Consenso de la Sociedad Española de Senología y Patología Mamaria (SESPM) sobre la biopsia selectiva del ganglio centinela (BSGC) y el manejo axilar en el cáncer de mama (2022) / Consensus of the Spanish Society of Breast Senology and Pathology (SESPM) on Selective Biopsy of the Sentinel Node (BSGC) and axylar management in breast cancer (2022)

La estadificación ganglionar inicial está indicada en aquellos casos de carcinoma de mama en los que la información obtenida pueda cambiar la actitud terapéutica o establecer una información pronóstica con implicaciones para el seguimiento de las pacientes.En los últimos años, los cambios conceptuales introducidos por ensayos clínicos y estudios observacionales han generado nuevos retos con disparidad de criterios respecto a la actitud terapéutica a seguir en determinados casos.Ello justifica la necesidad de revisar el último documento del Consenso de la SESPM del año 2013.Aunque el objetivo fundamental del documento es la actualización de la práctica clínica en ganglio centinela de cáncer de mama, los cambios acontecidos en los últimos años en el diagnóstico y el tratamiento de este tumor obligan a incluir aspectos que, aunque ajenos al ámbito estricto del procedimiento de la biopsia selectiva del ganglio centinela, se interrelacionan directamente con él. (AU)

Initial nodal staging is indicated in those cases of breast carcinoma in which the information obtained can change the therapeutic approach or establish prognostic information with implications for patient follow-up.In recent years, the conceptual changes introduced by clinical trials and observational studies have generated new challenges with disparity of criteria regarding the therapeutic approach to be followed in certain cases.This justifies the need to revise the latest consensus document of 2013.Although the main objective of the document is to update clinical practice in sentinel lymph node breast cancer, the changes that have occurred in recent years in the diagnosis and treatment of this tumor make it necessary to include aspects that, although outside the strict scope of the selective sentinel lymph node biopsy procedure, are directly related to it. (AU)

Effect of Low-Dose Radiotherapy on the Circulating Levels of Paraoxonase-1-Related Variables and Markers of Inflammation in Patients with COVID-19 Pneumonia.

The aim of our study was to investigate the changes produced by low-dose radiotherapy (LDRT) in the circulating levels of the antioxidant enzyme paraoxonase-1 (PON1) and inflammatory markers in patients with COVID-19 pneumonia treated with LDRT and their interactions with clinical and radiological changes. Data were collected from the IPACOVID prospective clinical trial (NCT04380818). The study included 30 patients treated with a whole-lung dose of 0.5 Gy. Clinical follow-up, as well as PON1-related variables, cytokines, and radiological parameters were analyzed before LDRT, at 24 h, and 1 week after treatment. Twenty-five patients (83.3%) survived 1 week after LDRT. Respiratory function and radiological images improved in survivors. Twenty-four hours after LDRT, PON1 concentration significantly decreased, while transforming growth factor beta 1 (TGF-ß1) increased with respect to baseline. One week after LDRT, patients had increased PON1 activities and lower PON1 and TGF-ß1 concentrations compared with 24 h after LDRT, PON1 specific activity increased, lactate dehydrogenase (LDH), and C-reactive protein (CRP) decreased, and CD4+ and CD8+ cells increased after one week. Our results highlight the benefit of LDRT in patients with COVID-19 pneumonia and it might be mediated, at least in part, by an increase in serum PON1 activity at one week and an increase in TGF-ß1 concentrations at 24 h.

Impact of non-adherence to radiotherapy on 1-year survival in cancer patients in Catalonia, Spain.

BACKGROUND: This study aims to assess the effects of non-adherence to external beam radiation therapy in cancer patients receiving treatment with a curative. METHODS: This retrospective cohort study collected health records data for all cancer patients treated with external beam radiotherapy with curative intent in 2016 in Catalonia, Spain. Adherence was defined as having received at least 90% of the total dose prescribed. A logistic regression model was used to assess factors related to non-adherence, and its association with one-year survival was evaluated using Cox regression. RESULTS: The final sample included 8721 patients (mean age 63.6 years): breast cancer was the most common tumour site (38.1%), followed by prostate and colon/rectum. Treatment interruptions prolonged the total duration of therapy in 70.7% of the patients, and 1.0% were non-adherent. Non-adherence was associated with advanced age, female gender, and some localization of primary tumour (head and neck, urinary bladder, and haematological cancers). The risk of death in non-adherent patients was higher than in adherent patients (hazard ratio [HR] 1.63, 95% confidence interval 0.97-2.74), after adjusting for the potential confounding effect of age, gender, tumour site and comorbidity. CONCLUSION: Non-adherence to radiotherapy, as measured by the received dose, is very low in our setting, and it may have an impact on one-year survival.

