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Background: Chemotherapy plus 1-year trastuzumab is the standard adjuvant treatment of HER2-positive breast cancer. The efficacy of less extended trastuzumab exposure is under investigation. The short-HER study was aimed to assess the non-inferiority of 9 weeks versus 1 year of adjuvant trastuzumab combined with chemotherapy. Patients and methods: HER2-positive breast cancer patients with node-positive or, if node negative, with at least one risk factor (pT>2 cm, G3, lympho-vascular invasion, Ki-67 > 20%, age 35 years, or hormone receptor negativity) were randomly assigned to receive sequential anthracycline-taxane combinations plus 1-year trastuzumab (arm A, long) or plus 9 weeks trastuzumab (arm B, short). This study was designed as a non-inferiority trial with disease-free survival (DFS) as primary end point. A DFS hazard ratio (HR)

Cristina Raimondi,1 Angela Gradilone,1 Giuseppe Naso,2 Enrico Cortesi,2 Paola Gazzaniga1 1Dipartimento Medicina Molecolare, Sapienza Università di Roma, Rome, Italy; 2Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Sapienza Università di Roma, Rome, Italy Abstract: To date, 10 years after the first demonstration of circulating tumor cells (CTCs), prognostic significance in metastatic breast cancer using the US Food and Drug Administration–cleared system CellSearch®, the potential utility of CTCs in early clinical development of drugs, their role as a surrogate marker of response to therapy, and their molecular analysis for patient stratification for targeted therapies are still major unsolved questions. Great expectations are pinned on the ongoing interventional trials aimed to demonstrate that CTCs might be of value for guiding treatment of patients and predicting cancer progression. To fill the gap between theory and practice with regard to the clinical utility of CTCs, a bridge is needed, taking into account innovative design for clinical trials, a revised definition of traditional CTCs, next-generation CTC technology, the potential clinical application of CTC analysis in non-validated settings of disease, and finally, expanding the number of patients enrolled in the studies. In this regard, the results of the first European pooled analysis definitely validated the independent prognostic value of CTC counting in metastatic breast cancer patients. Keywords: CTC, clinical trials, prognosis

Il Progetto Valdaso, promosso dalla Regione Marche, dalle Province di Ascoli Piceno e Fermo, e coordinato sul piano scientifico dal Dipartimento della Protezione Civile, è volto alla valutazione del rischio sismico di 24 Comuni della Valdaso. L‟obiettivo ultimo è la valutazione sul territorio comunale degli effetti prodotti su edifici e popolazione (in termini di edifici inagibili, crolli, vittime e senzatetto), conseguenti ad un sisma di data severità. La metodologia prevede la valutazione della pericolosità e della vulnerabilità sismica di ciascun centro urbano, partendo dai dati disponibili o da limitate integrazioni degli stessi, ottenute con rilievi in loco e anche con il supporto degli Uffici Tecnici Comunali. Il risultato di tali elaborazioni è sintetizzato in mappe di ciascun insediamento in cui sono evidenziate le zone a pericolosità e vulnerabilità omogenee, le quali, una volta sovrapposte, individuano le zone caratterizzate dall‟omogeneità di pericolosità e vulnerabilità e quindi di danno omogeneo. Il vantaggio di tale procedura consta nel fatto che gli scenari, formulati con maggior aderenza alle problematiche del territorio e del costruito locali, sono differenziati per le varie zone del centro urbano in cui questo viene preliminarmente suddiviso e pertanto possono rivelarsi un importante strumento di supporto alla pianificazione, con particolare riferimento a quella di emergenza. L'articolo descrive la metodologia adottata facendo riferimento ad alcuni centri urbani particolarmente significativi nell‟ambito del campione studiato.

PurposeBreast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice.MethodsReferents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year.ResultsBetween February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years.ConclusionsOur survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called "tailored follow-up", high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time.

In the Apennine fold and thrust belt of Italy, «thin-skinned» (i.e. detachment-dominated) and «thick-skinned» (i.e. crustal ramp-dominated) structures coexist, but with marked differences in both time and space. The external part of the northern Apennines and the deeper and younger portions (buried Apulian carbonates) of the thrust belt in the central and southern Apennines show limited amounts of shortening (in the range of 5–14 km). These result from similar deformation styles, involving the occurrence of relatively low-displacement, thick-skinned thrust ramps. The latter represent, at least in the northern Apennines, preexisting basement structures reactivated and inverted during contractional deformation. Interposed between the northern and southern parts of the fold and thrust belt, the central Apennines appear to constitute a transitional area in which strike-slip tectonics is relevant and carbonate platform units become predominant over pelagic basin ones, whereas the overall structure of the thrust belt becomes similar to that of the southern Apennines. In the latter, a peculiar structural style is revealed by the integrated analysis of surface and subsurface data. Structurally, the upper part of the thrust belt consists of allochthonous units made of Mesozoic peritidal carbonate platform and pelagic basin successions, and of Miocene foredeep sediments. These are completely detached from their original substratum and transported onto the 6–7 km thick, foreland carbonates of the Apulian platform. Based on available seismic data, the latter appears to be involved, together with the underlying Permo-Triassic clastics and, we infer, also the basement, in relatively low-displacement, thick-skinned structures. Therefore, in the southern Apennines, a transition from thin-to thick-skinned tectonics appears to have occurred through time. Thin-skinned structures characterise the shallower — and older — part of the thrust belt made of detached units, while a thick-skinned tectonic style is dominant in the buried Apulian carbonates of most recent accretion. The present boundary between the two different, superposed portions of the thrust belt consists of a low-angle, large-displacement thrust fault penetrated by numerous oil wells. Different styles and modes of contractional deformation in the investigated sectors of the Apennines appear to result from the geometrical requirement of maintaining strain compatibility and overall displacement continuity along a highly segmented orogen characterised by variable mechanical stratigraphy and southward increasing amounts of shortening.