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Pancreatic metastases are rare, <2% of all pancreatic neoplasia. This is the first case of pancreatic metastasis from adamantinoma, a rare, low grade and slow growing tumor which is frequently localized in long bones. We describe a case of a 45-year-old woman presenting with increased bilirubin level. Computed tomography and ecoendoscopic ultra sonography revealed a pancreatic head mass. Fine-needle aspiration biopsy was consistent with metastatic adamantinoma. The patient was submitted to a standard pancreaticoduodenectomy. As in the case presented, standard pancreatic resections are safe and feasible options to treat non-pancreatic primary tumor improving patient’s survival and quality of life.

Abstract Background Access to quality Home Palliative Care (HPC) is a public health priority. This study analyzed HPC services in Piedmont, a large, diverse Italian region (4.3 million inhabitants), as a case study to understand organizational variations in complex settings and inform equity-focused policies. Methods A cross-sectional survey covered Piedmont's 12 Local Health Authorities (LHAs) and 35 districts. Pre-pandemic data for 2019 were collected in 2023 via in-person questionnaires and interviews with HPC managers/directors. Key structural, process, and outcome indicators were analyzed descriptively. 2022 data were collected for comparison. Results Substantial heterogeneity was found across LHAs in 2019. Formal Local Palliative Care Networks existed in only 8/12 LHAs. Dedicated HPC units were present in 11/12 LHAs, but with varying structures and staffing (physician Full-Time Equivalents, or FTEs, range 0.59-3.00 per 100,000 inhabitants; regional average 1.71, below standards). Nurse FTE data faced challenges. Care pathways showed fragmentation and coordination with emergency services were limited, but psychological support was guaranteed. Large disparities emerged in care intensity (ratio of actual assistance days to total care days range 0.09-0.64) and place of death for cancer patients (home deaths range 6.26%-44.03%). Fragmented data systems hindered monitoring. The 2019-2022 comparison showed improvements (hospital deaths decreased from 23.6% to 16.0%) but confirmed persistent heterogeneity. Conclusions Mapping revealed marked variability in Piedmont's HPC organization, resourcing, delivery, and outcomes. Key challenges identified include network gaps, resource disparities (esp. physicians), fragmented models/pathways, poor care continuity, and inadequate monitoring. Addressing these disparities requires understanding a complex, often poorly documented system lacking systematic data. This study offers a valuable methodology applicable in similar contexts. Key messages • Mapping regional Home Palliative Care reveals significant disparities in organization, resources, and outcomes, impacting equity of access and quality. • Detailed regional analysis provides an evidence base for targeted policies and standardized improvements towards equitable, high-quality HPC across Europe.

Background To prevent the spread of SARS-CoV-2, containment measures were implemented leading to huge healthcare changes worldwide. This study aimed to describe the impact of COVID-19 pandemic on surgical oncology healthcare in a large Italian sample. Methods A retrospective observational study included 99651 patients admitted to the hospitals of Piedmont (Northern Italy) to undergo oncological surgery, provided in ordinary hospitalization. We compared data of 2020 with 2016-2019 mean values. Data were stratified by tumor site, year, month and admission way. Chi-squared tests were used to assess differences in the percentage of admission modes between 2020 and 2016-2019. Results An overall reduction in oncological surgery (-12.3%) was observed in 2020 (n = 17923) compared to the mean of period 2016-2019 (n = 20432). A relevant decrease began in March (-11%), continued in April (-18%) and peaked in May (-26%). There was a greater reduction in surgery of breast (-19.2%), bladder (-17.5%), colorectal (-16.5%), kidney (-14.2%), prostate (-14%). Little or no difference was observed for liver (-5.2%), body of uterus (-0.54%), ovary (-0.07%), lymphoma (+4.5%). There was a marked reduction of non-emergency admissions (-13.6%), in particular for some tumor sites: colorectal (-19.4%), breast (-19.4%), bladder (-18.7%). The overall volume of surgeries following an emergency access was unchanged (-0.3%). The proportion of hospitalizations with emergency access increased (p < 0.001). Conclusions Our results highlight the burden of the reduction in cancer surgery in 2020 and the risk of delays in diagnosis and treatment for time-dependent conditions. For cancers that can be diagnosed early thanks to screening, the reduction in surgery is likely to be an indirect consequence of discontinuing screening activities. Therefore, further studies are needed to assess, as soon as data are available, the trend in 2021, and to compare our results with those reported in other European countries. Key messages • The COVID-19 pandemic caused a significant decline in cancer surgeries in 2020 in Piedmont, Italy. It is necessary to compare our results with those reported in other European countries. • These results show an increase in the proportion of oncological surgical admissions following emergency access in 2020 compared to the average for 2016-2019.

