Changes in metabolic risk, insulin resistance, leptin and adiponectin following a lifestyle intervention in overweight and obese breast cancer survivors.

Adiposity and physical activity are modifiable factors that could be important determinants of breast cancer (BC) prognosis through their effects on endogenous reproductive hormones, chronic inflammation and metabolic changes. Therefore, it is necessary to evaluate whether offering lifestyle interventions to BC survivors could affect the levels of certain biomarkers involved in these mechanisms. We designed a pre-post intervention study offering diet and exercise sessions over 12 weeks to 42 overweight/obese BC survivors. Before and after the intervention, we obtained dietary information, anthropometry and cardiorespiratory fitness (CRF) measurements and blood samples to measure metabolic risk, insulin resistance and adipokines biomarkers. Wilcoxon signed-rank tests and Spearman partial correlation coefficients were used to compare pre- and post-measurements and assess the correlations between changes in biomarkers and changes in anthropometry and CRF. Breast cancer survivors showed significant improvements in metabolic risk biomarkers and insulin resistance indicators along with a non-significant leptin decrease and a significant adiponectin decrease. The improvements in metabolic risk biomarkers, insulin resistance indicators and leptin were moderately correlated (0.32 ≤ |r| ≤ 0.55) with the decrease in body mass index and the increase in CRF. Diet and exercise interventions implemented in overweight/obese BC survivors may improve metabolic risk, insulin resistance and leptin biomarkers.

Predictive and Prognostic Brain Metastases Assessment in Luminal Breast Cancer Patients: FN14 and GRP94 from Diagnosis to Prophylaxis.

FN14 has been implicated in many intracellular signaling pathways, and GRP94 is a well-known endoplasmic reticulum protein regulated by glucose. Recently, both have been associated with metastasis progression in breast cancer patients. We studied the usefulness of FN14 and GRP94 expression to stratify breast cancer patients according their risk of brain metastasis (BrM) progression. We analyzed FN14 and GRP94 by immunohistochemistry in a retrospective multicenter study using tissue microarrays from 208 patients with breast carcinomas, of whom 52 had developed BrM. Clinical and pathological characteristics and biomarkers expression in Luminal and non-Luminal patients were analyzed using a multivariate logistic regression model adjusted for covariates, and brain metastasis-free survival (BrMFS) was estimated using the Kaplan-Meier method and the Cox proportional hazards model. FN14 expression was associated with BrM progression mainly in Luminal breast cancer patients with a sensitivity (53.85%) and specificity (89.60%) similar to Her2 expression (46.15 and 89.84%, respectively). Moreover, the likelihood to develop BrM in FN14-positive Luminal carcinomas increased 36.70-fold (3.65-368.25, p = 0.002). Furthermore, the worst prognostic factor for BrMFS in patients with Luminal carcinomas was FN14 overexpression (HR = 8.25; 95% CI: 2.77-24.61; p = 0.00015). In these patients, GRP94 overexpression also increased the risk of BrM (HR = 3.58; 95% CI: 0.98-13.11; p = 0.054-Wald test). Therefore, FN14 expression in Luminal breast carcinomas is a predictive/prognostic biomarker of BrM, which combined with GRP94 predicts BrM progression in non-Luminal tumors 4.04-fold (1.19-8.22, p = 0.025), suggesting that both biomarkers are useful to stratify BrM risk at early diagnosis. We propose a new follow-up protocol for the early prevention of clinical BrM of breast cancer patients with BrM risk.

FN14 and GRP94 expression are prognostic/predictive biomarkers of brain metastasis outcome that open up new therapeutic strategies.

