru-Cut biopsy to diagnose laryngopharyngeal masses

by Elvio Fiori and Fausto Chiesa

Cancer, 2007

Central neck dissection in differentiated thyroid cancer: technical notes

by Elvio Fiori, E. Grosso, and Fausto Chiesa

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2014

Differentiated thyroid cancers may be associated with regional lymph node metastases in 20-50% of... more Differentiated thyroid cancers may be associated with regional lymph node metastases in 20-50% of cases. The central compartment (VIupper VII levels) is considered to be the first echelon of nodal metastases in all differentiated thyroid carcinomas. The indication for central neck dissection is still debated especially in patients with cN0 disease. For some authors, central neck dissection is recommended for lymph nodes that are suspect preoperatively (either clinically or with ultrasound) and/or for lymph node metastases detected intra-operatively with a positive frozen section. In need of a better definition, we divided the dissection in four different areas to map localization of metastases. In this study, we present the rationale for central neck dissection in the management of differentiated thyroid carcinoma, providing some anatomical reflections on surgical technique, oncological considerations and analysis of complications. Central neck dissection may be limited to the compa...

Impact of Margin Status on Laser Surgery for Early Glottic Cancer—Reply

by Augusto Cattaneo and Fausto Chiesa

Archives of Otolaryngology–Head & Neck Surgery, 2010

Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

by Augusto Cattaneo, Luigi De Benedetto, and Fausto Chiesa

European Archives of Oto-Rhino-Laryngology, 2010

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser su... more Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, diseasespecific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan-Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced diseasefree survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.

Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery

by Augusto Cattaneo, Daniele Scelsi, Luigi De Benedetto, and Fausto Chiesa

Head & Neck, 2016

Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery

by Augusto Cattaneo and Fausto Chiesa

Head & neck, 2017

The purpose of this study was to identify the factors influencing oncologic outcomes for patients... more The purpose of this study was to identify the factors influencing oncologic outcomes for patients with early-intermediate glottic cancer treated by transoral laser microsurgery (TLM). This was a retrospective mono-institutional study. A total of 590 patients with cTis-cT3 glottic cancer underwent TLM with curative intent. TLM alone was performed in 538 patients (91.2%) and TLM followed by adjuvant radiotherapy (RT) was done in 52 (8.8%). Five-year recurrence-free survival (RFS) and 10-year overall survival (OS) were 85.3% and 74.7%, respectively. The larynx-preservation ratio was 95.9%. In particular, from our data, we found that occult metastases were rare (1.2%); preventive tracheotomy was not necessary; the local recurrence rate of Tis was similar to that in the T2 and T3 group; and no major or lethal complications were observed. Age (>60 vs ≤60), type of cordectomy (≥IV vs ≤III), status of margins, fixed arytenoid, and pathologic T classification, were the variables associate...

Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

by Augusto Cattaneo and Fausto Chiesa

European Archives of Oto Rhino Laryngology Official Journal of the European Federation of Oto Rhino Laryngological Societies Affiliated With the German Society For Oto Rhino Laryngology Head and Neck Surgery, May 1, 2010

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser su... more Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, diseasespecific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan-Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced diseasefree survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.

Learning Curve for Translaryngeal Tracheotomy in Head and Neck Surgery

by Gioacchino Giugliano and Fausto Chiesa

The Laryngoscope, 2001

Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its s... more Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long-term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery. Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999. Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short-term and long-term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed. TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter-cannula and stylet. In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter-cannula and stylet.

Three-dimensional conformal postoperative radiotherapy in patients with parotid tumors: 10 years' experience at the European Institute of Oncology

by Gioacchino Giugliano and Fausto Chiesa

Tumori

Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-relate... more Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-related toxicity and clinical outcome in patients treated at our division with postoperative radiotherapy (pRT) for parotid tumors. Forty-three consecutive patients (32 with primary parotid tumors, 9 with parotid metastases and 2 with recurrent benign diseases) were retrospectively analyzed. The median follow-up was 28 months. Twenty and 5 patients had a follow-up longer than 2 and 5 years, respectively. Thirty-seven patients were alive and most of them (78%) were free from disease. The local and distant control rates were higher in patients with primary parotid tumors (94% and 87.5%) than in patients with parotid metastases (87.5% and 75%). Grade 3 radiotherapy-related acute toxicity of skin and mucosa was recorded in 20.9% and 28% of patients, respectively. Two patients (4.7%) had grade 4 skin toxicity. Late toxicity data were available for 33 (77%) patients. None of the patients developed s...

