Progressive Sensorineural Hearing Loss Following Cisplatin Chemotherapy: Mechanisms Underlying Cochlear Retention and Long-Term Ototoxicity Antonio Ruggiero, Pasqualina Maria Picciotti, Stefano Mastrangelo, Alberto Romano, Dario Talloa, Jacopo Galli, Giorgio Attinà Pharmaceuticals, 2026 Cisplatin-induced ototoxicity is a permanent, bilateral sensorineural hearing loss occurring in up to 80% of treated patients. Its defining and clinically challenging feature is the progressive worsening of auditory function that continues well after chemotherapy has ended, a trajectory that cannot be explained by cumulative dose alone. This article is a comprehensive review of the present research studies on mechanisms that are responsible for this post-treatment progression. The cochlea, unlike other organs, appears to be unable to eliminate platinum (the active divalent metal ion released from cisplatin and responsible for its cytotoxic and ototoxic effects): traces of it can be found in human temporal bone tissue even more than 18 months after last infusion, and bone might serve as a long-term systemic reservoir. Within the inner ear, platinum accumulates preferentially in the stria vascularis, impairing endocochlear potential and outer hair cell function. Retained platinum sustains cascading effects including sustained NOX3-dependent oxidative stress, mitochondrial dysfunction, ongoing genotoxic injury to non-regenerative cells, and the early loss of ribbon synapses that precipitates delayed spiral ganglion neurodegeneration. Pharmacogenetic variability in platinum transport and antioxidant metabolism further modulates individual susceptibility. These findings support lifelong audiological surveillance and provide a basis for designing strategies that can protect hearing without compromising the essential anticancer efficacy of cisplatin therapy.
Effects of Clay Therapy on Emotional and Physical Outcomes in Hospitalized Pediatric Cancer Patients: A Prospective Pilot Study Antonella Guido, Alberto Romano, Laura Peruzzi, Matilde Tibuzzi, Serena Sannino, Paola Adamo, Daniela Pia Rosaria Chieffo, Antonio Ruggiero Cancers, 2026 Background: Pediatric cancer is a highly stressful and potentially traumatic condition affecting physical health, emotional well-being, developmental trajectories, and family functioning. Hospitalization and intensive treatments often exacerbate emotional distress and symptom burden, negatively impacting quality of life (QoL). Integrating psychosocial and expressive interventions into pediatric oncology care is increasingly recognized as essential. Clay therapy is a multisensory, hands-on creative intervention that may promote emotional regulation, coping, and a sense of agency in hospitalized children. Objectives: This prospective pilot study evaluated the effects of clay therapy on emotional and physical well-being in pediatric oncology patients and explored potential indirect effects on caregivers’ emotional status. Methods: From December 2023 to December 2024, forty hospitalized children with onco-hematological diseases and one parent per patient were enrolled. Each child participated in a one-hour clay therapy workshop led by a professional ceramist. Emotional outcomes were assessed before (T0) and immediately after (T1) the intervention using the Visual Analog Scale (VAS) and the ArtsObs observational scale. Physical symptoms, including pain, fatigue, and nausea, were also evaluated. Results: Following clay therapy, children showed statistically significant improvements across all VAS emotional domains, independent of age and gender. ArtsObs assessments confirmed a significant increase in observed mood, with high levels of relaxation and engagement; female patients demonstrated greater mood improvement than males. Significant reductions in pain, fatigue, and nausea were also observed. Parents exhibited a significant improvement in mood following their child’s participation. Conclusions: These findings suggest that clay therapy is feasible and could be an effective supportive intervention in pediatric oncology, benefiting both emotional and physical well-being. Its integration into multidisciplinary, family-centered care models may enhance QoL during hospitalization and provide holistic support for children with cancer and their families.
