BIA-ALCL Epidemiology in an Aesthetic Breast Surgery Cohort of 1501 Patients.

BACKGROUND: Epidemiologic studies on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) currently estimate the risk between 1:300 and 1:30,000, assessed mainly in large breast reconstruction populations. OBJECTIVES: The aim of the study was to assess BIA-ALCL epidemiology in a cohort of patients who have received textured implants for cosmetic indications. METHODS: In a prospective cohort observational study, 1501 patients who received a cosmetic breast augmentation between 2006 and 2016 were monitored, recording any implant-related complications, including BIA-ALCL. Cross-checking of clinical, pathology, and external records data identified cases. Prevalence, implant-specific prevalence (I-SP), incidence rate (IR), event-free time (EFT), and the Kaplan-Meier survival estimate were calculated. RESULTS: All but 2 patients received macrotextured or microtextured devices bilaterally. Mean follow-up was 3.2 years (1 months to 16.4 years). Five BIA-ALCL cases were investigated. Prevalence was 1:300 patients; I-SP was 6.9 cases/1000 individuals/Allergan BIOCELL devices and 1.3 cases/1000 individuals/Mentor Siltex devices; and IR was 1.07 cases/1000 females/year. Mean (SD) EFT was 9.2 years. CONCLUSIONS: When using a denominator based on a cohort of cosmetic patients, BIA-ALCL occurrence is higher than previously reported, particularly with macrotextured devices. Given the similar IRs in reconstructive and cosmetic cohorts, their even distribution could be consequent to underreporting due to poorer follow-up and lower awareness in the latter group. The genetic predisposition in the oncologic cohort reasonably affects the early onset more than the IR. The importance of accurate follow-up is confirmed. Stratification risks analysis can guide surgeons during patient counseling regarding the decision for prophylactic explantation.

[Photodynamic therapy in the treatment of breast cancer]. / Terapia fotodynamiczna w leczeniu raka piersi.

Breast cancer is the most common women's cancer in the world. The effective therapies that would not only reduce the high mortality rate associated with the disease, but also improve the quality of life patients with breast cancer are still searching for. PDT is one of the alternative method of cancers treatment, such as bladder, esophagus, respiratory tract and gynaecological cancers. PDT permit to eliminate selected cells from organism with photosensitizers and light use. Obtained results depend on both properties of cells as well as properties and localization of photosensitizer and illumination condition. In recent years possibilities of PDT using in breast cancer treatment are analyzed. These researches are focused mainly on the efficacy's assessing of different photosensitizers used in photodynamic therapy in vitro of different breast cancer cell lines, including also cells derived from metastatic lesions. The viability and proliferative activity of these cells, expression of selected proapoptotic genes, release of cytochrome c by mitochondria into the cytoplasm, the activity of caspases are analyzed. The first results of clinical trials were also described.

Expression of proapoptotic BAX and TP53 genes and antiapoptotic BCL-2 gene in MCF-7 and T-47D tumour cell cultures of the mammary gland after a photodynamic therapy with photolon.

BACKGROUND: Breast cancer is the most common malignant tumour in women in the whole world. Despite significant developments in the early diagnosis of breast cancer, there is no effective method which would assure total recovery of the patient. Currently available clinical data and laboratory tests indicate a possibility to introduce photodynamic therapy (PDT) to the supplementary treatment of breast cancer. OBJECTIVES: The aim of this study was to assess the influence of PDT with Photolon as a photosensibilizator on the expression of apoptosis associated genes (BCL-2, BAX, TP53) in human breast cancer cell lines, preceded by assessment of survivorship and proliferative activity in the tested cells after PDT. MATERIAL AND METHODS: In the present study human breast cancer cell lines MCF-7 and T-47D were used. Photolon (chlorin e6 complex: PVP 1:1) was used as a photosensitizer. Assessments of survivorship and proliferative activity of cells under the influence of PDT (WST-1 test) were conducted along with the expression of selected genes involved in the process of apoptosis: BCL-2, BAX, TP53 (RT-QPCR). RESULTS: PDT limited both survivorship and proliferative activity of breast cancer cells in the two tested lines. In case of T-47D cell line was found increase of BAX and BCL-2 genes expression after PDT and sustained activity of TP53 gene. Conversely, in MCF-7 cell line a decrease in expression was found for both BAX and TP53 genes, but also an increase of BCL-2 gene expression. CONCLUSIONS: A progressing decrease (24, 48 and 72 h after PDT) in the count of culture cells, which suggests the occurrence of apoptosis initiated by a photodynamic reaction with simultaneous increase of BCL-2/BAX index, indicates activation of a different endogenous apoptosis pathway than the one examined, namely pointing to suicidal death of cells after PDT.