Giorgio Bogani
@istitutotumori.mi.it
Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
RESEARCH INTERESTS
Gynecologic oncology
Scopus Publications
Scopus Publications
Giorgio Bogani, Francesco Raspagliesi, Mario Malzoni, Ilaria Cuccu, Giuseppe Vizzielli, Giovanni Scambia, Fabio Ghezzi, Jvan Casarin, Andrea Giannini, Violante Di Donato,et al.
Elsevier BV
Giorgio Bogani, Giovanni Scambia, Francesco Raspagliesi, and Giovanni Corso
Ovid Technologies (Wolters Kluwer Health)
Ilaria Cuccu, Tullio Golia D’Augè, Ilaria Firulli, Emanuele De Angelis, Giovanni Buzzaccarini, Ottavia D’Oria, Aris Raad Besharat, Donatella Caserta, Giorgio Bogani, Ludovico Muzii,et al.
MDPI AG
This scoping review explores the therapeutic strategies available for managing genitourinary syndrome of menopause (GSM), a condition often underdiagnosed and undertreated despite significantly affecting women’s quality of life. GSM results from decreased estrogen levels during menopause, leading to a range of symptoms including vulvovaginal atrophy and urinary tract issues. Material and Methods: we screened the literature for original studies with “menopause”, “hormonal therapy”, “vulvovaginal atrophy”, “urinary incontinence”, “urinary infections”, “genitourinary syndrome”. Results: A total of 451 relevant articles were retrieved. After screening, 19 articles were included in this scoping review. Discussion: First-line treatments typically include lubricants and moisturizers for short-term symptom relief, while unresolved or severe cases may warrant hormonal treatment. Topical hormonal treatments often have fewer side effects than systemic alternatives. Special attention is given to selective estrogen receptor modulators like ospemifene and steroid hormones like dehydroepiandrosterone (DHEA), which have shown beneficial effects on GSM symptoms. Moreover, innovative therapeutic approaches, such as laser treatment, are discussed in the context of their efficacy and accessibility. The safety of GSM hormonal therapy in women with a history or risk of cancer is also addressed, noting the need for more definitive research in this area. While there is a growing demand for tailored therapy, this scoping review emphasizes the importance of effective communication and counseling to allow women to make informed decisions about their treatment. Overall, this review underscores the need for increased awareness and further research into effective treatment options for GSM.
Giorgio Bogani and Francesco Raspagliesi
American Medical Association (AMA)
Antonino Ditto, Fabio Martinelli, Marco Dri, Umberto Leone Roberti Maggiore, Giorgio Bogani, Shigeky Kusamura, Biagio Paolini, Edgardo Somigliana, and Francesco Raspagliesi
BMJ
Objective To report 20 years of experience with fertility-sparing surgery for patients with early-stage cervical cancer, comparing the oncological outcomes with outcomes for those who underwent a radical hysterectomy. Methods Patients with pre-operative stage IA1 with lymphovascular space invasion, IA2 and IB1 cervical cancer (any grade) were included (2018 International Federation of Gynecology and Obstetrics staging system). Inclusion criteria comprised age (18–44 years), histology (squamous, adenocarcinoma, or adenosquamous) and absence of previous/concomitant cancer. A thorough counseling about oncological and obstetrical potential risks was mandatory for patients asking for fertility sparing. Results for consecutive patients who underwent fertility-sparing surgery (cervical conization and nodal evaluation) were analyzed and compared with results for patients treated with radical surgery. Oncological outcomes were assessed with a propensity score adjustment with inverse probability of treatment weighting. Results Overall, 109 patients were included in the study. Ten patients abandoned the fertility-sparing route because of nodal involvement (n=5), margin positive (n=2), or because patients requested radical treatment (n=3). Sentinel node mapping was performed in 19 of 49 (38.8%) patients in the fertility-sparing surgery group. Among the patients in the fertility-sparing group, 6 (12.2%) patients relapsed. 34 (69.4%) patients attempted to conceive. Pre-operative covariates selected to define the probability of having either fertility-sparing or radical surgery were well balanced using inverse probability of treatment weighting. Pathological features were similar between the groups, including grading, histotype, stage, and lymphovascular space invasion. After a median follow-up of 38.8 (range 5–186) months there were no differences in progression-free survival (p=0.32) and overall survival (p=0.74) between the fertility-sparing and radical hysterectomy groups. The results after inverse probability of treatment weighting adjustment did not show significant differences in progression-free survival (p=0.72) and overall survival (p=0.71) between the groups. Conclusion Fertility-sparing surgery based on conization plus laparoscopic lymph node evaluation, may be considered safe and effective for patients with early-stage cervical cancer.
