Thyroid hormone therapy in differentiated thyroid cancer.

Surgery-with or without postoperative radioiodine-is the standard of care for most patients with differentiated thyroid carcinoma (DTC). Thyroid hormone replacement therapy is the mainstay of long-term medical management. Patients treated with total thyroidectomy and some who undergo lobectomy alone require thyroid hormone therapy to restore euthyroidism with normal serum thyroid-stimulating hormone (TSH) levels. Because TSH acts as a growth factor for thyroid follicular cells (including those that are neoplastic), it can potentially affect the onset and/or progression of follicular-cell derived thyroid cancer. For this reason, some patients are placed on thyroid hormone therapy at doses that suppress secretion of TSH (suppression therapy). This mini-review looks at the potential benefits and risks of this practice in patients diagnosed with DTC. Aggressive TSH-suppressive therapy is of little or no benefit to the vast majority of patients with DTC. Practice guidelines, therefore, recommend a graded algorithm in which the potential benefits of suppression are weighed against the associated cardiovascular and skeletal risks. Large randomized controlled studies are needed to confirm the presumed oncological benefits of TSH-suppression and its causal role in adverse cardiac, skeletal, and quality of life effects and to assess the efficacy of TSH normalization in reversing or reducing these effects.

The effect of "xanthan gum-based fluid thickener" on hydration, swallowing functions and nutritional status in total maxillectomy patients.

PURPOSE: Swallowing functions are affected after total maxillectomy operations and adjuvant chemoradiotherapy. The purpose of our study is to assess the role of xanthan gum based thickening agents on swallowing and hydration of maxillectomy patients on a randomized controlled fashion. METHODS: 12 of the 22 patients diagnosed with maxillary carcinoma and planned to undergo total maxillectomy was identified as study group and 10 of them were identified as control group. The study group used "xantham based liquid thickener" for liquid foods up to 3 months postoperatively and the control group did not use. Dysphagia-related quality of life, bioimpedance analysis, EAT-10 scores, swallowing functions were evaluated both preoperative and postoperative period. RESULTS: The mean age of the study group was 56 ± 9.87, and 41.6% were women. The mean age of control group was 60 ± 15.63, and 50% were women. Postoperative EAT-10 scores were statistically significant higher than preoperative scores in both groups (p < 0.05). In both of the study and control groups, a statistically significant reduction in dysphagia related quality of life was detected postoperatively (p < 0.05). Intracellular water, extracellular water and total body water detected statistically significant higher in study group at postoperative month three. CONCLUSION: Swallowing functions are affected due to total maxillectomy and radiotherapy. With this study, it has been shown that, total maxillectomy and radiotherapy reduce dysphagia-related quality of life. Swallowing dysfunction and dehydration has been shown to affect total maxillectomy patients. Using of 'xanthan gum-based fluid thickener' helps to maintain intracellular water, extracellular water, and total body water.

Validation and suggestion of eighth T classifications of the UICC/AJCC staging system for nasopharyngeal carcinoma patients: a retrospective analysis.

BACKGROUNDS: With the aim to validate the applicability of the eighth T classifications of AJCC/UICC staging system for nasopharyngeal carcinoma patients. MATERIALS AND METHODS: We compare the seventh and eighth T classifications of the UICC/AJCC staging system in 382 newly diagnosed nasopharyngeal carcinoma patients without cervical lymph node metastasis who were staged with magnetic resonance imaging and treated by intensity-modulated radiotherapy. Univariate analysis was performed using the log-rank test and multivariate analyses with the Cox proportional hazards model were used to evaluate the prognostic values between adjacent stage categories. The Akaike information criterion and Harrell's concordance index were applied to compare the two systems. RESULTS: The median follow-up time was 61.1 months. For local relapse-free survival and distant metastasis failure-free survival, the eighth editions had superior prognostic value to the seventh edition. The Akaike information criterion value was smaller and Harrell's concordance index value was larger for the eighth edition compared with the seventh edition staging system. Our research also found that the difference in overall survival, local relapse-free survival and distant metastasis failure-free survival rates between T1 and T2 patients was not significant according to the eighth edition of the UICC/AJCC staging system, indicating that the discrimination among T1-2 patients was diminished. CONCLUSIONS: Intensity-modulated radiotherapy with elective neck irradiation provides excellent local-regional control for nasopharyngeal carcinoma patients and the eighth T classification seems to be superior to the seventh T classification. Since local control has improved in the modern era, the study considered that the staging system could be further improved and simplified by downstaging the current T2 classification patients to T1 with modern treatment. Researchers are attempting to incorporate individualized prognostic factors, such as Epstein-Barr virus DNA, into nomogram.

