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1.
Ann Surg Oncol ; 26(4): 986-995, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30719634

RESUMEN

PURPOSE: This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery. METHODS: In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan-Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS). RESULTS: A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72-15.58; and OR 3.09; 95% CI 1.93-4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97-7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57-6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78-2.97; and HR 0.73; 95% CI 0.13-4.14). CONCLUSIONS: Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.


Asunto(s)
Adenocarcinoma/mortalidad , Carcinoma de Células Escamosas/mortalidad , Quimioradioterapia/mortalidad , Neoplasias Esofágicas/mortalidad , Esofagectomía/mortalidad , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Adenocarcinoma/terapia , Factores de Edad , Anciano , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Comorbilidad , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
2.
Eur J Cancer ; 94: 138-147, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29571082

RESUMEN

BACKGROUND: Treatment for oesophageal cancer has evolved due to developments including the centralisation of surgery and introduction of neoadjuvant treatment. Therefore, this study evaluated trends in stage distribution, treatment and survival of oesophageal cancer patients in the last 26 years in the Netherlands. PATIENTS AND METHODS: Patients with oesophageal cancer diagnosed in the period 1989-2014 were selected from the Netherlands Cancer Registry. Patients were divided into two groups: non-metastatic (M0) and metastatic (M1). Trends in stage distribution, treatment and relative survival rates were evaluated according to histology. RESULTS: Among all 35,760 patients, the percentage of an unknown tumour stage decreased from 34% to 10% during the study period, whereas the percentage of patients with metastatic disease increased from 21% to 34%. Among surgically treated patients 32% underwent a resection in a high-volume hospital in 2005 which increased to 92% in 2014. Use of neoadjuvant chemoradiotherapy increased in non-metastatic oesophageal adenocarcinoma (OAC) and squamous cell carcinoma (OSCC) patients from respectively 4% and 2% in 2000-2004 to 43% and 26% in 2010-2014. Five-year relative survival increased from 8% to 22% for all patients; from 12% to 36% for non-metastatic OAC and from 9% to 27% for non-metastatic OSCC over 26 years. Median overall survival of metastatic patients improved from 18 to 22 weeks. CONCLUSION: In the Netherlands, survival for oesophageal cancer patients improved significantly, especially in the period 2005-2014 which might be the result of better treatment related to the centralisation of surgery and introduction of neoadjuvant chemoradiotherapy.


Asunto(s)
Neoplasias Esofágicas/mortalidad , Adulto , Anciano , Quimioradioterapia Adyuvante/métodos , Quimioradioterapia Adyuvante/mortalidad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Esofagectomía/métodos , Esofagectomía/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Terapia Neoadyuvante/mortalidad , Países Bajos/epidemiología , Sistema de Registros
3.
Int J Radiat Oncol Biol Phys ; 97(4): 813-821, 2017 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-28244418

RESUMEN

PURPOSE: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. METHODS AND MATERIALS: Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated. RESULTS: Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. CONCLUSION: With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.


Asunto(s)
Anastomosis Quirúrgica/mortalidad , Quimioradioterapia Adyuvante/mortalidad , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/terapia , Estenosis Esofágica/mortalidad , Esofagectomía/mortalidad , Traumatismos por Radiación/mortalidad , Comorbilidad , Esofagoplastia/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Intubación Gastrointestinal/mortalidad , Masculino , Persona de Mediana Edad , Cuello/cirugía , Terapia Neoadyuvante , Países Bajos/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento
4.
Artículo en Inglés | MEDLINE | ID: mdl-32095564