Future challenges in head and neck cancer: From the bench to the bedside?

by Gioacchino Giugliano and Fausto Chiesa

Critical Reviews in Oncology/Hematology, 2012

Inactivation of the putative suppressor gene DOK1 by promoter hypermethylation in primary human cancers

by Ishraq Hussain and Fausto Chiesa

International journal of cancer. Journal international du cancer, 2011

The DOK1 gene is a putative tumour suppressor gene located on the human chromosome 2p13 which is ... more The DOK1 gene is a putative tumour suppressor gene located on the human chromosome 2p13 which is frequently rearranged in leukaemia and other human tumours. We previously reported that the DOK1 gene can be mutated and its expression down-regulated in human malignancies. However, the mechanism underlying DOK1 silencing remains largely unknown. We show here that unscheduled silencing of DOK1 expression through aberrant hypermethylation is a frequent event in a variety of human malignancies. DOK1 was found to be silenced in nine head and neck cancer (HNC) cell lines studied and DOK1 CpG hypermethylation correlated with loss of gene expression in these cells. DOK1 expression could be restored via demethylating treatment using 5-aza-2'deoxycytidine. In addition, transduction of cancer cell lines with DOK1 impaired their proliferation, consistent with the critical role of epigenetic silencing of DOK1 in the development and maintenance of malignant cells. We further observed that DOK1...

Surgery versus combined therapies for cancer of the anterior floor of the mouth

Head & Neck Surgery, 1983

cancer of the anterior floor of the mouth. Most of the tumors were advanced: 39 were treated with... more cancer of the anterior floor of the mouth. Most of the tumors were advanced: 39 were treated with simple resection, and 36 underwent combined treatment, consisting of surgery associated with either chemotherapy or surgery. Three-and five-year observed survival rates of the whole series were good (41% and 25%, respectively), considering the tumor stage of these patients, but the determined survival rates were particularly high (56% and 46%, respectively). No real advantage was found in the use of multiple planned sequential therapies over surgery alone, and deaths from intercurrent diseases seemed to be more frequent in the patients who underwent combined therapies. We conclude that for patients in poor general condition, such as those with carcinomas of the anterior floor of the mouth, aggressive and complex treatments should be considered with caution in controlled clinical trials.

Linee Guida sul Cancro della Laringe

sioechcf.it

La corretta programmazione dell'iter diagnostico e terapeutico non può prescindere da un'approfon... more La corretta programmazione dell'iter diagnostico e terapeutico non può prescindere da un'approfondita conoscenza della storia naturale di una neoplasia. La storia naturale dei carcinomi squamocellulari della laringe è caratterizzata dalla crescita locale e dalla diffusione regionale e negli stadi avanzati, a distanza. I carcinomi della laringe che si sviluppano nel piano glottico inizialmente si presentano, nella maggior parte dei casi, come lesioni leucoplasiche e/o eritroplasiche ed hanno un sviluppo superficiale, seguendo le barriere anatomiche. Naturalmente anche lesioni pre-neoplastiche ed aree di cheratosi senza displasia possono manifestarsi clinicamente con aree leucoplasiche e/o eritroplasiche che differiscono chiaramente per il loro pattern di crescita. Dirimente è l'esame istologico della lesione. Negli ultimi decenni il miglioramento della preservazione d'organo e delle sue funzioni grazie a tecniche chirurgiche conservative della laringe (per via endoscopica con laser CO2 o a cielo aperto), e a trattamento non chirurgico di chemio-radioterapia, non si è tradotto in un significativo incremento della sopravvivenza a causa della comparsa di metastasi a distanza e secondi tumori.

Effects of benzydamine on the oral mucositis during antineoplastic radiotherapy and/or intra-arterial chemotherapy

International journal of tissue reactions

In view of the good results obtained with benzydamine against oral radio-chemomucositis in a prev... more In view of the good results obtained with benzydamine against oral radio-chemomucositis in a previous trial, a double-blind/placebo study was undertaken in order to ascertain the possible oral histoprotective effect of benzydamine mouthwash during the intra-arterial polychemotherapy and/or radiotherapy for neoplasms of the head and neck. Statistical comparison of the results obtained in these two groups, treated with benzydamine and placebo mouthwash, revealed a marked difference in the clinical evolution of iatrogenic tissue damage. The benzydamine topical application was more effective than placebo in the control of mucositis symptoms and signs produced by radiotherapy and/or intra-arterial antineoplastic chemotherapy.