Influence of POLG on Radiosensitivity of Nasopharyngeal Carcinoma Cells.

BACKGROUND AND OBJECTIVE: There is a high incidence of nasopharyngeal carcinoma (NPC), malignant head and neck tumors, in southern China. Radioresistance is the main cause affecting the efficacy of NPC treatments. The POLG gene particularly plays an important role in radiation-induced damage repair. In this study, the authors established RNAi CNE-1 and CNE-2 knockdown in two NPC cell lines to observe whether this gene affects the radiosensitivity of NPC cells. MATERIALS AND METHODS: Four short hairpin RNA (shRNA) expression plasmids targeting POLG gene were constructed and transfected into the NPC cell lines CNE-1 and CNE-2. Screening was performed to evaluate the stable expression of cloned cells, which were named CNE-1/POLG-shRNA1, CNE-1/POLG-shRNA2, CNE-2/POLG-shRNA1, and CNE-2/POLG-shRNA2. The negative controls CNE-1/Neg-shRNA and CNE-2/Neg-shRNA were additionally used. The MTT method, flow cytometry, clone formation analysis, cell migration, and other experimental methods were employed to verify changes in the radiosensitivity of the NPC cells. RESULTS: Fluorescent quantitative PCR and Western blot confirmed the downregulation of the PLOG gene through diminished PLOG messenger RNA and protein levels. Consequently, the authors report the stable knockdown of the POLG gene in an NPC model. Dose-dependent radiation exposure of POLG inhibited NPC cell growth and increased apoptosis compared with control cells (p < 0.01), as demonstrated through colony formation assay and flow cytometry. Functional assays indicated that knockdown of the POLG in CNE-1 and CNE-2 cells remarkably reduced cell viability and proliferation. Specifically, POLG knockdown led to G1 phase arrest and apoptosis. CONCLUSIONS: Overall, the authors conclude that POLG downregulation alters the radiosensitivity of NPC cells, indicating that the gene is likely involved in conferring the radiation response of the cells. In addition, findings in this study suggest a novel role for POLG as a potential predictive marker for NPC radiotherapy efficiency. POLG gene can be used as a potential clinical target to effectively improve the radiosensitivity of NPC.

Anaplastology in times of facial transplantation: Still a reasonable treatment option?

Optimum functional and aesthetic facial reconstruction is still a challenge in patients who suffer from inborn or acquired facial deformity. It is known that functional and aesthetic impairment can result in significant psychosocial strain, leading to the social isolation of patients who are affected by major facial deformities. Microvascular techniques and increasing experience in facial transplantation certainly contribute to better restorative outcomes. However, these technologies also have some drawbacks, limitations and unsolved problems. Extensive facial defects which include several aesthetic units and dentition can be restored by combining dental prostheses and anaplastology, thus providing an adequate functional and aesthetic outcome in selected patients without the drawbacks of major surgical procedures. Referring to some representative patient cases, it is shown how extreme facial disfigurement after oncological surgery can be palliated by combining intraoral dentures with extraoral facial prostheses using individualized treatment and without the need for major reconstructive surgery.

The effect of resistance training during radiotherapy on spinal bone metastases in cancer patients - a randomized trial.

