RESUMEN
PURPOSE: The aim of this study was to evaluate clinical practice heterogeneity in use of neoadjuvant systemic therapy (NST) for patients with clinically node-positive breast cancer in Europe. METHODS: The study was preplanned in the international multicenter phase-III OPBC-03/TAXIS trial (ClinicalTrials.gov Identifier: NCT03513614) to include the first 500 randomized patients with confirmed nodal disease at the time of surgery. The TAXIS study's pragmatic design allowed both the neoadjuvant and adjuvant setting according to the preferences of the local investigators who were encouraged to register eligible patients consecutively. RESULTS: A total of 500 patients were included at 44 breast centers in six European countries from August 2018 to June 2022, 165 (33%) of whom underwent NST. Median age was 57 years (interquartile range [IQR], 48-69). Most patients were postmenopausal (68.4%) with grade 2 and 3 hormonal receptor-positive and human epidermal growth factor receptor 2-negative breast cancer with a median tumor size of 28 mm (IQR 20-40). The use of NST varied significantly across the countries (p < 0.001). Austria (55.2%) and Switzerland (35.8%) had the highest percentage of patients undergoing NST and Hungary (18.2%) the lowest. The administration of NST increased significantly over the years (OR 1.42; p < 0.001) and more than doubled from 20 to 46.7% between 2018 and 2022. CONCLUSION: Substantial heterogeneity in the use of NST with HR+/HER2-breast cancer exists in Europe. While stringent guidelines are available for its use in triple-negative and HER2+ breast cancer, there is a need for the development of and adherence to well-defined recommendations for HR+/HER2-breast cancer.
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Neoplasias de la Mama , Humanos , Persona de Mediana Edad , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/metabolismo , Terapia Neoadyuvante , Estudios Prospectivos , Mama/patología , Europa (Continente)/epidemiología , Receptor ErbB-2/metabolismoRESUMEN
We present the first Corynebacterium associated therapy resistant granulomatous mastitis successfully treated with negative pressure wound therapy (NPWT). Our patient had received five different courses of antibiotic therapy, and three surgical explorations before NPWT was introduced and resulted in healing. For a successful treatment, the use of targeted antibiotic therapy, steroid therapy and in case of progressive disease, wide excision is required. When this results in a large wound cavity, NPWT seems an effective and innovative option.
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Neoplasias de la Mama , Mastitis Granulomatosa , Terapia de Presión Negativa para Heridas , Corynebacterium , Femenino , Mastitis Granulomatosa/tratamiento farmacológico , HumanosRESUMEN
Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue into the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 3rd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations.
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Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Mastectomía Segmentaria , Mastectomía/métodos , Axila , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/radioterapia , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Intraductal no Infiltrante/cirugía , Carcinoma Lobular/patología , Carcinoma Lobular/cirugía , Contraindicaciones , Femenino , Humanos , Hungría , Neoplasias Inflamatorias de la Mama/patología , Neoplasias Inflamatorias de la Mama/cirugía , Escisión del Ganglio Linfático/métodos , Metástasis Linfática/diagnóstico , Mamoplastia/métodos , Mastectomía Segmentaria/métodos , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/prevención & control , Enfermedad de Paget Mamaria/patología , Enfermedad de Paget Mamaria/cirugía , Tumor Filoide/patología , Tumor Filoide/cirugía , Mastectomía Profiláctica , Radioterapia Adyuvante , Biopsia del Ganglio Linfático CentinelaRESUMEN
Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue in the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 2nd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations.