RESUMEN

PURPOSE: To evaluate different registration methods, setup margins and number of corrections for CBCT-based position verification for oesophageal cancer and to evaluate anatomical changes during the course of radiotherapy treatment. METHODS: From 50 patients, 440 CBCT-scans were registered automatically using a soft tissue or bone registration algorithm and compared to the clinical match. Moreover, relevant anatomical changes were monitored. A sub-analysis was performed to evaluate if tumour location influenced setup variations. Margin calculation was performed and the number of setup corrections was estimated. Results were compared to a patient group previously treated with MV-EPID based position verification. RESULTS: CBCT-based setup variations were smaller than EPID-based setup variations, resulting in smaller setup margins of 5.9 mm (RL), 7.5 mm (CC) and 4.7 mm (AP) versus 6.0 mm, 7.8 mm and 5.5 mm, respectively. A reduction in average number of setup corrections per patient was found from 0.75 to 0.36. From all automatically registered CBCT-scans, a clipbox around PTV and vertebras combined with soft tissue registration resulted in the smallest setup margins of 5.9 mm (RL), 7.7 mm (CC), 4.8 mm (AP) and smallest average number of corrections of 0.38. For distally located tumours, a setup margin of 7.7 mm (CC) was required compared to 5.6 mm for proximal tumours. Reduction of GTV volume, heart volume and change in diaphragm position were observed in 16, 10 and 15 patients, respectively. CONCLUSIONS: CBCT-based set-up variations are smaller than EPID-based variations and vary according to tumour location. When using kV-CBCT a large variety of anatomical changes is revealed, which cannot be observed with MV-EPID.

5.
Eur J Surg Oncol ; 42(8): 1183-90, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27134188

RESUMEN

BACKGROUND: Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3-8 weeks. In practice, surgery is often delayed for various reasons. The aim of this study was to evaluate whether delaying surgery beyond 8 weeks has an effect on postoperative morbidity, long-term survival, and pathologic response in patients treated for oesophageal ADC. METHODS: Patients who underwent nCRT followed by surgery, for cT1-3, N0-3, M0 ADC between 2001 and 2014 were retrospectively included from a prospectively obtained database. Patients with a time from the end of nCRT to surgery (TTS) ≤8 weeks were compared with patients with a TTS >8 weeks. RESULTS: Of 190 patients, 65 had a TTS ≤8 weeks, and 125 had a TTS >8 weeks. Patient characteristics were comparable for both groups, but patients with TTS >8 weeks exhibited higher ASA scores (p = 0.013) and more comorbidities (p = 0.007). Multivariate analysis revealed that TTS did not significantly influence postoperative morbidity, pathologic complete response rates, and five-year survival rates (42% in patients with TTS ≤8 weeks and 37% in patients with TTS >8 weeks). CONCLUSIONS: Delaying surgery beyond 8 weeks after nCRT did not significantly influence postoperative morbidity, pathologic response, and survival in patients with non-metastatic ADC. Therefore, it appears reasonable to postpone surgery beyond 8 weeks in patients who have not yet recovered from nCRT. However, if the patient is fit for surgery, postponing surgery does not have any additional advantages.


Asunto(s)
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia , Neoplasias Esofágicas/terapia , Esofagectomía/métodos , Terapia Neoadyuvante , Complicaciones Posoperatorias/epidemiología , Adenocarcinoma/patología , Anciano , Carboplatino/administración & dosificación , Neoplasias Esofágicas/patología , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Paclitaxel/administración & dosificación , Radioterapia Conformacional , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
6.
Eur J Surg Oncol ; 39(11): 1186-91, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24063971

RESUMEN

BACKGROUND: The purpose of the study was to determine the effectiveness of routine follow-up to detect contralateral breast cancer (CBC) in young women. METHODS: We used the data of the population-based Eindhoven Cancer Registry, which covers the southern part of the Netherlands. Between 1988 and 2005, 1451 women aged ≤ 40 years were treated for early-stage breast cancer with breast-conserving treatment or mastectomy. RESULTS: Of the 94 patients who developed CBC 17 had an in situ carcinoma. Fifty-seven CBCs (61%) were diagnosed more than 5 years after the primary tumour. Forty-two CBCs (45%) were detected during routine follow-up visits, while 52 (55%) presented between two visits. Of the CBC diagnosed between two visits, only 27 (60%) were visible on mammography. Of the invasive CBCs more than 25% was larger than 2 cm in diameter and in 34% positive axillary lymph nodes were found. CONCLUSIONS: These figures indicate that routine follow-up does not guarantee early detection of CBC in young women with breast cancer.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Carcinoma in Situ/diagnóstico , Detección Precoz del Cáncer , Ganglios Linfáticos/patología , Adulto , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Carcinoma in Situ/patología , Carcinoma in Situ/terapia , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Mamografía , Mastectomía Radical Modificada , Mastectomía Segmentaria , Persona de Mediana Edad , Radioterapia Adyuvante , Recurrencia , Resultado del Tratamiento
7.
Eur J Surg Oncol ; 39(8): 892-8, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23726902