PURPOSE: To compare the effects of resistance training versus passive physical therapy on bone density in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to quantify pathological fractures after combined treatment. MATERIAL AND METHODS: In this randomized trial, 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. Bone density in metastatic and non-metastatic vertebral bone was assessed at baseline, 3 and 6 months after RT. RESULTS: Bone density in all metastases increased significantly by 28.3% (IQR 11.4-139.0) and 80.3% (IQR 32.6-250.6) after 3 and 6 months in group A (both p < 0.01). The bone density in group A was significantly increased compared to control group after 3 and 6months (both p < 0.01, median 59.7; IQR 21.1-98.3 and median 62.9; IQR -9.7 to 161.7). The bone density data in group B showed no significant increase over the course of time (p = 0.289, median 5.5, IQR 0.0-62.2 and p = 0.057, median 52.1, IQR 0.0-162.7). 23.3% of the patients in group A and 30.0% of the patients in group B had pathological fractures, no fracture was assigned to intervention, and no difference between groups after 3 and 6 months was observed (p = 0.592 and p = 0.604). CONCLUSIONS: Our trial demonstrated that resistance training concomitant to RT can improve bone density in spinal bone metastases. This combined treatment is effective, practicable, and without side effects for patients. Importantly, the pathological fracture rate in the intervention group was not increased. The results offer a rationale for future large controlled investigations to confirm these findings. TRIAL REGISTRATION: Clinical trial identifier NCT01409720.

One step polymerizing technique for fabricating a hollow obturator.

PURPOSE: Although a closed hollow obturator is often applied to post maxillectomy patients, it has a few problems such as complexity of fabrication and water leakage to inside. A one step curing technique to fabricate a closed hollow obturator by constructing a small hollow bulb made by two thermoplastic resin sheets is described in the present report. METHODS: In the one step curing technique, after dewaxing the wax denture fabricated conventionally, one size smaller hollow body was fabricated with two thermoplastic resin sheets and set into the investment mold as a core. Then the circumferential part of obturator was cured by the pour type resin. This technique was used to fabricate an obturator prosthesis in a 60-year-old post-maxillectomy patient. The weight of this obturator was well controlled and the definitive prosthesis weighed 22 g. At a one year follow-up, the obturator fared well without any water leakage or breakage. CONCLUSIONS: This technique allows the fabricator to control the thickness and weight of the obturator by the amount of relief provided by the hollow bulb. It also rectifies the disadvantages of the closed hollow obturator such as water leakage and complexity of fabrication.

A work-directed intervention to enhance the return to work of employees with cancer: a case study.

The purpose of this case study was to describe how the return-to-work process evolved in an employee with cancer in the Netherlands and how a work-directed intervention supported this process. The patient was a 35-year old female employee diagnosed with cervix carcinoma. After surgery, the patient experienced depression, fatigue, fear of recurrence, and low mental working capacity. Communication with the occupational physician was difficult. A social worker at the hospital provided three counselling sessions aimed to support return to work and sent letters to the occupational physician to improve the communication. The support by the social worker helped the patient to resume work gradually and the sending of information from the treating physician and social worker improved the communication with the occupational physician. This resulted in the patient being able to achieve lasting return to work. This work-directed intervention was highly valued by the patient and could be an important addition to usual psycho-oncological care for employees with cancer.

Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial.

BACKGROUND: Although early rehabilitation programs have been reported to be effective after laparoscopic colectomy, there is no report of the efficacy of rehabilitation programs after rectal cancer surgery. This study was designed to evaluate the efficacy of an early rehabilitation program after laparoscopic low anterior resection for mid or low rectal cancer in a randomized, controlled trial. METHODS: Ninety-eight patients who had undergone a laparoscopic low anterior resection with defunctioning ileostomy were randomized on a 1:1 basis to an early rehabilitation program (n = 52) or conventional care (n = 46). The primary endpoint was recovery rate at 4 days postoperatively. The secondary endpoints were recovery time, postoperative hospital stay, complications, readmission rates, pain on a visual analogue scale, and quality of life (QOL) according to Short Form 36. RESULTS: The recovery rates were not different in both groups (rehabilitation, 25 % vs. conventional, 13 %, p = 0.135). Recovery time and postoperative hospital stay was similar between the groups (rehabilitation, 137 h [107-188] vs. conventional, 146.5 h [115-183], p = 0.47; 7.5 days [7-11] vs. 8.0 days [7-10], p = 0.882). The complication rates did not differ between the two groups, but more complications were noted in the rehabilitation program group (42.3 vs. 24.0 %, p = 0.054), which was related to postoperative ileus (28.8 vs. 13.0 %, p = 0.057) and acute voiding difficulty (19.6 vs. 4.7 %, p = 0.032). There was no readmission within 1 month of surgery. Pain and QOL were similar in both groups. CONCLUSIONS: This randomized trial did not show that an early rehabilitation program is beneficial after laparoscopic low anterior resection. Our results confirm that postoperative ileus and acute voiding difficulty are major obstacles to fast-track surgery for mid or low rectal cancer. This study was registered (registration number NCT00606944).