Small sized phyllodes tumor of the breast

European Journal of Surgical Oncology

From 1970 to 1988, 106 women (aged 13-63 years) suffering from phyllodes tumor of the breast unde... more From 1970 to 1988, 106 women (aged 13-63 years) suffering from phyllodes tumor of the breast underwent surgery at the Day Hospital in the Istituto Nazionale Tumori, Milan. Treatment consisted of enucleation in 57, enucleoresection in 42 and wide resection in seven. Ninety-two cases (86.8%) were benign, 12 (11.3%) borderline and two malignant. All the borderline and malignant tumors were submitted to wider resection as inpatients. The 12 borderline cases underwent wide resection while a subcutaneous mastectomy was performed in the two malignant cases. A mean follow-up of 49 months was carried out on 85 patients (range 1-186). The relapses, all in the benign group (6 cases; 6.52%), were much lower than reported by other authors (20-33%). This may be related to neoplasia size (less than 40 mm in 85.3%) and not to type of limited surgery. Although limited surgery was performed in 93.4% of cases (pre-operative diagnosis being unknown) the number of relapses was so low that re-operation w...

Outpatient surgical treatment of lip carcinomas: Immediate and long-term results

Tumori

From 1977 to 1987, outpatient surgery was performed under local anesthesia on 131 patients with s... more From 1977 to 1987, outpatient surgery was performed under local anesthesia on 131 patients with squamous cell carcinoma of the lip without regional lymph nodes at the Day Hospital of the Istituto Nazionale Tumori (INT) Milan. Radical surgery was achieved in 117 cases (89.3%), independently of the size of the neoplasm. Of the 7 patients in whom radical surgery was not achieved at first operation, 3 were reoperated on as outpatients, 2 were hospitalized and reoperated, and 2 underwent X-ray treatment. Finally, in the remaining 7 patients radical surgery was not obtained or was near the borderline of the neoplasm. Complications (diastasis and/or suppuration) arose in 4.6% of the cases. During the follow-up (mean duration, 30 months) 7 patients developed a relapse and 2 manifested regional metastasis. Twenty-three patients developed a second tumor (13 on the lip, 3 in the lung, and 7 in other areas). These results prove that day hospital surgery of T1-T2 lip squamous carcinoma is feasib...

Papillary carcinoma in thyroglossal duct remnants

by GIBELLI Bianca and Fausto Chiesa

European Archives of Oto-Rhino-Laryngology, 1991

About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world lit... more About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk&#39;s operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed.

Percorsi diagnostici e terapeutici per le neoplasie di cavo orale, faringe, laringe, ghiandole salivari, tiroide

by GIBELLI Bianca and Fausto Chiesa

Compartmental surgery in tongue tumours: description of a new surgical technique

by GIBELLI Bianca and Fausto Chiesa

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2009

The aim of curative surgical oncology is to remove the primary tumour with a wide margin of norma... more The aim of curative surgical oncology is to remove the primary tumour with a wide margin of normal tissue. What constitutes a sufficiently wide margin particularly in oral cancer is fundamentally unclear. The currently accepted standard is to remove the primary lesion with a 1.5-2 cm circumferential macroscopic margin. In the last ten years, anatomical considerations in the approach to primary, advanced and untreated tumours of the tongue led us to develop and improve a new surgical approach to their demolition and reconstruction. From July 1999 to July 2009, at the European Institute of Oncology in Milano, Italy, 155 patients were treated, while defining and refining the concept of compartmental tongue surgery (CTS) and its main components: 1) anatomical approach to the disease that requires removal of the primary lesion and all of the potential pathways of progression--muscular, lymphatic and vascular; 2) identification of a distinct territory at risk of metastatic representation ...

US-guided transcutaneous tru-cut biopsy of laryngo-hypopharyngeal lesions

by Elvio Fiori and Fausto Chiesa

European Radiology, 2010

Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous tru-cu... more Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous tru-cut biopsy (USGTCB) in selected patients (with stenosis of airways or difficult intubation or contraindication to general anaesthesia) with untreated or previously treated suspicious laryngo-hypopharyngeal masses. Methods: Biopsies were performed with a free-hand technique by a single radiologist. Thirty-six USGTCBs were scheduled in 34 patients (24 males, 10 females; age range 47-95 years). Two USGTCBs were not performed, as lesions were not detectable: therefore, 16 USGTCBs were performed for an untreated mass suspicious for malignancy and 18 were performed for a mass suspicious for recurrence after radiotherapy alone, or associated with endoscopic laser surgery or chemotherapy. Results: USGTCB diagnosed 25 squamous cell carcinomas (73.5%) and nine benign lesions (26.5%); no false positives and two false negatives were reported, both in patients previously treated with radiotherapy. The sensitivity, specificity, positive and negative predictive value of the technique was 92.5%, 100%, 100% and 77.7% respectively, with no major complications. Conclusion: Although biopsy under microlaryngoscopy remains the "gold-standard" technique, USGTCB is feasible, carries the advantages of avoiding general anaesthesia, is suitable for outpatients and is cost-effective. If applied to selected patients, it could be considered for the histological diagnosis of both primary and recurrent laryngo-hypopharyngeal masses.

