PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy.

BACKGROUND AND OBJECTIVES: The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. METHODS: The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. RESULTS: Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%-7.1%). With regard to the patients' characteristics, body mass index <22.5 was the only significant risk for failure (p = 0.027). CONCLUSION: The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.

Aesthetic evaluation in oncoplastic and conservative breast surgery: a comparative analysis.

BACKGROUND: In conservative breast surgery, the achievement of a satisfactory cosmetic result could be challenging; oncoplastic techniques may be helpful in many cases. A comparative analysis was performed among 3 groups of patients undergoing oncoplastic techniques plus external radiation therapy or intraoperative radiotherapy (IORT) and breast conservative surgery plus external radiation therapy; long-term oncologic results in terms of disease relapse and aesthetic outcomes were compared. METHODS: Ninety-six patients were considered: 32 patients treated with oncoplastic surgery, 16 then subjected to radiotherapy (group 1) and another 16 treated with IORT (group 2); 64 patients treated by conservative surgery and radiotherapy formed the control group (group 3). Patients were asked to give a judgment on the cosmetic result considering the following parameters: breast symmetry, appearance of the residual scar, symmetry between the 2 nipple-areola complexes, global aesthetic judgment, and satisfaction about the result. RESULTS: With respect to the oncological and aesthetic outcome, the statistical significance of the results obtained in the 3 groups was calculated using the chi-square test. The results, processed by the chi-square test, were not statistically significant; however, the overall judgments expressed by the patients of all 3 groups were more than satisfactory (scores greater than or equal to 6). CONCLUSIONS: In our experience, when the inclusion criteria are satisfied and the equipment is available, oncoplastic techniques associated with IORT should be considered the treatment of choice for breast cancer in early stage. The excellent cosmetic results and patient's satisfaction encourage us to continue on this way.

Predictive factors of non-sentinel lymph node involvement in patients with invasive breast cancer and sentinel node micrometastases.

Patient-related, tumor-related, and sentinel node (SN)-related factors have been identified with the aim of predicting non-SN status in patients with SN micrometastases. According to our previous experience, primary tumor size (p=0.005) and the presence of lymphovascular invasion (LVI) (p=0.000) significantly predicted non-SN status in patients with SN micrometastasis; moreover, non-SN metastases were never detected in patients with pT1a-1b, G1, and no LVI. A prospective assessment was undertaken in a validation set of 126 patients to confirm these findings. Univariate analysis indicated that primary tumor size (p=0.05), Scarff-Bloom-Richardson (SBR) grade (p=0.008), LVI (p=0.001), and the number of mitoses/mm(2) (p=0.01) were significant predictors of non-SN status. By logistic regression analysis, tumor size (p=0.03), LVI (p=0.001), grade (p=0.003) and the number of mitoses/mm(2) (p=0.01) were the only variables remaining in the model. Three subsets of patients were identified: i) 18.3% of patients (pT1, G1, and no LVI) had tumor-negative non-SN (no risk group); ii) 37.3% of patients (number of mitoses/mm(2) <10, SBR grade II-III) had a rate of tumor-positive non-SN <15% (intermediate risk); iii) 44.4% of patients had a mean rate of non-SN involvement of 46% (high risk). By these parameters, more than 50% of patients could be selectively spared unnecessary axillary lymph node dissection without staging or therapeutic benefit, especially in patients with well-differentiated pT1 tumors without LVI.

Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients.

BACKGROUND: Heparin solution is routinely used to maintain the patency of infusion devices. Literature supports the alternative use of normal saline solution for flushing and locking intravenous infusion devices especially for pediatric patients. There is uncertainty regarding safety and efficacy of this policy for intermittent locking of implanted ports. OBJECTIVE: This study evaluates efficacy and safety of normal saline solution for intermittent locking procedures of implanted ports. METHODS: This is a retrospective observational cohort study of 610 implanted ports receiving 2 different locking solutions conducted at the National Institute for Cancer Research, IST Genova, Italy, from January 2007 to August 2009. Group A (n = 297) received heparinized solution (10 mL/500 U heparin), whereas group B (n = 313), 10 mL normal saline. Primary endpoint was irreversible port occlusion. Minimum follow-up was 12 months. The role of age, type of tumor, disease stage, access site, access body side, catheter tip position, and concomitant use of parenteral nutrition and chemotherapy was evaluated in secondary aim. RESULTS: : Results fail to show statistically significant differences in implanted ports survival free from failure for occlusive events between the use of heparinized solution and that of normal saline for the maintenance of port patency, both in univariate (P = .9) and in multivariate analyses (P = .7). CONCLUSION: Normal saline solution seems to be as effective as heparinized solution for keeping patent implanted ports in adult cancer patients. IMPLICATIONS FOR PRACTICE: Switching from heparinized solution to normal saline for catheter intermittent lock of ports seems a safe procedure.

Preliminary experience using oncoplastic techniques of reduction mammaplasty and intraoperative radiotherapy: report of 2 cases.

BACKGROUND: Since 2004 in the Department of Oncological Integrated Surgery at the National Institute for Cancer Research of Genoa, we have applied different techniques of reduction mammaplasty for a subgroup of 26 patients with medium- to large-sized and ptotic breasts who are candidates for conservative surgery. METHODS: In this series of patients, the choice between different techniques of breast reduction (superior or inferior pedicled or with free areola-nipple graft) depended only on cancer position. The chosen technique minimized reshaping and displacement of residual glandular flaps. In September 2009, the radiotherapists at the Institute began to apply intraoperative radiotherapy (IORT) to early breast cancer, and at the time of this report, more than 200 patients have been treated. RESULTS: This report describes two cases of reduction mammaplasty associated with this new and easily performed radiotherapy option (IORT) and discusses its advantages and cautions. CONCLUSIONS: Close collaboration between surgical oncologist, plastic surgeon, and radiotherapist is essential before and during surgery to obtain adequate tumor resection and good aesthetic results and to minimize postoperative complications.

Primary osteosarcoma of the spermatic cord: case report and literature review.

Primary osteosarcoma of the spermatic cord is a rare tumour with few mentions in the literature. A 59-year-old man presented with a large painless left inguinal and scrotal mass. The patient underwent excision of the mass, which arose from the spermatic cord. A left high dissection of the spermatic cord and radical orchiectomy due to associated atrophy of the left testicle were performed. Pathological findings were suggestive of spermatic cord osteosarcoma. The patient died eleven years later of metastatic lung disease. Spermatic cord osteosarcoma is an uncommon neoplasm and its preoperative diagnosis is very difficult. Any palpable suspicious mass of the cord should be investigated with ultrasonography before excision; CT scan and magnetic resonance imaging may be helpful in defining preoperative diagnosis and the extension of the mass into the neighbouring tissues. Surgical treatment of spermatic cord sarcomas in adults is via a radical orchiectomy with high dissection of the spermatic cord and en bloc excision of involved neighbouring tissues; overall 5- and 10-year survival rates are reported in the literature to be 75% and 55%, respectively.