Diencephalic Syndrome: Clinical Features, Pathophysiology, and Long-Term Outcomes Antonio Ruggiero, Palma Maurizi, Alberto Romano, Fernando Fuccillo, Dario Talloa, Stefano Mastrangelo, Giorgio Attinà Children, 2026 Background/Objectives: Diencephalic syndrome (DS) is an uncommon pediatric disorder presenting with severe failure to thrive despite adequate caloric intake and preserved linear growth. First characterized by Russell, this condition predominantly affects infants under 12 months and remains diagnostically challenging. Methods: We performed a comprehensive literature review examining clinical presentation, underlying pathophysiology, associated pathology, diagnostic approaches, and long-term outcomes of DS. Results: DS typically manifests in the first year of life with profound cachexia, normal or increased appetite, preserved height velocity, and characteristic features including hyperactivity, euphorism, and visual pathway involvement. Low-grade gliomas of the hypothalamic–chiasmatic region, particularly pilocytic astrocytomas, represent the predominant underlying pathology. The pathophysiological mechanisms remain incompletely understood but likely involve complex dysregulation of hypothalamic energy homeostasis. While overall survival exceeds 90% at five years, most patients experience significant long-term morbidity including visual impairment, multiple endocrine deficiencies, and hypothalamic obesity. Diagnostic delays averaging 11 months contribute to irreversible complications. Conclusions: Early recognition of DS is essential to prevent permanent visual loss and optimize outcomes. Multidisciplinary management incorporating chemotherapy as first-line treatment for underlying gliomas has improved survival while reducing radiation-associated toxicities. However, survivors face substantial lifelong sequelae requiring comprehensive monitoring and intervention. Future research should focus on elucidating precise pathophysiological mechanisms, developing targeted molecular therapies, and improving management of hypothalamic obesity and other late effects.
Concurrent chemoradiotherapy with temozolomide in newly pediatric diffuse intrinsic pontine glioma: clinical outcomes and safety analysis Giorgio Attinà, Palma Maurizi, Alberto Romano, Dario Talloa, Tommaso Verdolotti, Paolo Frassanito, Gianpiero Tamburrini, Silvia Chiesa, Stefano Mastrangelo, Antonio Ruggiero Translational Pediatrics, 2026 Background: Diffuse intrinsic pontine glioma (DIPG) is one of the most aggressive pediatric brain tumors, with a median overall survival of less than 12 months despite radiotherapy remaining the current standard of care. This study aimed to evaluate the clinical outcomes and toxicity of concurrent radiotherapy with temozolomide followed by adjuvant therapy in newly diagnosed pediatric DIPG. Methods: /day, days 1-5, every 28 days for ≤13 cycles) was conducted. Primary endpoints included overall survival (OS), progression-free survival (PFS), and treatment-related toxicity. Response assessment utilized standardized neuroimaging criteria at predetermined intervals. Results: Median age was 7 years (range, 3-16 years). H3K27M mutation was detected in 74% of biopsied cases (14/19). Post-radiotherapy imaging showed partial response in 12 patients (50%), stable disease in 9 (38%), and progression in 3 (12%). Median OS was 12.0 months [95% confidence interval (CI): 7.0-14.0]; median PFS was 9.0 months (95% CI: 7.0-12.0). One- and two-year OS rates were 54% and 8%, respectively. Grade 3-4 hematological toxicity occurred in 10 patients (42%): leucopenia (n=4), thrombocytopenia (n=6). No treatment-related deaths occurred. Conclusions: Concurrent chemoradiotherapy achieved encouraging response rates with manageable toxicity profile. However, survival outcomes remain limited, underscoring the need for novel therapeutic approaches targeting specific molecular pathways in this devastating malignancy.
Complete response to pembrolizumab in a paediatric patient with Lynch syndrome-associated colorectal cancer: a case report and review of immunotherapy-related bowel obstruction Antonio Ruggiero, Fernando Fuccillo, Palma Maurizi, Alberto Romano, Dario Talloa, Stefano Mastrangelo, Michele Basso, Vito Briganti, Maria Cristina Giustiniani, Roberto Persiani, Giorgio Attinà Drugs in Context, 2026 Colorectal cancer (CRC) is extremely rare in paediatrics with aggressive histopathology and advanced presentation. Whilst pembrolizumab has shown efficacy in adult microsatellite instability-high or mismatch repair deficiency CRC, paediatric data remain scarce. A 12-year- old boy with Lynch syndrome-associated CRC developed severe cardiac toxicity after initial chemotherapy. Treatment was switched to off-label pembrolizumab, resulting in a complete response after 24 cycles. Despite good tolerability, the patient developed a delayed bowel stricture at the tumour site. After surgery, there was no pathological evidence of residual adenocarcinoma. This case demonstrates the potential of pembrolizumab in paediatric CRC, highlighting the importance of molecular-guided rather than age-restricted therapy selection.
