Bevacizumab for advanced ovarian cancer treatment. A GRADE based approach

Background: in advanced ovarian cancer, over the last 10 years no studies have demonstrated more appropriate therapeutic options compared to the current standard Carboplatin-Paclitaxel (Cb-P) regimen. Two phase III randomized studies (GOG-218 36 and ICON-7 37) have recently demonstrated the efficacy of bevacizumab (recombinant monoclonal antibody that binds with a high affinity to VEGF-A) in adjunct to Cb-P, with 12-15 months maintenance treatment. Methods: the quality of evidence provided was assessed by the use of the GRADE method. Each outcome (deemed to be essential for the purpose of evaluation of the intervention) was assessed to express the degree of confidence in the entity of the beneficial and/or harmful effects of the intervention. Thus, limitations in the quality of conducting the studies (risk of bias), direct applicability/relevance of results to the target population, and precision of results were taken into account. Results: the GOG-218 and the ICON7 study (high-risk subgroup) demonstrated with MODERATE confidence an improvement in critical outcomes PFS and OS, with an absolute reduction of 96 (GOG-218) – 103 (ICON-7) episodes of progression, and 40 (GOG-218) – 135 (ICON-7) deaths per 1 000 patients. A marked increase in risk of hypertension of Grade ≥3 was observed, with an absolute increase of 59 episodes per 1 000 patients in the ICON-7 study, and 157 episodes in the GOG-218 study, respectively, the majority of which were controlled by means of appropriate treatment. The increased risk of other adverse events considered was negligible. Conclusions: the positive effects produced should be viewed as taking prevalence over the negative effects (FAVOURABLE benefit/harm ratio)

Análise espácio-temporal de hospitalizações por cancro da mama em Portugal em 2002–2016

ABSTRACT - Introduction: Breast cancer (BC) is the most common cancer among Portuguese women and it is associated with high hospitalization rates. Therefore, this study aims to characterize the BC hospital admission rate (HAR) in women in the period of 2002–2016, with an additional focus on spatiotemporal patterns of hospitalizations by BC (main code). Methods: After a descriptive analysis of all BC hospitalizations, the main BC code HAR was studied using mapping techniques, analysis of spatiotemporal clusters, and analysis of spatial variations in temporal trends. Results: The BC-HAR was 118.72/105 women, showing a growth of 3.109% per year in this period. The median length of stay (LOS) in these patients was 5 days, and most cases were programmed surgical admissions. Several spatiotemporal clusters and spatial variations in temporal trends were detected. The seaside area of the country showed 4 high HAR clusters in the spatiotemporal analysis. Additionally, the seaside north of the country and 2 isolated counties presented significantly different temporal trends in BC-HAR versus the rest of the country. These clusters suggest regional asymmetries, as they showed differences in terms of: demographic characteristics (age at admission and rurality of county of residence), the type of admission, LOS, and outcomes of hospitalization. Conclusion: This study identified key areas of high BC-HAR and increasing trends for female HAR, providing evidence of spatial heterogeneities in this health indicator.RESUMO - Introdução: O cancro da mama é a neoplasia mais comum em mulheres Portuguesas e é responsável por elevadas taxas de hospitalização. Como tal, este estudo pretende caracterizar as admissões hospitalares por cancro da mama feminino no período de 2002–2016, com foco adicional nos padrões espácio-temporais das hospitalizações por cancro da mama (código principal). Métodos: Após uma análise descritiva de todas as hospitalizações com código de cancro da mama, os internamentos com código principal para esta patologia foram estudados com recurso a técnicas de mapeamento, análise de clusters espácio-temporais e variações espaciais em tendências temporais. Resultados: A taxa de internamento hospitalar por cancro da mama foi 118.72/105 mulheres, mostrando um crescimento de 3.109%/ano neste período. A mediana do tempo de hospitalização nestas doentes foi 5 dias, e a maioria dos internamentos corresponderam a admissões cirúrgicas programadas. Vários clusters espácio-temporais e variações espaciais em tendências temporais foram detetados. A zona costeira do país apresentou 4 clusters com elevada taxa de internamento hospitalar na análise espácio-temporal. Adicionalmente, a zona norte costeira e 2 concelhos isolados exibiram tendências temporais significativamente diferentes das descritas no resto do país. Estes clusters sugerem assimetrias regionais, apresentando divergências nas características demográficas (idade de admissão e ruralidade do concelho de residência), tipo de admissão, tempo de internamento e outcome da hospitalização. Conclusão: Este estudo identificou áreas chave de elevada taxa de internamento hospitalar por cancro da mama e uma tendência crescente nestes internamentos, fornecendo dados sobre a heterogeneidade espacial neste indicador de saúde.info:eu-repo/semantics/publishedVersio