GEICAM Guidelines for the Management of Patients with Breast Cancer During the COVID-19 Pandemic in Spain.

Breast cancer (BC) is the most common cancer in women in Spain. During the COVID-19 pandemic caused by the SARS-CoV-2 virus, patients with BC still require timely treatment and follow-up; however, hospitals are overwhelmed with infected patients and, if exposed, patients with BC are at higher risk for infection and serious complications if infected. Thus, health care providers need to evaluate each BC treatment and in-hospital visit to minimize pandemic-associated risks while maintaining adequate treatment efficacy. Here we present a set of guidelines regarding available options for BC patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the lack of evidence about COVID-19 infection, these recommendations are mainly based on expert opinion, medical organizations' and societies' recommendations, and some published evidence. We consider this a useful tool to facilitate medical decision making in this health crisis situation we are facing. IMPLICATIONS FOR PRACTICE: This work presents a set of guidelines regarding available options for breast cancer (BC) patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the suddenness of this health crisis, specialists have to make decisions with little evidence at hand. Thus, these expert guidelines may be a useful tool to facilitate medical decision making in the context of a worldwide pandemic with no resources to spare.

Diagnosis and locoregional treatment of patients with breast cancer during the COVID-19 pandemic / Diagnostico y tratamiento locorregional de las pacientes con cancer de mama durante la pandemia de la COVID-19

We are facing a pandemic that is going to affect a significant part of the population. At the end of April in the world there are about 3,000,000 cases, with 205,000 deaths and 860,000 patients recovered. The response to this pandemic has in many cases led to a significant change in the daily work of caring for cancer patients, the good results of which depend largely on time-adjusted protocols and multidisciplinary treatments. We present a review of local, surgical and radiotherapy treatment together with authors' recommendations made from personal experience on ways to act in the diagnosis and surgical treatment of breast cancer during the COVID-19 pandemic. The multidisciplinary Breast Committees must continue to meet weekly in videoconference format. All surgical actions and irradiations must be carried out with maximum safety for both the patients and the participating teams. Hypofractionation in radiation therapy should be the standard treatment. Sometimes it is recommended to apply a primary systemic treatment or even a primary irradiation. Great coordination between the surgical and oncology teams, both medical and radiotherapeutic, is essential

Nos enfrentamos a una pandemia que afecta a una parte importante de la población.  A finales de abril de 2020, en el mundo hay cerca de 3.000.000 de casos, con 205.000 muertes y 860.000 pacientes recuperados. La respuesta a esta pandemia en muchos casos ha supuesto modificaciones importantes en el cuidado diario de las pacientes con cáncer, dependiendo el buen resultado en buena parte del ajuste de los protocolos a las circunstancias especiales y a los tratamientos multidisciplinarios. Presentamos una revisión del tratamiento quirúrgico y radioterapia junto con las recomendaciones de los autores basadas en su experiencia personal a la hora del diagnóstico y tratamiento locorregional del cáncer de mama durante la pandemia del COVID-19. Los comités multidisciplinarios deben seguir reuniéndose semanalmente en formato de videoconferencia. Todos las intervenciones quirúrgicas e irradiaciones deben ser llevadas a cabo con la máxima seguridad tanto para las pacientes como para el personal sanitario que participa. El hipofraccionamiento debe ser el tratamiento radioterápico estándar. En algunos casos se utilizará tratamiento sistémico primario o incluso radioterapa preoperatoria. Es esencial una coordinación importante entre los equipos quirúrgicos y los oncológicos, tanto radioterápicos como médicos

Radiation therapy for bone-only metastases in breast cancer patients: A GOCO survey of current clinical practice.

