RESUMEN
PURPOSE: Several studies showed a breast cancer downstaging due to screening. A first national survey was conducted in France in 2001-2002 to evaluate in the current clinical practice the clinicopathological features and treatments of 1049 firstly operated breast cancers. In order to assess the impact of the national screening program implemented in all regions in France in 2004, a new survey was performed in 2007-2008. MATERIAL: The new survey included 1433 firstly operated breast cancers prospectively collected. These new data were compared to the results of the first national survey. RESULTS: According to TN classification, we found in the second survey T0: 27.6%, T1: 48.6%, T2: 21.3%, T3T4: 3.8% and Tx: 0.7%. Infiltrating ductal and lobular carcinomas represented 80% and 13% of tumours. Hormone receptors were positive in 85.3% and Her-2 overexpressed in 12.4% of tumours (83.9% and 20.6% in the first survey); 68.2% and 32% were pN0 and pN1-3. Lumpectomy and mastectomy were performed in 77% and 23% of the cases. Axillary dissection, sentinel node biopsy or both were performed in 42.6%, 41% and 16.4% of the cases, respectively. Radiotherapy, chemotherapy, hormonotherapy and trastuzumab were given to 93%, 51%, 83% and 9.3% of the patients. Compared with the results from the first survey, we found an increase of infraclinical lesions (T0 from 8.4 to 27.6%) and a wide decrease of pN+ rate (from 44% to 32%). The mastectomy rate was constant (23%), as well as radiotherapy use, whereas chemotherapy use decreased from 62.8 to 55.6%. CONCLUSION: A complete national screening coverage clearly provides a favourable modification of breast cancer clinicopathological features. Both locoregional and adjuvant treatments were greatly downscaled.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Tamizaje Masivo , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/epidemiología , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/terapia , Carcinoma Lobular/epidemiología , Carcinoma Lobular/metabolismo , Carcinoma Lobular/patología , Carcinoma Lobular/terapia , Quimioterapia Adyuvante/estadística & datos numéricos , Femenino , Francia/epidemiología , Encuestas Epidemiológicas , Humanos , Escisión del Ganglio Linfático/estadística & datos numéricos , Mastectomía/estadística & datos numéricos , Mastectomía Segmentaria/estadística & datos numéricos , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Estudios Prospectivos , Radioterapia Adyuvante , Receptor ErbB-2/metabolismo , Receptores de Estradiol/metabolismo , Receptores de Progesterona/metabolismo , Biopsia del Ganglio Linfático Centinela/estadística & datos numéricos , Trastuzumab , Adulto JovenAsunto(s)
Antineoplásicos/uso terapéutico , Inhibidores de Histona Desacetilasas/uso terapéutico , Ácidos Hidroxámicos/uso terapéutico , Indoles/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Tumores de los Cordones Sexuales y Estroma de las Gónadas/tratamiento farmacológico , Adulto , Anciano , Antineoplásicos/farmacología , Ensayos Clínicos Fase II como Asunto , Femenino , Inhibidores de Histona Desacetilasas/farmacología , Humanos , Ácidos Hidroxámicos/farmacología , Indoles/farmacología , Persona de Mediana Edad , Panobinostat , Resultado del TratamientoRESUMEN
Chemotherapy is the reference treatment for gestational trophoblastic neoplasia. In case of chemoresistance, hysterectomy has to be considered even in women wishing to conceive. A 31-year-old nulliparous patient presented a recurrent invasive mole, despite two regimens of chemotherapy. She underwent a partial uterine resection of an intramyometrial choriocarcinoma followed by a third-line regimen. Two years later she gave birth by cesarean section at 32 weeks of amenorrhea to a healthy child after a spontaneous pregnancy. In order to preserve patient's fertility, conservative uterine surgery is an alternative to hysterectomy for selected chemoresistant gestational trophoblastic neoplasia.