Giorgio Bogani, Luca Lalli, Jvan Casarin, Fabio Ghezzi, Valentina Chiappa, Francesco Fanfani, Giovanni Scambia, and Francesco Raspagliesi
BMJ
Noemi Tonti, Tullio Golia D’Augè, Ilaria Cuccu, Emanuele De Angelis, Ottavia D’Oria, Giorgia Perniola, Antonio Simone Laganà, Andrea Etrusco, Federico Ferrari, Stefania Saponara,et al.
MDPI AG
Growing evidence has demonstrated the role of mutations of tumor biomarkers in diagnosing and treating epithelial ovarian cancer. This review aims to analyze recent literature on the correlation between tumor biomarkers and chemotherapy in nonmucinous ovarian cancer, providing suggestions for personalized treatment approaches. An extensive literature search was conducted to identify relevant studies and trials. BRCA1/2 mutations are central in homologous recombination repair deficiency (HRD) in ovarian cancer, but several other genetic mutations also contribute to varying cancer risks. While the role of MMR testing in ovarian cancer is debated, it is more commonly linked to non-serous ovarian cancer, often associated with Lynch syndrome. A significant proportion of ovarian cancer patients have HRD, affecting treatment decisions in both first-line (especially in advanced stages) and second-line therapy due to HRD’s connection with platinum-based therapy and PARP inhibitors’ response. However, validated genetic tests to identify HRD have not yet been universally implemented. There is no definitive therapeutic algorithm for advanced ovarian cancer, despite ongoing efforts and multiple proposed tools. Future research should focus on expanding the utility of biomarkers, reducing resistance, and increasing the actionable biomarker pool.
Antonino Ditto, Stefano Ferla, Fabio Martinelli, Giorgio Bogani, Umberto Leone Roberti Maggiore, and Francesco Raspagliesi
Elsevier BV
Giorgio Bogani, Luca Lalli, Jvan Casarin, Fabio Ghezzi, Valentina Chiappa, Francesco Fanfani, Giovanni Scambia, and Francesco Raspagliesi
BMJ
ObjectiveTo assess the role of histopathological and molecular features in predicting the risk of nodal metastases in apparent early-stage endometrial cancer patients undergoing sentinel node mapping.MethodsThis is a prospective trial. Consecutive patients with apparent early-stage endometrial cancer, undergoing laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and sentinel node mapping, were enrolled. Histological and molecular features were used to predict the node positivity.ResultsCharts of 223 apparent early-stage endometrial cancer patients were included in this study. Four (1.8%) patients were excluded from this study due to the lack of data about molecular features. Additionally, nine (4%) patients did not meet the inclusion criteria (due to the presence of peritoneal carcinomatosis or bulky nodes (the presence of p53 abnormality correlated with the presence of advanced stage disease (p<0.001)). The study population included 178 (84.8%) and 32 (15.2%) patients with endometrioid and non-endometrioid endometrial cancer, respectively. According to pathological uterine risk factors, 93 (44.3%), 45 (21.4%), 40 (19.1%), and 32 (15.2%) were classified as low, intermediate, intermediate-high, and high-risk, respectively. Using the surrogate molecular classification, 10 (4.8%), 42 (20%), 57 (27.1%), and 101 (48.1%) were included in the POLE mutated, p53 abnormal, MMRd/MSI-H, and NSMP, respectively. Overall, 41 (19.5%) patients were detected with positive nodes. Molecular features were not associated with the risk of having nodal metastases (OR 1.03, 95% CI 0.21 to 5.05, p=0.969 forPOLEmutated; OR 0.788, 95% CI 0.32 to 1.98, p=0.602 for p53 abnormal; OR 1.14, 95% CI 0.53 to 2.42, p=0.733 for MMRd/MSI-H). At multivariable analysis, only deep myometrial invasion (OR 3.318, 95% CI 1.357 to 8.150, p=0.009) and lymphovascular space invasion (OR 6.584, 95% CI 2.663 to 16.279, p<0.001) correlated with the increased risk of positive nodes.ConclusionOur data suggest that molecular classification does not seem useful to tailor the need of nodal dissection in apparent early-stage endometrial cancer. p53 abnormality predicts the risk of having advanced disease at presentation. Further external validation is needed.Clinical trial registrationNCT05793333.