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Neoplasias de la Mama/cirugía , Guías de Práctica Clínica como Asunto , Biopsia del Ganglio Linfático Centinela , Axila , Femenino , Humanos , Hungría , Escisión del Ganglio Linfático , Ganglios LinfáticosRESUMEN
Importance: The role of axillary lymph node dissection (ALND) to determine nodal burden to inform systemic therapy recommendations in patients with clinically node (cN)-positive breast cancer (BC) is currently unknown. Objective: To address the association of ALND with systemic therapy in cN-positive BC in the upfront surgery setting and after neoadjuvant chemotherapy (NACT). Design, Setting, and Participants: This was a prospective, observational, cohort study conducted from August 2018 to June 2022. This was a preplanned study within the phase 3 randomized clinical OPBC-03/TAXIS trial. Included were patients with confirmed cN-positive BC from 44 private, public, and academic breast centers in 6 European countries. After NACT, residual nodal disease was mandatory, and a minimum follow-up of 2 months was required. Exposures: All patients underwent tailored axillary surgery (TAS) followed by ALND or axillary radiotherapy (ART) according to TAXIS randomization. TAS removed suspicious palpable and sentinel nodes, whereas imaging-guidance was optional. Systemic therapy recommendations were at the discretion of the local investigators. Results: A total of 500 patients (median [IQR] age, 57 [48-69] years; 487 female [97.4%]) were included in the study. In the upfront surgery setting, 296 of 335 patients (88.4%) had hormone receptor (HR)-positive and Erb-B2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-negative disease: 145 (49.0%) underwent ART, and 151 (51.0%) underwent ALND. The median (IQR) number of removed positive lymph nodes without ALND was 3 (1-4) nodes compared with 4 (2-9) nodes with ALND. There was no association of ALND with the proportion of patients undergoing adjuvant chemotherapy (81 of 145 [55.9%] vs 91 of 151 [60.3%]; adjusted odds ratio [aOR], 0.72; 95% CI, 0.19-2.67) and type of systemic therapy. Of 151 patients with NACT, 74 (51.0%) underwent ART, and 77 (49.0%) underwent ALND. The ratio of removed to positive nodes was a median (IQR) of 4 (3-7) nodes to 2 (1-3) nodes and 15 (12-19) nodes to 2 (1-5) nodes in the ART and ALND groups, respectively. There was no observed association of ALND with the proportion of patients undergoing postneoadjuvant systemic therapy (57 of 74 [77.0%] vs 55 of 77 [71.4%]; aOR, 0.86; 95% CI, 0.43-1.70), type of postneoadjuvant chemotherapy (eg, capecitabine: 10 of 74 [13.5%] vs 10 of 77 [13.0%]; trastuzumab emtansine-DM1: 9 of 74 [12.2%] vs 11 of 77 [14.3%]), or endocrine therapy (eg, aromatase inhibitors: 41 of 74 [55.4%] vs 36 of 77 [46.8%]; tamoxifen: 8 of 74 [10.8%] vs 6 of 77 [7.8%]). Conclusion: Results of this cohort study suggest that patients without ALND were significantly understaged. However, ALND did not inform systemic therapy recommendations.
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Neoplasias de la Mama , Humanos , Femenino , Persona de Mediana Edad , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Biopsia del Ganglio Linfático Centinela , Metástasis Linfática/patología , Estudios de Cohortes , Estudios Prospectivos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Terapia Neoadyuvante , AxilaRESUMEN
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Neoplasias de la Mama , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Hungría , Mastectomía , Oncología Médica , PronósticoRESUMEN