RESUMEN

BACKGROUND: Few studies have focussed on the prognosis of young women with local recurrence (LR) after breast-conserving therapy and the factors that can be used to predict their prognosis. METHODS: We studied the outcome and related prognostic factors in 124 patients with an isolated local recurrence in the breast following breast-conserving surgery and radiotherapy for early stage breast cancer diagnosed at the age of 40 years or younger. RESULTS: The median follow-up of the patients after diagnosis of LR was 7.0 years. At 10 years from the date of salvage treatment, the overall survival rate was 73% (95% CI, 63-83), the distant recurrence-free survival rate was 61% (95% CI, 53-73), and the local control rate (i.e. survival without subsequent LR or local progression) was 95% (95% CI, 91-99). In the multivariate analysis, the risk of distant metastases also tended to be higher for patients with LR occurring within 5 years after BCT, as compared to patients with LR more than 5 years after BCT (Hazard ratio [HR], 1.89; p = 0.09). A worse distant recurrence-free survival was also observed for patients with a LR measuring more than 2 cm in diameter, compared to those with a LR of 2 cm or smaller (HR, 2.88; p = 0.007), and for patients with a LR causing symptoms or suspicious findings at clinical breast examination, compared to those with a LR detected by breast imaging only (HR 3.70; p = 0.03). CONCLUSIONS: These results suggest that early detection of LR after BCT in young women can improve treatment outcome.


Asunto(s)
Neoplasias de la Mama/cirugía , Mastectomía Segmentaria/métodos , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Adulto , Factores de Edad , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Estudios de Cohortes , Intervalos de Confianza , Supervivencia sin Enfermedad , Detección Precoz del Cáncer , Femenino , Humanos , Mastectomía Segmentaria/efectos adversos , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Sistema de Registros , Reoperación/métodos , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
8.
Eur J Cancer ; 49(15): 3093-101, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23800672

RESUMEN

AIM: To evaluate trends in the risk of local recurrences after breast-conserving treatment (BCT) and to examine the impact of local recurrence (LR) on distant relapse-free survival in a large, population-based cohort of women aged ≤40 years with early-stage breast cancer. METHODS: All women (n=1143) aged ≤40 years with early-stage (pT1-2/cT1-2, N0-2, M0) breast cancer who underwent BCT in the south of the Netherlands between 1988 and 2010 were included. BCT consisted of local excision of the tumour followed by irradiation of the breast. RESULTS: After a median follow-up of 8.5 (0.1-24.6)years, 176 patients had developed an isolated LR. The 5-year LR-rate for the subgroups treated in the periods 1988-1998, 1999-2005 and 2006-2010 were 9.8% (95% confidence interval (CI) 7.1-12.5), 5.9% (95% CI 3.2-8.6) and 3.3% (95% CI 0.6-6.0), respectively (p=0.006). In a multivariate analysis, adjuvant systemic treatment was associated with a reduced risk of LR of almost 60% (hazard ratio (HR) 0.42; 95%CI 0.28-0.60; p<0.0001). Patients who experienced an early isolated LR (≤5 years after BCT) had a worse distant relapse-free survival compared to patients without an early LR (HR 1.83; 95% CI 1.27-2.64; p=0.001). Late local recurrences did not negatively affect distant relapse-free survival (HR 1.24; 95% CI 0.74-2.08; p=0.407). CONCLUSION: Local control after BCT improved significantly over time and appeared to be closely related to the increased use and effectiveness of systemic therapy. These recent results underline the safety of BCT for young women with early-stage breast cancer.