Spatiotemporal analysis of breast cancer hospitalizations in Portugal in 2002–2016

Breast cancer (BC) is the most common cancer among Portuguese women and it is associated with high hospitalization rates. Therefore, this study aims to characterize the BC hospital admission rate (HAR) in women in the period of 2002-2016, with an additional focus on spatiotemporal patterns of hospitalizations by BC (main code). Methods: After a descriptive analysis of all BC hospitalizations, the main BC code HAR was studied using mapping techniques, analysis of spatiotemporal clusters, and analysis of spatial variations in temporal trends. Results: The BC-HAR was 118.72/105 women, showing a growth of 3.109% per year in this period. The median length of stay (LOS) in these patients was 5 days, and most cases were programmed surgical admissions. Several spatiotemporal clusters and spatial variations in temporal trends were detected. The seaside area of the country showed 4 high HAR clusters in the spatiotemporal analysis. Additionally, the seaside north of the country and 2 isolated counties presented significantly different temporal trends in BC-HAR versus the rest of the country. These clusters suggest regional asymmetries, as they showed differences in terms of: demographic characteristics (age at admission and rurality of county of residence), the type of admission, LOS, and outcomes of hospitalization. Conclusion: This study identified key areas of high BC-HAR and increasing trends for female HAR, providing evidence of spatial heterogeneities in this health indicator.publishersversionpublishe