Összefoglaló. Bevezetés: Napjainkban az orszemnyirokcsomó felkeresésének legelterjedtebb módszere a radioizotópos és kék festékes kettos jelölés, emellett azonban több más jelölés is alkalmazható. Az indociánzöld-fluoreszcencia ígéretes nyirokút-térképezési módszer, mely a találati arányát tekintve - irodalmi adatok alapján - összevetheto a radioizotópos módszerrel. Módszer: Osztályunkon 2020. 03. 31. és 2020. 04. 15. között 10, emlorák miatt operált betegünknél alkalmaztuk az indociánzöld és a kék festékes kettos jelölés módszerét az orszemnyirokcsomó felkeresésére. Eredmények: A 10 operált betegünknél összesen 17 orszemnyirokcsomót azonosítottunk és távolítottunk el. 16 orszemnyirokcsomó jól festodött indociánzölddel (találati arány: 0,94; 95%-os konfidenciaintervallum [CI ]: 0,73-0,99), míg kék festékkel 9 jelölodött (találati arány: 0,53; 95%-os CI: 0,31-0,74). A szövettani feldolgozás során összesen 2 orszemnyirokcsomó bizonyult áttétesnek, ezek közül 1 kék és fluoreszcens volt, 1 pedig csak kék festékkel jelölodött. Következtetés: Kezdeti, kis esetszámnál nyert tapasztalataink alapján az indociánzöld jelölés emlorák során végzett orszemnyirokcsomó-biopszia esetén jól használható kettos jelölési módszer részeként, kék festékkel kiegészítve. A módszer találati aránya, valamint fals negatív aránya irodalmi adatok alapján nem különbözik szignifikánsan a radioizotópos jelölés módszerétol. Orv Hetil. 2021; 162(8): 293-297. INTRODUCTION: The current practice in sentinel lymph node biopsy for breast cancer is the radioisotope and blue dye dual labelling technique, however, other mapping methods are also available. Indocyanine green fluorescence is one of the best alternatives of the standard technique, with detection rates comparable to those of the radioisotope method. METHOD: Between 31. 03. 2020 and 15. 04. 2020, a total of 10 sentinel lymph node biopsies for breast cancer were performed using the indocyanine green fluorescence and blue dye dual technique. RESULTS: 17 sentinel lymph nodes were detected and removed in total, from which 16 showed explicit fluorescence activity (detection rate: 0.94; 95% confidence interval [CI]: 0.73-0.99), whilst 9 where blue (detection rate: 0.53; 95% CI: 0.31-0.74). During histopathological examination, 2 sentinel lymph nodes proved to be metastatic, from which 1 was fluorescent and blue, the other was blue only. CONCLUSION: Regarding our early experience based on a small number of patients, indocyanine green fluorescence, used together with blue dye as part of a dual technique, is a usable method for sentinel lymph node mapping. Based on data from the literature, the detection rate and the false-negative rate of the indocyanine green fluorescence method shows no significant difference from the radioisotope mapping technique. Orv Hetil. 2021; 162(8): 293-297.
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Neoplasias de la Mama/diagnóstico por imagen , Verde de Indocianina , Imagen Óptica , Biopsia del Ganglio Linfático Centinela , Femenino , HumanosRESUMEN
AIM: We developed tailored axillary surgery (TAS) to reduce the axillary tumor volume in patients with clinically node-positive breast cancer to the point where radiotherapy can control it. The aim of this study was to quantify the extent of tumor load reduction achieved by TAS. METHODS: International multicenter prospective study embedded in a randomized trial. TAS is a novel pragmatic concept for axillary surgery de-escalation that combines palpation-guided removal of suspicious nodes with the sentinel procedure and, optionally, imaging-guided localization. Pre-specified study endpoints quantified surgical extent and reduction of tumor load. RESULTS: A total of 296 patients were included at 28 sites in four European countries, 125 (42.2%) of whom underwent neoadjuvant chemotherapy (NACT) and 71 (24.0%) achieved nodal pathologic complete response. Axillary metastases were detectable only by imaging in 145 (49.0%) patients. They were palpable in 151 (51.0%) patients, of whom 63 underwent NACT and 21 had residual palpable disease after NACT. TAS removed the biopsied and clipped node in 279 (94.3%) patients. In 225 patients with nodal disease at the time of surgery, TAS removed a median of five (IQR 3-7) nodes, two (IQR 1-4) of which were positive. Of these 225 patients, 100 underwent ALND after TAS, which removed a median of 14 (IQR 10-17) additional nodes and revealed additional positive nodes in 70/100 (70%) of patients. False-negative rate of TAS in patients who underwent subsequent ALND was 2.6%. CONCLUSIONS: TAS selectively reduced the tumor load in the axilla and remained much less radical than ALND.
