RESUMEN
AIMS: Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. MATERIALS AND METHODS: An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. RESULTS: Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14-21% of the MDTs and the most recommended resection margins for breast surgery were 'no tumour on ink' in benign phyllodes (39%) and 10 mm in the remaining subtypes (25-29%). Immediate breast reconstruction was supported by 11-18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. CONCLUSION: The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.
Asunto(s)
Neoplasias de la Mama , Tumor Filoide , Sarcoma , Neoplasias de los Tejidos Blandos , Humanos , Femenino , Tumor Filoide/epidemiología , Tumor Filoide/cirugía , Estudios Transversales , Irlanda/epidemiología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Sarcoma/epidemiología , Sarcoma/cirugía , Reino Unido/epidemiología , Recurrencia Local de Neoplasia/patologíaAsunto(s)
Ciclosporina/uso terapéutico , Rechazo de Injerto , Enfermedad Injerto contra Huésped/prevención & control , Intestino Delgado/trasplante , Trasplante Homólogo/inmunología , Animales , Anticuerpos Monoclonales , Ciclosporina/administración & dosificación , Esquema de Medicación , Antígenos de Histocompatibilidad Clase I/análisis , Ganglios Linfáticos/inmunología , Ganglios Linfáticos Agregados/inmunología , Ratas , Ratas Endogámicas , Bazo/inmunologíaAsunto(s)
Rechazo de Injerto/fisiología , Enfermedad Injerto contra Huésped/fisiopatología , Intestino Delgado/microbiología , Intestino Delgado/trasplante , Animales , Bacterias/aislamiento & purificación , Enfermedad Injerto contra Huésped/microbiología , Ratas , Ratas Endogámicas , Trasplante Heterotópico , Trasplante Homólogo/inmunología , Trasplante Homólogo/fisiología , Trasplante Isogénico/inmunología , Trasplante Isogénico/fisiologíaRESUMEN
Small bowel transplantation is associated with a significant risk of graft versus host disease owing to the large amount of organized lymphoid tissue within the graft. This study assessed whether graft lymphoid cells could persist in the long term following fully allogeneic small bowel transplantation when graft rejection was prevented by cyclosporin immunosuppression. Transplantation was carried out between PVG and DA strains of rat. Cyclosporin (15 mg/kg) was given daily from transplantation, and groups of animals were studied at 28 and 56 days after grafting. The proportions of donor- and recipient-derived cells in the graft and in the host gut and lymphoid tissues were assessed using immunohistochemical tissue staining and monoclonal antibodies specific for cells expressing class I antigens from the two strains of rat. Results demonstrated a persisting population of graft-derived T cells which were capable of migration to the host. Therefore, there may be a long-term risk of graft versus host disease after small bowel transplantation under cyclosporin immunosuppression.
Asunto(s)
Intestino Delgado/trasplante , Trasplante Homólogo/patología , Animales , Recuento de Células , Movimiento Celular/fisiología , Supervivencia Celular/fisiología , Ciclosporinas/uso terapéutico , Modelos Animales de Enfermedad , Rechazo de Injerto , Técnicas para Inmunoenzimas , Intestino Delgado/patología , Ratas , Factores de TiempoRESUMEN
A specific T lymphocyte immunotoxin was used to pre-treat small bowel grafts in an attempt to prevent graft-versus-host (GVH) reactivity and GVH disease in a rat transplant model. The immunotoxin used was a conjugate of the anti-CD5 MoAb MRC OX-19 with ricin A chain. The grafts were perfused ex vivo with a standard solution of immunotoxin followed by incubation at 4 degrees C for 1 h before transplantation. In a semi-allogeneic strain combination (parent to F1 hybrid offspring) graft treatment with immunotoxin led to a prolongation of recipient survival compared with groups receiving similar transplants without immunotoxin treatment. An additive effect on survival was observed when the host was treated with cyclosporin. The effect of immunotoxin was greater than that of mesenteric lymphadenectomy in increasing host survival. The effect of graft treatment with the immunotoxin on cellular migration from graft to host lymphoid tissues was assessed in fully allogeneic transplantation (PVG to DA). Host lymphoid tissues were subjected to immunohistochemical analysis using a MoAb specific for donor class I MHC antigens. Graft treatment with the immunotoxin led to a significant decrease in the number of graft cells found in host lymphoid tissues 7 days after transplantation. However, this effect was less marked than that achieved by graft mesenteric lymphadenectomy. With our current protocol graft treatment with a specific T cell immunotoxin can significantly reduce but not abolish GVH reactivity in rat small bowel transplantation.