Asunto(s)
Coriocarcinoma/cirugía , Nacimiento Vivo , Neoplasias Uterinas/cirugía , Adulto , Cesárea , Coriocarcinoma/tratamiento farmacológico , Resistencia a Antineoplásicos , Femenino , Preservación de la Fertilidad/métodos , Edad Gestacional , Humanos , Histerectomía , Recién Nacido , Embarazo , Neoplasias Uterinas/tratamiento farmacológico , Útero/cirugíaRESUMEN
Bisphosphonates are indicated for the treatment of bone lesions in patients with solid tumours or multiple myeloma. Bisphosphonates have proven their effectiveness in reducing the number of bone complications (hypercalcemia, pain, disease-related fractures, spinal cord compression) and delaying their occurrence in patients with bone tumours; they have also been shown to reduce the need for bone surgery and palliative or pain-relieving radiotherapy in these patients. International recommendations for the treatment of bone lesions related to malignant solid tumours and multiple myeloma have been established. We have elaborated clinical practice guidelines on the use of bisphosphonates to assist treatment decision-making in bone oncology. The guide contains decision trees and tables with information to guide pre-treatment evaluation and patient follow-up, as well as indications and conditions of use of bisphosphonates. In 2007, the regional cancer network of Rhône-Alpes, ONCORA, formed a working group (GIP ONCORA) to elaborate the guideline. The final version was then discussed and adopted at a plenary session in July 2009, during a collaborative workshop on supportive care recommendations organized by ONCORA and the regional cancer network of Lorraine.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Difosfonatos/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Neoplasias Óseas/secundario , Árboles de Decisión , HumanosRESUMEN
Oral chemotherapy is increasingly used in oncology. Poor adherence, that is, non-respect of medical advice about taking the therapy and surveillance of adverse effects, is the main risk associated with this administration route. Poor adherence may be explained by non-adherence by the patient to the treatment, misunderstanding the advice or it could also reflect the poor adaptation of the healthcare team to a new administration route. Here we report the results from a qualitative study that aimed to describe and understand existing practice for capecitabine, an oral chemotherapy, which is used for the treatment of metastatic breast and colon cancer. We interviewed 42 patients who were receiving oral capecitabine in groups and individually as well as 10 prescribers. This study was carried out in two specialist cancer centres. The results showed a wide diversity in the prescribers' practices, who make decisions based on their experience of practice guidelines for intravenous chemotherapies. Although the results for the patients do not suggest deliberate non-adherence, they show poor observance of the dose schedule. The most important result of this study is the patient's inability to identify and to report important signs of harmful toxicity.
Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias del Colon/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Fluorouracilo/análogos & derivados , Cumplimiento de la Medicación , Administración Oral , Anciano , Anciano de 80 o más Años , Capecitabina , Desoxicitidina/administración & dosificación , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Investigación Cualitativa , Factores de RiesgoAsunto(s)
Neoplasias Encefálicas/cirugía , Coriocarcinoma/secundario , Coriocarcinoma/cirugía , Mola Hidatiforme/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/cirugía , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Adulto , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundario , Coriocarcinoma/diagnóstico , Educación Médica Continua , Endosonografía , Resultado Fatal , Femenino , Humanos , Mola Hidatiforme/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundario , Metástasis Linfática , Embarazo , Factores de Riesgo , Resultado del Tratamiento , Neoplasias Uterinas/diagnósticoRESUMEN
OBJECTIVE: To assess the feasibility and efficacy of cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) without adjuvant chemotherapy for relapsed or persistent advanced ovarian cancer. METHODS: This observational study included stage IIIC ovarian cancer patients due to undergo CRS (interval debulking or recurrent surgery) followed by HIPEC with oxaliplatin (460 mg/m2) for 30 min. RESULTS: Twenty-two patients (12 interval debulking procedures and 10 recurrence procedures) were enrolled between September 2003 and September 2007. HIPEC was not performed in four patients because of operative findings. No patient received adjuvant chemotherapy after HIPEC. Patients were followed up routinely until recurrence or death. Median peritoneal cancer index at surgery was 6 (range: 1-18). Before HIPEC, all patients had completeness of cytoreduction scores of 0 or 1. Median length of hospital stay was 21 days (range 13-65). Ten patients (55.6%) had CTCAE grade 3-4 toxicity, including three patients (16.7%) requiring reoperation. No postoperative mortality was observed. With a median follow-up of 38 months (CI 95% 23.8-39.2), median overall survival was not reached. The 3-year overall survival rate was 83% (CI 95% 54-95). Median disease-free survival was, respectively, 16.9 months (CI 95% 10.2-23.2) and 10 months (CI 95% 4.5-11.3) for patients undergoing interval debulking or recurrence surgery. CONCLUSION: HIPEC without adjuvant chemotherapy is both feasible and safe, but with a high rate of grade 3-5 toxicity. Survival results are encouraging but should be confirmed in a randomized trial.