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Neoplasias de la Mama , Axila/patología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Estudios de Factibilidad , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Estadificación de Neoplasias , Estudios Prospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
Introduction: The introduction of sentinel node biopsy (SNB) has led to a significant decrease of axillary lymph node dissections (ALND). The importance of the extracapsular extension (ECE) in the sentinel lymph node (SN) remains unclear. Method: The data of 635 patients with T1-T2N0M0 invasive breast cancer who underwent SNB between 2014 and 2018 were retrospectively analysed. 25% of the SNB patients (158) had metastasis in the SNs. These patients were grouped based on the presence or absence of ECE. The main objective of our study was to analyse the occurrence of massive (>3) node metastasis in the case of ECE negative and ECE positive patients, where ALND was performed. Results: There were 91/158 patients (58%) in the ECE negative group and 67/158 patients (42%) in the ECE positive group. ALND was performed in 42% of the ECE negative and in 69% of the ECE positive patients. There were no significant differences in the mean age of the patients; size, histological type and grade of the tumours, presence of lymphovascular invasion and proportion of hormone and HER2 receptor positivities. In the ECE negative ALND group, pN1 involvement was 82%, pN2+pN3 involvement represented 18% of cases. In the ECE positive ALND group, pN1 involvement was 60%, pN2+pN3 involvement was found in 40% of cases. The presence of ECE was associated with greater axillary disease burden. These results show a significant difference (p = 0.038). Conclusions: ECE of the SN is an important predictor for non-sentinel lymph node involvement. These data suggest, when ECE is confirmed, it is a further factor to be considered in deciding about ALND.
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Neoplasias de la Mama/patología , Extensión Extranodal/patología , Ganglios Linfáticos/patología , Biopsia del Ganglio Linfático Centinela , Ganglio Linfático Centinela/patología , Axila , Neoplasias de la Mama/cirugía , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/cirugía , Metástasis Linfática , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
The surgical treatment is still the most effective method in curing of early breast cancer. Breast preservation and the application of oncoplastic principles became generally accepted, the sentinel lymph node biopsy in the surgical treatment of the axilla is primary, and the indication for axillary block dissection (ABD) is narrowing further. The neoadjuvant oncological treatment that is applied more and more widely presented surgery with new challenges. Hereunder we summarise our recommendations on the surgical treatment of breast cancer based on the content of the 3rd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations.
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Neoplasias de la Mama , Terapia Neoadyuvante , Biopsia del Ganglio Linfático Centinela , Axila , Neoplasias de la Mama/cirugía , Humanos , Escisión del Ganglio Linfático , Ganglios LinfáticosRESUMEN
Small breast cancers often require different treatment than larger ones. The frequency and predictability of further nodal involvement was evaluated in patients with positive sentinel lymph nodes and breast cancers < or =15 mm by means of 8 different predictive tools. Of 506 patients with such small tumors 138 with positive sentinel nodes underwent axillary dissection and 39 of these had non-sentinel node involvement too. The Stanford nomogram and the micrometastatic nomogram were the predictive tools identifying a small group of patients with low probability of further axillary involvement that might not require completion axillary lymph node dissection. Our data also suggest that the Tenon score can separate subsets of patients with a low and a higher risk of non-sentinel node metastasis. Predictive tools based on multivariate models can help in omitting completion axillary dissection in patients with low risk of non-sentinel lymph node metastasis based on their small tumor size.