Asunto(s)
Neoplasias de la Mama/terapia , Recurrencia Local de Neoplasia/patología , Adulto , Factores de Edad , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Estudios de Cohortes , Terapia Combinada , Femenino , Humanos , Recurrencia Local de Neoplasia/epidemiología , Países Bajos/epidemiología , Pronóstico , Factores de Riesgo , Adulto Joven
9.
N Engl J Med ; 366(22): 2074-84, 2012 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-22646630

RESUMEN

BACKGROUND: The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established. We compared chemoradiotherapy followed by surgery with surgery alone in this patient population. METHODS: We randomly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin (doses titrated to achieve an area under the curve of 2 mg per milliliter per minute) and paclitaxel (50 mg per square meter of body-surface area) for 5 weeks and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by surgery. RESULTS: From March 2004 through December 2008, we enrolled 368 patients, 366 of whom were included in the analysis: 275 (75%) had adenocarcinoma, 84 (23%) had squamous-cell carcinoma, and 7 (2%) had large-cell undifferentiated carcinoma. Of the 366 patients, 178 were randomly assigned to chemoradiotherapy followed by surgery, and 188 to surgery alone. The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia (6%) and neutropenia (2%); the most common major nonhematologic toxic effects were anorexia (5%) and fatigue (3%). Complete resection with no tumor within 1 mm of the resection margins (R0) was achieved in 92% of patients in the chemoradiotherapy-surgery group versus 69% in the surgery group (P<0.001). A pathological complete response was achieved in 47 of 161 patients (29%) who underwent resection after chemoradiotherapy. Postoperative complications were similar in the two treatment groups, and in-hospital mortality was 4% in both. Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group. Overall survival was significantly better in the chemoradiotherapy-surgery group (hazard ratio, 0.657; 95% confidence interval, 0.495 to 0.871; P=0.003). CONCLUSIONS: Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer. The regimen was associated with acceptable adverse-event rates. (Funded by the Dutch Cancer Foundation [KWF Kankerbestrijding]; Netherlands Trial Register number, NTR487.).


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia Adyuvante , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Unión Esofagogástrica , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carboplatino/administración & dosificación , Quimioradioterapia Adyuvante/efectos adversos , Neoplasias Esofágicas/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Paclitaxel/administración & dosificación , Cuidados Preoperatorios
10.
Ann Surg Oncol ; 19(4): 1185-91, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22031063

RESUMEN

PURPOSE: To evaluate the trend in the use of primary endocrine treatment (PET) for elderly patients with operable breast cancer and to study mean time to response (TTR), local control, time to progression (TTP), and overall survival. METHODS: Data of 184 patients aged≥75 years, diagnosed with breast cancer in the south of the Netherlands between 2001 and 2008 and receiving PET, were analyzed. RESULTS: The percentage of women≥75 years with breast cancer receiving PET in the south of the Netherlands decreased from 23% in the period 1988-1992 to 12% in 1997-2000, and increased to 29% in 2005-2008. Mean age at diagnosis of 184 patients treated with PET in the period 2001-2008 was 84 years (range 75-89 years). Mean length of follow-up was 2.6 years. In 107 patients (58%), an initial response was achieved (mean TTR 7 months), 21 patients (12%) showed stable disease. A total of 64 patients (35%), with or without prior response, eventually displayed progression (mean TTP 20 months). No differences in TTR and TTP were observed between the patients starting with tamoxifen or an aromatase inhibitor. One hundred nineteen (65%) of 184 patients had died by January 1, 2010. In 17 patients (14%), breast cancer was the cause of death. CONCLUSIONS: Tumor progression was observed in a substantial proportion of the cohort, but only a small number of patients died of breast cancer. Further research is needed on the safety and effectiveness of PET for elderly women with breast cancer to justify the current widespread use.