Soft tissue sarcomas: evaluation of biomarkers and clinical outcomes

Background: Soft tissue sarcomas (STS) are a rare, heterogeneous and complex group of tumors of mesenchymal origin. A great proportion of patients (pts) with high-risk STS eventually develop metastatic disease, and pts with advanced disease have a median overall survival (OS) of about 12 months [Judson I et al, Lancet Oncol 2014]. STS have a tendency to metastasize to lungs, but may also relapse in other distant organs. Systemic chemotherapy (CT) comprising anthracycline therapy remains to date the standard reference regimen. Among the over 50 different histological types known, leiomyosarcoma (LMS), undifferentiated pleomorphic sarcoma (UPS) and myxofibrosarcoma (MFS) contain complex genomes characterized by a multitude of rearrangements, amplifications, and deletions. Only few diagnostic and prognostic markers exist, and the accurate diagnosis and prediction of the clinical behaviour of many of these tumors remain a challenge. Some biomarkers, specifically markers related to Epithelial to Mesenchymal transition (EMT) and its reverse process (MET) and microRNAs (miRNAs) may be useful to identify a possible signature with prognostic and diagnostic value, and could also elucidate new possible pathogenic mechanisms. The aims of this study were to describe efficacy and toxicity of CT for advanced STS in a cohort of unselected pts treated at Istituto Oncologico Veneto (IOV), and to evaluate the significance and the prognostic value of the expression of markers linked to EMT/MET processes, related miRNAs and myo-miRNAs in tumors samples. Patients and methods: Medical records of pts with advanced STS treated at Istituto Oncologico Veneto from January 2010 to December 2015 were reviewed and clinical data retrieved. Vital status was recorded as of September 30th 2016. OS was estimated with Kaplan-Meier method, and univariate analysis for OS was performed with Cox regression. Tumor tissues from pts affected by STS referred to the Istituto Oncologico Veneto, Padova, were either retrieved from the Tissue Biobank of the Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, or freshly received as tru-cut biopsy or surgical specimen. All the specimens were reviewed by an expert pathologist for confirmation of representativeness of the samples. Samples were collected from November 2014 (date of Ethical Approval) to September 2016. Eligible histological types were LMS, UPS, and MFS. Total RNA, enriched in low molecular weight molecules, was extracted using NucleoSpin miRNA columns (MN GmbH & Co, Germany) from frozen or fresh tissue samples. Markers linked to EMT/MET were analyzed by qRT-PCR using primers specific for epithelial markers (E-cadherin and ZO-1), and mesenchymal markers (Snail, Slug, Vimentin, Zeb−1, Zeb−2, and N-cadherin). Expression of alpha-SMA was also evaluated along with Periostin. The expression of specific miRNAs linked to EMT (miR-100-5p-5p), to MET (miR200b-3p, miR30b-5p and miR30c-5p) and myo-miRNAs (miR1, miR133a-3p andmiR133b) was measured. The study was approved by the institutional Ethics Committee and conducted in accordance with the Helsinki Declaration and Good Clinical Practice guidelines. Written informed consent was obtained from all pts. Results: Clinical evaluation of pts referred to Medical Oncology Unit 1 – Istituto Oncologico Veneto, IOV - IRCCS. Overall 405 pts were eligible, of whom 51.4% had advanced or metastatic disease. One hundred-sixty seven patients were taken in charge at Istituto Oncologico Veneto. Median age was 61 years (range 16-89); 87 patients (52.1%) were female, and 54 (32.3%) were aged ≥ 70 years. Out of these, 37 patients (19.8%) did not receive chemotherapy. The prevalent histological types were LPS (24%), LMS (19.8%) and UPS (11.4%). Most pts had ECOG PS 0-1 (71.8%). Globally, median OS was 17.7 months (95%CI 13.59-21.75) and median PFS was 10 months (95%CI 7.9-12.0). Patients receiving only first-line CT were 57 (34.1%); 43 patients (25.7%) received more than two lines of CT. First-line CT regimens were anthracycline-based in 81 patients (62.3%). Median OS of patients treated with CT was 19.9 months (95%CI 16.4–23.5), while that of untreated patients was 3.3 months (95%CI 1.3-5.2), p<0.001. At univariate analysis ECOG PS, anemia and lymphopenia were associated with prognosis. Patients with PS 0 had better median OS compared to those with PS 1 and PS 