Medialization thyroplasty for voice restoration after transoral cordectomy.

Fourteen dysphonic patients who had previously undergone total or extended cordectomy underwent medialization thyroplasty. A minimum delay of 6 months was respected to allow the spontaneous "neocord" formation, to evaluate the voice recovery achieved by speech therapy alone and to avoid an undiagnosed early recurrence. Surgery was performed under general anaesthesia, using a laryngeal mask, because undermining the fibrous tissue at the inner side of the thyroid ala is a prolonged and difficult procedure. This step was essential to ensure an easy placement of the implant and to avoid tearing the fibrous tissue, with subsequent risk of implant extrusion. Visual control of the implant implementation was obtained by flexible videoendoscopy. The Montgomery(®) implant system (Boston, Westborough, MA) was used for the majority of the cases. Hand-made modified Montgomery implants or Gore-tex(®) were used in case of extended scarring or peculiar anatomic defect. The voice assessment showed a decrease of the VHI score from 50.5 to 39.4; a decrease of G from 2.4 to 2; an increase of maximum phonation time (MPT) from 6.2 to 7.3 s; a decrease of the maximum fundamental frequency (Fo-high) from 338.7 to 242.4 Hz and a decrease of the phonation quotient from 1,144.9 to 544.9 ml/s. The lower intensity (I-low) remained unchanged, from 60 to 58 dB. Statistically significant improvement was noted only for VHI and G grading. A decrease of the voice efforts and fatigue were noticed by all the patients.

Attitudes and behavior of radiation oncologists toward sexual issues of cervical cancer patients who receive radiation therapy: a survey in China.

OBJECTIVE: Cervical cancer is known to impair women's sexual function. This study aimed at investigating the attitudes and behavior of radiation oncologists regarding sexual functioning of female cervical cancer patients who receive radiation therapy. METHODS: A total of 186 radiation oncologists were included. A self-reported questionnaire was used to investigate the attitudes and behavior of radiation oncologists. The oncologists were queried on their history of consultation on sexual issues, attitudes, and behavior toward sexual issues and considerations of sexual life for cervical cancer patients who receive radiotherapy. RESULTS: Among 120 radiation oncologists who completed the questionnaires, 101 (84.2%) had been consulted on sexual issues, of whom only 29 (24.2%) were consulted by more than 10% of cervical cancer patients who received radiation therapy or their families. Compared with those without a history of consultation, radiation oncologists with a history of consultation were more likely to agree that "radiation oncologists should deal with a patient's sexual issues" (88.1% vs 68.4%) and disagree that "sex is private and should not be interfered with" (66.2% vs 44.5%). Five radiation oncologists (4.2%) had received special training to deal with the sexual issues of cervical cancer patients who receive radiotherapy, and 112 oncologists (93.3%) did not have any information on sexual functioning to give the their patients. CONCLUSIONS: History of consultation on sexual issues affects radiation oncologists' attitudes and behavior toward sexual issues of cervical cancer patients. Radiation oncologists should have a more positive attitude toward sexual issues and should receive more specific relevant training.

[Breast reconstruction after mastectomy]. / Reconstruction mammaire après mastectomie.

The mutilating surgery for breast cancer causes deep somatic and psychological sequelae. Breast reconstruction can mitigate these effects and permit the patient to help rebuild their lives. The purpose of this paper is to focus on breast reconstruction techniques and on factors involved in breast reconstruction. The methods of breast reconstruction are presented: objectives, indications, different techniques, operative risks, and long-term monitoring. Many different techniques can now allow breast reconstruction in most patients. Clinical cases are also presented in order to understand the results we expect from a breast reconstruction. Breast reconstruction provides many benefits for patients in terms of rehabilitation, wellness, and quality of life. In our mind, breast reconstruction should be considered more as an opportunity and a positive choice (the patient can decide to do it), than as an obligation (that the patient would suffer). The consultation with the surgeon who will perform the reconstruction is an important step to give all necessary informations. It is really important that the patient could speak again with him before undergoing reconstruction, if she has any doubt. The quality of information given by medical doctors is essential to the success of psychological intervention. This article was written in a simple, and understandable way to help gynecologists giving the best information to their patients. It is maybe also possible to let them a copy of this article, which would enable them to have a written support and would facilitate future consultation with the surgeon who will perform the reconstruction.

