Research ArticleClinical Studies

Impact of COVID-19 Pandemic on Surgical Breast Cancer Patients Undergoing Neoadjuvant Therapy: A Multicentric Study

GIANLUCA VANNI, MARCO PELLICCIARO, FRANCESCA COMBI, SIMONA PAPI, MARCO MATERAZZO, SILVIA SEGATTINI, STEFANO RIZZA, MARCELLO CHIOCCHI, TOMMASO PERRETTA, ROSARIA MEUCCI, ILARIA PORTARENA, CHIARA ADRIANA PISTOLESE, BENEDETTO IELPO, MICHELA CAMPANELLI, GIORGIO LISI, AGOSTINO CHIARAVALLOTI, GIOVANNI TAZZIOLI and ORESTE CLAUDIO BUONOMO
Anticancer Research September 2021, 41 (9) 4535-4542; DOI: https://doi.org/10.21873/anticanres.15265

Abstract

Background/Aim: Due to the SARS-CoV-2 pandemic, many scientific committees proposed neoadjuvant therapy (NACT) bridging treatment as a novel strategy and indication. The aim of the study was to evaluate the impact of COVID-19 pandemic on breast cancer patients undergoing NACT. Patients and Methods: All breast cancer patients referred to two Breast Units during COVID-19-pandemic were enrolled. Results: Out of 814 patients, 43(5.3%) were enrolled in the COVID-19-group and compared with 94 (7.9%) similar Pre-COVID-19 patients. We observed a reduction in the number of patients undergoing NACT, p=0.0019. No difference was reported in terms of clinical presentation, indications, and tumor response. In contrast, a higher number of vascular adverse events was reported (6.9% vs. 0% p=0.029). Immediate breast cancer reconstructions following invasive surgery suffered a significant slowdown (5.9% vs. 47.7%, p=0.019). Conclusion: COVID-19 caused a reduction in the number of patients undergoing NACT, with no changes in terms of indications, clinical presentation, and tumor response. Furthermore, there was an increased incidence of vascular events.

Key Words:

Neoadjuvant therapy (NACT) was introduced in the 1970s, aiming to downstage inoperable locally advanced breast cancer and turn it operable (1). Subsequently, NACT indications were extended to early breast cancer, aiming to permit more conservative breast surgeries (2). Nowadays, NACT is widely used, with the indications and aims changing frequently (3). NACT, a systemic treatment, might be somewhat more likely to eradicate micro-metastatic disease and improve overall survival than might a therapy delayed until after breast surgery (4, 5). Moreover, it permits to test tumor response to drug therapy in-vivo, which could be used as adjuvant treatment (5).

Since the beginning of the past year (2020), SARS-CoV-2 has dramatically spread worldwide and an epidemiological emergency was declared (6). Several restrictions and preventive measures were introduced as a strategy to flatten the epidemiological curve of the pandemic (7). All these measures have disturbed daily life and impacted public health; especially in non-COVID-19 related disease (8).

During the pandemic, clinicians caring for oncological patients must balance efforts and resources to adequately treat their patients while minimizing their access to the hospital in order to reduce the risk of exposure to coronavirus (9). Accordingly, many recommendations are issued by scientific committees and researchers for the management of breast cancer disease during the COVID-19 emergency (9, 10). All these proposals are driven by the common aim to preserve breast cancer treatments and avoid delays (11-13). Patients with a SARS-CoV-2 infection and a concomitant breast cancer diagnosis were strongly recommended to treat COVID-19 disease first, utilizing bridging therapy in order to avoid cancer progression (13, 14). In this perspective, a novel indication for NACT was emphasized and proposed as a strategy.

The aim of this study was to evaluate the impact of COVID-19 pandemic on the numbers, indications, and short-term outcome of breast cancer NACT.

Patients and Methods

Study design. In this retrospective study, we evaluated all patients with breast cancer diagnosis referred to Tor Vergata Breast (Tor Vergata Hospital, Rome, Italy) and to Modena Breast Units (Hospital of Modena, Modena, Italy) from March 1, 2019 to March 1, 2021.

One thousand nine hundred and eighty-four (n=1984) patients were considered in our study. This multicentric retrospective study was approved by the local Ethical Committee of the Fondazione Policlinico Tor Vergata (reference 122/21).

We analyzed all patients with breast cancer diagnosis, admitted to Tor Vergata Breast Unit and to at Modena Breast Unit undergoing neoadjuvant therapy from March 1, 2020 to March 1, 2021. These patients were designated as COVID-19 group and were compared with patients referred to both Breast departments during the same periods of the previous year (From March 1, 2019 to March 1, 2019), designated as Pre-Covid-19 group.

For each patient, ages, sex, type of tumor, date of diagnosis and tumor staging were reported.

Usually, pre-neoadjuvant diagnosis was obtained from a core needle biopsy or a Vacuum assisted biopsy. Tumor staging and lesions’ maximum diameter (reported in millimetres) were collected from breast magnetic resonance reports at diagnosis. Pre-neoadjuvant treatments and lymph nodes staging were collected from magnetic resonance imaging or positron emission tomography-computed tomography (PET-CT) scan. Metastasis was evaluated by PET-CT scan. SUV max of the primary tumor and of the lymph nodes were reported and analyzed. Breast cancer staging based on recommendations from AJCC 2018 (edition VIII) of TNM classification was reported (13). Data from biopsy specimens were included in this study. Tumor grading was reported from pathological examination. Prognostic and predictive factors for breast cancer [estrogen receptor (ER), progesterone receptor (PR), and Ki67 index] were collected and expressed as percentages of positive cells in specimens studied through immunohistochemistry. Over-expression of Her2 gene (HER2+) and a relative score were determined by immunohistochemistry and confirmed by FISH.

Administration of neoadjuvant chemotherapy or hormonotherapy, adverse events, type and duration of treatment data were collected from clinical notes, reported and analyzed between the groups.

Clinical response was defined by the primary tumor response after neoadjuvant treatments and evaluated by magnetic resonance (radiological response) and by surgical pathological examination (pathological response). Clinical response was reported and categorized as follows: complete response, complete radiographic resolution of tumor; partial response, 50% or greater reduction of tumor; stable disease, stable or no more than 25% increase or decrease in primary tumor size; progressive disease, more than 25% increase in tumor size.

