Personalized Medicine in Skull Base and Sinonasal Tumors

: Skull base and sinonasal tumors (SBSNTs) represent a considerable challenge for clinicians in view of their rarity, anatomical complexity of the site of origin, and great histological variety [...]

The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population

Sinonasal Cancer: Improving Classification, Stratification and Therapeutic Options

: The nasal cavities and paranasal sinuses are the site of origin of a wide spectrum of histologically and clinically distinct disease entities [...]

Optimal Supportive Measures during Primary Treatment

AbstractSupportive care during curative treatment of head and neck cancer patients has different scopes: reducing the burden of acute toxicities and limiting the risk of developing late adverse effects; increasing the quality of life of the patients; allowing to perform optimal curative therapy, maintaining treatment dose intensity; preventing higher grade toxicities so to reduce also the costs associated with hospitalization, examinations, visits and use of drugs. At the same time, it is necessary to give uniformity in the supportive care protocols, as these preventive and therapeutic measures may influence the results of oncological treatments and their efficacy should be evaluated in a consistent manner. Several preventive and therapeutic interventions are available, particularly in the context of chemoradiotherapy, where the adverse events are more prominent. An accurate evaluation of the patient and a tailored approach with preventative indications and therapeutic interventions represent key factors. This approach could be easily identified within a "simultaneous care" strategy, as the optimal supportive measures are provided concurrently to the best therapeutic approach since the beginning of the treatment

Measuring financial toxicity in head and neck cancer: a systematic review

Objective: The current study systematically reviews the literature about financial toxicity (FT) in head and neck cancer patients. Three databases were reviewed: PubMed, Scopus and Web of Science. Methods: Full text English papers published from 2000 to 2022 reporting on quantitative results about FT in head and neck cancer survivors collected through structured questionnaires or interviews were included. Results: Twenty-seven articles were included. Most of the articles were published after 2015 and from United States. There was a slight prevalence of papers dealing with oropharyngeal cancer, squamous-cell carcinoma and locally advanced head and neck cancer. Measures of FT were obtained through validated questionnaires like COST, FIT and FDQ. Collected data were mostly referrable to financial spending, financial resources, psychosocial aspect, support seeking, coping care and coping lifestyle subdomain. FT scores by COST were found to be worse in the COVID era. Financial counseling and adequate information about the costs of treatment were two effective strategies to mitigate FT. Conclusions: FT is a relatively new challenge in head and neck cancer treatment, whose expenses are higher than therapies for other cancers. A universal method to assess FT and a unified guideline for the administration of questionnaires are needed to mitigate FT and to improve patient outcomes

Ambrosio Borsano: un exponente de la escuela de ingeniería militar de Milán al servicio de la Monarquía Hispánica (1633-1661)

En este artículo se examina una etapa crucial en la vida de Ambrosio Borsano, uno de los principales ingenieros militares de la Europa de la segunda mitad del siglo XVII: la de su formación como cartógrafo militar. Una etapa sobre la que se disponía de contadas y dispersas referencias. En el mismo se intenta resolver, en primer lugar, la cuestión de su nacimiento y el marco familiar milanés en el que se educó. Después, se describen las actividades militares que llevó a cabo, entre 1648 y 1658, en el norte de Italia, durante las cuáles conoció al que terminaría siendo su maestro: Gaspare Beretta, ingeniero mayor del ejército español en el Estado de Milán. A continuación, se analiza la formación que recibió como cartógrafo militar de Beretta y que es preciso situarla en el marco de la escuela de ingeniería militar de Milán. El artículo se cierra explicando el último capítulo de su etapa de formación: el de su traslado a la península Ibérica en 1661 para luchar contra los independentistas portugueses

Ambrosio Borsano: un exponente de la escuela de ingeniería militar de Milán al servicio de la Monarquía Hispánica (1633-1661)

Lo scritto giunge per primo a ricostruire gli anni della formazione e della iniziale attività a difesa delle frontiere del Ducato milanese di Ambrosio Borsano (1633-1708), esponente di spicco della folta schiera di ingegneri militari e cartografi italiani a servizio della Corona di Spagna. Di Borsano è in particolare la Gran Mapa de Cataluña del 1687 (http://www.bne.es/es/AreaPrensa/noticias2015/1210-borsano.html), che da ultimo è stata oggetto di una digitalizzazione ad alta definizione. Lo studio, condotto con il prof. Francesc Nadal Piqué del Departament de Geografia Humana dell’Universitat de Barcelona (UB), è destinato, nelle intenzioni dell’Institut Cartogràfic i Geològic de Catalunya, a confluire, opportunamente sviluppato, in una prossima edizione a stampa della Gran Mapa

Comparative Effectiveness of DPP-4 Inhibitors Versus Sulfonylurea for the Treatment of Type 2 Diabetes in Routine Clinical Practice: A Retrospective Multicenter Real-World Study

Introduction: DPP-4 inhibitors (DPP4i) and sulfonylureas are popular second-line therapies for type 2 diabetes (T2D), but there is a paucity of real-world studies comparing their effectiveness in routine clinical practice. Methods: This was a multicenter retrospective study on diabetes outpatient clinics comparing the effectiveness of DPP4i versus gliclazide extended release. The primary endpoint was change from baseline in HbA1c. Secondary endpoints were changes in fasting plasma glucose, body weight, and systolic blood pressure. Automated software extracted data from the same clinical electronic chart system at all centers. Propensity score matching (PSM) was used to generate comparable cohorts to perform outcome analysis. Results: We included data on 2410 patients starting DPP4i and 1590 patients starting gliclazide (mainly 30–60 mg/day). At baseline, the two groups differed in disease duration, body weight, blood pressure, HbA1c, fasting glucose, HDL cholesterol, triglycerides, liver enzymes, eGFR, prevalence of microangiopathy, and use of metformin. Among DPP4i molecules, no difference in glycemic effectiveness was detected. In matched cohorts (n = 1316/group), patients starting DPP4i, as compared with patients starting gliclazide, experienced greater reductions in HbA1c (− 0.6% versus − 0.4%; p < 0.001), fasting glucose (− 14.1 mg/dl versus − 8.8 mg/dl; p = 0.007), and body weight (− 0.4 kg versus − 0.1 kg; p = 0.006) after an average 6 months follow-up. DPP4i improved glucose control more than gliclazide, especially in patients who had failed with other glucose-lowering medications or were on basal insulin. Conclusions: This large retrospective real-world study shows that, in routine clinical practice, starting a DPP4i allows better glycemic control than starting low-dose gliclazide. Funding: The Italian Diabetes Society, with external support from AstraZeneca