To investigate the possible role of imatinib, an inhibitor of the tyrosine kinase activity of PDGF-R, in desmoplastic small round cell tumor (DSRCT). From August 2005 to June 2009, DSRCT patients refractory to conventional treatment were enrolled. Patients received imatinib 400 mg daily. Primary end point of this open label, prospective, Phase II trial was objective response rate. Of the 13 enrolled patients, eight were evaluable for response. Median age was 20 years (range: 9-32). Objective responses at 3 months were: stable disease in one patient and progressive disease in seven patients. Imatinib showed no efficacy in the treatment of DSRCT unresponsive to conventional therapy, despite molecular-based selection of patients.

Objective Percutaneous biopsies are gaining acceptance in the diagnosis of soft-tissue tumours. Sampling in the most representative area is not easy in sarcomas of huge dimension. We hypothesised that ultrasound (US) contrast medium could identify the representative area for focus core-needle biopsy (CNB) Methods This is a retrospective cohort series of 115 soft-tissue masses treated from January 2007 to November 2008. Accuracy of US-guided CNB after contrast-enhanced US (CEUS) was determined by comparing the histology of the biopsy with the definitive diagnosis in 105 surgically excised samples (42 benign, 63 malignant) and with the expected outcome in the remaining ten malignant cases not surgically treated. A myxoid component was present in 21 sarcomas (34.4%). Results Of samples, 94.8% were adequate for diagnosis with 97.1% sensitivity and 92.5% specificity. Sensitivity and specificity in specific histopathological subgroupings were 100%, and in grading definition they were 100% and 96.8%. Discussion US-guided CNB is safe and effective. US contrast medium depicts tumour vascular supply and identifies the representative area(s) for sampling. Sensitivity and specificity are also high in subgrouping and grading, including myxoid types. Discussion about biopsy is part of the essential multidisciplinary strategy for these tumours.

The aim of this study is to compare the quality of life and the levels of anxiety and depression in a relatively large group of subjects undergoing chemotherapy for soft tissue sarcoma and a control group of subjects undergoing chemotherapy for the most common types of cancer. 56 soft tissue sarcoma affected patients and 56 patients with common tumours, homogeneous in regards to stages of disease and sociodemographic characteristics, were enrolled in two oncological centres in Turin, Italy. Quality of life was assessed by Functional Assessment of Cancer Therapy-General and anxiety and depression by Hospital Anxiety and Depression Scale. All patients had ongoing chemotherapy. The comparison between the two groups shows no difference in either quality of life or in anxiety and depression. There are instead gender differences, since females in the group of common tumours show higher levels of anxiety in comparison to those affected by sarcomas, while males show, at a lower degree, the opposite trend. This study suggest that levels of Quality of Life, anxiety and depression are similar in rare and common tumours. The majority of patients are able to cope with the disease in an adaptive manner. However, for some patients the disease poses a threat to their physical and mental integrity; psychological support of these patients may reduce the development of significant morbidity and help patients to better manage the course of the disease and the effects of the treatment.