Surgical procedure following neoadjuvant treatments was reported and distinguished between conservative surgery and invasive surgery. Conservative surgery included all surgical procedures with a partial gland removal while invasive surgery included all procedures with a complete removal of the glandular breast tissue.

The axillary surgical procedure was analysed. Patients without clinical or radiological lymph nodes involvement at pre neoadjuvant treatment underwent sentinel lymph node biopsy procedure. Otherwise, patients with previous malignant axillary involvement or sentinel lymph node positivity at frozen section examination underwent axillary lymph node dissection. Adjuvant radiotherapy, chemo and hormone therapy were reported and analyzed between the groups.

Statistical analysis. Data were collected into the EXCEL database (Microsoft, Washington, DC, USA). Continuous variables were reported with median and ranges. t-test was used to determine whether there were significant differences between the two groups. Categorical data were recorded in numbers and percentages. Analysis was performed using the Fisher’s exact test in case of dichotomous variables or Monte Carlo test for non-dichotomous variables. Variables with assigned p-values <0.05 were considered statistically significant. Statistical analysis was performed with SPSS statistical package version 23.0 (SPSS Inc., Chicago, IL, USA).

Results

From March 1, 2020 to March 1, 2021, eight hundred and fourteen (n=814) patients were discussed at the breast cancer multidisciplinary meetings (COVID-19 group) at Tor Vergata Breast and to at Modena Breast Units. This group was compared to the one thousand and one hundred seventy patients (n=1170) discussed in the same period of the previous year (Pre-COVID-19 group). During the pandemic, we observed an absolute reduction of roughly 30% of discussed cases.

Out of eight hundred and fourteen cases, in the COVID-19 group, forty-three (n=43) patients were to undergo breast cancer neoadjuvant therapy and fulfilled the inclusion criteria (5.3%). During the previous year, 94 cases (7.9%) underwent neoadjuvant treatment, showing a statistically significant difference, p=0.019. Out of these patients, no case of neoadjuvant treatment was reported in male patients during the COVID-19 period versus 1 case (1%) in the Pre-COVID-19 group, p=1.000. Medians of age were 53.7±11.2 years in the COVID-19 group and 53.6±12 years in the Pre-COVID-19 group, and the relative p value was 0.644. Only one patient (2.1%) received neoadjuvant hormone therapy as bridging therapy due to concomitant SARS-CoV2 infection during the pandemic periods versus no case in the control group (p=0.313).

In the COVID-19 group, 69 (73.4%), 12 (12.7%) and 1 (1%) case were determined as ductal carcinoma, lobular carcinoma and others, respectively. In the control group, respective incidences were 36 (83.7%), 7 (16.2%) and no case of other type of tumor. No statistically significant differences were found and the p value was 0.872.

Median tumor diameters at magnetic resonance were 34.31±18.2 mm in the COVID-19 group and 30.29±14.8 mm in the control group. Diameters of the lesions did not show a statistically significant difference between the groups, p=0.09. Despite larger dimension in the pandemic group, T distribution did not show a statistically significant difference, p=0.670. T staging is summarized in Table I.

View this table:
Table I.

Pre neoadjuvant tumor staging and prognostic and predictive factors.

Differently, primary lesions showed a statistically significant difference in term of SUV max at PET-CT scan with higher value during the pandemic 11.92±7.9 vs. 7.6±3.8, p=0.005. Lymph node maximum diameters at magnetic resonance were 13.61±8.72 mm in the COVID-19 group versus 14.31±10.30 mm in the pre-COVID-19 population and the relative p-Value was 0.383. Pre-NACT lymph nodes involvement did not show a statistically significant difference, p=0.137. N staging is summarized in Table I. Pre-NACT tumor grading did not show any statistically significant difference, its distribution and relative p are presented in Table I with other breast cancer prognostic and predictive factors.

No difference was reported between the groups in s of NACT therapeutic schedule p=0.991. Due to adverse events, 6 patients (13.9%) were suspended from NACT within three months. During the same period of the previous year, 5 patients (5.3%) reported NACT adverse events and chemotherapy was suspended, p=0.099. NACT adverse events leading to therapy suspension are presented in Table II with relative p-Values. During the pandemic, 3 cases (6.9%) of vascular disease leading to NACT suspension were reported. One case was pulmonary embolism, one deep vein thrombosis and one transient ischemic attack, and relative NSCT schedules were combined with monoclonal antibody in the first two cases and paclitaxel in the third. Patients with pulmonary embolism and deep vein thrombosis were associated with a previous SARS-CoV2 infection. No cases of vascular disease were reported in the pre-COVID-19 group, showing a statistically significant difference between groups, p=0.029.

View this table:
Table II.

Neoadjuvant chemotherapy adverse events leading to treatment suspension.

Both radiological and pathological tumor responses did not show any statistically significant difference between the two periods as shown in Table III, with respective p-Values of 0.854 and 0.820.

View this table:
Table III.

Neoadjuvant chemotherapy pathological and radiological response.

Seventeen patients (39.5%) underwent an invasive breast surgery during the pandemic and 26 (60.5%) received a breast conservative surgery. In the control group, pre-COVID-19, 44 (47.3%) cases undergone an invasive surgery and 49 cases (52.7%) received a conservative procedure. This surgical strategy did not show any statistically significant difference, p=0.460. Conversely, strategy of reconstruction showed a statistically significant difference between the two groups, p=0.019. During the pandemic, only 1 patient (5.9%) received an immediate breast reconstruction following mastectomy versus 21 (47.7%) during the previous year. In both groups, no patients received breast autologous reconstruction.

Surgical axillary procedure did not show a different trend between the two periods, p=0.054: 29 (67.4%) underwent sentinel lymph node biopsy, 1 (2.3%) axillary lymph nodes dissection due to sentinel node positivity, and 11 (25.5%) up front axillary lymph nodes dissection during the pandemic versus, 39 (41.9%), 30 (32.1%), and 10 (10.1%) in the control group, respectively.

Pathological staging and prognostic and predictive factors did not show any statistically significant differences and medians and relative p-Values are presented in Table IV.

View this table:
Table IV.

Pathological tumor staging and prognostic and predictive factors.