Asunto(s)
Androstadienos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Nitrilos/uso terapéutico , Triazoles/uso terapéutico , Anciano , Anciano de 80 o más Años , Anastrozol , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/metabolismo , Carcinoma Lobular/mortalidad , Carcinoma Lobular/patología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Letrozol , Receptor ErbB-2/metabolismo , Tasa de Supervivencia , Tamoxifeno/uso terapéutico , Resultado del Tratamiento
11.
Eur J Surg Oncol ; 36(7): 646-51, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20537838

RESUMEN

OBJECTIVE: To evaluate axillary staging and management in patients with local recurrence (LR) after a previous negative sentinel lymph node biopsy (SNB). METHODS: Between 1999 and 2008, 130 patients with previous negative SNB developed a LR of breast or chest wall. After examination of clinical records, 70 patients met the inclusion criteria and remained available for analysis. RESULTS: Thirty-seven patients were treated with axillary lymph node dissection (ALND), followed by axillary radiotherapy in 9 cases. In 26 of these 37 patients no positive axillary lymph nodes were found. Nineteen patients received no treatment of the axilla at all. Of those, 9 were older than 70 years of age at diagnosis of LR. In 13 patients a second SNB was attempted, but was successful in only 5 cases. Eight patients underwent a complementary ALND. Overall, positive lymph nodes were detected in 13 of the 50 patients who underwent axillary staging, either by SNB or ALND. The median length of follow-up of the 70 patients following their diagnosis of LR was 24 months (range 2-81 months). During this follow-up period one patient developed an axillary recurrence. This was a patient who refused to undergo ALND but was given locoregional radiotherapy instead. CONCLUSIONS: In the absence of guidelines for staging and management of the axilla at time of LR of breast or chest wall, many different strategies are being used. Considering the high rate of positive axillary lymph nodes in these patients, repeat surgical staging is appropriate.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/terapia , Biopsia del Ganglio Linfático Centinela , Pared Torácica/patología , Adulto , Anciano , Anciano de 80 o más Años , Axila/diagnóstico por imagen , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Países Bajos , Sistema de Registros , Resultado del Tratamiento , Ultrasonografía
12.
Ned Tijdschr Geneeskd ; 152(46): 2495-500, 2008 Nov 15.
Artículo en Holandés | MEDLINE | ID: mdl-19055255

RESUMEN

The incidence of breast cancer in the Netherlands in women under 40 years has been more or less stable for the last 2 decades, while the mortality rate has decreased in the same period. Breast cancer in young women generally has a worse prognosis than in older women. Systemic therapy reduces the risk oflocoregional relapse after breast-conserving therapy from approximately 2% to less than 1% on an annual basis. Breast-conserving therapy therefore seems to be a safe option in young women who have consented beforehand to receive adjuvant systemic therapy. According to current treatment guidelines, adjuvant systemic therapy will be offered to approximately 80% of young breast cancer patients. The risk of premature postmenopausal symptoms, osteoporosis and unwanted infertility are, however, disadvantages of adjuvant chemotherapy and hormonal therapy. This specific treatment-related toxicity in young breast cancer patients requires support by experts with endowments for these specific issues.


Asunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/terapia , Quimioterapia Adyuvante/métodos , Radioterapia Adyuvante/métodos , Adulto , Factores de Edad , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/mortalidad , Quimioterapia Adyuvante/efectos adversos , Femenino , Fertilidad , Humanos , Incidencia , Satisfacción del Paciente , Selección de Paciente , Pronóstico , Calidad de Vida , Radioterapia Adyuvante/efectos adversos , Resultado del Tratamiento
13.
Breast Cancer Res Treat ; 105(1): 63-8, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17115109