Giorgio Bogani, Giovanni Scambia, Anna Fagotti, Francesco Fanfani, Andrea Ciavattini, Francesco Sopracordevole, Mario Malzoni, Jvan Casarin, Fabio Ghezzi, Enrico Vizza,et al.
Elsevier BV
Camilla Valsecchi, Andrea Franza, Giorgio Bogani, Luigi Rolli, Michele Ferrari, Giovanni Leuzzi, Alessia Stanzi, Federica Sabia, Ugo Pastorino, and Arsela Prelaj
AME Publishing Company
Background Stage III lung cancer (LC) represents a heterogeneous group of diseases, and the optimal management is still a matter of debate. To date, only a few studies have assessed the role of multidisciplinary team (MDT) discussion in impacting survival of stage III LC. Hence, we aimed to reported the impact of the implementation of MDT discussion on long-term survival of stage III LC patients. Methods This is a retrospective, observational, single-centre cohort study evaluating data of consecutive patients with a clinical and pathological diagnosis of stage III LC treated before [2005–2011] and after [2012–2020] the implementation of MDT. The primary outcome was 5-year overall survival (OS). Results A total of 983 patients were enrolled with stage III LC, 411 (41.8%) pre-MDT and 572 (58.2%) post-MDT. The 5-year OS rates were 25.3% for the pre-MDT cohort and 33.9% for the post-MDT cohort (P=0.0008). Resected patients (n=670), who underwent trimodality therapy achieved a higher 5-year OS in both pre-MDT and post-MDT groups. An increased 5-year OS was observed in patients who underwent systemic therapy, from 28.2% in pre-MDT to 40.2% in post-MDT cohorts. In non-resected patients, there was an increased in 5-year OS in both systemic and chemoradiotherapy groups. Conclusions The implementation of an MDT increased the 5-year OS in both resected and non-resected stage III LC patients. Implementing MDT might be useful in improving the management of therapy with less invasive local and surgical strategies personalized for each LC patient.
Violante Di Donato, Andrea Giannini, Valerio Galli, Mariano Catello Di Donna, Mario Antonio Congiu, Giorgia Garganese, Francesco Plotti, Flavia Sorbi, Tullio Golia D'Augè, Antonio Simone Laganà,et al.
BMJ
Objective To assess if the use of a V-Y reconstructive flap after excisional radical surgery positively influences the surgical outcomes in patients with vulvar cancer. Methods This was a multicenter, retrospective, controlled study. Surgical outcomes and complication rates of women with invasive vulvar cancer who underwent radical surgery and vulvar reconstruction and those who underwent radical surgery without the reconstruction step were compared. Only patients who underwent bilateral or unilateral V-Y advancement fascio-cutaneous flaps were included in the reconstruction group. Univariate and multivariate logistic regression models were used to analyze predicting variables for their association with complication rates. Results Overall, 361 patients were included: 190 (52%) underwent the reconstructive step after the excisional radical procedure and were compared with 171 (47.4%) who did not undergo the reconstructive step. At multivariate analysis, body mass index >30 kg/m 2 (odds ratio (OR) 3.36, p=0.007) and diabetes (OR 2.62, p<0.022) were independently correlated with wound infection. Moreover, increasing age (OR 1.52, p=0.009), body mass index >30 kg/m 2 (OR 3.21, p=0.002,) and International Federation of Gynecology and Obstetrics (FIGO) stages III–IV (OR 2.25, p=0.017) were independent predictors of wound dehiscence. A significant reduction in the incidence of postoperative wound complications among patients who underwent V-Y reconstructive flaps was demonstrated. This was correlated more significantly in women with lesions >4 cm. Conclusions The adoption of V-Y flaps in vulvar surgery was correlated with reduced surgical related complications, particularly in vulnerable patients involving large surgical defects following excisional radical procedures.