Following the surgical procedure, 16 patients (37.2%) received adjuvant chemotherapy and 24 (55.8%) adjuvant hormone therapy in the pandemic group. In the pre-COVID-19 group, 37 patients (39.3%) underwent adjuvant chemotherapy and 36 (38.2%) adjuvant hormone therapy. Both these comparisons did not show any statistically significant differences with p values of 0.478 and 0.085, respectively. Indication for adjuvant radiation therapy did not show a statistically significant difference between the two periods, p=0.096.

Discussion

Since the early 1970s, when introduced for breast cancer management, indications for NACT have been broadened and changed (1). First, the treatment was reserved for downstaging inoperable locally advanced breast cancer, to achieve a partial response and an operable condition (1). Subsequently, indication was extended to allow a conservative breast surgery and avoid invasive surgeries (1, 2). Nowadays, NACT aims and indications are further broadened, and its application is widely used, even in early breast cancer (3). In early breast cancer, NACT allows a complete or partial response with high frequencies, permitting the option of a conservative breast surgery (4). Despite allowing more conservative treatments, NACT could be associated with higher frequency of local recurrence if compared with the same chemotherapy used as adjuvant treatment, but reduces distant recurrence and breast cancer mortality (4-15). Indeed, NACT might be somewhat more potent in eradicating a micro-metastatic disease and improving overall survival than adjuvant therapy (4, 5). Moreover, as reported in many studies, the ability to test tumor response to treatment schedule in vivo holds importance in order to predict future response to adjuvant treatments (3-5).

Since the beginning of 2020, SARS-CoV-2 infection dramatically spread worldwide, disturbing daily life, strongly impairing public health and penalizing patients with non-COVID-19 related disease (6-8). During the pandemic, many health resources have been shifted towards COVID-19 patients (7). Furthermore, management of oncological patients suffered a significant slow-down with the reduction in dedicated hospital bed, operation rooms, and healthcare professionals (6). In addition, temporary suspension of screening programs and the refusal to access healthcare due to COVID-19 anxiety led to delays in breast cancer treatments with consequent more advanced staging (6, 10, 11, 16). Beyond advanced stages, many studies reported a reduction in the absolute number of procedures or access to health services (8, 10, 11, 17, 18). Similarly, during the pandemic we report a significant reduction in the absolute number of cases evaluated for breast cancer.

In order to avoid further delays, many oncological scientific committees issue recommendations for the management of breast cancer during the COVID-19 pandemic (7, 19-22). Moreover, the role of neoadjuvant chemo and endocrine therapy was rediscussed, and many oncological societies further proposed new indications as a bridging therapy in patients with concomitant SARS-CoV-2 infection or when up front surgery could be not be performed due to pandemic associated effects (13, 23, 24). In our study, only one case underwent a neoadjuvant endocrine therapy as a bridging strategy for concomitant COVID-19. Despite the novel indication for neoadjuvant chemo and endocrine therapy, we report an absolute reduction in the number of NACT during the pandemic. Moreover, we also observed a reduction of approximately 2.5% in the incidence of cases undergoing NACT in the COVID-19 group. This reduction in incidence could be related to the increase in extremely advanced cases, as we reported in a previous study, in addition to the reluctancy of the physicians to abandon conventional care, when possible, during the pandemic (11, 25-27).

We did not observe a variation of indication or of breast cancer staging clinical presentation in patients undergoing NACT. Indications for NACT, despite the new proposal as bridging treatment, are well established with entrenched guidelines, and breast physicians are probably reluctant to abandon conventional standard care (3, 4, 14, 20, 21, 27-33).

Additionally, therapeutic schedules did not change during the pandemic; we can attribute this result to the indications and types of neoadjuvant treatment which are correlated with the tumor type, subtype, staging and predictive and prognostic breast cancer risk factors (1, 3, 5).

During the pandemic, we reported a significant increase in vascular adverse events during NACT. Two of these had a previous history of SARS-CoV2 infection and both received NACT with a monoclonal antibody. On the one hand, many studies pointed towards the association between COVID-19 and ischemic and thrombotic disease, including following virus infection resolution (34-38). On the other hand, cases of vascular disease are reported in association with cancer drugs as well (30-42). Due to similar schedule of NACT and no cases of such adverse events in the Pre-COVID-19 group, we may postulate an association of vascular disease with COVID-19; however, due to small sample of cases we could not confirm this hypothesis. Despite the higher number of vascular adverse events, all cases of NACT suspension were comparable between the two periods.

Factors influencing tumor response are well established in the literature (e.g. phenotype and biomarkers) (43-45). Both radiological and pathological responses did not change during the pandemic. This is an expected result due to the comparability of tumor type, sub-type, clinical presentation and schedule of NACT in the two periods analyzed.

Surgical strategies, including conservative or invasive breast surgery, did not change during the pandemic period as reported in our previous published studies (10, 11). As for indications and schedule of NACT; surgical strategy is correlated with tumor characteristics and follow the good clinical practices and guidelines (3, 4, 14, 20, 21, 25, 26). Additionally, a drastic reduction of immediate breast reconstructions is reported. Avoiding an immediate and preferring a temporary reconstruction could lead to a higher availability of operation rooms and hospital beds allowing to perform more oncological surgeries and preventing delays, as suggested by many recommendations (6, 20, 46-49). In addition, the surgical procedure was not impacted by the pandemic according to standard clinical practices (21, 25, 26, 50, 51).

Administration of breast cancer adjuvant and radiation therapies during the pandemic did not show statistically significant differences. This finding stems from the fact that the indications for adjuvant treatments are strongly supported by other features such as breast cancer biomarkers, prognostic and predictive factors (14, 20-22).

Conclusion

While the COVID-19 pandemic disturbed daily life, and many scientific committees proposed NACT bridging therapy as a novel strategy, in our study, we did not observe any differences in terms of NACT indications and breast cancer clinical presentation. We observed a reduction in the absolute number of patients undergoing NACT during the pandemic. Furthermore, we reported an increase in vascular events in patients undergoing NACT during the COVID-19 era. Nevertheless, due to the small number of cases, we could not confirm this hypothesis. Further studies on this aspect with a larger number of patients are required.

Acknowledgements

This study was funded by the non-conditional contribution of the Italian Ministry of Health.