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Neoplasias de la Mama/patología , Ganglios Linfáticos/patología , Nomogramas , Biopsia del Ganglio Linfático Centinela , Adulto , Anciano , Axila , Femenino , Humanos , Modelos Logísticos , Metástasis Linfática , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica , Valor Predictivo de las PruebasRESUMEN
INTRODUCTION: In the recent past, both clinically node-positive and node-negative but sentinel node-positive patients underwent axillary lymph node dissection (ALND), although the two groups seem to have substantially different degree of nodal involvement. METHODS: Data on consecutive primary breast cancer patients with documented axillary ultrasound (AXUS) results who underwent ALND between January 2003 and December 2015 either because of AXUS-guided fine needle aspiration (A-FNAC) results or because of a positive sentinel lymph node were retrospectively analysed. RESULTS: After exclusions, 316 patients staged by SNB and ALND with negative AXUS or A-FNAC (group A) were compared with 159 patients having positive A-FNAC results (group B). Tumour size and the proportion of mastectomies were greater, histological grade higher and lymphovascular invasion more frequent in Group B, where palpable lymph nodes were also more common. The proportion of cases with extensive nodal involvement (pN2 and pN3 cases) was about 3 times as much in Group B (63%) than in Group A (18%). Removal of the 50 patients with palpable lymph nodes from the analysis did not greatly influence these proportions: 60% and 19% extensive nodal involvements were noted, respectively. In this series, patients with suspicious AXUS and negative A-FNAC had more often extensive nodal involvement (25%) than AXUS negative patients (17%). CONCLUSIONS: Patients in whom axillary metastases are detected by ultrasound-guided biopsy have significantly more involved nodes than SLNB-positive patients, and therefore are likely to benefit from axillary treatment.
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Axila/diagnóstico por imagen , Biopsia con Aguja Fina , Neoplasias de la Mama/patología , Biopsia Guiada por Imagen , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Ultrasonografía/métodos , Adulto , Anciano , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Preoperatorios , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
UNLABELLED: Sentinel node biopsy (SNB) is controversial for in situ breast cancers. We reviewed our experience with in situ and microinvasive carcinomas and surveyed the literature. METHODS: SNB was performed with intraparenchymal administration of vital dye alone or combined with radiocolloid. The SNs were assessed histologically with haematoxylin eosin staining and cytokeratin immunohistochemistry. RESULTS: Patients with in situ (36) or microinvasive (20) carcinomas underwent SNB: 59 axillary and 1 parasternal, and 39 axillary and 1 parasternal SNs were recovered, respectively. The SNs were positive in 4 patients and 1 patient, respectively: 1 micrometastasis and 3 isolated tumour cells, and 1 micrometastasis in the respective groups. No further axillary nodes were found positive after dissection. Further 21 invasive carcinomas (often with extensive intraductal component) had an in situ carcinoma diagnosis preoperatively: of 39 axillary and 3 parasternal SNs 10 patients had nodal involvement in 13 axillary SNs; 5 patients also had further lymph nodes involved after dissection. CONCLUSIONS: The definitive diagnosis of in situ carcinoma does not warrant SNB. This procedure should be considered if the tumour is to be removed by mastectomy, or if the diagnosis is preoperative and there are associated high-risk factors for the subsequent diagnosis of invasive cancer.
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Neoplasias de la Mama/cirugía , Carcinoma in Situ/cirugía , Carcinoma Ductal de Mama/cirugía , Ganglios Linfáticos/patología , Biopsia del Ganglio Linfático Centinela , Adulto , Anciano , Neoplasias de la Mama/patología , Carcinoma in Situ/patología , Carcinoma Ductal de Mama/patología , Medios de Contraste/administración & dosificación , Femenino , Hospitales de Condado , Humanos , Hungría , Inmunohistoquímica , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática/diagnóstico , Persona de Mediana Edad , Cintigrafía , Radiofármacos , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela/métodos , Agregado de Albúmina Marcado con Tecnecio Tc 99mRESUMEN
BACKGROUND: Sentinel lymph node biopsy (SLNB) is a standard procedure in women with breast cancer. The risk of morbidity related to axillary lymph node dissection (ALND) is similar for men and women with breast cancer and SLNB could minimize this risk. METHODS: Between January 2004 and August 2013, 25 men with primary breast cancer were operated on at the Bács-Kiskun County Teaching Hospital. These were reviewed retrospectively. SLNB was performed following lymphoscintigraphy with intraoperative gamma probe detection and blue dye mapping. RESULTS: SLNB was successful in all 16 male patients (100 %), in whom it was attempted. The SLNs were negative in 4 cases (25 %) and were involved in 12. Intraoperative imprint cytology was positive in 9 of the 12 involved cases (75 %) and resulted immediate completion ALND. In 7 patients, the intraoperative imprint cytology was negative, with 3 false-negative results that resulted in delayed completion ALND. After a median follow-up of 48 months, there was only one axillary recurrence after ALND and none in the SLNB group. CONCLUSIONS: SLNB is successful and accurate in male breast cancer patients too. Although compared to women a larger proportion of men have positive nodes, for men with negative nodes, ALND-related morbidity may be reduced by SLNB. We recommend SLNB in male patients with breast cancer and clinically negative axilla.
