Síndrome de contracción capsular en retinitis pigmentosa: estudio mediante tomografía de coherencia óptica de segmento anterior / Capsule contraction syndrome in retinitis pigmentosa: Study using anterior segment optical coherence tomography

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Metaplastic breast cancer: to radiate or not to radiate?

BACKGROUND: The role of radiation therapy (RT) is unclear for metaplastic breast cancer (MBC). We hypothesized that RT would improve overall survival (OS) and disease-specific survival (DSS). MATERIALS AND METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify MBC patients diagnosed from 1988 to 2006. Univariate analyses of patient, tumor, and treatment-specific factors on OS and DSS were performed using the Kaplan-Meier method and differences among survival curves assessed via log rank. Variables assessed included patient age, race/ethnicity, histologic subtype, tumor grade, T stage, N stage, M stage, hormone receptor status, surgery type, and use of RT. Cox proportional hazards models used all univariate covariates. Risks of mortality were reported as hazard ratios (HR) with 95% confidence intervals (95% CI); significance was set at P ≤ 0.05. RESULTS: Among 1501 patients, RT was given to 580 (38.6%). Ten-year OS and DSS were 53.2, and 68.3%, respectively. In the overall analysis, RT provided an OS (HR 0.64; 95% CI, 0.51-0.82; P < 0.001) and DSS (HR 0.74; CI, 0.56-0.96; P < 0.03) benefit. When patients were stratified according to type of surgery, RT provided an OS but not a DSS benefit to lumpectomy (HR 0.51; CI, 0.32-0.79, P < 0.01) and mastectomy patients (HR 0.67; CI, 0.49-0.90; P < 0.01). CONCLUSIONS: Our findings support the use of RT for patients with MBC following lumpectomy or mastectomy. These retrospective findings should be confirmed in a prospective clinical trial.

Biphasic metaplastic sarcomatoid carcinoma of the breast: report of a case.

A 69-year-old woman was admitted to our hospital with the complaint of a right breast mass. As a result of thorough examinations, she was diagnosed with breast cancer and underwent breast-conserving surgery. The pathological findings of the resected specimen showed that the tumor consisted of intermingled carcinomatous and sarcomatous components with a transition zone. On immunohistochemical study, the sarcomatous cells in this transition zone showed partial positive staining for CD10, the myoepithelial marker, suggesting that the myoepithelial cells had transformed into sarcoma, and then this biphasic tumor was formed. Finally, she was diagnosed with biphasic metaplastic sarcomatoid carcinoma of the breast. Biphasic metaplastic sarcomatoid carcinoma of the breast is a relatively rare but aggressive disease. The pathological diagnosis is often controversial, requiring detailed immunohistochemical analysis. We report our experience with a case of biphasic metaplastic sarcomatoid carcinoma of the breast.

Metaplastic carcinoma of the breast: a retrospective review.

PURPOSE: Metaplastic carcinoma of the breast represents a rare and heterogeneous group of malignancies that accounts for less than 1% of all breast cancers. The purpose of this study is to better characterize the clinical management of this disease including the role of radiation therapy after surgery. We compared patients that have been treated with either modified radical mastectomy (MRM) or breast-conserving surgery (BCS). METHODS AND MATERIALS: We performed a retrospective review of 43 patients with metaplastic breast cancer who were evaluated in our regional radiation oncology department between 1987 and 2002. Twenty-one patients were treated with an MRM and 22 with BCS. Five patients from the MRM group received adjuvant radiation, as did 19 patients from the BCS group. Univariate and multivariate analysis of pathologic and treatment-related factors was performed. Local control, disease-free, and overall survival rates were calculated by the Kaplan-Meier method and compared for the two groups. RESULTS: Mean follow-up for all patients was 44.2 months. Mean tumor size was 3.4 cm. Four patients (9%) had positive estrogen receptors and 20 (25%) had positive nodes. The overall 5-year projected local recurrence-free (88% vs. 85%, p = 0.86), disease-free (55% vs. 84%, p = 0.13), and overall survivals (80% vs. 89%, p = 0.58) were not significantly different for both groups. The only tumor parameter significantly associated with overall survival was nodal status. CONCLUSION: Our study suggests that breast conservation appears to be a reasonable treatment option for women with metaplastic breast cancer, achieving equal survival to mastectomy. The use of adjuvant radiation seems essential for achieving high local control rates after conservation therapy. Further studies will be needed to determine the impact of chemotherapy on survival outcomes.

Role of adjuvant radiotherapy in metaplastic matrix producing breast cancer: a case study with review of literature.

A rare and unique variant of breast cancer--metaplastic matrix producing carcinoma, is presented. Surgery has been the mainstay of treatment. The role of adjuvant postoperative radiotherapy, as has been used in this patient, has been reviewed.

The role of adjuvant radiotherapy in carcinoma of the endometrium-results in 550 patients with pathologic stage I disease.