INTRODUCTION: The role of radiation therapy (RT) for patients with bone-only metastatic (BOM) breast cancer has not been investigated sufficiently. The aim of this survey was to evaluate current clinical practice in treating breast cancer patients with BOM in Radiation Therapy Departments in Catalonia and Occitania within the scope of the GOCO group. MATERIALS AND METHODS: An electronic questionnaire was completed by experienced radiation oncologists from fourteen RT centers. The items surveyed the professional experience, therapeutic approach, technique, dose stereotactic body RT (SBRT) availability. RESULTS: All Radiation Oncology Departments (ROD) in Catalonia (12) and Occitania (2) responded to the survey. Eleven (78.5%) of the RODs advise RT for BOM as initial treatment in the oligometastatic setting. RT to asymptomatic bone oligometastases is more often restricted for "risky lesions". The most inconsistent approaches were the treatment for asymptomatic lesions, when to treat bone metastases with respect to systemic treatment (ST) and the indication for RT after a complete response to ST. CONCLUSION: While BOM breast cancer patients have a relatively good prognosis, there is a lack of consistency in their approach with RT. This can be explained by the absence of evidence-based guidelines and an incomplete availability of SBRT.

Ablación no invasiva de taquicardia ventricular con radioterapia estereotáctica en un paciente con miocardiopatía arritmogénica de ventrículo derecho / Noninvasive ablation of ventricular tachycardia with stereotactic radiotherapy in a patient with arrhythmogenic right ventricular cardiomyopathy

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Linfoma anaplásico de células grandes asociado a implantes mamarios. Documento de consenso (I): epidemiología, patogenia, clínica y diagnóstico / Breast-implant associated anaplastic large-cell lymphoma. Consensus document (I). Epidemiology, pathogenesis, symptoms and diagnosis

El linfoma anaplásico de células grandes asociado a implantes mamarios (BIA-ALCL según sus siglas en inglés) es un tipo raro de linfoma no Hodgkin que se ha descrito en el contexto de la cirugía reconstructiva y estética de mama mediante implantes. Estos artículos presentan un consenso de la Sociedad Española de Senología y Patología Mamaria (SESPM) con la idea de unificar, en esta primera parte, los criterios de diagnóstico de esta enfermedad describiendo asimismo la epidemiología y la etiopatogenia

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin lymphoma that has been described in the context of reconstructive and aesthetic breast implant surgery. These articles present a consensus of the Spanish Society of Senology and Breast Disease (SESPM). In this first part, the aim is to unify the diagnostic criteria of this disease and describe its epidemiology and etiopathogenesis

Linfoma anaplásico de células grandes asociado a implantes mamarios. Documento de consenso parte II: estadificación, tratamiento, pronóstico y seguimiento / Breast implant-associated anaplastic large-cell lymphoma. Consensus document part II: Staging, prognosis and follow-up

El linfoma anaplásico de células grandes asociado a implantes mamarios (BIA-ALCL según sus siglas en inglés) es un tipo raro de linfoma no Hodgkin que se ha descrito en el contexto de la cirugía reconstructiva y estética de mama mediante implantes. Este segundo artículo presenta la parte del consenso de la Sociedad Española de Senología y Patología Mamaria (SESPM) sobre el tratamiento quirúrgico, médico, radioterápico, pronóstico y seguimiento

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin lymphoma that has been described in the context of breast implant reconstructive and cosmetic surgery. This second article presents the consensus of the Spanish Society of Senology and Breast Disease (SESPM) on the medical and surgical treatment of this disease, radiotherapy, prognosis and follow-up

Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer: A mixed-methods study.

BACKGROUND AND PURPOSE: Radiation oncology guidelines favour hypofractionated whole-breast radiotherapy (HWBRT) over more conventional schemes in the conservative treatment of breast cancer, but its adoption still varies in clinical practice. This study assessed the patterns of HWBRT adoption in Catalonia (Spain). MATERIAL AND METHODS: We used a mixed-methods approach based on an explanatory sequential design, first collecting and analysing quantitative data on HWBRT use (>2.5Gy per fraction) in 11 public radiotherapy centres (2005-2015) and then performing 25 semi-structured interviews with all department heads and reference radiation oncologist/s. RESULTS: Of the 34,859 patients fulfiling the study criteria over the study period, just 12% were hypofractionated, reaching a percentage of 29% in 2015 (p<0.001). Our analysis showed a narrowing age gap between patients receiving conventional fractionation and hypofractionation in centres leading adoption. However, there were important differences in clinicians' interpretation of evidence (e.g. regarding the perceived risk of long-term toxicity) and selection of patients for specific indications, both within and between departments. CONCLUSIONS: Differences observed in the rate of adoption of HWBRT could not be tackled only using a rational, evidence-based approach. Factors related to the management of radiotherapy departments play a major role in the diffusion of therapeutic strategies.

Are breast cancer patients treated with radiotherapy younger now than ten years ago?