Stefano Restaino, Federico Paparcura, Martina Arcieri, Giulia Pellecchia, Alice Poli, Valerio Gallotta, Salvatore Gueli Alletti, Stefano Cianci, Vito Andrea Capozzi, Giorgio Bogani,et al.
MDPI AG
The operating room is the environment where harm to the patient is most likely. Robotic surgery was listed as one of the top 10 health hazards as late as 2020. Taking inspiration from other fields of application, such as aeronautics, checklists have been increasingly implemented in medical practice over the years, becoming essential components of the operating theatre. In addition to checklists, simulation has taken on a fundamental importance in reducing errors. This paper aims to provide a narrative review to assess the importance of checklists and training in robotic surgery and how they improve the outcome. A comprehensive literature search from January 2000 to September 2023 was conducted. A total of 97 articles were included in the initial search. Eleven studies were deemed relevant and were considered eligible for full-text reading. Among these, ten studies focused on the analysis of training effectiveness. An article in our review assessed the benefits of introducing checklists in the operating room. Innovations created in aviation, such as checklists and simulation, have entered the medical field to prevent human error. Developing dedicated checklist and surgical teams, through theoretical and practical training, has become essential in modern medicine. Tools such as checklists, training, and simulation are among the best methods to reduce adverse medical events.
Marco Di Stanislao, Camelia Alexandra Coada, Francesca De Terlizzi, Stella Di Costanzo, Enrico Fiuzzi, Francesco Mezzapesa, Giulia Dondi, Damiano Paoli, Gianluca Raffaello Damiani, Francesco Raspagliesi,et al.
MDPI AG
This study aimed to investigate the efficacy and duration of multiple non-ablative intravaginal CO2 laser (V-lase®) cycles in breast cancer patients, gynecological and other pelvic cancers previously subjected to multiple oncological treatments. This prospective study enrolled women under the age of 65 years who reported vaginal symptoms. Data on the Vaginal Health Index (VHI), vaginal length (VL), vaginal pain measured using a Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI) were collected at baseline and before each laser application, and at subsequent follow-up visits. A total of 170 laser applications were performed on 113 women with various types of cancer. Most patients (57.5%) had received radiotherapy-based treatments before receiving laser treatment. Vaginal health parameters and sexual function improved significantly with each laser application. However, a temporary decline in these improvements occurred during the intervals between cycles. Such worsening was reversed with the subsequent cycle in all groups of patients, irrespective of the type of oncological treatments they had undergone. Multiple course vaginal laser therapy showed promising results as a potential treatment for vaginal atrophy in heavily treated gynecological and breast cancer patients, necessitating further research to determine the optimal time interval between cycles to ensure sustained positive effects.