Ultrasound-guided transcutaneous Tru-Cut biopsy to diagnose laryngopharyngeal masses

by Elvio Fiori and Fausto Chiesa

Cancer, 2007

Central neck dissection in differentiated thyroid cancer: technical notes

by Elvio Fiori, E. Grosso, and Fausto Chiesa

Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2014

Differentiated thyroid cancers may be associated with regional lymph node metastases in 20-50% of... more Differentiated thyroid cancers may be associated with regional lymph node metastases in 20-50% of cases. The central compartment (VIupper VII levels) is considered to be the first echelon of nodal metastases in all differentiated thyroid carcinomas. The indication for central neck dissection is still debated especially in patients with cN0 disease. For some authors, central neck dissection is recommended for lymph nodes that are suspect preoperatively (either clinically or with ultrasound) and/or for lymph node metastases detected intra-operatively with a positive frozen section. In need of a better definition, we divided the dissection in four different areas to map localization of metastases. In this study, we present the rationale for central neck dissection in the management of differentiated thyroid carcinoma, providing some anatomical reflections on surgical technique, oncological considerations and analysis of complications. Central neck dissection may be limited to the compa...

Impact of Margin Status on Laser Surgery for Early Glottic Cancer—Reply

by Augusto Cattaneo and Fausto Chiesa

Archives of Otolaryngology–Head & Neck Surgery, 2010

Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

by Augusto Cattaneo, Luigi De Benedetto, and Fausto Chiesa

European Archives of Oto-Rhino-Laryngology, 2010

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser su... more Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, diseasespecific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan-Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced diseasefree survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.

Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery

by Augusto Cattaneo, Daniele Scelsi, Luigi De Benedetto, and Fausto Chiesa

Head & Neck, 2016

Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery

by Augusto Cattaneo and Fausto Chiesa

Head & neck, 2017

The purpose of this study was to identify the factors influencing oncologic outcomes for patients... more The purpose of this study was to identify the factors influencing oncologic outcomes for patients with early-intermediate glottic cancer treated by transoral laser microsurgery (TLM). This was a retrospective mono-institutional study. A total of 590 patients with cTis-cT3 glottic cancer underwent TLM with curative intent. TLM alone was performed in 538 patients (91.2%) and TLM followed by adjuvant radiotherapy (RT) was done in 52 (8.8%). Five-year recurrence-free survival (RFS) and 10-year overall survival (OS) were 85.3% and 74.7%, respectively. The larynx-preservation ratio was 95.9%. In particular, from our data, we found that occult metastases were rare (1.2%); preventive tracheotomy was not necessary; the local recurrence rate of Tis was similar to that in the T2 and T3 group; and no major or lethal complications were observed. Age (>60 vs ≤60), type of cordectomy (≥IV vs ≤III), status of margins, fixed arytenoid, and pathologic T classification, were the variables associate...

Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

by Augusto Cattaneo and Fausto Chiesa

European Archives of Oto Rhino Laryngology Official Journal of the European Federation of Oto Rhino Laryngological Societies Affiliated With the German Society For Oto Rhino Laryngology Head and Neck Surgery, May 1, 2010

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser su... more Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, diseasespecific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan-Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced diseasefree survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.

Learning Curve for Translaryngeal Tracheotomy in Head and Neck Surgery

by Gioacchino Giugliano and Fausto Chiesa

The Laryngoscope, 2001

Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its s... more Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long-term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery. Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999. Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short-term and long-term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed. TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter-cannula and stylet. In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter-cannula and stylet.

Three-dimensional conformal postoperative radiotherapy in patients with parotid tumors: 10 years' experience at the European Institute of Oncology

by Gioacchino Giugliano and Fausto Chiesa

Tumori

Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-relate... more Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-related toxicity and clinical outcome in patients treated at our division with postoperative radiotherapy (pRT) for parotid tumors. Forty-three consecutive patients (32 with primary parotid tumors, 9 with parotid metastases and 2 with recurrent benign diseases) were retrospectively analyzed. The median follow-up was 28 months. Twenty and 5 patients had a follow-up longer than 2 and 5 years, respectively. Thirty-seven patients were alive and most of them (78%) were free from disease. The local and distant control rates were higher in patients with primary parotid tumors (94% and 87.5%) than in patients with parotid metastases (87.5% and 75%). Grade 3 radiotherapy-related acute toxicity of skin and mucosa was recorded in 20.9% and 28% of patients, respectively. Two patients (4.7%) had grade 4 skin toxicity. Late toxicity data were available for 33 (77%) patients. None of the patients developed s...

Future challenges in head and neck cancer: From the bench to the bedside?

by Gioacchino Giugliano and Fausto Chiesa

Critical Reviews in Oncology/Hematology, 2012