Background The results of Phase III of the (SSG)XVIII/AIO clinical study on imatinib (IM) in adjuvant treatment of GIST show that, after five years of follow up, 3 years of treatment lead to 66% of patients free of recurrence compared to 48% who received IM for only one year, with a 18% relative risk reduction. This result will determine the new standard of 3 years of adjuvant IM treatment in GIST patients at high risk of recurrence. Purpose To analyse the budget impact on Piedmont Region, over 3 years, after the approval by the Italian National Regulatory Agency of 3 years’ adjuvant treatment in high-risk GIST. Materials and Methods The analysis was performed considering the estimated incidence of 60 new cases of GIST in Piedmont: 28 patients are at very low/low risk of relapse and don’t need IM; 8 patients are at intermediate risk of recurrence and should receive IM only for 1 year; 12 patients are at very high/high risk and are treated with adjuvant IM for 3 years; 12 patients are metastatic at diagnosis and require lifelong treatment (5–13 years). The price of IM considered in this study was fixed (6–2011) in the regional competition in Piedmont (at 16.7305€/100 mg capsule). Results The annual expenditure for 12 very high/high risk patients is 293,118.6€ which adds up to a total of 879,355.08€ in 3 years. Given the stability of GIST incidence (5 cases/1,000,000 people) and 30% drop off from treatment for intolerance as reported in the SSG/AIO study, the result of our study was: in the first year 12 patients were treated at a total cost of 293,118.36€. The second year for 20 patients (8 from the first year + 12 new) the expenditure was 488,530.6€ (+66.66%). The third year there were 27 patients (7 from the first year, 8 from the second year, 12 new) and a total amount of 659,516.31€ (+35% compared to the second year). The total expenditure on very high/high risk patients at the end of 3 years of observational study was 1,441,165.27€ and the overall incremental cost was +125%. Conclusions The cost of health interventions in rare tumours should be carefully planned with a specific cancer and pharmacological registry. The availability of comprehensive databases or regional registries of these treatments would allow a more accurate analysis that takes into account both the cost of medicines and ambulatory treatment and follow-up cost. Even though data on current costs are alarming it is important to consider that in 2014 IM will lose the Novartis patent and costs will drop about 30–40%. No conflict of interest.

Purpose This phase II study was designed in order to evaluate efficacy and safety of the combination of vinorelbine (VNB), fluorouracil (FU) and leucovorin (LV) in patients with metastatic breast carcinoma (MBC) previously treated with anthracyclines and taxanes. Methods From 12/2003 to 12/2007, 51 women (median age 59) were treated. Performance status (PS) (ECOG) was 0-2 (median 0). The chemotherapy consisted of VNB 25 mg/sqm on day 1 added to FU and LV (following De Gramont schedule) on day 1 and 2. Treatment was repeated every 14 days. 518 cycles of CT were administered (median 12). Most common sites of metastatic spread were: bone, liver, lymph nodes, lung. Results We recorded three cases of G4 neuthropenia and in one case it was febrile; no others G4 toxicities were seen. G3 toxicities were more common, especially neuthropenia (8 patientss) asthenia (4) mucositis (2) and Hand-Foot Syndrome (2). Overall response rate was 27.5% (14 patients had a PR) and disease control rate was 76.5%; 12 patients experienced disease progression. Median time to progression (TTP) was 7.70 months and overall survival (OS) was 18.70 months. Conclusions Results demonstrate that the ViFL regimen has substantial activity in patients with MBC already treated with anthracyclines and taxanes. The combination may be considered a valid choice for the treatment of MBC. Better survival results were seen in patients with visceral metastases than bone involvement. The low response rate shows that the ViFL regimen is not suitable for the neoadjuvant setting.

To evaluate the feasibility and activity of gemcitabine and vinorelbine as a second/third-line approach in patients with advanced breast cancer. Entered into the study were 51 consecutive patients. All had been previously treated with anthracyclines. Of these 51 patients, 36 had experienced failure or relapse after one chemotherapy line for advanced disease, and 15 after two chemotherapy lines. The dominant sites of involvement were brain in 4 patients (7.8%), liver in 22 (43.2%), lung in 10 (19.6%), bone in 10 (19.6), and soft-tissue in 5 (9.8%). Treatment consisted of vinorelbine 25 mg/m(2) and gemcitabine 1000 mg/m(2) administered on days 1 and 8 every 21 days. The scheme was well tolerated. Grade 3/4 neutropenia was observed in 11% of patients. Grade 3 nausea and vomiting occurred in 6%, and grade 2 neurotoxicity in 6%. No patients experienced grade 3/4 alopecia. The median relative dose intensity was 94.6% (49.7-100%) and 90.0% (23.1-100%) for vinorelbine and gemcitabine, respectively. Two patients (3.9%) were not evaluable for disease response, 4 (7.8%) attained a clinical complete response, 13 (25.5%) a partial response (for an overall response rate of 33.3%, 95% coefficient interval 20.0-46.0%), 23 (45.2%) showed stable disease, and 9 (17.6%) progressed. The median time to progression of responding patients was 10.8 months, and the median overall survival of the entire population was 17.8 months. Vinorelbine and gemcitabine is a manageable scheme with moderate activity in pretreated patients with advanced breast cancer.