AIM: The aim of the present study was to analyze the age of breast cancer patients managed with curative approach at the time of treatment with radiotherapy. BACKGROUND: Breast cancer is the most frequent neoplasm in women. Little is known with regard to the age of patients at diagnosis, and some authors have suggested that breast cancer is now affecting women who are younger than before. MATERIALS AND METHODS: We performed a descriptive study of our series of breast cancer patients from 1998 to 2011. The age of patients, city of residence, year of treatment and uni- or bilateral location were extracted from the administrative database of the Radiation Oncology Department. The demographical and reference populational data were extracted from the Catalan Institute of Statistics. RESULTS: 3382 patients were obtained. The mean age was 57.79 years. No statistical differences were observed in the mean age during the period of study (p > 0.05), nor in patients with bilateral neoplasias with regard to unilateral tumours (p > 0.5). Patients aged less than 30, 40, 50 and 65 years were 0.3%, 6.3%, 27.0% and 69.1%, respectively. The proportion of patients aged less, equal or more than 40 and 50 years was not statistically different. CONCLUSIONS: Breast cancer patients treated with adjuvant radiotherapy after radical surgery have not experienced significant changes in their mean age at treatment. The subgroups of patients that remain out of the mammographic screening programmes were unchanged as well. The observed differences can be explained by demographical disparities and by a probable increase in the indications for adjuvant radiotherapy.

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.

Encuesta nacional sobre la actitud ante el hallazgo de metástasis en el ganglio centinela por cáncer de mama en distintas unidades hospitalarias / National survey on actions taken in breast units when finding sentinel node disease

Objetivo: En los últimos años, ha cambiado la indicación de la linfadenectomía axilar como gesto integrante del manejo del cáncer de mama, sobre todo desde la introducción de la biopsia del ganglio centinela. El objetivo es conocer la actitud actual en función de los hallazgos de enfermedad en éste. Pacientes y métodos: Se realizó un estudio descriptivo a partir de datos obtenidos de una encuesta, dirigida específicamente a unidades de mama españolas, sobre las consideraciones que, en el tratamiento quirúrgico y adyuvante, supone el hallazgo de metástasis en el ganglio centinela dependiendo de su carga tumoral. Resultados: Se recibieron un total de 66 encuestas cumplimentadas de 110 solicitadas (60%). El estudio del ganglio centinela se hace mayoritariamente de forma intraoperatoria (84,8%) y mediante la técnica de OSNA (69,7%). El hallazgo de células tumorales aisladas no conlleva linfadenectomía, aunque hay más variabilidad ante el hallazgo de macrometástasis y, sobre todo, de micrometástasis (en las que se realiza en un 86,3 y un 33,3%, respectivamente). En este sentido resulta llamativa la falta de uniformidad en los criterios para indicar o no la linfadenectomía y la asociación de tratamientos adyuvantes. Conclusiones: En la actualidad existe una gran variabilidad en la actitud ante el hallazgo de enfermedad ganglionar en el ganglio centinela en el cáncer de mama, especialmente en el caso de enfermedad considerada de baja carga tumoral (micrometástasis). Esta variabilidad se refiere tanto a la indicación de completar la linfadenectomía, como a la indicación de tratamientos adyuvantes en esos casos concretos (AU)

Aim: The indication for axillary lymphadenectomy has changed as a main aspect in the management of breast cancer in the last few years, overall since the introduction of sentinel node biopsy. The objective of this study was to find out the current attitude as regards the involvement of the sentinel node. Patients and methods: A descriptive study was performed using the data obtained from a survey aimed specifically at Spanish Breast Units as regards the surgical and adjuvant treatment decisions made when sentinel node metastases were found. Results: Sixty-six (60%) of the 110 questionnaires sent out were completed. Sentinel node analysis is mainly performed during surgery (84.8%) and by using the one-step nucleic acid amplification assay (OSNA) (69.7%). The diagnosis of isolated tumour cells does not lead to a lymphadenectomy, although there was a wide variation when macrometastases or micrometastases were found (axillary dissection was performed in 86.3% and 33.3%, respectively). There was notable lack of uniformity in the criteria to indicate whether or not to perform a lymphadenectomy, as well as in the adjuvant therapy combination to use. Conclusions: There is currently a wide variation in the attitudes of different Breast Units toward the finding of disease in the sentinel node, particularly when there is a low tumour load (micrometastases). This variability was seen in the indication of axillary lymphadenectomy as well as in the indication of adjuvant therapies in these cases (AU)