Footnotes

  • Authors’ Contributions

    Gianluca Vanni, and Marco Pellicciaro: conceptualization, methodology, formal, analysis, review. Marco Pellicciaro: Writing original draft. Gianluca Vanni and Marco Pellicciaro: review and editing. Francesca Combi, Simona Papi, Marco Materazzo, Silvia Segattini, Stefano Rizza, Marcello Chiocchi, Tommaso Perretta, Rosaria Meucci, Ilaria Portarena,: statistical analysis. Francesca Combi, Simona Papi, Marco Materazzo, Silvia Segattini, Stefano Rizza, Marcello Chiocchi, Tommaso Perretta, Rosaria Meucci, Ilaria Portarena, Chiara Adriana Pistolese, Benedetto Ielpo, Michela Campanelli, Giorgio Lisi, Agostino Chiaravalloti data collection and curation. Giovanni Tazzioli and Oreste Claudio Buonomo: Supervision. All the Authors reviewed and approved the manuscript.

  • Conflicts of Interest

    The Authors declare no conflicts of interest regarding this study.

  • Received July 17, 2021.
  • Revision received August 4, 2021.
  • Accepted August 6, 2021.

References

  1. ↵
    1. Rubens RD,
    2. Sexton S,
    3. Tong D,
    4. Winter PJ,
    5. Knight RK and
    6. Hayward JL
    : Combined chemotherapy and radiotherapy for locally advanced breast cancer. Eur J Cancer 16(3): 351-356, 1980. PMID: 7371690. DOI: 10.1016/0014-2964(80)90352-7
    OpenUrlCrossRefPubMed
  2. ↵
    1. Clough KB,
    2. Acosta-Marín V,
    3. Nos C,
    4. Alran S,
    5. Rouanet P,
    6. Garbay JR,
    7. Giard S,
    8. Verhaeghe JL,
    9. Houvenaeghel G,
    10. Flipo B,
    11. Dauplat J,
    12. Dorangeon PH,
    13. Classe JM,
    14. Rouzier R and
    15. Bonnier P
    : Rates of neoadjuvant chemotherapy and oncoplastic surgery for breast cancer surgery: A French national survey. Ann Surg Oncol 22(11): 3504-3511, 2015. PMID: 25665949. DOI: 10.1245/s10434-015-4378-6
    OpenUrlCrossRefPubMed
  3. ↵
    1. Vugts G,
    2. Maaskant-Braat AJ,
    3. Nieuwenhuijzen GA,
    4. Roumen RM,
    5. Luiten EJ and
    6. Voogd AC
    : Patterns of care in the administration of neo-adjuvant chemotherapy for breast cancer. A population-based study. Breast J 22(3): 316-321, 2016. PMID: 26945566. DOI: 10.1111/tbj.12568
    OpenUrlCrossRefPubMed
  4. ↵
    1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)
    : Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 19(1): 27-39, 2018. PMID: 29242041. DOI: 10.1016/S1470-2045(17)30777-5
    OpenUrlCrossRefPubMed
  5. ↵
    1. Vaidya JS,
    2. Massarut S,
    3. Vaidya HJ,
    4. Alexander EC,
    5. Richards T,
    6. Caris JA,
    7. Sirohi B and
    8. Tobias JS
    : Rethinking neoadjuvant chemotherapy for breast cancer. BMJ 360: j5913, 2018. PMID: 29326104. DOI: 10.1136/bmj.j5913
    OpenUrlFREE Full Text
  6. ↵
    1. Vanni G,
    2. Pellicciaro M,
    3. Materazzo M,
    4. Palombi L and
    5. Buonomo OC
    : Breast cancer diagnosis in Coronavirus-era: Alert from Italy. Front Oncol 10: 938, 2020. PMID: 32574281. DOI: 10.3389/fonc.2020.00938
    OpenUrlCrossRefPubMed
  7. ↵
    1. Buonomo OC,
    2. Materazzo M,
    3. Pellicciaro M,
    4. Caspi J,
    5. Piccione E and
    6. Vanni G
    : Tor Vergata University-Hospital in the beginning of COVID-19-Era: Experience and recommendation for breast cancer patients. In Vivo 34(3 Suppl): 1661-1665, 2020. PMID: 32503826. DOI: 10.21873/invivo.11958
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Vanni G,
    2. Legramante JM,
    3. Pellicciaro M,
    4. DE Carolis G,
    5. Cotesta M,
    6. Materazzo M,
    7. Buonomo C,
    8. Farinaccio A,
    9. Santori F,
    10. Saraceno F,
    11. Ielpo B,
    12. Aiello F,
    13. Paganelli C,
    14. Grande M,
    15. DE Andreis G,
    16. Chiocchi M,
    17. Palombi L and
    18. Buonomo OC
    : Effect of lockdown in surgical emergency accesses: Experience of a COVID-19 hospital. In Vivo 34(5): 3033-3038, 2020. PMID: 32871849. DOI: 10.21873/invivo.12137
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Vanni G,
    2. Pellicciaro M,
    3. Materazzo M,
    4. Bruno V,
    5. Oldani C,
    6. Pistolese CA,
    7. Buonomo C,
    8. Caspi J,
    9. Gualtieri P,
    10. Chiaravalloti A,
    11. Palombi L,
    12. Piccione E and
    13. Buonomo OC
    : Lockdown of breast cancer screening for COVID-19: Possible scenario. In Vivo 34(5): 3047-3053, 2020. PMID: 32871851. DOI: 10.21873/invivo.12139
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Vanni G,
    2. Tazzioli G,
    3. Pellicciaro M,
    4. Materazzo M,
    5. Paolo O,
    6. Cattadori F,
    7. Combi F,
    8. Papi S,
    9. Pistolese CA,
    10. Cotesta M,
    11. Santori F,
    12. Caspi J,
    13. Chiaravalloti A,
    14. Muscoli S,
    15. Lombardo V,
    16. Grasso A,
    17. Caggiati L,
    18. Raselli R,
    19. Palli D,
    20. Altomare V,
    21. D’Angelillo RM,
    22. Palombi L and
    23. Buonomo OC