2-3, respectively 23.5 months (95%CI 18.5–28.5), 15.8 months (95%CI 18.5–28.5), 6.6 months (95%CI 1.0-12.3), p<0,001. Baseline low lymphocyte count was associated with worse survival, with median OS of12.5 months (95%CI 5.4-19.5) compared to patients with neutrophil/lymphocyte ratio <3, who had median OS of 22.8 months (95%CI 15.2-30.4), p=0.005. Baseline anemia was also associated with worse survival, with median OS for anemic patients (Hb<12 g/dL) being 9 months (95%CI 3.2-14.8) and median OS for non-anemic patients being 20.9 months (95%CI 16.6-25.4). No difference in OS was seen according to age, gender, chemotherapy regimen, BMI, albumin levels, or LDH levels. Grade ≥3 toxicities occurred in 59 patients (45.4%), and 23 patients (17.7%) required hospitalization for toxicity management. Molecular analysis on samples Overall, 55 STS samples were fully characterized, specifically 28 LMS, of which 10 low/intermediate grade (LG) and 18 high grade (HG) LMS; 13 myxoid sarcomas (of which 8 MFS/ and 5 low-grade FMS); and 14 UPS. Correlation of EMT-related markers and miRNA with histological type and grade was assessed. The samples were analysed for the expression of E-cadherin and ZO-1, as epithelial markers, and of Slug, Vimentin, Snail, ZEB-1, ZEB-2, N-cadherin, and Periostin, as markers related to a mesenchymal status. E-cadherin expression was not found in all analysed STS. Alpha-SMA was significantly expressed in LMS compared to UPS and MFS/FMS (p<0.001), and not significantly different in UPS compared to MFS/FMS. ZEB-1 and ZEB-2 expression was significantly higher in LMS compared to MFS/FMS (p<0.001) and UPS (p=0.001 for ZEB-1, p=0.003 for ZEB-2), whereas no differential expression was measured between UPS and MFS/FMS. Interestingly, ZEB-1 and ZEB-2 were differentially expressed in HG and LG LMS (p=0.038 for ZEB-1, p=0.048 for ZEB-2). Also N-cadherin expression was significantly higher in LMS compared to MFS/FMS (p=0.006) and UPS (p=0.028), whereas no differential expression was measured according to the grading. As for periostin, this was found to be higher in LMS compared to MFS/SFM (p=0.002), and in UPS compared to MFS/FMS (p=0.005); no difference was observed between LMS and UPS. miR-1, miR-133a-3p and miR-133b (“myo-miRNAs”) expression was found to be significantly higher in LMS compared to MFS and UPS (p=0.002), though no difference was observed between HG and LG LMS. All other analysed miRNAs did not show a different expression in the three histological subtypes, nor it was different according to grade., with the exception of miR-100-5p, which was found to be significantly over-expressed in LMS compared to MFS/FMS (p=0.02). An inverse correlation between Slug and myo-miRNAs expression was observed. Also, a direct correlation between ZEB family members, and an inverse correlation between ZEB-1 and miR-200b was observed. In univariate analysis, high ZEB-1 (≥0.4) was correlated with worse OS (2.3 months, 95%CI 0.9-3.4) vs low ZEB-1 (8.6 months, 1.5 – n.r.), p=0.058. Similarly, high ZEB-2 (≥0.9) was correlated with worse OS (2.2 months, 95%CI 0.9-32.7) vs low ZEB-2 (8.6 months, 95%CI 1.5 – n.r.), p=0.052. High Periostin was also correlated with worse OS (2.2 months, 95%CI 1.2-2.5) vs low Periostin (8.6 months, 95%CI 1.3 – n.r.), p=0.028. In multivariate analysis, grade and periostin and ZEB-1 levels confirmed to be associated with overall survival. All the other analysed EMT-related markers, as well as all analysed miRNAs, were not correlated with OS nor with PFS. Conclusions: Our clinical data confirm that there is a benefit for pts that have been treated for advanced disease compared to those not receiving active treatment. There remains a need for novel effective therapies in metastatic STS, particularly for pts with certain chemo-resistant subtypes. The analysis on tumor samples highlighted that a “myo-miRNA” signature may serve as potential confirmatory markers in LMS samples with difficult/controversial histological findings Moreover, some biomarkers linked to the mesenchymal phenotype (i.e. ZEB-1, ZEB-2, and Periostin) may have prognostic value. In light of the findings from this study, we have planned to proceed with validation of such results in a larger sample and to provide a correlation with immunoistochemical staining. Also, we are planning to verify whether circulating Periostin and N-cadherin may be correlated with outcomes and response to therapy in STS