Asunto(s)
Antineoplásicos/administración & dosificación , Hipertermia Inducida/métodos , Compuestos Organoplatinos/administración & dosificación , Neoplasias Ováricas/terapia , Adulto , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Terapia Combinada/mortalidad , Progresión de la Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Hipertermia Inducida/efectos adversos , Hipertermia Inducida/mortalidad , Infusiones Parenterales , Tiempo de Internación , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Oxaliplatino , Tasa de SupervivenciaRESUMEN
BACKGROUND: A prospective phase II study was conducted to evaluate the efficacy and toxicity of oral gimatecan in patients with recurrent epithelial ovarian, fallopian tube or peritoneal cancer. PATIENTS AND METHODS: Patients had a maximum of three prior chemotherapy lines with no more than two prior platinum-containing regimens and a progression-free interval after the last dose of platinum <12 months. A total dose of 4 mg/m(2)/cycle (0.8 mg/m(2)/day from day 1 to day 5) was administered, repeated every 28 days. RESULTS: From June 2005 to December 2005, 69 assessable patients were enrolled. The best overall response to study treatment by combined CA-125 and RECIST criteria was partial response in 17 patients (24.6%) and disease stabilization in 22 patients (31.9%). The median time to progression and overall survival were 3.8 and 16.2 months, respectively. A total of 312 cycles were administered. Neutropenia grade 4 and thrombocytopenia grade 4 occurred in 17.4% and 7.2% of patients, respectively. Diarrhea grade 4 was never observed. Asthenia and fatigue were reported by 36.2% and 18.8% of patients, but were all grade 2 or less. CONCLUSION: Gimatecan is a new active agent in previously treated ovarian cancer with myelosuppression as main toxicity.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/análogos & derivados , Neoplasias de las Trompas Uterinas/tratamiento farmacológico , Neoplasias Glandulares y Epiteliales/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Peritoneales/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Antineoplásicos/administración & dosificación , Camptotecina/administración & dosificación , Quimioterapia Adyuvante , Neoplasias de las Trompas Uterinas/patología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Glandulares y Epiteliales/patología , Neoplasias Ováricas/patología , Neoplasias Peritoneales/patología , Platino (Metal)/administración & dosificación , Recurrencia , Taxoides/administración & dosificaciónRESUMEN
BACKGROUND: Epoetin (EPO) administration reduces the need for transfusion. Identifying patients at high risk of anemia requiring red blood cell (RBC) transfusion is needed. This multicentric phase III trial tested epoetin alpha (EPOalpha) administration according to our risk model on the basis of three clinical parameters: hemoglobin (Hb) <12 g/dl, lymphocytes Asunto(s)
Anemia/tratamiento farmacológico
, Eritropoyetina/administración & dosificación
, Hematínicos/administración & dosificación
, Neoplasias/complicaciones
, Adulto
, Anciano
, Anciano de 80 o más Años
, Anemia/etiología
, Quimioprevención
, Epoetina alfa
, Femenino
, Humanos
, Masculino
, Persona de Mediana Edad
, Modelos Biológicos
, Estudios Prospectivos
, Proteínas Recombinantes
, Factores de Riesgo
RESUMEN
The safety and maximum tolerated dose (MTD) of erlotinib with docetaxel/carboplatin were assessed in patients with ovarian cancer. Chemonaive patients received intravenous docetaxel (75 mg m(-2)) and carboplatin (area under the curve 5) on day 1 of a 3-week cycle, and oral erlotinib at 50 (cohort 1), 100 (cohort 2a) or 75 mg day(-1) (cohort 2b) for up to six cycles. Dose-limiting toxicities were determined in cycle 1. Forty-five patients (median age 59 years) received treatment. Dose-limiting toxicities occurred in 1/5/5 patients (cohorts 1/2a/2b). The MTD of erlotinib in this regimen was determined to be 75 mg day(-1) (cohort 2b; the erlotinib dose was escalated to 100 mg day(-1) in 11 out of 19 patients