Brain metastasis is a devastating problem in patients with breast, lung and melanoma tumors. GRP94 and FN14 are predictive biomarkers over-expressed in primary breast carcinomas that metastasized in brain. To further validate these brain metastasis biomarkers, we performed a multicenter study including 318 patients with breast carcinomas. Among these patients, there were 138 patients with metastasis, of whom 84 had brain metastasis. The likelihood of developing brain metastasis increased by 5.24-fold (95%CI 2.83-9.71) and 2.55- (95%CI 1.52-4.3) in the presence of FN14 and GRP94, respectively. Moreover, FN14 was more sensitive than ErbB2 (38.27 vs. 24.68) with similar specificity (89.43 vs. 89.55) to predict brain metastasis and had identical prognostic value than triple negative patients (p < 0.0001). Furthermore, we used GRP94 and FN14 pathways and GUILD, a network-based disease-gene prioritization program, to pinpoint the genes likely to be therapeutic targets, which resulted in FN14 as the main modulator and thalidomide as the best scored drug. The treatment of mice with brain metastasis improves survival decreasing reactive astrocytes and angiogenesis, and down-regulate FN14 and its ligand TWEAK. In conclusion our results indicate that FN14 and GRP94 are prediction/prognosis markers which open up new possibilities for preventing/treating brain metastasis.

Is Quality of Life Related to Cardiorespiratory Fitness in Overweight and Obese Breast Cancer Survivors?

This study assessed changes in quality of life (QoL) and cardiorespiratory fitness (CRF) during a diet and physical activity (PA) intervention in breast cancer (BC) survivors and investigated the relation between these changes. The intervention of this single-arm pre-post study involved supervised, 1-hour weekly, diet sessions and 75-minute bi-weekly PA sessions of moderate-to-high intensity. This 12-week intervention targeted overweight/obese women who had recently completed BC treatment. Pre- and post-CRF and QoL measurements were compared using paired t-tests. Linear regression models, including baseline participants' characteristics and weight change, were used to assess the association between changes in CRF and QoL. The 37 BC survivors who completed the intervention between May 7, 2012 and July 27, 2012 showed significant increases in CRF and QoL. Peak oxygen uptake (mL/kg/min) increased from 19.0 ± 2.8 to 24.0 ± 4.1 while peak workload (watts/kg) increased from 1.3 ± 0.3 to 1.7 ± 0.3. Although statistical significance was not reached, the increase in workload seemed associated with increases in physical, mental, and general health and with a decrease in fatigue. This lifestyle intervention improved BC survivors' QoL and CRF and suggested possible relationships between CRF and QoL. More research needs to confirm these associations and promote lifestyle interventions aiming at improving BC survivors' QoL.

The use of an interstitial boost in the conservative treatment of breast cancer: how to perform it routinely in a radiotherapy department.

PURPOSE: To demonstrate the utility of a boost with interstitial brachytherapy (BT) in breast-conserving therapy (BCT) by doing a thorough review of the literature and describing in detail our technique for delivering this boost. MATERIAL AND METHODS: Our department has been delivering the boost with interstitial BT since 1989, in most cases with rigid needles and a theoretical dosimetry. In the early years, we used low-dose-rate (LDR) with iridium-192 wires. The dose administered was 15 Gy if there were no risk factors for local relapse or 20-25 Gy in the presence of risk factors. The risk factors considered were the presence of a close margin (less than 10 mm) and an extensive intraductal component (more than 25%). After 2002, we switched to high-dose-rate (HDR); using the linear quadratic model we changed the low dose to 3 fractions of 4.5 Gy in the case of no risk factors for local relapse or to 3 fractions of 5 Gy in the presence of risk factors. RESULTS: In 79 consecutive boost patients treated in our department between 2010 and 2011, with a median follow-up of 46 months, the local control rate was 97.47%. With respect to cosmesis, fibrosis occurred in 17 cases (21.5%) and hyperpigmentation in 26 cases (32.9%). Our hospital's results are comparable in terms of local control and cosmesis to those of other authors. CONCLUSIONS: This educational article describes our department's boost technique with rigid needles and comments briefly on our results using this technique in a group of consecutively treated patients in our department. A review of the literature and the published results on local control and cosmesis is also described.

Self-concept in preadolescence: A brief version of AF5 scale / Auto-conceito na pré-adolescência: Uma breve versão da escala AF5 / Autoconcepto en la preadolescencia: Una versión breve de la escala AF5

The purpose of this study was to analyze the psychometric properties of a brief version of the AF5 questionnaire (García & Musitu, 2001) using exploratory and confirmatory techniques on a preadolescent population in the Valencian community (Spain). The sample was made up of 541 participants between 10 and 12 years old, 55.1% (298) boys and 44.9% (243) girls. After observing the results of different reliability and validity analyses (exploratory factor analysis (EFA) and confirmatory factor analysis (CFA)), it was found that the reduced scale consisting of 20 items showed a similar reliability and validity to the original scale. The factorial structure also fits that of the original model established a priori. According to the results of the study, the use of this diagnostic tool with Spanish children seems justified...