The early development phases of a European Organisation for Research and Treatment of Cancer (EORTC) module to assess patient reported outcomes (PROs) in women undergoing breast reconstruction.

INTRODUCTION: A comprehensive evaluation of breast reconstruction (BRR) surgery includes measurement of patient reported outcomes (PROs). There is, however, a lack of validated BRR-specific PRO measures (PROMs) that adequately assess relevant issues. This study is developing a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire/module specific for PROs in BRR to supplement the cancer-core and breast cancer EORTC questionnaires, respectively: the QLQ-C30 and QLQ-BR23. METHODS: Phases I and II of questionnaire development followed EORTC guidelines including a systematic literature review to identify all potential 'issues' (concepts relevant to PROs) and semi-structured interviews with 89 patients and 9 European multi-disciplinary health care professionals (HCPs) (Sweden, Italy and the United Kingdom [UK]). Interviewers asked participants the 'relevance' of outcomes identified in the literature and captured additional 'issues' of importance. RESULTS: The literature search and interviews of patients and HCPs yielded 69 issues relating to BRR operationalised into 31 provisional items (single questions) for the module, which was conceptualised to contain five scales: treatment/surgery related symptoms (affecting the shoulder, arm and reconstructed breast), body image, sexuality, cosmetic outcomes (pertaining to three areas: breast, donor site and nipple) and overall satisfaction. DISCUSSION: The provisional development of the EORTC BRR module has 31 items addressing issues of importance to patients as well as HCPs. Further international testing is underway as a UK National Cancer Research Network trial to ensure that this PROM will be psychometrically and clinically robust and applicable for use in clinical trials, cohort studies, national audit and clinical practice.

The role of intraoperative fluid optimization using the esophageal Doppler in advanced gynecological cancer: early postoperative recovery and fitness for discharge.

OBJECTIVE: To determine the effect of fluid optimization using esophageal Doppler monitoring (EDM) when compared to standard fluid management in women who undergo major gynecological cancer surgery and whether its use is associated with reduced postoperative morbidity. METHODS: From January 2009 to December 2010, women undergoing laparotomy for pelvic masses or uterine cancer had either fluid optimization using intraoperative EDM or standard fluid replacement without using EDM. Cases were selected from 2 surgeons to control for variability in surgical practice. Demographic and surgical details were collected prospectively. Univariate and multivariate analyses were performed to quantify the association between the use of EDM with "early postoperative recovery" and "early fitness for discharge." RESULTS: A total of 198 women were operated by the 2 prespecified surgeons; 79 women had fluid optimization with EDM, whereas 119 women had standard anesthetic care. The use of ODM was associated with earlier postoperative recovery (adjusted odds ratio, 2.83; 95% confidence interval, 1.20-6.68; P = 0.02) and earlier fitness for discharge (adjusted odds ratio, 2.81; 95% confidence interval, 1.01-7.78; P = 0.05). Women with advanced-stage disease in the "EDM" group resumed oral diet earlier than women in the "no EDM" group (median, 1 day vs 2 days; P = 0.02). These benefits with EDM did not extend to women with early-stage disease/benign/borderline tumors. No significant difference in postoperative complications was noted. CONCLUSIONS: Intraoperative fluid optimization with EDM in women with advanced gynecological cancer may be associated with improved postoperative recovery and early fitness for discharge. Studies with adequate power are needed to investigate its role in reducing postoperative complications.

Post-traumatic growth among elderly women with breast cancer compared to breast cancer-free women.