The role of N-acetylcisteine and genetic polymorphisms in XRCC1, XRCC3, GST genes in the modulation of DNA damage and tissue toxicity induced by medical ionizing radiation exposure

Ionizing procedures provide essential life-saving information, but great care must be taken regarding their possible long-term health consequences. The biological and clinical burdens of medical radiation represents a worrisome social and medical problem. DNA damage is the main initiating event by which radiation may results in cancer development. Thus considerable efforts should be made to mitigate radiation-induced cell damage. Because radiation induced cellular damage is attributed primarily to the harmful effects of free radicals, the efficacy of non-toxic radioprotectors with radical scavenging properties should be investigated in the clinical setting. These agents may inhibit or reduce free radical toxicity, thus offering protection against radiation. N-acetylcysteine (NAC) is considered a promising radio-protector for its antioxidant and anticarcinogenic properties and could be able to inhibit or reduce free radical toxicity, thus offering protection against radiation. Moreover, recent evidences have recognized that genetic factors influence the risk of radiation-induced effects and the Seventh National Academy of Science report on Biological Effects of Ionizing Radiation (BEIR VII) included the identification of genes conferring predisposition to radiation-induced health effects as a top research need. Genetic polymorphisms in the detoxification and DNA repair genes are specifically proposed as candidates for genetic predisposition to radiation-induced biological damage. The identification and characterization of genes that enhance prediction of disease risk and improve prevention, treatment, and quality of care remain important goals in the modern imaging practice. Specifically, it is anticipated that the use of genetic markers may serve as the basis for personalized radiotherapy in which cancer management is formulated so that it optimizes the treatment plan for each patient based on their genetic background (radiogenomics). In order to improve this knowledge, the primary aims of the project were: - Aim 1: to evaluate the ability of NAC in conferring protection against radiation induced chromosomal DNA damage. - Aim 2: to assess the value of functional polymorphisms of genes involved in DNA damage repair and oxidative stress response as predictive factors for the occurrence of acute skin reactions. To reach aim 1, 65 patients undergoing invasive cardiovascular procedures received the standard hydration protocol consisting of intravenous isotonic saline for 12 h after catheterization (Group I) while 30 patients received a clinically driven double intravenous dose of NAC for 1 hour before and a standard dose for 12 hours following catheterization (Group II). Micronucleus assay (MN) was performed as biomarker of chromosomal damage and intermediate endpoint in carcinogenesis. MN frequency evaluated before, 2 and 24 hours after the radiation exposure showed a significant increase of 24.1% at 2 hours and of 21.4 % at 24 hours in the Group I (p=0.03), while the non-significant increase of MN was 13.1% at 2 hours and 8.7% at 24 hours in Group II (p=0.4). These results suggested that NAC may be an effective promising, well-tolerated antioxidant approach easily usable in the clinical practice to offer protection against DNA damage induced by ionizing radiation exposure during cardiac catheterization procedures. To reach aim 2, skin toxicity was scored according to Radiation Therapy Oncology Group (RTOG) criteria in 59 breast cancer patients undergoing radiation therapy after conserving surgery. Single nucleotide polymorphisms (SNPs) in XRCC3 (Thr241Met), XRCC1 (Arg399Gln, and Arg194Trp) and in GSTT1 and GSTM1 were determined by PCR-RFPL analysis. According to RTOG criteria, grade 1 and 2 acute skin reactivity was observed in 24 (41%) of the 59 participants. Univariate analysis indicated that XRCC3 241Met variant (OR: 2.5 95% CI: 1.0-7.3, p=0.05) and GSTM1 null genotype (OR: 3.5 95% CI:1.2-10.4 p=0.02) as well as BMI (OR: 3.6 CI: 1.2-11, p=0.02) were associated with the risk of acute skin radiosensitivity. The logistic multivariate analysis confirmed that the two genetic variants increased the individual susceptibility to acute skin reaction. Our findings suggest that the presence of SNPs involved in DNA repair and oxidative stress may in part explain the individual response to acute skin toxicity in patients undergoing partial breast irradiation after conserving surgery. The association analysis between clinical characteristics and genotype with the acute radiation skin toxicity in breast cancer patients suggests that approaches based on (multiple) genetic markers and clinical characteristics have the potential to predict normal tissue radiosensitivity. Although our findings are to be carefully assessed with further large, randomized studies, taken together have outmost clinical relevance since add important information to reach a personalized measure of radiation risk in order to implement tailored preventive and chemopreventive strategies

[Numbers: cancers in the very elderly]