    : Delay in breast cancer treatments during the first COVID-19 lockdown. A multicentric analysis of 432 patients. Anticancer Res 40(12): 7119-7125, 2020. PMID: 33288611. DOI: 10.21873/anticanres.14741
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Vanni G,
    2. Pellicciaro M,
    3. Materazzo M,
    4. Pedini D,
    5. Portarena I,
    6. Buonomo C,
    7. Perretta T,
    8. Rizza S,
    9. Pistolese CA and
    10. Buonomo OC
    : Advanced stages and increased need for adjuvant treatments in breast cancer patients: The effect of the one-year COVID-19 pandemic. Anticancer Res 41(5): 2689-2696, 2021. PMID: 33952500. DOI: 10.21873/anticanres.15050
    OpenUrlAbstract/FREE Full Text
    1. Pellicciaro M,
    2. Granai AV,
    3. Marchese G,
    4. Materazzo M,
    5. Cotesta M,
    6. Santori F,
    7. Giacobbi E,
    8. Servadei F,
    9. Grelli S,
    10. Perretta T,
    11. Meucci R,
    12. Pistolese CA and
    13. Vanni G
    : Breast cancer patients with hormone neoadjuvant bridging therapy due to asymptomatic Corona virus infection. Case report, clinical and histopathologic findings. Int J Surg Case Rep 76: 377-380, 2020. PMID: 33052300. DOI: 10.1016/j.ijscr.2020.10.020
    OpenUrlCrossRefPubMed
  13. ↵
    1. Vanni G,
    2. Materazzo M,
    3. Santori F,
    4. Pellicciaro M,
    5. Costesta M,
    6. Orsaria P,
    7. Cattadori F,
    8. Pistolese CA,
    9. Perretta T,
    10. Chiocchi M,
    11. Meucci R,
    12. Lamacchia F,
    13. Assogna M,
    14. Caspi J,
    15. Granai AV,
    16. DE Majo A,
    17. Chiaravalloti A,
    18. D’Angelillo MR,
    19. Barbarino R,
    20. Ingallinella S,
    21. Morando L,
    22. Dalli S,
    23. Portarena I,
    24. Altomare V,
    25. Tazzioli G and
    26. Buonomo OC
    : The effect of Coronavirus (COVID-19) on breast cancer teamwork: A multicentric survey. In Vivo 34(3 Suppl): 1685-1694, 2020. PMID: 32503830. DOI: 10.21873/invivo.11962
    OpenUrlAbstract/FREE Full Text
  14. ↵
    1. Gradishar WJ,
    2. Anderson BO,
    3. Abraham J,
    4. Aft R,
    5. Agnese D,
    6. Allison KH,
    7. Blair SL,
    8. Burstein HJ,
    9. Dang C,
    10. Elias AD,
    11. Giordano SH,
    12. Goetz MP,
    13. Goldstein LJ,
    14. Isakoff SJ,
    15. Krishnamurthy J,
    16. Lyons J,
    17. Marcom PK,
    18. Matro J,
    19. Mayer IA,
    20. Moran MS,
    21. Mortimer J,
    22. O’Regan RM,
    23. Patel SA,
    24. Pierce LJ,
    25. Rugo HS,
    26. Sitapati A,
    27. Smith KL,
    28. Smith ML,
    29. Soliman H,
    30. Stringer-Reasor EM,
    31. Telli ML,
    32. Ward JH,
    33. Young JS,
    34. Burns JL and
    35. Kumar R
    : Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 18(4): 452-478, 2020. PMID: 32259783. DOI: 10.6004/jnccn.2020.0016
    OpenUrlCrossRefPubMed
  15. ↵
    1. Vanni G,
    2. Materazzo M,
    3. Pellicciaro M,
    4. Morando L,
    5. Portarena I,
    6. Anemona L,
    7. D’Angelillo MR,
    8. Barbarino R,
    9. Chiaravalloti A,
    10. Meucci R,
    11. Perretta T,
    12. Deiana C,
    13. Orsaria P,
    14. Caspi J,
    15. Pistolese CA and
    16. Buonomo OC
    : Does age matter? Estimating risks of locoregional recurrence after breast-conservative surgery. In Vivo 34(3): 1125-1132, 2020. PMID: 32354901. DOI: 10.21873/invivo.11884
    OpenUrlAbstract/FREE Full Text
  16. ↵
    1. Vanni G,
    2. Materazzo M,
    3. Pellicciaro M,
    4. Ingallinella S,
    5. Rho M,
    6. Santori F,
    7. Cotesta M,
    8. Caspi J,
    9. Makarova A,
    10. Pistolese CA and
    11. Buonomo OC
    : Breast cancer and COVID-19: The effect of fear on patients’ decision-making process. In Vivo 34(3 Suppl): 1651-1659, 2020. PMID: 32503825. DOI: 10.21873/invivo.11957
    OpenUrlAbstract/FREE Full Text
  17. ↵
    1. Cammalleri V,
    2. Muscoli S,
    3. Benedetto D,
    4. Stifano G,
    5. Macrini M,
    6. Di Landro A,
    7. Di Luozzo M,
    8. Marchei M,
    9. Mariano EG,
    10. Cota L,
    11. Sergi D,
    12. Bezzeccheri A,
    13. Bonanni M,
    14. Baluci M,
    15. De Vico P and
    16. Romeo F
    : Who has seen patients with ST-segment-elevation myocardial infarction? First results from Italian real-world Coronavirus disease 2019. J Am Heart Assoc 9(19): e017126, 2020. PMID: 32901560. DOI: 10.1161/JAHA.120.017126
    OpenUrlCrossRefPubMed
  18. ↵
    1. Aiello F,
    2. Genzano Besso F,
    3. Pocobelli G,
    4. Gallo Afflitto G,
    5. Colabelli Gisoldi RAM,
    6. Nucci C,
    7. Ponzin D and Italian Society Eye Bank Group (SIBO)
    : Corneal transplant during COVID-19 pandemic: the Italian Eye Bank national report. Cell Tissue Bank: 1-6, 2021. PMID: 34028630. DOI: 10.1007/s10561-021-09934-8
    OpenUrlCrossRefPubMed
  19. ↵
    1. Lambertini M,
    2. Toss A,
    3. Passaro A,
    4. Criscitiello C,
    5. Cremolini C,
    6. Cardone C,
    7. Loupakis F,
    8. Viscardi G,