Adolescent Renal Tumours: Diagnostic and Therapeutic Challenges in a Transitional Age Group—A Multidisciplinary Case Report Series from a Single Center Antonio Ruggiero, Fernando Fuccillo, Valerio Di Paola, Alberto Romano, Palma Maurizi, Dario Talloa, Nazario Foschi, Pierluigi Russo, Marco Racioppi, Stefano Mastrangelo, Giorgio Attinà Oncology Research, 2026 Background: The management of renal neoplasms in adolescent patients poses unique clinical challenges due to their transitional position between paediatric and adult populations. This age group exhibits marked heterogeneity in tumour histology, ranging from entities commonly observed in paediatric oncology to tumours typical of adult age, as well as rare histological subtypes that exceptionally affect the kidney. Given the substantial differences in clinical protocols between paediatric and adult populations, rigorous multidisciplinary evaluation is essential to determine optimal diagnostic and therapeutic strategies for adolescent patients. Case Description: We present four cases from our tertiary referral centre that illustrate the variability in radiological and histopathological presentations and clinical outcomes in this population, underscoring the critical importance of a multidisciplinary approach. Case 1 demonstrates the typical management of Wilms' tumour in an older paediatric patient. Case 2 exemplifies the diagnostic challenge of distinguishing between Wilms' tumour and renal cell carcinoma at the upper end of the adolescent spectrum. Case 3 revealed the unexpected diagnosis of renal Ewing sarcoma in a 13-year-old female. Case 4 highlights the potential for severe perioperative complications, including life-threatening thromboembolic events, in a patient with Wilms' tumour. Conclusions: The variability in tumour types, biological behaviour, and potential for severe complications underscores the necessity of comprehensive multidisciplinary management in specialized hospital settings. An integrated approach ensures accurate diagnosis, individualized treatment planning, and effective management of complications, ultimately optimizing outcomes for adolescent patients with renal neoplasms.
The state of targeted therapeutic pharmacological approaches in pediatric neurosurgery: report from the European Society for Pediatric Neurosurgery (ESPN) Consensus Conference 2024 P. Frassanito, U. W. Thomale, M. Obersnel, A. Romano, P. Leblond, F. Knerlich-Lukoschus, B. J. Due-Tønnessen, D. Thompson, F. Di Rocco, and Child S Nervous System, 2025 Objective The development of novel targeted therapies is opening new perspectives in the treatment of pediatric brain tumors. Their precise role in therapeutic protocols still needs still to be defined. Thus, these novel pharmacological approaches in pediatric neurosurgery were the topic of the European Society for Pediatric Neurosurgery (ESPN) Consensus Conference held in Lyon (France) in January 25–27, 2024. Method The paper reviews the current knowledge about targeted therapy as well as the current literature published on the topic. The conference aimed for an interdisciplinary consensus debate among pediatric oncologists and pediatric neurosurgeons on the following questions. Question 1: What is the current role for targeted therapies as neoadjuvant treatments before pediatric brain tumor removal? Question 2: What are the benefits, cost/efficiency, and long-term side effects of targeted therapies in the treatment of pediatric brain tumors? Question 3: Based on contemporary data, at which stage and in which pathologies do targeted therapies play a significant role? Results Ninety-two participants answered consensus polls on the state of the art of targeted therapies, the ethical issues related to their use, and the evolving change in the role of pediatric neurosurgeons. The neoadjuvant role of targeted therapies is difficult to define as there are many different entities to consider. Despite the recently reported potential benefits, questions regarding the use of targeted therapies are manifold, in particular regarding sustainable benefits and long-term side effects. Additionally, challenging cost issues is a limiting factor for the broader availability of these drugs. Studies have demonstrated superiority of targeted therapy compared to chemotherapy both in randomized trials and compared to historical cohorts in the management of a subset of low-grade gliomas. The same drug combinations, BRAFi and MEKi, may be effective in HGG that have relapsed, progressed, or failed to respond to first-line therapy. Similar conclusions on efficacy may be drawn for mTORi in TSC and selumetinib in plexiform neurofibromas. For other tumors, the picture is still obscure due to the lack of data or even the lack of suitable targets. In conclusion, targeted treatment may not always be the best option even when a target has been identified. Safe surgery remains to be a favorable option in the majority of cases. Conclusion The constantly evolving drug technology and the absence of long-term safety and efficacy studies made it difficult to reach a consensus on the predefined questions. However, a report of the conference is summarizing the present debate and it might serve as a guideline for future perspectives and ongoing research.