RESUMEN

BACKGROUND: Invasive lobular breast carcinoma is known for its multicentricity and is associated with a higher incidence of incomplete excision after breast-conserving therapy. The aim of the study was to examine the influence of positive surgical margins on the local recurrence rate in patients diagnosed with invasive lobular cancer and treated with breast-conserving therapy. METHODS: All 416 women diagnosed with invasive lobular breast cancer and undergoing breast-conserving treatment between 1995 and 2002 were selected from the population-based Eindhoven Cancer Registry. Their medical charts were reviewed and detailed information was collected. RESULTS: The risk of margin involvement was 29% after the first operation and 17% when taking into account the final margin status of the patients undergoing re-excision. During follow-up, 18 patients developed a local recurrence. The 5 year actuarial risk of developing a local recurrence was 3.5% (95% confidence interval 2.5-4.5) and the 8 year risk was 6.4% (95% confidence interval 4.7-8.0). There was no influence of positive surgical margins on the risk of local recurrence, neither in the univariate analysis nor after adjustment for age, tumour size, nodal status and adjuvant systemic treatment. CONCLUSION: Patients with invasive lobular cancer, treated with breast-conservation, have a low risk of local recurrence, despite their high risk of having a microscopically incomplete excision of the tumour.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Lobular/patología , Carcinoma Lobular/cirugía , Factores de Edad , Anciano , Mama/patología , Neoplasias de la Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Femenino , Humanos , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Recurrencia , Riesgo , Factores de Tiempo , Resultado del Tratamiento
14.
Br J Cancer ; 95(3): 393-7, 2006 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-16804522

RESUMEN

Among 1276 primary breast carcinoma in situ (BCIS) patients diagnosed in 1972-2002 in the Southern Netherlands, 11% developed a second cancer. Breast carcinoma in situ patients exhibited a two-fold increased risk of second cancer (standardised incidence ratios (SIR): 2.1, 95% confidence interval (CI): 1.7-2.5). The risk was highest for a second breast cancer (SIR: 3.4, 95% CI: 2.6-4.3; AER: 66 patients per 10,000 per year) followed by skin cancer (SIR: 1.7, 95% CI: 1.1-2.6; AER: 17 patients per 10,000 per year). The increased risk of second breast cancer was similar for the ipsilateral (SIR: 1.9, 95% CI: 1.3-2.7) and contralateral (SIR: 2.0, 95% CI: 1.4-2.8) breast. Risk of second cancer was independent of age at diagnosis, type of initial therapy, histologic type of BCIS and period of diagnosis. Standardised incidence ratios of second cancer after BCIS (SIR: 2.3, 95% CI: 1.8-2.8) resembled that after invasive breast cancer (SIR: 2.2, 95% CI: 2.1-2.4). Surveillance should be directed towards second (ipsi- and contra-lateral) breast cancer.


Asunto(s)
Neoplasias de la Mama/epidemiología , Carcinoma in Situ/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Sistema de Registros/estadística & datos numéricos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/terapia , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Primarias Secundarias/diagnóstico , Vigilancia de la Población , Sistema de Registros/normas , Factores de Riesgo
15.
Eur J Surg Oncol ; 32(1): 34-8, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16305821

RESUMEN

AIMS: The increasing use of breast-conserving therapy (BCT) and the rising incidence and improved prognosis of early breast are causing a substantial increase in the absolute number of patients with a late local recurrence following BCT. This study examined the characteristics and the prognosis of patients with a local recurrence occurring more than 5 years after BCT. METHODS: In the period 1982-1997, 3280 patients with invasive breast cancer underwent breast-conserving therapy in one of the eight community hospitals in the South-eastern part of The Netherlands. Of these patients, 98 developed a local recurrence in the breast more than 5 years after BCT. RESULTS: Eighty-five of the 98 recurrences were invasive, 12 were purely in situ and for one patient this information was not available. The 5 years distant recurrence-free survival rate of 85 patients with a late invasive local recurrence was 68% (95% confidence interval [CI], 56-80) and significantly better than the rate of 41% (95% CI, 33-48) in an existing cohort of 173 patients with invasive recurrence within 5 years after BCT (p=0.007). Local excision of the recurrence was followed by a significantly lower local control rate than salvage mastectomy (50 vs 89%; p=0.004). CONCLUSION: The prognosis of patients with a local recurrence more than 5 years after BCT is significantly better than of patients with local recurrence within 5 years after BCT.