OBJECTIVES: A retrospective analysis of 550 women with pathological stage I carcinoma of the endometrium who were seen between January 1984 and December 1988 was performed in order to assess the value of adjuvant radiation therapy. METHODS: Two-hundred twenty-eight patients were treated with surgery alone (S); 97 received adjuvant external beam radiotherapy (S + EXT); 217 received external beam radiotherapy and colpostats (S + EXT + IC); and 8 patients received only colpostats (S + IC). Pelvic radiation therapy, usually 40 Gy in 20 fractions, was administered to 94% of patients whose tumors showed greater than 50% myometrial invasion and to 89% of patients with FIGO grade 3 tumors. Colpostats were used in 40% of patients, the majority of whom had lower uterine segment involvement. RESULTS: The overall survival rate for the whole group using Kaplan-Meier estimates was 84% at 5 years. The 5-year overall survival rates for each treatment group, excluding the S + IC group, were 90% for S alone, 79% for S + EXT, and 82% for S + EXT + IC. The 5-year disease-free survival rates were 84, 77, and 77%, respectively. Local control rates at 5 years were 93, 94, and 95% in the three treatment groups, but the patterns of relapse were different. Distant metastases occurred more frequently among the patients who received adjuvant radiation therapy (36/49, 73%) than among those who did not (4/19, 21%). Late toxicity was documented in 66 patients. Twelve patients had EORTC/RTOG grade 3 and 4 complications; all had been treated with S + EXT + IC. FIGO grade (P = 0.009), lower uterine segment involvement (P = 0.009), and age (P = 0.03) were significant predictors of worse disease-free survival in a multiple regression analysis. CONCLUSIONS: The addition of vaginal vault brachytherapy to external beam radiotherapy did not appear to improve local cure rates nor survival, but increased the incidence of late radiation toxicity.

[Low-dose postoperative vaginal brachytherapy of adenocarcinoma of the endometrium]. / Curiethérapie vaginale postopératoire des adénocarcinomes de l'endomètre à bas débit de dose.

PURPOSE: Surgery is the primary treatment for endometrial carcinoma. Methods of complementary treatment are still debated, with the potential association of external radiotherapy and/or brachytherapy before or after surgery. This study was aimed at evaluating local control and complications rates in a series of patients treated by hysterectomy followed by postoperative vaginal low-dose rate brachytherapy (BT) combined with pelvic irradiation in case of poor prognosis factors. PATIENTS AND METHODS: From 1978 to 1993, 101 patients were treated at the Centre Alexis-Vautrin, France according to this scheme. Forty five had deep myometrial invasion, and thirteen cervical involvement. Fifty patients received pelvic irradiation (median dose 46 Gy) combined with BT (dose 14 Gy, median volume 127 cm3); 51 patients had BT alone (dose 60 Gy, median volume 71 cm3). RESULTS: The 5-year overall survival rate was 83% and the local control rate 97% with a median follow-up of 7 years. Multivariate analysis showed two factors of bad prognosis, i.e., deep myometrial invasion and cervical involvement. Three severe complications occurred in two patients for whom the treated volume was larger than the theoretical target volume. Eleven patients developed metastases. CONCLUSION: Results obtained from this series are comparable with those of previous studies, particularly in regard to pre-operative BT. The complication rate is also satisfactory and depends on the irradiation precision and the definition of the target volume.

Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors.

In order to assess the role of postoperative radiotherapy and prognostic factors, 126 patients who were treated with radiotherapy after surgery for clinical early-stage carcinoma of the cervix were reviewed. All patients received external pelvic radiotherapy and 37 patients were treated with additional vaginal cuff irradiation. The 5-year overall survival, disease-free survival and locoregional control rates were 71.1, 69.9 and 78.1%, respectively. The 5-year disease-free survival rates were 40% for grade 3 vs. 75.4% for grade 1 tumours (p = 0.05), 76.5% for pathological stage IB versus 54.1% for pathological stage IIA (p = 0.04), 36.6% for node-positive patients versus 82.5% for node-negative patients (p = 0.0017), 54% for full thickness cervical invasion versus 100% superficial cervical invasion (p = 0.01), 34.8% for positive margins versus 78.1 for negative margins (p < 0.0001). After a multivariate analysis, tumour grade (p = 0.026) and presence of positive margins (p = 0.006) were found to independently influence the outcome. Grade II and III complication rate was 5.5% in all patients. In conclusion, postoperative radiotherapy should be used in patients treated with simple hysterectomy as well as those treated with radical hysterectomy with unfavorable pathological findings.

Hematoporphyrin derivative and laser photoradiation in the treatment of lung cancer.

Photoradiation therapy (PRT) was performed in 13 lung cancer cases and in one case of severely atypical squamous metaplasia following administration of hematoporphyrin derivative (HpD). The HpD is activated by visible red light (630 nm, 90 to 400 mW) from an argon dye laser. The cytocidal effects were due to the activation of the HpD, since 400 mW of power has in itself no effect on normal epithelium, even with long-term exposure. HpD is retained longer by malignant tissue than by normal tissue. Therefore, the lesions were irradiated with the red laser beam, delivered by a quartz fiber inserted through the instrumentation channel of the fiberoptic bronchoscope, 48 hours or more after intravenous injection of 2.5 to 4.0 mg/kg of HpD. A total of 14 cases received PRT. In one, two small, smooth-surfaced, squamous cell carcinoma tumors in the right B2b of a 74-year-old man who had refused surgery disappeared three days after HpD-photoradiation, and the patient remained disease-free 16 months after the treatment. In 12 cases of centrally located lung cancer local effects were obtained in all. However, there was no significant improvement in survival, attributable to the fact that all were advanced-stage cases. One patient with severely atypical squamous metaplasia requested treatment, and complete disappearance of metaplastic atypic was obtained.