from cycle 2 onwards). Neutropaenia was the predominant grade 3/4 haematological toxicity (85/100/95% respectively). Common non-haematological toxicities were diarrhoea, fatigue, nausea and rash. There were five complete and seven partial responses in 23 evaluable patients (52% response rate). Docetaxel/carboplatin had no measurable effect on erlotinib pharmacokinetics. In subsequent single-agent maintenance, erlotinib was given at 100-150 mg day(-1), with manageable toxicity, until tumour progression. Further investigation of erlotinib in epithelial ovarian carcinoma may be warranted, particularly as maintenance therapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de las Trompas Uterinas/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Peritoneales/tratamiento farmacológico , Adulto , Anciano , Carboplatino/administración & dosificación , Carboplatino/efectos adversos , Docetaxel , Clorhidrato de Erlotinib , Neoplasias de las Trompas Uterinas/mortalidad , Femenino , Humanos , Dosis Máxima Tolerada , Persona de Mediana Edad , Neoplasias Ováricas/mortalidad , Neoplasias Peritoneales/mortalidad , Quinazolinas/administración & dosificación , Quinazolinas/efectos adversos , Quinazolinas/farmacocinética , Taxoides/administración & dosificación , Taxoides/efectos adversosRESUMEN
ICON3 trial results have suggested that CAP and carboplatin-taxol regimens as first-line treatment of advanced ovarian cancer (AOC) yield similar survival. We explored the impact of increased dose of cyclophosphamide in a modified CAP regimen on the disease-free survival (DFS) and overall survival (OS) of AOC patients. From February 1994 to June 1997, 164 patients were randomised to receive six cycles every 3 weeks of either standard CEP (S) combining cyclophosphamide (C), 500 mg m(-2), epirubicin (E) 50 mg m(-2), and cisplatin (P) 75 mg m(-2) or intensive CEP (I) with E and P at the same doses, but with (C) 1800 mg m(-2) and filgrastim 5 mug kg(-1) per day x 10 days. Response was evaluated at second-look surgery. Patient characteristics were well balanced. Except for grade 3-4 neutropaenia (S: 54%, I: 38% of cycles), Arm1 presented a significantly more important toxicity: infection requiring antibiotics, grade 3-4 thrombocytopaenia, anaemia, nausea-vomiting, diarrhoea, mucositis. Median follow-up was 84 months. DFS (15.9 vs 14.8 months) and OS (33 vs 30 months) were not significantly different between S and I (P>0.05). Increasing cyclophosphamide dose by more than 3 times with filgrastim support in the modified CAP regimen CEP induces more toxicity but not better efficacy in AOC.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Carboplatino/administración & dosificación , Carcinoma Endometrioide/tratamiento farmacológico , Cisplatino/administración & dosificación , Ciclofosfamida/administración & dosificación , Cistadenocarcinoma Seroso/tratamiento farmacológico , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Aromatase inhibitors have demonstrated their superiority to tamoxifen as adjuvant therapy for early breast cancer in postmenopausal women, but are associated with an increased risk of fractures. The aim of our study was to analyze bone loss, bone turnover and their determinants in postmenopausal women treated with anastrozole. We investigated bone loss and bone turnover markers (BTM) in a prospective open cohort study of 118 postmenopausal women treated with anastrozole for an early hormone-dependent breast cancer. Women without osteoporosis were not treated and compared with an age-matched control group of 114 healthy women. Osteoporotic patients (T-score
Asunto(s)
Antineoplásicos Hormonales/efectos adversos , Conservadores de la Densidad Ósea/uso terapéutico , Remodelación Ósea/efectos de los fármacos , Difosfonatos/uso terapéutico , Nitrilos/efectos adversos , Osteoporosis Posmenopáusica/prevención & control , Triazoles/efectos adversos , Anciano , Anciano de 80 o más Años , Anastrozol , Densidad Ósea/efectos de los fármacos , Neoplasias de la Mama/tratamiento farmacológico , Colágeno Tipo I/sangre , Estradiol/sangre , Femenino , Fracturas Óseas/epidemiología , Fracturas Óseas/prevención & control , Humanos , Persona de Mediana Edad , Osteocalcina/sangre , Osteoporosis Posmenopáusica/inducido químicamente , PosmenopausiaRESUMEN