Chiara Perrone, Roberto Angioli, Daniela Luvero, Andrea Giannini, Violante Di Donato, Ilaria Cuccu, Ludovico Muzii, Francesco Raspagliesi, and Giorgio Bogani
XMLink
Mutations in genes encoding for proteins along the RAS-RAF-MEK-ERK pathway have been detected in a variety of tumor entities including ovarian carcinomas. In the recent years, several inhibitors of this pathway have been developed, whose antitumor potential is currently being assessed in different clinical trials. Low grade serous ovarian carcinoma, is a rare gynecological tumor which shows favorable overall survival, compared to the general ovarian cancer population, but worrying resistance to conventional chemotherapies. The clinical behavior of low grade serous ovarian carcinoma reflects the different gene profile compared to high-grade serous carcinoma: KRAS/BRAF mutations. BRAF inhibitors as single agents were approved for the treatment of BRAF mutated tumors. Nevertheless, many patients face progressive disease. The understanding of the mechanisms of resistance to BRAF inhibitors therapy and preclinical studies showing that BRAF and mitogen-activated protein kinase kinase (MEK) inhibitors combined therapy delays the onset of resistance compared to BRAF inhibitor single agent, led to the clinical investigation of combined therapy. The aim of this paper is to review the efficacy and safety of the combination of BRAF plus MEK inhibitors on ovarian carcinomas, in particularly focusing on low grade serous ovarian carcinoma.
Stefano Restaino, Giulia Pellecchia, Martina Arcieri, Giorgio Bogani, Cristina Taliento, Pantaleo Greco, Lorenza Driul, Vito Chiantera, Alfredo Ercoli, Francesco Fanfani,et al.
MDPI AG
Cervical cancer continues to have a significant incidence, despite global efforts in HPV vaccination campaigns. Managing this condition involves a diverse team of healthcare professionals. Research in this field is undergoing a period of great revolution in multiple areas, and international guidelines will soon have to adapt to new scientific evidence. This could be true mainly in locally advanced stages, and it could also be true for minimal invasive surgery. This paper aims to summarize and compare the most recent recommendations published by international gynecological oncological societies for patients with cervical cancer. From their comparison, common aspects and disagreements emerged, especially in the diagnostic pathway and follow-up strategies. Several issues that remain to be debated in the literature were addressed and compared, highlighting similarities and differences, from the role of the sentinel lymph node in early stages to that of the adjuvant hysterectomy in locally advanced tumors. On the surgical side, for this last subset of patients, currently, a laparotomic approach is recommended. At the same time, the advent of immunotherapy has just opened up new and promising scenarios in systemic treatment for locally advanced cervical cancer, and international guidelines will soon introduce it into their algorithms.
Ilaria Cuccu, Tullio Golia D’Augè, Noemi Tonti, Emanuele De Angelis, Roberta Arseni, Giorgio Bogani, Ottavia D’Oria, Angela Musella, Giorgia Perniola, Ludovico Muzii,et al.
IMR Press
Objectives : Until 2018, cervical cancer (CC) was clinically staged; however, it was frequently under-staged. For this reason, in 2018, the International Federation of Gynecology and Obstetrics (FIGO) incorporated the imaging assessment into the staging of this malignancy. The aim of this review is to discuss available data regarding the role of imaging in the diagnosis, pretreatment staging, and how an adequate radiological evaluation could assist in the treatment planning for CC. Mechanism : An extensive literature search was conducted to identify relevant studies across various databases, including articles addressing topics related to imaging used in CC. The selected articles underwent thorough examination and evaluation to identify studies that met the objectives of this review, taking into account the specified inclusion and exclusion criteria. Subsequently, relevant data were extracted and analyzed for each article. Findings in Brief : Transvaginal ultrasound (TVS) and transrectal ultrasound (TRUS) have been shown to be accurate diagnostic tools to assessing the local spread of CC disease. Currently, magnetic resonance imaging (MRI) appears to offer the highest sensitivity, specificity, and accuracy in detecting parametrial and stromal invasion, as well as tumor size. Computed tomography (CT) and contrast-enhanced (CE)-CT are considered the best imaging modalities for the detection of lymph node metastases. However, positron emission tomography (PET) has demonstrated notable precision and exhibited high negative predictive value in predicting the pelvic nodal status during the early-stage diagnosis of CC diagnosis. Radiomics represents a newly introduced field of translational research with the potential to predict several clinically and pathological relevant variables in cervical carcinoma patients. These variables include disease staging, histological type, lymph node status, probability of recurrence, and estimated survival. Conclusions : Imaging plays an indispensable role in diagnosis, tumor staging, and monitoring the evolution of pathology in response to therapies over time. It provides physicians with the indispensable tool for optimal regulation of therapeutic strategy.