    9. Meattini I,
    10. Dieci MV,
    11. Ferrara R,
    12. Giusti R and
    13. Maio MD
    : Cancer care during the spread of coronavirus disease 2019 (COVID-19) in Italy: young oncologists’ perspective. ESMO Open 5(2): e000759, 2020. PMID: 32229501. DOI: 10.1136/esmoopen-2020-000759
    OpenUrlAbstract/FREE Full Text
  20. ↵
    1. Curigliano G,
    2. Cardoso MJ,
    3. Poortmans P,
    4. Gentilini O,
    5. Pravettoni G,
    6. Mazzocco K,
    7. Houssami N,
    8. Pagani O,
    9. Senkus E,
    10. Cardoso F and editorial board of The Breast
    : Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic. Breast 52: 8-16, 2020. PMID: 32334323. DOI: 10.1016/j.breast.2020.04.006
    OpenUrlCrossRefPubMed
  21. ↵
    1. Martí C and
    2. Sánchez-Méndez JI
    : Neoadjuvant endocrine therapy for luminal breast cancer treatment: a first-choice alternative in times of crisis such as the COVID-19 pandemic. Ecancermedicalscience 14: 1027, 2020. PMID: 32368252. DOI: 10.3332/ecancer.2020.1027
    OpenUrlCrossRefPubMed
  22. ↵
    1. Sheng JY,
    2. Santa-Maria CA,
    3. Mangini N,
    4. Norman H,
    5. Couzi R,
    6. Nunes R,
    7. Wilkinson M,
    8. Visvanathan K,
    9. Connolly RM,
    10. Roussos Torres ET,
    11. Fetting JH,
    12. Armstrong DK,
    13. Tao JJ,
    14. Jacobs L,
    15. Wright JL,
    16. Thorner ED,
    17. Hodgdon C,
    18. Horn S,
    19. Wolff AC,
    20. Stearns V and
    21. Smith KL
    : Management of breast cancer during the COVID-19 pandemic: A stage- and subtype-specific approach. JCO Oncol Pract 16(10): 665-674, 2020. PMID: 32603252. DOI: 10.1200/OP.20.00364
    OpenUrlCrossRefPubMed
  23. ↵
    1. Cavalcante FP,
    2. Novita GG,
    3. Millen EC,
    4. Zerwes FP,
    5. de Oliveira VM,
    6. Sousa ALL and
    7. Freitas Junior R
    : Management of early breast cancer during the COVID-19 pandemic in Brazil. Breast Cancer Res Treat 184(2): 637-647, 2020. PMID: 32803637. DOI: 10.1007/s10549-020-05877-y
    OpenUrlCrossRefPubMed
  24. ↵
    1. Dowsett M,
    2. Ellis MJ,
    3. Dixon JM,
    4. Gluz O,
    5. Robertson J,
    6. Kates R,
    7. Suman VJ,
    8. Turnbull AK,
    9. Nitz U,
    10. Christgen M,
    11. Kreipe H,
    12. Kuemmel S,
    13. Bliss JM,
    14. Barry P,
    15. Johnston SR,
    16. Jacobs SA,
    17. Ma CX,
    18. Smith IE and
    19. Harbeck N
    : Evidence-based guidelines for managing patients with primary ER+ HER2- breast cancer deferred from surgery due to the COVID-19 pandemic. NPJ Breast Cancer 6: 21, 2020. PMID: 32550266. DOI: 10.1038/s41523-020-0168-9
    OpenUrlCrossRefPubMed
  25. ↵
    1. Thompson CK,
    2. Lee MK,
    3. Baker JL,
    4. Attai DJ and
    5. DiNome ML
    : Taking a second look at neoadjuvant endocrine therapy for the treatment of early stage estrogen receptor positive breast cancer during the COVID-19 outbreak. Ann Surg 272(2): e96-e97, 2020. PMID: 32675509. DOI: 10.1097/SLA.0000000000004027
    OpenUrlCrossRefPubMed
  26. ↵
    1. Orsaria P,
    2. Caredda E,
    3. Genova F,
    4. Materazzo M,
    5. Capuano I,
    6. Vanni G,
    7. Granai AV,
    8. DE Majo A,
    9. Portarena I,
    10. Sileri P,
    11. Petrella G,
    12. Palombi L and
    13. Buonomo OC
    : Additional nodal disease prediction in breast cancer with sentinel lymph node metastasis based on clinicopathological features. Anticancer Res 38(4): 2109-2117, 2018. PMID: 29599329. DOI: 10.21873/anticanres.12451
    OpenUrlAbstract/FREE Full Text
  27. ↵
    1. D’Alessandro R,
    2. Roselli M,
    3. Ferroni P,
    4. Mariotti S,
    5. Spila A,
    6. Aloe S,
    7. Carone MD,
    8. Abbolito MR,
    9. Carlini S,
    10. Perri P,
    11. Ricciotti A,
    12. Botti C,
    13. Conti F,
    14. Vici P,
    15. Chiappetta NR,
    16. Cognetti F,
    17. Buonomo O and
    18. Guadagni F
    : Serum tissue polypeptide specific antigen (TPS): a complementary tumor marker to CA 15-3 in the management of breast cancer. Breast Cancer Res Treat 68(1): 9-19, 2001. PMID: 11678313. DOI: 10.1023/a:1017903724176
    OpenUrlCrossRefPubMed
    1. Roselli M,
    2. Guadagni F,
    3. Buonomo O,
    4. Belardi A,
    5. Ferroni P,
    6. Diodati A,
    7. Anselmi D,
    8. Cipriani C,
    9. Casciani CU,
    10. Greiner J and
    11. Schlom J
    : Tumor markers as targets for selective diagnostic and therapeutic procedures. Anticancer Res 16(4B): 2187-2192, 1996. PMID: 8694541.
    OpenUrlPubMed
    1. Orsaria P,
    2. Varvaras D,
    3. Vanni G,
    4. Pagnani G,
    5. Scaggiante J,
    6. Frusone F,
    7. Granai AV,
    8. Petrella G and
    9. Buonomo OC
    : Nodal status assessment in breast cancer: strategies of clinical grounds and quality of life implications. Int J Breast Cancer 2014: 469803, 2014. PMID: 24672730. DOI: 10.1155/2014/469803
    OpenUrlCrossRefPubMed
  30. ↵