The influence of tumor location on the onset of endocrine deficits in pediatric brain tumor survivors Giorgio Attinà, Alberto Romano, Palma Maurizi, Tommaso Verdolotti, Stefano Mastrangelo, Antonio Ruggiero Translational Cancer Research, 2025 Background: Pediatric central nervous system (CNS) tumors are the second most common malignancy in children and are associated with significant long-term morbidity despite advancements in therapy. Endocrine dysfunction is one of the most frequent and impactful late sequelae, requiring timely detection and management. This study aimed to investigate the timing and risk factors associated with endocrine dysfunction in pediatric brain tumor survivors and to propose optimized follow-up protocols. Methods: A cohort of 33 pediatric patients with brain tumors, excluding craniopharyngiomas, pituitary adenomas, and germ cell tumors, treated at the Pediatric Oncology Unit of Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS in Rome (2005-2015), was retrospectively analyzed. Endocrine dysfunction was assessed through clinical and laboratory evaluations, with a median follow-up of 114.1 months. Results: Endocrine dysfunction was identified in a high percentage of patients, with hypothyroidism and panhypopituitarism being the most common. Age at diagnosis and treatment influenced the appearance and the timing of dysfunction. Hypothalamic and suprasellar tumors were associated with early onset, while tumors in posterior cranial fossa exhibited delayed onset. Conclusions: Tumor location and patient age are critical determinants of the timing of endocrine dysfunction in pediatric brain tumor survivors. We propose a stratified follow-up based on tumor location, with immediate evaluation for hypothalamic and supratentorial tumors and periodic assessments for other regions. These tailored recommendations aim to ensure timely detection and management of endocrine complications, improving outcomes and quality of life. Future research with larger cohorts is needed to validate and refine these findings.
Metronomic Chemotherapy: An Alternative Strategy in Cancer Treatment Based on Continuous Low-Dose Administration Giorgio Attina, Stefano Mastrangelo, Alberto Romano, Dario Talloa, Palma Maurizi, Antonio Ruggiero Biomedical and Pharmacology Journal, 2025 Traditionally, cancer treatment relied on the maximum tolerated dose (MTD) approach, in which chemotherapeutic agents are given at the highest dose that patients can tolerate, with scheduled breaks to allow for recovery. However, this method has notable drawbacks, including significant toxicity, tumor regrowth during drug-free intervals, and the development of resistance. Metronomic chemotherapy offers an innovative alternative, characterized by continuous low-dose administration without treatment interruptions. This approach primarily targets the tumor microenvironment, including tumor vasculature and cancer stem cells, while also affecting the immune system. By maintaining a steady level of drug exposure, metronomic therapy prevents the recovery of tumor endothelial cells and enhances immune surveillance, leading to prolonged disease stabilization and potentially improved long-term outcomes. Due to its reduced toxicity, cost-effectiveness, and suitability for oral administration, metronomic chemotherapy is especially beneficial for long-term maintenance therapy for the elderly, or frail patients. This review explores the mechanisms, clinical advantages, and challenges of metronomic chemotherapy, as well as its potential for integration with other treatment modalities to improve patient outcomes. Additional research is needed to optimize drug dosing, identify biomarkers for treatment response, and conduct large-scale clinical trials comparing metronomic approaches with standard chemotherapy regimens.