O objetivo deste estudo foi analisar as propriedades psicométricas de uma versão reduzida do questionário AF5 (Garcia & Musitu, 2001), utilizando técnicas exploratórias e confirmatórias, em uma população pré-adolescente na comunidade Valenciana (Espanha). A amostra foi composta de 541 participantes entre 10 e 12 anos de idade, 55,1% do sexo masculino (298) e 44,9% do sexo feminino (243). Depois de observar os resultados de diferentes análises de confiabilidade e validade (análise fatorial exploratória (EFA) e análise fatorial confirmatória (CFA)), verificou-se que o questionário reduzido, composto por 20 itens, mostrou uma confiabilidade e validade semelhantes aos do questionário original. A estrutura fatorial também se encaixa no modelo original estabelecido a priori. De acordo com os resultados da pesquisa, o uso desta ferramenta de diagnóstico com crianças espanholas parecem justificados...

El objetivo de este estudio fue analizar las propiedades psicométricas de una versión abreviada del cuestionario AF5 (García & Musitu, 2001) utilizando técnicas exploratorias y confirmatorias en una población preadolescente en la comunidad Valenciana (España). La muestra se compone de 541 participantes entre 10 y 12 años de edad, 55.1% niños (298) y el 44,9% niñas (243). Tras observar los resultados de diferentes análisis de fiabilidad y validez (análisis factorial exploratorio (EPT) y el análisis factorial confirmatorio (CFA)), se encontró que la escala reducida consistente en 20 ítems mostró una fiabilidad y validez similar a la escala original. La estructura factorial también se ajusta a la del modelo original establecida a priori. De acuerdo con los resultados del estudio, el uso de esta herramienta de diagnóstico con niños españoles parece justificado...

Análisis de la percepción de los residentes sobre el impacto cultural y deportivo de un Gran Premio de Fórmula 1 / Análise da percepção dos residentes sobre o impacto cultural e desportivo de um grande prêmio de fórmula 1 / Analysis of resident's perception on the cultural and sport impact of a formula 1 grand prix

El objetivo de este estudio es analizar la percepción de los residentes sobre el impacto cultural y deportivo del Gran Premio de Europa de Fórmula 1. Se realizó un análisis clúster, combinando métodos jerárquicos y no jerárquicos, que permitió encontrar tres grupos con percepciones diferentes hacia este evento deportivo: Desfavorables, Desfavorables Moderados y Favorables Moderados. Los residentes consideran de forma mayoritaria que este evento no tiene un impacto considerable a nivel cultural y deportivo. Asimismo, se encontraron diferencias entre los tres grupos de residentes en función del interés por la Fórmula 1, el respaldo al evento, la asistencia y el grado de identificación

O objetivo do estudo é analisar a percepção dos residentes em relação ao impacto cultural e desportivo do Grande Prêmio da Europa de Fórmula 1. Realizou-se uma análise cluster, combinando métodos hierárquicos e não hierárquicos, que permitiu encontrar três grupos com percepções diferentes frente a este evento esportivo: Desfavoráveis, Desfavoráveis Moderados e Favoráveis Moderados. Os residentes consideram em sua maioria que este evento não tem um impacto considerável no nível cultural e esportivo. Também se encontraram diferenças entre os três grupos de residentes em função do interesse pela Fórmula 1, o respaldo ao evento, a assistência e o grau de identificação

The aim of this study is to analyze the resident's perception about the cultural and sport impact of European Formula 1 Grand Prix. Cluster analysis was performed by combining hierarchical and nonhierarchical methods, which allowed us to differentiate three groups with different perceptions towards sporting event: Unfavorable, Moderate Unfavorable and Moderate Favorable. Most residents believe that this event has no significant impact to cultural and sporting level. Also, differences were found between the three groups of residents in the interest of Formula 1, the support for the event, attendance and the degree of identification

Accelerated hypofractionated breast radiotherapy: FAQs (frequently asked questions) and facts.