    1. Orsaria P,
    2. Chiaravalloti A,
    3. Caredda E,
    4. Marchese PV,
    5. Titka B,
    6. Anemona L,
    7. Portarena I,
    8. Schillaci O,
    9. Petrella G,
    10. Palombi L and
    11. Buonomo OC
    : Evaluation of the usefulness of FDG-PET/CT for nodal staging of breast cancer. Anticancer Res 38(12): 6639-6652, 2018. PMID: 30504372. DOI: 10.21873/anticanres.13031
    OpenUrlAbstract/FREE Full Text
    1. Ielpo B,
    2. Pernaute AS,
    3. Elia S,
    4. Buonomo OC,
    5. Valladares LD,
    6. Aguirre EP,
    7. Petrella G and
    8. Garcia AT
    : Impact of number and site of lymph node invasion on survival of adenocarcinoma of esophagogastric junction. Interact Cardiovasc Thorac Surg 10(5): 704-708, 2010. PMID: 20154347. DOI: 10.1510/icvts.2009.222778
    OpenUrlCrossRefPubMed
    1. Vanni G,
    2. Materazzo M,
    3. Perretta T,
    4. Meucci R,
    5. Anemona L,
    6. Buonomo C,
    7. Dauri M,
    8. Granai AV,
    9. Rho M,
    10. Ingallinella S,
    11. Tacconi F,
    12. Ambrogi V,
    13. Chiaravalloti A,
    14. Schillaci O,
    15. Petrella G and
    16. Buonomo OC
    : Impact of awake breast cancer surgery on postoperative lymphocyte responses. In Vivo 33(6): 1879-1884, 2019. PMID: 31662515. DOI: 10.21873/invivo.11681
    OpenUrlAbstract/FREE Full Text
  33. ↵
    1. Rocco N,
    2. Montagna G,
    3. Di Micco R,
    4. Benson J,
    5. Criscitiello C,
    6. Chen L,
    7. Di Pace B,
    8. Esgueva Colmenarejo AJ,
    9. Harder Y,
    10. Karakatsanis A,
    11. Maglia A,
    12. Mele M,
    13. Nafissi N,
    14. Ferreira PS,
    15. Taher W,
    16. Tejerina A,
    17. Vinci A,
    18. Nava M and
    19. Catanuto G
    : The impact of the COVID-19 pandemic on surgical management of breast cancer: Global trends and future perspectives. Oncologist 26(1): e66-e77, 2021. PMID: 33044007. DOI: 10.1002/onco.13560
    OpenUrlCrossRefPubMed
  34. ↵
    1. Patell R,
    2. Bogue T,
    3. Koshy A,
    4. Bindal P,
    5. Merrill M,
    6. Aird WC,
    7. Bauer KA and
    8. Zwicker JI
    : Postdischarge thrombosis and hemorrhage in patients with COVID-19. Blood 136(11): 1342-1346, 2020. PMID: 32766883. DOI: 10.1182/blood.2020007938
    OpenUrlCrossRefPubMed
    1. Vlachou M,
    2. Drebes A,
    3. Candilio L,
    4. Weeraman D,
    5. Mir N,
    6. Murch N,
    7. Davies N and
    8. Coghlan JG
    : Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis 51(4): 978-984, 2021. PMID: 33386559. DOI: 10.1007/s11239-020-02370-7
    OpenUrlCrossRefPubMed
    1. Mai F,
    2. Del Pinto R and
    3. Ferri C
    : COVID-19 and cardiovascular diseases. J Cardiol 76(5): 453-458, 2020. PMID: 32736906. DOI: 10.1016/j.jjcc.2020.07.013
    OpenUrlCrossRefPubMed
    1. Merkler AE,
    2. Parikh NS,
    3. Mir S,
    4. Gupta A,
    5. Kamel H,
    6. Lin E,
    7. Lantos J,
    8. Schenck EJ,
    9. Goyal P,
    10. Bruce SS,
    11. Kahan J,
    12. Lansdale KN,
    13. LeMoss NM,
    14. Murthy SB,
    15. Stieg PE,
    16. Fink ME,
    17. Iadecola C,
    18. Segal AZ,
    19. Cusick M,
    20. Campion TR Jr.,
    21. Diaz I,
    22. Zhang C and
    23. Navi BB
    : Risk of ischemic stroke in patients with Coronavirus disease 2019 (COVID-19) vs. patients with influenza. JAMA Neurol 77(11): 1-7, 2020. PMID: 32614385. DOI: 10.1001/jamaneurol.2020.2730
    OpenUrlCrossRefPubMed
  38. ↵
    1. Noce A,
    2. Santoro ML,
    3. Marrone G,
    4. D’Agostini C,
    5. Amelio I,
    6. Duggento A,
    7. Tesauro M and
    8. Di Daniele N
    : Serological determinants of COVID-19. Biol Direct 15(1): 21, 2020. PMID: 33138856. DOI: 10.1186/s13062-020-00276-1
    OpenUrlCrossRefPubMed
    1. Conti E,
    2. Romiti A,
    3. Musumeci MB,
    4. Passerini J,
    5. Zezza L,
    6. Mastromarino V,
    7. D’Antonio C,
    8. Marchetti P,
    9. Paneni F,
    10. Autore C and
    11. Volpe M
    : Arterial thrombotic events and acute coronary syndromes with cancer drugs: are growth factors the missed link?: what both cardiologist and oncologist should know about novel angiogenesis inhibitors. Int J Cardiol 167(6): 2421-2429, 2013. PMID: 23414744. DOI: 10.1016/j.ijcard.2013.01.052
    OpenUrlCrossRefPubMed
    1. Smart PJ,
    2. Burbury KL,
    3. Lynch AC,
    4. Mackay JR and
    5. Heriot AG
    : Thromboembolism during neoadjuvant therapy for gastrointestinal cancer. Am J Clin Oncol 37(6): 627-634, 2014. PMID: 23466578. DOI: 10.1097/COC.0b013e318280d78a
    OpenUrlCrossRefPubMed
    1. Redana S,
    2. Sharp A,
    3. Lote H,
    4. Mohammed K,
    5. Papadimitraki E,
    6. Capelan M and
    7. Ring A
    : Rates of major complications during neoadjuvant and adjuvant chemotherapy for early breast cancer: An off study population. Breast 30: 13-18, 2016. PMID: 27569021. DOI: 10.1016/j.breast.2016.07.019
    OpenUrlCrossRefPubMed
  42. ↵