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Neoplasias de la Mama Masculina/cirugía , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/cirugía , Ganglios Linfáticos/patología , Mastectomía/métodos , Recurrencia Local de Neoplasia , Biopsia del Ganglio Linfático Centinela/métodos , Anciano , Axila , Neoplasias de la Mama Masculina/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Estudios de Cohortes , Colorantes , Humanos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/diagnóstico por imagen , Linfocintigrafia , Masculino , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Mamoplastia , Mastectomía/métodos , Terapia Neoadyuvante , Cuidados Paliativos , Lactancia Materna , Neoplasias de la Mama/patología , Neoplasias de la Mama Masculina/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Carcinoma Lobular/cirugía , Femenino , Humanos , Metástasis Linfática , Masculino , Mamoplastia/métodos , Mastectomía Segmentaria , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/terapia , Enfermedad de Paget Mamaria/cirugía , Cuidados Paliativos/métodos , Tumor Filoide/cirugía , Embarazo , Complicaciones Neoplásicas del Embarazo/cirugía , Recurrencia , Biopsia del Ganglio Linfático CentinelaRESUMEN
INTRODUCTION: The neoadjuvant chemotherapy is increasingly being used in the treatment of patients with locally advanced breast cancer. We describe the hypothesis of the biological behaviour of breast cancer supporting the reason for the existence of this treatment. The improvement of neoadjuvant chemotherapy is being discussed as well as the advantages, disadvantages and problems of the treatment. THE AIM OF EXAMINATION: To study the results of neoadjuvant chemotherapy in patients with locally advanced breast cancer and the proportion of breast preserving surgery after the treatment. METHODS: Sixty seven patients were given neoadjuvant chemotherapy treatment between 01.01.1999 and 12.31.2003. Twenty three patients were stage III A while 35 stage III B and 9 stage III C. 63% of the patients received CEF chemotherapy and 19% were given MMM. 18% were given neoadjuvant Taxotere + Carboplatin and 4% were given Taxotere + Farmorubicin chemotherapy. RESULTS: After neoadjuvant chemotherapy 5 patients had SD (stable disease), 32 patients had MR (minor response) and in 28 cases patients had PR (partial response). Two patients showed pCR (complete pathologic response). Twenty patients (30%) had breast preserving surgery. CONCLUSIONS: On the basis of our own experience neoadjuvant therapy is justified in patients with locally advanced breast cancer as they have bigger chance for breast preserving surgery. If mastectomy and axillary block dissection has to be carried out they are easier to perform. Taxans must be introduced for neoadjuvant treatment in order to improve our results. A longer follow-up is necessary before drawing final conclusions.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Mastectomía Segmentaria , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Carboplatino/administración & dosificación , Quimioterapia Adyuvante , Ciclofosfamida/administración & dosificación , Citarabina/administración & dosificación , Docetaxel , Epirrubicina/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Estudios Retrospectivos , Taxoides/administración & dosificación , Resultado del TratamientoAsunto(s)
Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático/métodos , Mastectomía/métodos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama Masculina/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Carcinoma Lobular/cirugía , Carcinoma de Células Escamosas/cirugía , Contraindicaciones , Femenino , Humanos , Masculino , Mamoplastia , Mastectomía Segmentaria , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Enfermedad de Paget Mamaria/cirugía , Biopsia del Ganglio Linfático CentinelaRESUMEN
Whether an axillary lymph node dissection (ALND) is needed for breast cancer patients with minimal sentinel lymph node (SLN) involvement is arguable despite recent data supporting the omission of axillary clearance in these patients. Data on disease recurrence of 111 patients with SLN involvement and no ALND were analysed. Patients with minimal SLN involvement were assessed for their risk of non-SLN metastasis by means of several nomograms. The series included patients with isolated tumour cells (n = 76), micrmetastasis (n = 33) and macrometastasis (n = 2) who were followed for a median of 37 months (range 12-148 months). Six patients died, 3 of disease and 3 of unrelated causes. Eight further patients had breast cancer related events: 1 local breast recurrence and seven distant metastases. No axillary regional recurrence was detected. Disease related events were not associated with the risk of non-SLN metastasis. The presented data suggest that omitting ALND in patients with low volume SLN metastasis may be a safe procedure, and support the observation that systemic disease recurrence may not be associated with axillary recurrence or the risk of NSLN involvement predicted by nomograms.