T. Golia D’Augè, I. Cuccu, A. Etrusco, A. D’Amato, A.S. Laganà, O. D’Oria, G. Bogani, V. Di Donato, L. Muzii, and A. Giannini
Edra SpA
Umberto Leone Roberti Maggiore, G Bogani, Biagio Paolini, Fabio Martinelli, Giulia Chiarello, Ludovica Spanò Bascio, Valentina Chiappa, Simone Ferrero, Antonino Ditto, and Francesco Raspagliesi
BMJ
ObjectiveTo compare survival outcomes and patterns of recurrence between endometriosis-associated ovarian cancer patients and non-endometriosis-associated ovarian cancer patients.MethodsThis retrospective study included data of consecutive patients with endometrioid or clear cell ovarian cancer treated at the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano between January 2010 and June 2021. Patients were assigned to one of two groups according to the absence or presence of endometriosis together with ovarian cancer at final histological examination. Survival outcomes were assessed using Kaplan-Meier and Cox hazard models. Proportions in recurrence rate and pattern of recurrence were evaluated using the Fisher exact test.ResultsOverall, 83 women were included in the endometriosis-associated ovarian cancer group and 144 in the non-endometriosis-associated ovarian cancer group, respectively. Patients included in the non- endometriosis-associated ovarian cancer group had a shorter disease-free survival than those in the endometriosis-associated ovarian cancer group (23.4 (range 2.0–168.9) vs 60.9 (range 4.0–287.8) months; p<0.001). Univariable and multivariable analyses showed that the association with endometriosis, previous hormonal treatment, early stage at presentation, and endometrioid histology were related to better disease-free survival in the entire study population. Similarly, patients in the non-endometriosis-associated ovarian cancer group had a shorter median (range) overall survival than those in the endometriosis-associated ovarian cancer group (54.4 (range 0.7–190.6) vs 77.6 (range 4.5–317.8) months; p<0.001). Univariable and multivariable analyses showed that younger age at diagnosis, association with endometriosis, and early stage at presentation were related to better overall survival. The recurrence rate was higher in the non-endometriosis-associated ovarian cancer group (63/144 women, 43.8%) than in the endometriosis-associated ovarian cancer group (17/83 women, 20.5%; p<0.001).ConclusionsEndometriosis-associated ovarian cancer patients had significantly longer disease-free survival and overall survival than non-endometriosis-associated ovarian cancer patients, while the recurrence rate was higher in non-endometriosis-associated ovarian cancer patients.
Andrea Giannini, Ilaria Cuccu, Tullio Golia D'Auge, Emanuele De Angelis, Antonio Simone Laganà, Vito Chiantera, Donatella Caserta, Salvatore Giovanni Vitale, Ludovico Muzii, Ottavia D'Oria,et al.
Elsevier BV
Antonino Ditto, Mariangela Longo, Giulia Chiarello, Luigi Mariani, Biagio Paolini, Umberto Leone Roberti Maggiore, Fabio Martinelli, Giorgio Bogani, and Francesco Raspagliesi
Elsevier BV
G. Bogani, B.J. Monk, M.A. Powell, S.N. Westin, B. Slomovitz, K.N. Moore, R.N. Eskander, F. Raspagliesi, M.-P. Barretina-Ginesta, N. Colombo,et al.
Elsevier BV
Giorgio Bogani, Francesco Sopracordevole, Andrea Ciavattini, Enrico Vizza, Paolo Vercellini, Fabio Ghezzi, Giovanni Scambia, Violante Di Donato, Andrea Giannini, and Francesco Raspagliesi
Wiley
Human papillomavirus (HPV) is the primary cause of cervical dysplasia and cervical cancer. Attempts are needed to better categorize patients with HPV in order to provide useful information for prognosticating and appropriately tailoring surveillance.