ABSTRACT
ABSTRACT BACKGROUND: Use of mammary adenectomy for breast carcinoma treatment remains controversial. OBJECTIVE: This study aimed to verify the oncological safety of mammary adenectomy and immediate breast reconstruction for treating selected patients with infiltrating breast carcinoma and to evaluate patients' satisfaction with the reconstructed breasts. DESIGN AND SETTING: Cohort study conducted among patients treated at Hospital Sírio-Libanês, São Paulo, Brazil. METHODS: This study was based on 152 selected patients (161 operated breasts) with infiltrating breast carcinoma who underwent mammary adenectomy and immediate breast reconstruction. In all patients, the diameter of the largest focus of the tumor was less than 3.0 cm, the imaging tumor-nipple distance was greater than 2.0 cm and the pathological assessment showed clear margins. The cumulative incidence of local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method. After at least one year of follow-up, 64 patients were asked about their satisfaction with the reconstructed breast(s). RESULTS: At a mean follow-up time of 43.5 months, seven cases of LR (4.4%), four distant metastases (2.6%) and five deaths (3.3%) were recorded. The five-year actuarial LR-free survival, RFS and OS were 97.6%, 98.3% and 98.3%, respectively. No cases of nipple-areolar complex recurrence were reported. Forty-one patients (64%) indicated a high level of satisfaction with the reconstructed breasts. CONCLUSIONS: Mammary adenectomy is a safe and efficacious procedure for selected patients with early-infiltrating breast carcinoma and results in a high rate of patient satisfaction with the reconstructed breasts.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast Neoplasms/surgery , Patient Satisfaction , Mammaplasty/methods , Carcinoma, Ductal, Breast/surgery , Retrospective Studies , Cohort Studies , Follow-Up Studies , Treatment Outcome , Disease-Free Survival , Mastectomy/methods , Neoplasm Recurrence, LocalABSTRACT
A angiogênese tem papel fundamental no crescimento tumoral. Células neoplásicas secretam fator de crescimento do endotélio vascular (vascular endothelial growthfactor - VEGF-A), estímulo para formação de nova vascularização, que promove suprimento sanguíneo às células tumorais e permite seu crescimento, invasão e metastatização. Os inibidores da angiogênese agem por meio da ligação inibitória ao VEGF (bevacizumabe) ou bloquando o receptor do VEGF-A (sunitinibe e sorafenibe). Seus efeitos antiangiogênicos incluem regressão e inibição da formação de neovasos. Essas medicações atualmente têm ampla utilização em terapias oncológicas. São agentes comercializados pela primeira vez em câncer colorretal metastático (becacizumabe) em 2004, mas que vêm desde então expandindo suas indicações: câncer de pulmão metastático (2006), carcinoma de células renais (2006), câncer de mama metastático (2008), glioblastoma multiforme recidivado (2008) e hepatocarcinoma avançado (2008). estudos atuais investigam o impacto da introdução desses agentes de maneira cada vez mais precoce na evolução da doença. Com isso, aumentam o tempo de exposição dos pacientes ao medicamento e o risco de seus efeitos colaterais. Viabiliza-se, portanto, o surgimento dos efeitos adversos tardios, até então pouco conhecidos, exigindo vigilância constante tanto clínica como epidemiológica. Os efeitos adversos...
Venous thromboembolism is a serious and potentially fatal disorder, which complicates the course of 20% of cancer patients, and has a significant impact on the quality of life and clinical outcomes of these patients. The pathophysiology of the association between thrombosis and cancer is complex. Malignancy is associated with a baseline hypercoagulable state secondary to the release of inflammatory cytokines, activation of the clotting system, expression of hemostatic proteins on tumor cells, inhibition of natural anticoagulants and impaired fibrinolysis. Several risk factors have been identified as contributing to venous thromboembolism and may be related to the patient characteristics, to the disease, and to the therapeutic interventions. The use of heparins and fondaparinux is indicated for selected cancer patients according to the types of malignancies and treatments. The treatment of venous thromboembolism in patients with cancer is challenging: the complications associated with the use of anticoagulants are significantly higher, may interfere with anticancer therapy and have a negative impact on quality of life.
Subject(s)
Humans , Hypertension/complications , Hypertension/diagnosis , Angiogenesis Inhibitors/therapeutic use , Toxicity/analysis , Risk FactorsABSTRACT
CONTEXT: There are no reports in the literature of massive deep venous thrombosis (DVT) associated with cisplatin, bleomycin and etoposide (BEP) cancer treatment. CASE REPORT: The patient was a 18-year-old adolescent with a nonseminomatous germ cell tumor of the right testicle, with the presence of pulmonary, liver, and massive retroperitoneal metastases. Following radical orchiectomy, the patient started chemotherapy according to the BEP protocol (without routine prophylaxis for DVT). On day 4 of the first cycle, massive DVT was diagnosed, extending from both popliteal veins up to the thoracic segment of the inferior vena cava. Thrombolytic therapy with streptokinase was immediately started. On day 2 of thrombolytic therapy, the patient developed acute renal failure, due to extension of the thrombosis to the renal veins. Streptokinase was continued for six days and the outcome was remarkably favorable.
CONTEXTO: Não há relatos na literatura de trombose venosa profunda (TVP) extensa associada ao protocolo de quimioterapia cisplatina, bleomicina e etoposite (BEP). RELATO DO CASO: O paciente era um adolescente de 18 anos com um tumor germinativo não-seminomatoso no testículo direito, com metástases pulmonares, hepáticas e retroperitoneais. Após orquiectomia radical, o paciente começou a receber quimioterapia de acordo com o protocolo BEP (sem profilaxia rotineira para TVP). No quarto dia do ciclo, TVP massiva foi diagnosticada, estendendo-se das veias poplíteas até o segmento inferior da veia cava torácica. Tratamento trombolítico foi iniciado imediatamente com estreptoquinase. No segundo dia da terapia trombolítica, o paciente desenvolveu insuficiência renal aguda, devido ao acometimento das veias renais pela trombose. Estroptoquinase foi mantida por seis dias e o paciente teve evolução surpreendentemente favorável.