Asunto(s)
Refuerzo Inmunológico de Injertos/métodos , Enfermedad Injerto contra Huésped/prevención & control , Inmunotoxinas/uso terapéutico , Intestino Delgado/trasplante , Ricina/uso terapéutico , Linfocitos T/inmunología , Animales , Anticuerpos Monoclonales/uso terapéutico , Antígenos CD/inmunología , Antígenos CD5 , Movimiento Celular/efectos de los fármacos , Ciclosporina/uso terapéutico , Escisión del Ganglio Linfático , Tamaño de los Órganos/efectos de los fármacos , Ratas , Ratas Endogámicas Lew , Ratas Endogámicas , Bazo/efectos de los fármacosAsunto(s)
Ciclosporinas/toxicidad , Íleon/irrigación sanguínea , Microcirculación/efectos de los fármacos , Animales , Relación Dosis-Respuesta a Droga , Microcirculación/diagnóstico por imagen , Microcirculación/patología , Músculo Liso/irrigación sanguínea , Radiografía , Ratas , Ratas Endogámicas Lew , Valores de ReferenciaAsunto(s)
Ciclosporinas/toxicidad , Íleon/irrigación sanguínea , Yeyuno/irrigación sanguínea , Administración Oral , Animales , Ciclosporinas/administración & dosificación , Íleon/efectos de los fármacos , Íleon/patología , Inyecciones Intramusculares , Yeyuno/efectos de los fármacos , Yeyuno/patología , Ratas , Ratas Endogámicas , Valores de Referencia , Flujo Sanguíneo Regional/efectos de los fármacosAsunto(s)
Intestino Delgado/trasplante , Linfocitos/inmunología , Animales , Anticuerpos Monoclonales , Ciclosporinas/uso terapéutico , Mucosa Intestinal/inmunología , Intestino Delgado/inmunología , Ganglios Linfáticos/inmunología , Macrófagos/inmunología , Ratas , Ratas Endogámicas , Trasplante Heterotópico/inmunologíaAsunto(s)
Rechazo de Injerto , Intestino Delgado/trasplante , Microcirculación/patología , Animales , Intestino Delgado/irrigación sanguínea , Intestino Delgado/diagnóstico por imagen , Microcirculación/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , Interpretación de Imagen Radiográfica Asistida por Computador , RatasAsunto(s)
Intestino Delgado/irrigación sanguínea , Intestino Delgado/trasplante , Angiografía , Animales , Rechazo de Injerto , Enfermedad Injerto contra Huésped/inmunología , Enfermedad Injerto contra Huésped/patología , Íleon/irrigación sanguínea , Yeyuno/irrigación sanguínea , Microcirculación , RatasRESUMEN
The effect of surgical drainage materials on rat colonic healing has been investigated in a prospective randomized and controlled study. Latex, silicone rubber (Silastic), polyvinylchloride (PVC) and polytetrafluoroethylene (Teflon) tubes were implanted alongside a colonic anastomosis and compared with a 'no drain' group using mechanical and histological assessments. There was a significant increase in anastomotic leakage in the latex group in which there appears to be a local inhibition of healing. Silastic, PVC and Teflon were not found to interfere with healing. The continued use of latex drains in colonic surgery is therefore questioned.