Asunto(s)
Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/terapia , Recurrencia Local de Neoplasia/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirugía , Terapia Combinada , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Mastectomía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Pronóstico , Estudios Retrospectivos , Factores de Tiempo
16.
Ned Tijdschr Geneeskd ; 150(17): 963-8, 2006 Apr 29.
Artículo en Holandés | MEDLINE | ID: mdl-17225737

RESUMEN

OBJECTIVE: To examine the level of compliance with the NABON-guidelines (i.e. breast cancer consensus recommendations) issued in 1999 with particular regard to the diagnostics and treatment of breast cancer in hospitals in the region covered by the Comprehensive Cancer Centre South (covering the Noord-Brabant and Noord-Limburg areas in the Netherlands). DESIGN: Retrospective, descriptive. METHOD: Using the Cancer Registry, the average number ofbreast cancer patients in 16 general hospital locations in the region covered by the Comprehensive Cancer Centre South was determined. Then, from I July 2003 to 30 June 2004, at each hospital location, all successive patients in whom carcinoma of the breast (invasive or in situ) had been diagnosed were included until one-third of the annual total was reached. Data from the medical-case notes of these patients were collected in order to examine to what extent the hospital locations had complied with the NABON-norms. RESULTS: A total of 581 breast cancer patients were included. In general the diagnostics and treatment complied with the consensus recommendations in the NABON-policy document. Improvements were mainly indicated in the area of logistics. One hospital met the guideline's recommendation that in 90% of cases, the pathology department should ensure that the results ofa histological needle-biopsy are available within 2 days of the biopsy being carried out. In 62% of patients, surgery was performed within 3 weeks of the necessity of an operation being confirmed, although the target norm was 90%. The interval between the last operation and the start of radiotherapy treatment was 44 instead of the proposed 28 days. Inter-hospital differences in diagnostics were seen mainly in the application of sentinel-node biopsy (34-95%). Furthermore, broad diversity was observed in the percentage of patients treated in the proposed space oftime between pathology result and initial surgery (3-87%) and between the last operation and start ofradiotherapy (0-46%) or chemotherapy (0-100%).


Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/terapia , Adhesión a Directriz/estadística & datos numéricos , Anciano , Biopsia con Aguja Fina/métodos , Neoplasias de la Mama/cirugía , Carcinoma in Situ/cirugía , Diagnóstico Diferencial , Femenino , Hospitales Generales/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Países Bajos , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina , Radioterapia Adyuvante , Derivación y Consulta , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
17.
Eur J Cancer ; 41(17): 2637-44, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16115758

RESUMEN

We have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years. At 10 years from the date of salvage treatment, the overall survival rate for the 226 patients with invasive local recurrence was 39% (95% CI, 32-46), the distant recurrence-free survival rate was 36% (95% CI, 29-42), and the local control rate (i.e., survival without subsequent local recurrence or local progression) was 68% (95% CI, 62-75). Among patients with a local recurrence at or near the original tumour site a better distant disease-free survival was observed for patients with recurrences measuring 1cm or less, compared to those with larger recurrences. This suggests, though does not prove, that early detection of local recurrence can improve the treatment outcome but might as well point towards a different biologic behaviour, facilitating early detection.


Asunto(s)
Neoplasias de la Mama/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Adulto , Anciano , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , Análisis de Regresión , Resultado del Tratamiento
18.
Eur J Surg Oncol ; 31(5): 485-9, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15922883

RESUMEN

AIM: To investigate the long-term prognosis of patients with axillary recurrence after axillary dissection for invasive breast cancer and describe the long-term survivors. METHODS: Between 1984 and 1994, 4669 patients with invasive breast cancer underwent axillary dissection in eight community hospitals in the south-eastern part of The Netherlands. Using follow-up data of the population-based Eindhoven Cancer Registry, 59 patients with axillary recurrence were identified. RESULTS: The median interval between treatment of the primary tumour and diagnosis of axillary recurrence was 2.6 years (range 0.3-10.7). The median length of follow-up after diagnosis of axillary recurrence was 11.1 years (5.7-15.6). Distant metastases occurred in 38 of the 59 patients. The 5- and 10-year distant recurrence-free survival rates were 39% (95% CI: 25-52%) and 29% (95% CI: 16-42%). CONCLUSIONS: Axillary recurrence following axillary dissection is associated with a high rate of subsequent distant metastasis and poor overall prognosis but is not always a fatal event. Our results show that it is possible to cure about one-third of the patients.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Adulto , Anciano , Anciano de 80 o más Años , Axila , Humanos , Metástasis Linfática/diagnóstico , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico , Recurrencia Local de Neoplasia , Pronóstico , Sistema de Registros , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento
19.
Eur J Cancer ; 41(5): 779-85, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15763655