La popolazione italiana sta progressivamente invecchiando sia perché la durata della vita aumenta (la speranza di vita alla nascita in media in Italia nel 2008 era di 78,7 anni per gli uomini e 84,0 per le donne), sia perché il tasso di natalità si riduce (nel 2008 si sono registrate 9,6 nascite ogni 1.000 abitanti). L’allungarsi della durata della vita fa sì che la popolazione anziana si vada sempre più differenziando, tanto da poter distinguere i «giovani anziani» (vicini alla soglia dei 65 anni) dai «grandi anziani» (ultra80enni). Nel 1980 i grandi anziani costituivano il 2,1% della popolazione italiana, percentuale che nel 2009 era già aumentata al 5,6%, con una netta prevalenza delle donne (7,2% degli ultra80enni) rispetto aglu uomini (3,9%). Tra gli ultraottantenni viene diagnosticato il 20% del totale dei tumori (17,9% fra gli uomini, e 23,5% fra le donne) che in questa fascia d’età hanno una frequenza molto elevata, quantificabile in circa 2 casi ogni 100 donne e in 3-4 casi ogni 100 uomini ogni anno. Dai dati dell’Associazione Italiana Registri Tumori (AIRTUM) emerge che i tumori più frequenti tra i grandi anziani sono gli epiteliomi della cute (18,3% e 18,5% del totale per uomini e donne, rispettivamente), seguiti dai tumori del colon retto (12,5% e 14,7%), del polmone (12,2% e 4,8%), della prostata (17,4% dei tumori maschili), della mammella (14,6% dei tumori femminili), dello stomaco (5,8% e 6,4%), della vescica (9,2% e 3,4%), del pancreas (2,5% e 4,5%), dal fegato (2,9% e 2,8%) e dai linfomi (2,3% e 3,0%)

Italia. I sette tumori a prognosi peggiore.

