RESUMO
BACKGROUND: Recent data from ACOSOG Z0011 and NSABP B32 trials suggested no need for axillary lymph node dissection (ALND) in patients with micrometastatic involvement of the sentinel lymph node (SLN). The low rate of axillary recurrence was attributed to the axilla coverage by the tangential fields (TgFs) irradiation and systemic therapy. This study aimed to evaluate dose distribution and coverage of the axilla levels I-II and the SLN area. PATIENTS AND METHODS: One hundred and nine patients were analyzed according to three groups: group 1 (50 Gy; n = 18), group 2 (60 Gy; n = 34) and group 3 (66 Gy; n = 57). Patients were treated using the standard (STgF; n = 22) or high (HTgF; n = 87) TgF. RESULTS: The median doses delivered to level I using HTgF versus STgF were 33 and 20 Gy (P = 0.0001). The mean dose delivered to the SLN area was only 28 Gy. Additionally, the SLN area was totally included in the HTgF in 1 out of 12 patients who had intraoperative clip placement in the SNL area. CONCLUSIONS: TgFs provide a limited coverage of the axilla and the SNLB area. This information should be considered when only TgFs are planned to target the axilla in patients with a positive SLN without ALND. Standardization of locoregional radiotherapy in this situation is urgently needed.
Assuntos
Neoplasias da Mama/radioterapia , Metástase Linfática/radioterapia , Recidiva Local de Neoplasia/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/mortalidade , Feminino , Humanos , Linfonodos/efeitos da radiação , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Sobrevida , Taxa de SobrevidaRESUMO
PURPOSE: To assess the incidence and presentation of ipsilateral cancer recurrences (ICR) after deep inferior epigastric perforator (DIEP) flap reconstruction for breast cancer. PATIENTS AND METHODS: Data of 247 consecutive women with DIEP flap reconstruction after breast cancer in our institution between 1997 and 2009 were retrospectively reviewed. RESULTS: Mean follow-up time was 4.1years±3.2 (SD) (median: 3years; range: 1month - 14years). Thirty-one patients (12.5%, 95%CI: =8.7-17.3) presented 34 relapses, in average 4.1years±2.6 after mastectomy: 14 (41%) were ipsilateral, 6 (18%) contralateral and 14 (41%) metastatic. ICRs occurred earlier (3.9 vs. 5.8years; P<0.05) than non-ICRs. Most ICRs (10/14, 71%) involved the periphery of the flap and presented as palpable nodules. The remaining (4/14, 29%) involved the axilla and 3/4 (75%) were palpable. Imaging procedures detected infra-clinical ICRs in 3 of 10 imaged patients (30%). CONCLUSION: ICRs after DIEP flap reconstruction are more frequent than contralateral recurrences suggesting the need for imaging follow-up of the reconstructed breast.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamoplastia/métodos , Mamografia , Segunda Neoplasia Primária/diagnóstico por imagem , Segunda Neoplasia Primária/epidemiologia , Retalho Perfurante , Adulto , Idoso , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Adenocarcinoma/patologia , Neoplasias das Glândulas Anais/patologia , Adenocarcinoma/terapia , Neoplasias das Glândulas Anais/terapia , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Doses de Radiação , ReoperaçãoRESUMO
A case of benign granular cell tumor of the perianal region is presented. The patient was treated by local excision of the tumor. This is an unusual site. Superficial biopsy specimens may indicate an incorrect diagnosis of squamous cell carcinoma.
Assuntos
Neoplasias das Glândulas Anais/patologia , Tumor de Células Granulares/patologia , Animais , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Isolated retroperitoneal bronchogenic cysts are extremely rare. We report a case which was intradiaphragmatic intimately associated with the musculature of the left crus diaphragmatic and unconnected with any other structures. Ultrasound and computed tomography findings were consistent with a pancreatic or an adrenal mass. Pathology confirmed a bronchogenic cyst. The outcome is favourable and the overall prognosis is good.