The demand for breast cancer care has increased as cancer treatment innovations have proliferated. Adjuvant radiotherapy to the breast is considered to be part of the standard treatment in breast cancer. The role of radiotherapy in terms of reducing loco-regional recurrence and increased survival after conservative surgery, and also after a mastectomy in selected cases, has been previously shown in several randomized trials. Patterns of radiotherapy commonly used for breast cancer comprise a period of approximately five weeks, frequently with the addition of an additional 1-1.5 weeks of a radiation boost to the primary tumour area. In last years, there has been a renewed interest in hypofractionated and accelerated radiotherapy schedules that reduce the overall treatment time to barely three weeks, leading to an improvement in quality of life for patients and also optimizing workload of radiation oncology departments. However, despite the existing evidence supporting the use of hypofractionated treatment regimens, their widespread is still far from complete. Many questions have generated resistance among clinical oncologists for their regular use. The aim of this review is to answer those questions that may arise with the use of moderate hypofractionation in breast cancer.

Brachytherapy for penile cancer: efficacy and impact on sexual function.

PURPOSE: Penis brachytherapy (PB) remains an alternative in the cancer treatment. The objective of this study was to assess the oncologic outcomes, sexual function, and the sexual behavior of men treated by PB for a cancer of the penis. METHODS AND MATERIALS: Between 1992 and 2009, 47 patients with a cancer of the penis were treated by PB ((192)Ir), in the Toulouse, Montpellier, and Barcelona cancer centers. The investigation into their sexuality was obtained by means of questionnaire. A total of 21 French patients were approached, of whom 19 (mean age=73.2 years) agreed to answer the questionnaire (participation rate=90.5%). RESULTS: Oncologic data: The specific survival and the disease-free survival at 5 years was 87.6% (95% confidence interval, 72.4-94.7%) and 84% (95% confidence interval, 57.6-94.7%), respectively. The rate of preservation of the penis was 66% (n=31). Sexual data: Among the 17 patients sexually active before brachytherapy, 10 patients remained sexually active after treatment (58.8%). Of the 18 patients who had erections before PB, 17 still had them after treatment (94.4%). Age was the main predictive factor. CONCLUSION: The PB seems to have a moderated impact on the sexual functions and the sexual behavior of the patients.

Radiation techniques used in patients with breast cancer: Results of a survey in Spain.

AIM: To evaluate the resources and techniques used in the irradiation of patients with breast cancer after lumpectomy or mastectomy and the status of implementation of new techniques and therapeutic schedules in our country. BACKGROUND: The demand for cancer care has increased among the Spanish population, as long as cancer treatment innovations have proliferated. Radiation therapy in breast cancer has evolved exponentially in recent years with the implementation of three-dimensional conformal radiotherapy, intensity modulated radiotherapy, image guided radiotherapy and hypofractionation. MATERIAL AND METHODS: An original survey questionnaire was sent to institutions participating in the SEOR-Mama group (GEORM). In total, the standards of practice in 969 patients with breast cancer after surgery were evaluated. RESULTS: The response rate was 70% (28/40 centers). In 98.5% of cases 3D conformal treatment was used. All the institutions employed CT-based planning treatment. Boost was performed in 56.4% of patients: electrons in 59.8%, photons in 23.7% and HDR brachytherapy in 8.8%. Fractionation was standard in 93.1% of patients. Supine position was the most frequent. Only 3 centers used prone position. The common organs of risk delimited were: homolateral lung (80.8%) and heart (80.8%). In 84% histograms were used. An 80.8% of the centers used isocentric technique. In 62.5% asymmetric fields were employed. CTV was delimited in 46.2%, PTV in 65% and both in 38.5%. A 65% of the centers checked with portal films. IMRT and hypofractionation were used in 1% and in 5.5% respectively. CONCLUSION: In most of centers, 3D conformal treatment and CT-based planning treatment were used. IMRT and hypofractionation are currently poorly implemented in Spain.