BACKGROUND: Although breast cancer (BC) may have negative psychological sequelae, it may also be experienced as an existential challenge, which can derive personal growth. Only one study has been conducted, however, on whether women with BC experience more post-traumatic growth (PTG) than BC-free women. We examined PTG in women with and without BC and whether the characteristics and treatment of BC were associated with PTG. MATERIAL AND METHODS: We used data from the questionnaire administered in the Diet, Cancer and Health cohort and included 774 women with BC and 666 randomly sampled BC-free women aged 63-81 years. PTG was measured with the PTG inventory, for which the women identified their own traumatic or life-changing event. Linear regression was used to compare PTG in women with and without BC and to examine the association between BC characteristics and treatment and PTG. RESULTS: Although women with BC experienced significantly more PTG in the domains 'appreciation of life' and 'relating to others' compared to BC-free women, no statistically significant difference in overall PTG was observed according to BC status, indicating that PTG is not limited to women with BC. Tumor size, number of positive lymph nodes, having undergone mastectomy and having received endocrine treatment were positively associated with overall PTG and/or specific PTG domains, implying that the severity of disease plays a role in the development of PTG. CONCLUSION: In order to avoid unnecessary pressure for personal growth, healthcare professionals should not expect that women with BC experience more PTG than BC-free women.

Changes in body mass index and alcohol and tobacco consumption among breast cancer survivors and cancer-free women: a prospective study in the Danish Diet, Cancer and Health Cohort.

BACKGROUND: A breast cancer diagnosis has been suggested as a teachable moment when a woman is more open to making healthier lifestyle changes. Little is known about the health behaviour changes women with breast cancer initiate compared to those made by other women. MATERIAL AND METHODS: We examined changes in body mass index (BMI) and tobacco and alcohol consumption among women with a diagnosis of breast cancer and among cancer-free women. We used data from 23 420 women aged 50-64 years who participated in the Diet, Cancer and Health cohort, of whom 449 were diagnosed with breast cancer between baseline (1993-1997) and follow-up (2000-2002), and 22 971 remained cancer-free. We used multiple linear regression analysis to examine differences in BMI and alcohol and tobacco consumption between the two groups and to examine whether demographic and prognostic factors were associated with behavioural changes in women with breast cancer. RESULTS: There were no significant differences in changes in BMI, alcohol and tobacco consumption between the two groups. Only in sub-analyses among women who lost weight between baseline and follow-up, women with breast cancer lost more weight than cancer-free women (ß = 0.2; CI 0.1; 0.4), but residual confounding from stage cannot be excluded. Among the women with breast cancer we found no significant changes in BMI, alcohol and tobacco consumption by level of education, marital status, chemotherapy, hormone therapy or radiation. CONCLUSION: Women with breast cancer did not reduce their BMI, or modify their alcohol use or tobacco consumption compared with cancer-free women. This study indicates that guidelines and interventions to change health behaviour are needed after a cancer diagnosis.

Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation.

BACKGROUND: This study reports the rate of breast reconstruction failure and cosmetic outcomes after postmastectomy radiation therapy (PMRT) with temporary tissue expanders (TEs) or implants in place. PATIENTS AND METHODS: Ninety-four patients underwent mastectomy (93 unilateral, 1 bilateral; 95 cases total) and immediate TE reconstruction followed by PMRT. Ninety TEs and 5 permanent implants were irradiated. All patients received a dose of 5400 cGy given in 180-cGy fractions to the reconstructed breast. Twenty-one patients (22%) received tangents alone and 74 patients (78%) were treated with tangents and a supraclavicular field using a monoisocentric technique. Bolus was used in 91 patients (96%). Eighty-eight patients (93%) received chemotherapy and 78 patients (82%) received endocrine therapy. RESULTS: With a median follow-up of 24.1 months, 19 patients (20%) experienced failure of reconstruction. The 1-, 2-, and 3-year actuarial rate of reconstruction failure was 9.7%, 19.3%, and 25.5%, respectively. Infection was the most common cause of failure. Of the 19 failures, 8 patients underwent salvage procedures with flap reconstruction. Univariate analysis was performed examining age, chemotherapy use, hormone therapy use, use of a supraclavicular field, smoking status, diabetes, hypertension, and menopausal status. No risk factors were found to be associated with reconstruction failure. In patients who did not experience reconstruction failure, good/excellent cosmesis was observed in 75% of patients. CONCLUSION: In the current series of women with a high risk of locoregional recurrence, PMRT with a TE/implant in place provides good cosmesis in the majority of women, with an acceptable risk of expander or implant loss.