cancer surviva

Italian Cancer Figures- Report 2012. Cancer in children and adolescents

Abstract OBJECTIVES: This study describes up-to-date cancer incidence and survival in Italian paediatric and adolescent patients, based on data collected by the network of Italian cancer registries (AIRTUM). It updates the monograph published on the same topic in 2008. The main objective of this monograph is to present the statistics according to standard rigorous epidemiological methods and disseminate them to a wide range of readers, including the lay public. Given the deep impact of the 2008 monograph on the general public, in this update we complement descriptive statistics with additional data and commentaries on issues of importance for public health, in order to provide unambiguous criteria on how to interpret the statistics. The study is the result of the collaboration between AIRTUM and AIEOP (Italian Association of Paediatric Haematology and Oncology) with contributions from interested parties, including representatives of parent associations. The monograph is divided into three parts. The first part presents incidence rates, survival probabilities, and time trends, by sex, age, geographical area, and cancer site or type, by means of tables and graphs as in the previous monograph, to facilitate direct comparisons. Four articles summarize and comment the results. The second part uses data from AIRTUM and AIEOP to outline patient management and health care issues; it includes estimates of the number of new cases in the next decade and of young adults living after a paediatric cancer diagnosis. Health organizational aspects of treatment services for paediatric patients, based on the AIEOP database, are also discussed, along with long-term complications in cured patients. The third section describes the changes in mortality trends due to improving therapies and healthcare services, and discusses risk factors and prevention of childhood cancer, late adverse events in cured patients, and other related issues. MATERIAL AND METHODS: Data herein presented were provided by AIRTUM population-based cancer registries, covering 47%of the Italian population below age 20 years, in the period 2003-2008. Quality of cancer registration in Italy is elevated, with high proportions of microscopically verified diagnoses (91%in the 0-14 years age group and 96% between 15 and 19 years of age) and a very small proportion of cases collected through death certificate only (0.1%).The proportion of cases in diagnostic groups XI (other malignant epithelial neoplasms) and XII (other and unspecified neoplasms) of the International Classification for Childhood Cancer (ICCC), based on the third revision of the International Classification of Diseases for Oncology (ICD-O-3), were 7.0% in the 0-14 years age group and 26.0%in the 15-19 years age group.The ratio between mortality and incidence was 17.7% in both children and adolescents. Detailed results are presented in 24 fact sheets for the 12 major ICCC-3 diagnostic groups and 10 sub-groups of special interest; the series is completed by a sheet on all malignant tumours and one on all tumours including non-malignant neoplasms of the central nervous system. All sheets include results for three age groups (0-14, 15-19, and 0-19 years) and are followed by two commentaries on incidence in the recent period, one on trends and the other on survival. Incidence rates were age-standardized on the European population and presented per million children. Incidence rates are also presented by age group, sex, and geographical area. Incidence trends were evaluated for two periods, 1988-2008 and 1998-2008, using estimated annual percent changes, and survival estimates were calculated by age and period. Indicators and corresponding 95% confidence intervals are shown in forms of graphics and tables at the end of the monograph and online at http://www.registri-tumori.it. Geographical analyses were conducted rearranging cancer registries into four macroareas (North-West, North-East, Centre, and South and Islands). Age groups were the same used in descriptive studies on children worldwide (0, 1-4, 5-9, 10- 14 years for paediatric tumours and 15-19 years for adolescents). Incidence trend analyses included cancer registries with three or more years of registration in the 5-year period, using Poisson regression models. Observed survival was computed according to the Kaplan-Meier method. The estimate of expected cases in the next decade was based on observed incidence rates in the most recent period, extended to the Italian estimated population of children and adolescents in the periods 2011-2015 and 2016-2020. The AIEOP database (Modello 1.01) allowed us to compare the number of patients treated and followed-up in specialized centres with expected cases based on AIRTUM estimates. The AIEOP database also provided information regarding health care migration throughout Italian regions and the number of foreign (immigrated) children treated in Italian AIEOP centres. RESULTS: In the period 2003-2008, 31 cancer registries reported 4,473 incident malignant neoplasms, 2,855 in children and 1,618 in adolescents. Cancer incidence rates were 164 cases per million in children aged 14 years or below and 269 cases per million in patients aged 15-19 years. Limited geographical variations emerged. In children (0-14 years) a significant increase in malignant cancer incidence was observed until 1997 (APC: +3.2%), followed by a plateau (APC: -1.1%not statistically significant).Until the late Nineties, a statistically significant increase was also observed in the incidence of all leukaemias in males (APC: +5.7%), lymphoid leukaemias (APC: +5.6%), representing 80% of all leukaemias, Hodgkin and non- Hodgkin lymphomas (APC: +6.3%). A significant decrease emerged for lymphoid leukaemia starting in 1995 (APC: -1.9%), while no substantial change in cancer incidence rates was observed in the last decade of observation for all malignant neoplasms and lymphomas. In addition, no variation emerged for malignant (according to the most recent classification) central nervous system (CNS) neoplasms, while an annual increase of 1.8% (significant) was observed in the period 1988-2008, when non-malignant tumours were included. Increases in cancer incidence were observed throughout the study period for neuroblastoma (APC: +1.9%) and epithelial tumours or melanoma (APC: +4.1%). In the period 1998-2008, in addition to lymphoid leukaemias, a significant decrease was observed for all malignant neoplasms, lymphomas in girls, CNS tumours (males and females), and renal tumours in girls, while no increases were observed in this age group. In adolescents (15-19 years) between 1988 and 2008, a significant increase in incidence rates was observed (APC: +2.0%) for all malignant neoplasms, all lymphomas (APC: +2.9%; in particular Hodgkin lymphoma, APC: +3.6%), thyroid cancer (APC: +6.1%), and melanoma (APC: +8.1%). Conversely, lymphoid leukaemia is the only neoplasm showing a long-term decrease in adolescents. Recent trends (1998-2008) confirm the long-term increases only for all malignant neoplasms in girls and thyroid cancer (APC: +7.9%, boys and girls), while a decrease in bone tumour incidence emerged in girls, albeit based only on 46 cases. Cancer mortality in children showed a persistent decrease for all neoplasms and even for more frequent cancer sites or types, and mortality rates for cancer were three-fold higher in the early Seventies than in 2008. In addition, five-year survival after cancer diagnosis increased in the last three decades and was still increasing in the period 2003- 2008, reaching 82% in children and 86% in adolescents. In the period 2008-2010, 4,488 children (0-14 years) were treated in one of the AIEOP clinical centres and we estimate, based on the above-presented incidence rates, that they represented 92% of all cancer cases in Italy. However, in adolescents, the proportion of patients treated in AIEOP centres was only 25%. A migration of patients living in the South of Italy to Central and Northern Italy emerged from AIEOP information. The expected number of cancer cases in children aged between 0 and 14 years of age is approximately 7,000 in the period 2016- 2020, while the corresponding figure for adolescents between 15 and 19 years of age is 4,000, with no relevant variation in comparison with the previous five-year period. COMMENTS: The present findings update descriptive cancer epidemiology in children and adolescents in Italy based on data provided by an extensive network of general and specialized population-based cancer registries. Data obtained from cancer registries are supplemented by additional information collected by specialized clinical AIEOP centres and mortality reports collected by the National Institute of Statistics (ISTAT). Incidence rates reported in Italy were slightly higher in comparison to other developed Countries, but relatively consistent between different Italian areas. Our results also showed that the significant increase in cancer incidence observed until the end of Nineties has halted, with the exception solely of thyroid cancer in adolescents. Efficacy of therapeutic protocols has improved constantly since the Seventies, and recent findings confirm this trend in all age groups and, in particular, for rarer tumours and cancer types that have very poor prognosis. Findings derived from cross-analysis with AIEOP data suggest that it is possible to further improve the efficiency of our healthcare system, in particular for adolescents; migration can be reduced with a more rational use of hospitals throughout Italy