The aim of the study was to compare our reference adjuvant chemotherapy, FEC100 (fluorouracil 500 mg m(-2), epirubicin 100 mg m(-2) and cyclophosphamide 500 mg m(-2), six cycles every 21 days), to an epirubicin-vinorelbine (Epi-Vnr) combination for early, poor-prognosis breast cancer patients. Patients (482) were randomised to receive FEC100, or Epi-Vnr (epirubicin 50 mg m(-2) day 1 and vinorelbine 25 mg m(-2), days 1 and 8, six cycles every 21 days). The 7-year disease-free survival rates were 59.4 and 58.8%, respectively (P=0.47). The relative dose intensity of planned epirubicin doses was 89.1% with FEC100 and 88.9% with Epi-Vnr. There were significantly more grades 3-4 neutropenia (P=0.009) with Epi-Vnr, and significantly more nausea-vomiting (P<0.0001), stomatitis (P=0.0007) and alopecia (P<0.0001) with FEC100. No cases of congestive heart failure were reported, whereas four decreases in left ventricular ejection fraction occurred after FEC100 and five after Epi-Vnr. One case of acute myeloblastic leukaemia was registered in the FEC100 arm. After 7 years of follow-up, there was no difference between treatment arms. Epi-Vnr regimen provided a good efficacy in such poor-prognosis breast cancer patients, and could be an alternative to FEC100, taking into account respective safety profiles of both regimens.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma/tratamiento farmacológico , Ciclofosfamida/administración & dosificación , Epirrubicina/administración & dosificación , Fluorouracilo/administración & dosificación , Vinblastina/análogos & derivados , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma/mortalidad , Carcinoma/patología , Carcinoma/cirugía , Quimioterapia Adyuvante/efectos adversos , Ciclofosfamida/efectos adversos , Progresión de la Enfermedad , Epirrubicina/efectos adversos , Femenino , Fluorouracilo/efectos adversos , Francia , Humanos , Metástasis Linfática , Mastectomía , Persona de Mediana Edad , Análisis de Supervivencia , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , VinorelbinaRESUMEN
OBJECTIVES: The aim of this study was both to analyse if gestational trophoblastic neoplasia (GTN) registered to the French Trophoblastic Disease Reference Center (TDRC) in Lyon (France) were managed according to the FIGO criteria for diagnosis of GTN and if chemotherapy was adapted to the 2000 FIGO prognostic scoring system. PATIENTS AND METHODS: Retrospective, descriptive analysis of 167 GTN registered to GTC of Lyon between 1999 and 2005. RESULTS: On the one hand, 66% of women (104/158) had a diagnosis of GTN according to FIGO criteria. One third (n=54) of the patients therefore had a premature or erroneous diagnosis of a tumor, when the treatment started. No supporting element of this premature diagnosis has been found out for 26 patients. The identification of lung and vaginal metastasis and histological diagnosis of invasive mole appeared as the most mentioned inappropriate criteria for diagnosis. On the other hand, chemotherapy was adapted to 2000 FIGO scoring in 91, 5% of cases. Twelve low risk GTN were treated with polychemotherapy and two high risk GTN were treated with monochemotherapy. Moreover 29% of the patients received a non adequate treatment due to deviations from the recommended protocol. DISCUSSION AND CONCLUSION: Non respect of FIGO criteria for the diagnosis of GTN can lead to erroneous diagnosis of tumors. Identification of lung or vaginal metastasis or diagnosis of invasive mole should not automatically justify the diagnosis of gestational trophoblastic neoplasia if the decrease in HCG occurs properly. Respect of FIGO criteria for the diagnosis of GTN and adaptation of chemotherapy to 2000 FIGO scoring are necessary to avoid inadequate treatment of gestational trophoblastic neoplasia.