Infiltración con toxina botulínica para el control del dolor en cáncer de mama / Botulinum toxin infiltration for breast cancer pain control

Introducción. El dolor es frecuente entre las pacientes con cáncer de mama, siendo la causa principal de la baja calidad de vida. La toxina botulínica (TB) podría ser una opción de tratamiento en estas pacientes durante la reconstrucción mamaria o en el síndrome de dolor postmastectomía. Muy pocos autores han estudiado su efectividad en el tratamiento del dolor. Hipótesis. La infiltración con TB en el músculo pectoral provoca una inhibición del espasmo muscular mejorando el dolor. Objetivos. Valoración de la efectividad de la TB en el control del dolor, en la reconstrucción con expansor tisular, implantes mamarios y en el dolor crónico. Material y métodos. Tipo de estudio: cuasiexperimental. La muestra incluyó 89 pacientes seleccionados de forma no aleatorizada entre junio de 2009 y febrero de 2011. Todas presentaban cáncer de mama con enfermedad controlada y contractura dolorosa de pectoral mayor. Valoración: exploración clínica y la puntuación en la escala EVA previo y posterior a la infiltración. Resultados. El 21% fueron infiltradas durante la reconstrucción, el 16% portaban prótesis mamaria y el 63% tenían dolor crónico. El dolor nociceptivo fue más frecuente en el grupo de expansor (73,6%) y el mixto en dolor crónico (89,2%). La puntuación en la escala EVA inicial fue más alta para el grupo de expansor que obtuvo mayores descensos posteriores a la infiltración. Conclusiones. La infiltración del músculo pectoral mayor con TB tipo A mejora el dolor en el cáncer de mama, tanto durante la fase de reconstrucción mamaria con expansor como en las pacientes con implantes y en las que presentan síndrome de dolor postmastectomía (AU)

Introduction. Pain is common among patients with breast cancer, it being the leading cause of poor quality of life. Botulinum toxin (BT)may be a treatment option in these patients during breast reconstruction or in post-mastectomy pain syndrome. Very few authors have studied its effectiveness in treating pain. Hypothesis. Infiltration with BTin the breast muscle causes an inhibition of the muscle spasm, thus improving the pain. Objectives. To assess the effectiveness of BT in pain control in reconstruction with tissue expanders, breast implants and in chronic pain. Material and methods. The study had a quasi-experimental design. The sample included 89 randomly selected patients between June 2009 and February 2011. All had breast cancer with controlled disease and painful contracture of the pectoralis major. The evaluation was performed by clinical examination and score on the visual analogue scale (VAS) before and after the infiltration. Results. A total of 21% had undergone infiltration during reconstruction; 16% had a breast prosthesis and 63% had chronic pain. Nociceptive pain was more frequent in the expander (73.6%) and mixed chronic pain (89.2%) group. Initial VAS score was higher for the expander group that obtained greater declines after the injection. Conclusions. Infiltration of the pectoral muscle with BT type A improves pain in breast cancer subjects, both during breast reconstruction with expander and in patients with implants and in those with post-mastectomy pain syndrome (AU)

Optimal mode for maximal aerobic exercise testing in breast cancer survivors.

PURPOSE: To determine which mode of exercise is preferred by breast cancer survivors and to evaluate this response between graded exercise testing on a treadmill and on a cycle ergometer. METHODS: Twelve breast cancer survivors completed 2 maximal aerobic stress tests on separate days. The women completed a ramp protocol on an electronically braked cycle ergometer and an incremental step protocol on a treadmill to volitional fatigue. Test order was randomized. Expired gases were collected for the determination of peak aerobic capacity (Vo (2peak)). RESULTS: Exercise mode had a significant effect on the graded exercise response in breast cancer survivors, P = .003. Treadmill Vo (2peak) was significantly greater than bike Vo (2peak) (28.7 ± 4.7 vs 23.9 ± 4.7 mL/min/kg, respectively, P = .003) and VE(max) was equivalent between exercise modes (P = .731). Maximal heart rate was significantly higher by 11 bpm during the treadmill protocol (P = .004), and Ve/VCo (2) exhibited possible mode dependency (P = .018). CONCLUSION: This patient population felt more comfortable and produced significantly greater Vo2(peak) values using the treadmill protocol. These results discuss the potential implications concerning the design and interpretation of exercise interventions for breast cancer survivors.