Italian cancer figures, report 2013: Multiple tumours

This collaborative study, based on data collected by the network of Italian association of cancer registries (AIRTUM), provides updated estimates on the incidence risk of multiple primary cancer (MP). The objective is to highlight and quantify the bidirectional associations between different oncological diseases. The quantification of the excess or decreased risk of further cancers in cancer patients, in comparison with the general population, may contribute to understand the aetiology of cancer and to address clinical follow-up

[New incidence and mortality data. 2003-2005]

This is an update of incidence and mortality cancer data provided by the Italian Network of Cancer Registry (AIRTUM) relative to the period 2003-2005.AIRTUM is a network of general and specialized population-based cancer registries that covers about 1/3 of the Italian resident population (www.registri-tumori.it). Incidence and mortality data for the period 2003-2005 are based on 20 Registries. The five most frequently diagnosed cancers were: - prostate (18.5%), non melanoma skin (15.8%), lung (13.1%), colorectal (12.0%), bladder (5.7%) among males; - breast (24.9%), non melanoma skin (15.1%), colorectal (11.9%), lung (5.0%) and stomach (4.1%) among females. In the same period the most frequent causes of cancer death were: - cancer of the lung (27.6%), colorectal (10.7%), prostate (8.5%), stomach (7.3%) and liver (6.1%) among males; - breast cancer (16.3%), colorectal (11.9%), lung (10.3%), stomach (7.2%) and pancreas (6.5%) among females. According to the age-specific incidence rates one man and one woman every two will receive a cancer diagnosis during his/hers life (from birth to the age of 84 years). From 1993-1995 to 2003-2005, overall crude cancer incidence rate (males and females together) increased from 555.4 to 654.8 x 100,000. Standardization showed that 63% of this increase was due to ageing of the population. Moreover, most of the residual increase was among those cancer sites (breast, prostate, colorectal, thyroid and melanoma) for which early detection may have played a relevant role in anticipating (and therefore increasing) the number of diagnoses. Due to population ageing also overall cancer mortality did not show any decrease when crude rates were compared. On the contrary, standardized mortality rates (all cancers together) showed a strong decrease (311.4 vs. 266.5 x 100.000). The risk of receiving a diagnosis or dying because of cancer is still lower in residents in the regions of the South of Italy than in those of Central and Northern Italy, but they are becoming more and more similar. In Italy cancer incidence and mortality rates are similar to those in northern European countries and in USA among males, but they are still lower for women