RESUMEN

The prevalence of coexistent diseases in addition to breast cancer becomes increasingly important in an ageing population. However, the clinical implications are unclear. The age-specific prevalence of serious comorbidity among all new breast cancer patients diagnosed from 1995 to 2001 (n=8966) in the South of the Netherlands was analysed in relation to age, stage and treatment. Independent prognostic effects of age and comorbidity were evaluated (follow-up was continued until 1 January 2004). The prevalence of comorbidity increased from 9% for those aged <50 years to 56% for patients aged 80+ years. The most frequent conditions were cardiovascular disease (7%), diabetes mellitus (7%), and previous cancer (6%). In the presence of comorbidity, fewer patients received radiotherapy (51% vs. 66%, P<0.0001) and fewer patients who underwent breast-conserving surgery also had axillary dissection (P<0.0001). Relative 5-year survival rates for patients without comorbidity (87%) were significantly higher (P<0.01) than those for patients with previous cancer (77%), diabetes mellitus (78%), and for patients with 2+ coexistent diseases (59%). Relative survival of patients without comorbidity increased with age to 93% for patients older than 70 years. Comorbidity negatively affected prognosis, independent of age, stage of disease, and treatment (Hazard Ratio (HR)=1.3, P=0.0001 for one coexistent disease and HR=1.4, P=0.0001 for 2+ coexistent diseases). The most important effects were found for previous cancer (HR=1.4, P=0.003), cerebrovascular disease (HR=1.6, P<0.004) or dementia (HR=2.3, P<0.0001). Elderly breast cancer patients can be divided in those without other diseases, who have a relatively good prognosis, and those who have at least one other serious coexistent disease and significantly poorer prognosis.


Asunto(s)
Neoplasias de la Mama/mortalidad , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/terapia , Terapia Combinada , Comorbilidad , Métodos Epidemiológicos , Femenino , Humanos , Escisión del Ganglio Linfático/estadística & datos numéricos , Mastectomía Segmentaria/estadística & datos numéricos , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico
20.
Br J Cancer ; 90(12): 2332-7, 2004 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-15162155

RESUMEN

In the present study, we investigated whether age and serious comorbid conditions influence treatment decisions, complications and survival in breast cancer patients. The Eindhoven Cancer Registry records patient, tumour and therapy characteristics of all patients diagnosed with cancer in the southern part of the Netherlands. Additional information on severity of comorbidity and serious complications was collected for a random sample of 527 breast cancer patients (aged 40 years and older). More than 70% of the patients >or=80 exhibited high severity of comorbidity compared to 6% of those aged 40-49 years. Treatment was not influenced by severity of comorbidity. Less than 30% of the breast cancer patients had complications after diagnosis. The number of complications was not related to age or severity of comorbidity. The hazard ratio (HR) of dying for patients with low/moderate severity of comorbidity was 2.4 for those aged 40-69 years and 1.6 for those aged >or=70 years, after adjustment for age, nodal status and treatment. For patients with high severity of comorbidity, the risk of dying was almost three times higher. Older breast cancer patients with serious comorbidity were not treated differently and did not have more complications compared to those without comorbidity, but they exhibited a worse prognosis.


Asunto(s)
Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/patología , Adulto , Factores de Edad , Anciano , Neoplasias de la Mama/terapia , Comorbilidad , Toma de Decisiones , Femenino , Humanos , Persona de Mediana Edad , Países Bajos , Planificación de Atención al Paciente , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pronóstico , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Análisis de Supervivencia
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