Asunto(s)
Antineoplásicos/uso terapéutico , Enfermedad Trofoblástica Gestacional/diagnóstico , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/tratamiento farmacológico , Adulto , Diagnóstico Diferencial , Femenino , Francia , Enfermedad Trofoblástica Gestacional/patología , Humanos , Estadificación de Neoplasias , Embarazo , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias Uterinas/patologíaRESUMEN
BACKGROUND: The purpose of this study was to determine optimal adjuvant therapy between complete hormonal blockade in premenopausal patients with hormone receptor positive breast cancer and one to three positive nodes. PATIENTS AND METHODS: We randomised 333 patients to receive either LHRH agonist (triptorelin 3.75 mg i.m., monthly) plus tamoxifen 30 mg/day for 3 years (TAM-LHRHa, n=164), or fluorouracil 500 mg/m2, epirubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 every 21 days for six cycles, without any hormonal treatment (FEC50, n=169). RESULTS: The 7-year disease-free survival (DFS) was 76% with TAM-LHRHa, and 72% with FEC50 (P=0.13). The 7-year overall survival (OS) was 91% and 88%, respectively (P=0.20). The multivariate analysis confirmed that both treatments were not different for DFS and OS (P=0.83 and P=0.41, respectively). Amenorrhoea occurred in 64% of patients treated with FEC50; it was temporary in 58% of cases after hormonotherapy and in 31% after chemotherapy. CONCLUSION: In intermediate-risk breast cancer, complete hormonal blockade and chemotherapy provided similar outcomes. Hormonal treatment is an alternative to chemotherapy in hormone-sensitive patients, considering the preference of patients in terms of quality of life.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias de la Mama/tratamiento farmacológico , Epirrubicina/uso terapéutico , Antagonistas de Estrógenos/uso terapéutico , Adulto , Amenorrea/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/mortalidad , Quimioterapia Adyuvante , Ciclofosfamida/uso terapéutico , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/uso terapéutico , Hormona Liberadora de Gonadotropina/agonistas , Cardiopatías/inducido químicamente , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Neoplasias/inducido químicamente , Premenopausia/efectos de los fármacos , Receptores de Esteroides/análisis , Tamoxifeno/uso terapéutico , Pamoato de Triptorelina/uso terapéuticoRESUMEN
BACKGROUND: In 1993 the French National Federation of Cancer Centres (FNCLCC) initiated the Standards, Options and Recommendations (SOR) project. This is a collaboration between the FNCLCC, the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics, and some specialists learned societies. The main objective is to develop clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. MATERIALS AND METHODS: The SORs are developed using a methodology based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. RESULTS: In 1999, the initial SORs for the management of women with cervical cancer were published. At that time the use of chemoradiotherapy was considered as an option. Since this original publication, five randomised trials comparing chemoradiotherapy with radiotherapy have been published, as well as a systematic review and two other clinical practice guidelines. In the light of this additional evidence, it was decided to update the guidelines on chemoradiotherapy in women with cervical cancer. CONCLUSION: After selection, critical analysis and integration of new evidence, chemoradiotherapy has become a standard for women with cervical cancer.
Asunto(s)
Medicina Basada en la Evidencia , Guías de Práctica Clínica como Asunto , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/radioterapia , Ensayos Clínicos como Asunto , Terapia Combinada , Femenino , HumanosRESUMEN
The insulin-like growth factor (IGF)-system was evaluated in 150 breast cancer patients participating in a randomised phase III trial comparing octreotide pamoate and tamoxifen with tamoxifen+placebo. Alterations in the IGF-system in the two treatment arms and individual changes with respect to outcome were compared. Serum IGF-I and -II, free IGF-I, and insulin-like growth factor binding protein 1-3 (IGFBP1-3) were measured by radioimmmunoassay (RIA)/immunoradiometric assay (IRMA) and IGFBPs by Western ligand blots (WLB) before and during treatment. Combined treatment caused a higher increase in IGFBP-1 and larger suppression of total and free IGF-I, IGF-II, and IGFBP-3 (P<0.01 for all), but less suppression of IGFBP-2 (P<0.05) compared with tamoxifen monotherapy. An increase in IGFBP-2 25% was associated with decreased progression-free survival (PFS) in the total patient population and combined treatment group. Similar response rates and time to progression in the treatment arms suggests moderate suppression of circulating IGF-I has no influence on clinical outcome.