Asunto(s)
Neoplasias de la Mama/patología , Escisión del Ganglio Linfático/estadística & datos numéricos , Recurrencia Local de Neoplasia/patología , Nomogramas , Biopsia del Ganglio Linfático Centinela , Axila , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Clasificación del Tumor , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Pronóstico , Tasa de SupervivenciaRESUMEN
After a positive sentinel lymph node (SLN) biopsy, some patients may be considered to have a very low risk of non-SLN involvement and could be candidates for axillary sparing. The aim of this study was to validate the nomogram created at the Memorial Sloan-Kettering Cancer Center (MSKCC) for the prediction of non-SLN involvement in an independent set of 140 patients with both positive SLNs and axillary dissection. The predicted proportions of positive non-SLNs were compared with the observed percentages of non-SLN metastasis. Although the SLN metastasis size and tumor size did influence the risk of non-SLN involvement, the correlation between the predicted and observed proportions was weaker for our patients (R: 0.84) than for the patients assessed at the MSKCC (R: 0.97). Differences were noted in the intraoperative assessment and in the final histology of the SLNs (imprints vs frozen sections and more detailed vs less detailed, respectively), and these could partly explain the lower level of the correlation. The nomogram could not be validated and was found to be of only limited use for the prediction of non-SLN involvement in patients operated on under similar, though not fully identical conditions. We therefore warn against the unvalidated use of this prediction tool.
Asunto(s)
Neoplasias de la Mama/patología , Metástasis Linfática , Nomogramas , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática/diagnósticoRESUMEN
Although axillary lymph node dissection (ALND) has been the standard intervention in breast cancer patients with sentinel lymph node (SLN) metastasis, only a small proportion of patients benefit from this operation, because most do not harbor additional metastases in the axilla. Several predictive tools have been constructed to identify patients with low risk of non-SLN metastasis who could be candidates for the omission of ALND. In the present work, predictive nomograms were used to predict a high (>50 %) risk of non-SLN metastasis in order to identify patients who would most probably benefit from further axillary treatment. Data of 1000 breast cancer patients with SLN metastasis and completion ALND from 5 institutions were tested in 4 nomograms. A subset of 313 patients with micrometastatic SLNs were also tested in 3 different nomograms devised for the micrometastatic population (the high risk cut-off being 20 %). Patients with a high predicted risk of non-SLN metastasis had higher rates of metastasis in the non-SLNs than patients with low predicted risk. The positive predictive values of the nomograms ranged from 44 % to 64 % with relevant inter-institutional variability. The nomograms for micrometastatic SLNs performed much better in identifying patients with low risk of non-SLN involvement than in high-risk-patients; for the latter, the positive predictive values ranged from 13 % to 20 %. The nomograms show inter-institutional differences in their predictive values and behave differently in different settings. They are worse in identifying high risk patients than low-risk ones, creating a need for new predictive models to identify high-risk patients.