ABSTRACT
BACKGROUND: Immediate breast reconstruction (IBR) by means of skin expander is currently one of the most widely used methods of breast reconstruction in mastectomized patients. However, given that many breast cancer patients usually receive adjuvant chemotherapy, the adoption of IBR raises new questions concerning possible cumulative toxicity. The present study reports our experience in the use of concurrent adjuvant chemotherapy and immediate breast reconstruction with skin expander after mastectomy for breast cancer and the acute cumulative toxicity of the treatments. METHODS: We evaluated a consecutive series of 52 breast cancer patients who have received IBR by skin expander after radical mastectomy and adjuvant chemotherapy concurrently during skin expansion between 1995 and 1998 (IBR/CT group). We identified two series of control patients treated during the same period: 51 consecutive patients undergoing radical mastectomy and IBR without adjuvant chemotherapy (IBR group) and 63 consecutive patients undergoing radical mastectomy and adjuvant chemotherapy without IBR (CT group). For each patient, we evaluated the incidence of surgical complications and chemotherapy's side effects and dose intensity. RESULTS: The interval between surgery and the start of expander inflation was similar in IBR/CT (range 0-19, median 5 days) and IBR groups (range 0-40, median 5 days) and the timing of inflation was not influenced by chemotherapy. The overall incidence of surgical complications in patients undergoing IBR was low: seroma in eight cases, infection in one, skin necrosis in one, expander rupture in two and erythema in three. There were no statistically significant differences in the distribution of complications between the IBR/CT and IBR groups. The dose intensity of chemotherapy was similar between IBR/CT and CT groups, with a median dose intensity of 96% and 95% of the projected dose, respectively. The only statistically significant difference in terms of chemotherapy side effects (p = 0.03) was that stomatitis was more frequent and intense in the CT than in the IBR/CT group. CONCLUSIONS: Concurrent treatment with IBR and adjuvant chemotherapy appears feasible and safe, it does not increase acute surgical complications or chemotherapy side effects, and does not require any changes in dose intensity or the timing of inflation.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/therapy , Carcinoma in Situ/therapy , Carcinoma, Ductal, Breast/therapy , Carcinoma, Lobular/therapy , Mammaplasty/methods , Mastectomy, Radical , Tissue Expansion Devices , Adult , Aged , Chemotherapy, Adjuvant , Combined Modality Therapy , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
Transrectal ultrasound (TRUS) was performed preoperatively in 35 patients with rectal carcinoma and the results were compared to histologic findings. In the same group, postoperative studies were performed in 22 patients; in women, transvaginal ultrasound (TVUS) was added to the transrectal study. According to Duke's classification modified by Astler-Coller, in relation to the "T" parameter, TRUS correctly staged 33 of 35 neoplasms (accuracy, 94.3%); one was overstaged and one was understaged. In detection of lymph node involvement, accuracy was 74% (sensitivity 69%, specificity 73.9%). Recurrent local tumors, histologically confirmed, developed in two of 22 postoperative patients who had undergone curative anterior resection. This study demonstrates that TRUS is an accurate method in preoperative staging of rectal carcinoma. In the prospective study, the role of follow-up TRUS and TVUS in detection of local recurrences is evaluated.
Subject(s)
Neoplasm Recurrence, Local/diagnostic imaging , Rectal Neoplasms/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Methods , Middle Aged , Neoplasm Staging , Rectal Neoplasms/surgery , UltrasonographyABSTRACT
To evaluate the importance of several risk factors for breast cancer in the Italian female population, a large multicentric case-control study was conducted in 10 breast clinics in Italy. The study included 1,556 women affected by breast cancer, histologically and/or cytologically confirmed. Controls were 1,505 women admitted to a hospital in the same town, matched with cases for residence and with the same age distribution of the Italian female population. The risk factors considered in this study were family history of breast cancer, reproductive history, height and weight, use of oral contraceptives, other hormonal therapies and smoking history. The results of this study confirm the significant role of a positive family history of breast cancer (RR = 2.37); the relative risk was even higher when a first-degree relative was affected or the breast cancer was bilateral. The analysis of the reproductive history showed a significant trend of increasing risk with increasing age at first birth and, although less evident, with increasing number of children. Quetelet's index (kg/m-2) was positively correlated with breast cancer risk, mostly in postmenopausal women. Among other studied factors, only late age at menopause confirmed an increased risk for breast cancer, whereas age at menarche, use of oral contraceptives and smoking histories did not show any significant correlation with breast cancer risk. These results are in substantial agreement with other international studies, but represent an interesting contribution to studies about the Italian female population.
Subject(s)
Breast Neoplasms/etiology , Abortion, Spontaneous/epidemiology , Adolescent , Adult , Age Factors , Aged , Body Height , Body Weight , Breast Neoplasms/epidemiology , Breast Neoplasms/genetics , Child , Female , Humans , Italy , Maternal Age , Menarche , Menopause , Middle Aged , Parity , Pregnancy , Regression Analysis , RiskSubject(s)
Breast Neoplasms/therapy , Adult , Aged , Antineoplastic Agents/therapeutic use , Breast Neoplasms/analysis , Breast Neoplasms/pathology , Castration , Combined Modality Therapy , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Mastectomy , Middle Aged , Neoplasm Staging , Receptors, Estradiol/analysis , Receptors, Progesterone/analysis , Time FactorsABSTRACT
The Authors shortly describe some essential aspects of the gall-bladder primitive cancer, and state their experience about 19 cases of malignant neoplasms observed out of 2280 operations on biliary duct. They confirm the extremely severe prognosis of such disease due to diagnostic delay. As a conclusion, they affirm the simple cholecystectomy is the choice operation in the precocious forms, and suggest the preventive cholecystectomy in the risk patients for such pathology.
Subject(s)
Adenocarcinoma/surgery , Carcinoma/surgery , Gallbladder Neoplasms/surgery , Adenocarcinoma/diagnosis , Adult , Age Factors , Aged , Carcinoma/diagnosis , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/surgery , Cholecystectomy , Female , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/epidemiology , Humans , Male , Middle Aged , Prognosis , Sex FactorsABSTRACT
The incidence of thyroid diseases was evaluated in patients with primary hyperparathyroidism subjected to parathyroidectomy. Eleven patients (26.8%) were affected in this way: 2 with carcinoma, 5 with nodular goitre, and 4 with adenoma. The possible reasons for associations of this kind are discussed, and it is suggested that their high frequency points to a relationship of cause and affect.