Platinum-Induced Ototoxicity in Pediatric Cancer Patients: A Comprehensive Approach to Monitoring Strategies, Management Interventions, and Future Directions Antonio Ruggiero, Alberto Romano, Palma Maurizi, Dario Talloa, Fernando Fuccillo, et al. Children, 2025 Platinum-induced ototoxicity constitutes a significant adverse effect in pediatric oncology, frequently resulting in permanent hearing impairment with profound implications for quality of life, language acquisition, and scholastic performance. This comprehensive review critically evaluates contemporary ototoxicity monitoring practices across various pediatric oncology settings, analyzes current guideline recommendations, and formulates strategies for implementing standardized surveillance protocols. Through examination of recent literature-encompassing retrospective cohort investigations, international consensus recommendations, and functional outcome assessments-we present an integrated analysis of challenges and opportunities in managing chemotherapy-associated hearing loss among childhood cancer survivors. Our findings demonstrate marked heterogeneity in monitoring methodologies, substantial implementation obstacles, and considerable impact on survivors' functional status across multiple domains. Particularly concerning is the persistent absence of an evidence-based consensus regarding the appropriate duration of audiological surveillance for this vulnerable population. We propose a structured framework for comprehensive ototoxicity management emphasizing prompt detection, standardized assessment techniques, and integrated long-term follow-up care to minimize the developmental consequences of platinum-induced hearing impairment. This approach addresses critical gaps in current practice while acknowledging resource limitations across diverse healthcare environments.
Central nervous system pediatric multi-disciplinary tumor board: a single center experience Rosellina Russo, Tommaso Verdolotti, Alessandro Perna, Luigi Ruscelli, Rosa D’Abronzo, Alberto Romano, Giuseppe Ferrara, Davide Parisi, Amato Infante, Silvia Chiesa, Luca Massimi, Gianpiero Tamburrini, Antonio Ruggiero, Marco Gessi, Matia Martucci, Simona Gaudino BMC Cancer, 2024
Pathogenic G6PD variants: Different clinical pictures arise from different missense mutations in the same codon Simonetta Costa, Angelo Minucci, Amit Kumawat, Maria De Bonis, Giorgia Prontera, Mariannita Gelsomino, Milena Tana, Eloisa Tiberi, Alberto Romano, Antonio Ruggiero, Stefano Mastrangelo, Giuseppe Palumbo, Valentina Giorgio, Maria Elisabetta Onori, Martino Bolognesi, Carlo Camilloni, Lucio Luzzatto, Giovanni Vento British Journal of Haematology, 2024
European expert recommendations on clinical investigation and evaluation of high-risk medical devices for children Kathrin Guerlich, Bernadeta Patro‐Golab, Alex Barnacle, Ulrich Baumann, Andreas Eicken, Alan G. Fraser, Dariusz Gruszfeld, Nikolaus A. Haas, Anneliene H. Jonker, Michael Kammermeier, Damien Kenny, Sanja Kolaček, Risto Lapatto, Ian Maconochie, Silke Mader, Gearóid McGauran, Tom Melvin, Oliver Muensterer, Paul Piscoi, Alberto Romano, Amulya K. Saxena, Dominik T. Schneider, Mark A. Turner, Johan Vande Walle, Berthold Koletzko, and Acta Paediatrica International Journal of Paediatrics, 2023
Bisphosphonates: From Pharmacology to Treatment Antonio Ruggiero, Silvia Triarico, Alberto Romano, Palma Maurizi, Giorgio Attina, Stefano Mastrangelo Biomedical and Pharmacology Journal, 2023
Nutritional status in the pediatric oncology patients Silvia Triarico, Emanuele Rinninella, Giorgio Attinà, Alberto Romano, Palma Maurizi, Stefano Mastrangelo, Antonio Ruggiero Frontiers in Bioscience Elite, 2022
Hematological disorders in children with Down syndrome Silvia Triarico, Giovanna Trombatore, Michele Antonio Capozza, Alberto Romano, Stefano Mastrangelo, Giorgio Attinà, Palma Maurizi, Antonio Ruggiero Expert Review of Hematology, 2022
Managing children with brain tumors during the COVID-19 era: Don't stop the care! Michele Antonio Capozza, Silvia Triarico, Giorgio Attinà, Alberto Romano, Stefano Mastrangelo, Palma Maurizi, Paolo Frassanito, Federico Bianchi, Tommaso Verdolotti, Marco Gessi, Mario Balducci, Luca Massimi, Gianpiero Tamburrini, Antonio Ruggiero Computational and Structural Biotechnology Journal, 2021