    1. Gallù M,
    2. Marrone G,
    3. Legramante JM,
    4. De Lorenzo A,
    5. Di Daniele N and
    6. Noce A
    : Female sex as a thromboembolic risk factor in the era of nonvitamin K antagonist oral anticoagulants. Cardiovasc Ther 2020: 1743927, 2020. PMID: 32684980. DOI: 10.1155/2020/1743927
    OpenUrlCrossRefPubMed
  43. ↵
    1. Bownes RJ,
    2. Turnbull AK,
    3. Martinez-Perez C,
    4. Cameron DA,
    5. Sims AH and
    6. Oikonomidou O
    : On-treatment biomarkers can improve prediction of response to neoadjuvant chemotherapy in breast cancer. Breast Cancer Res 21(1): 73, 2019. PMID: 31200764. DOI: 10.1186/s13058-019-1159-3
    OpenUrlCrossRefPubMed
    1. Negrão EMS,
    2. Souza JA,
    3. Marques EF and
    4. Bitencourt AGV
    : Breast cancer phenotype influences MRI response evaluation after neoadjuvant chemotherapy. Eur J Radiol 120: 108701, 2019. PMID: 31610321. DOI: 10.1016/j.ejrad.2019.108701
    OpenUrlCrossRefPubMed
  45. ↵
    1. Sasanpour P,
    2. Sandoughdaran S,
    3. Mosavi-Jarrahi A and
    4. Malekzadeh M
    : Predictors of pathological complete response to neoadjuvant chemotherapy in Iranian breast cancer patients. Asian Pac J Cancer Prev 19(9): 2423-2427, 2018. PMID: 30255695. DOI: 10.22034/APJCP.2018.19.9.2423
    OpenUrlCrossRefPubMed
  46. ↵
    1. Pediconi F,
    2. Galati F,
    3. Bernardi D,
    4. Belli P,
    5. Brancato B,
    6. Calabrese M,
    7. Camera L,
    8. Carbonaro LA,
    9. Caumo F,
    10. Clauser P,
    11. Girardi V,
    12. Iacconi C,
    13. Martincich L,
    14. Panizza P,
    15. Petrillo A,
    16. Schiaffino S,
    17. Tagliafico A,
    18. Trimboli RM,
    19. Zuiani C,
    20. Sardanelli F and
    21. Montemezzi S
    : Breast imaging and cancer diagnosis during the COVID-19 pandemic: recommendations from the Italian College of Breast Radiologists by SIRM. Radiol Med 125(10): 926-930, 2020. PMID: 32661780. DOI: 10.1007/s11547-020-01254-3
    OpenUrlCrossRefPubMed
    1. Bielli A,
    2. Bernardini R,
    3. Varvaras D,
    4. Rossi P,
    5. Di Blasi G,
    6. Petrella G,
    7. Buonomo OC,
    8. Mattei M and
    9. Orlandi A
    : Characterization of a new decellularized bovine pericardial biological mesh: Structural and mechanical properties. J Mech Behav Biomed Mater 78: 420-426, 2018. PMID: 29223730. DOI: 10.1016/j.jmbbm.2017.12.003
    OpenUrlCrossRefPubMed
    1. Vanni G,
    2. Pellicciaro M,
    3. Materazzo M,
    4. Dauri M,
    5. D’angelillo RM,
    6. Buonomo C,
    7. De Majo A,
    8. Pistolese C,
    9. Portarena I,
    10. Mauriello A,
    11. Servadei F,
    12. Giacobbi E,
    13. Chiaravalloti A and
    14. Buonomo OC
    : Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency. Breast Cancer 28(1): 137-144, 2021. PMID: 32734327. DOI: 10.1007/s12282-020-01137-5
    OpenUrlCrossRefPubMed
  49. ↵
    1. Vanni G,
    2. Santori F,
    3. Pellicciaro M,
    4. Materazzo M,
    5. Caspi J,
    6. Granai AV,
    7. DE Majo A,
    8. Servadei F,
    9. Giacobbi E,
    10. Perretta T,
    11. Meucci R,
    12. Pistolese CA and
    13. Buonomo OC
    : Extremely advanced breast cancer presentation: possible effect of Coronavirus pandemic anxiety. In Vivo 35(4): 2331-2335, 2021. PMID: 34182514. DOI: 10.21873/invivo.12508
    OpenUrlAbstract/FREE Full Text
  50. ↵
    1. Buonomo O,
    2. Cabassi A,
    3. Guadagni F,
    4. Piazza A,
    5. Felici A,
    6. Piccirillo R,
    7. Atzei GP,
    8. Cipriani C,
    9. Schiaroli S,
    10. Mariotti S,
    11. Guazzaroni MN,
    12. Cossu E,
    13. Simonetti G,
    14. Pernazza E,
    15. Casciani CU and
    16. Roselli M
    : Radioguided-surgery of early breast lesions. Anticancer Res 21(3C): 2091-2097, 2001. PMID: 11501831.
    OpenUrlPubMed
  51. ↵
    1. Orsaria P,
    2. Chiaravalloti A,
    3. Fiorentini A,
    4. Pistolese C,
    5. Vanni G,
    6. Granai AV,
    7. Varvaras D,
    8. Danieli R,
    9. Schillaci O,
    10. Petrella G and
    11. Buonomo OC
    : PET probe-guided surgery in patients with breast cancer: proposal for a methodological approach. In Vivo 31(1): 101-110, 2017. PMID: 28064227. DOI: 10.21873/invivo.11031
    OpenUrlAbstract/FREE Full Text
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Reprints and Permissions
Impact of COVID-19 Pandemic on Surgical Breast Cancer Patients Undergoing Neoadjuvant Therapy: A Multicentric Study
GIANLUCA VANNI, MARCO PELLICCIARO, FRANCESCA COMBI, SIMONA PAPI, MARCO MATERAZZO, SILVIA SEGATTINI, STEFANO RIZZA, MARCELLO CHIOCCHI, TOMMASO PERRETTA, ROSARIA MEUCCI, ILARIA PORTARENA, CHIARA ADRIANA PISTOLESE, BENEDETTO IELPO, MICHELA CAMPANELLI, GIORGIO LISI, AGOSTINO CHIARAVALLOTI, GIOVANNI TAZZIOLI, ORESTE CLAUDIO BUONOMO
Anticancer Research Sep 2021, 41 (9) 4535-4542; DOI: 10.21873/anticanres.15265
Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords