Long-term outcome of neoadjuvant endocrine therapy with aromatase inhibitors in elderly women with hormone receptor-positive breast cancer.

BACKGROUND: Aromatase inhibitors (AIs) are more effective than tamoxifen as neoadjuvant endocrine therapy (NET) for hormone receptor (HR)-positive breast cancer. Here we report the surgical and long-term outcome of elderly postmenopausal patients with locally advanced, HR-positive breast cancer treated with preoperative AIs. METHODS: Between January 2003 and December 2012, 144 postmenopausal patients inoperable with breast conservative surgery (BCS) received letrozole, anastrozole, or exemestane as NET. Patients underwent breast surgery and received adjuvant AIs. Adjuvant systemic therapy, chemotherapy and/or trastuzumab, and adjuvant radiotherapy were administered as appropriate, but limited to high-risk patients with few or no comorbidities. RESULTS: After a median follow-up of 49 months, 4 (3.0 %) patients had local relapse, 18 (12.5 %) had distant metastases, and 24 (17.0 %) died. BCS was performed in 121 (84.0 %) patients. A tumor size <3 cm and human epidermal growth factor receptor 2 (HER2) negativity were predictors of BCS. The achievement of BCS and grade G1 were significantly associated with longer disease-free survival (DFS) (p = 0.009 and p = 0.01, respectively) and overall survival (p = 0.002 and p = 0.005, respectively). Residual tumor ≤2 cm (yT0-yT1) in the longest diameter after NET was also statistically associated with longer DFS (p = 0.005). CONCLUSIONS: The results of this retrospective study indicate that elderly breast cancer patients with a tumor size <3 cm at diagnosis and HER2 negativity have a higher probability of achieving BCS after NET. Moreover, patients treated with BCS and with grade G1 tumor have a reduced risk of recurrence and death in the long-term follow-up.

Long-term outcome of neoadjuvant systemic therapy for locally advanced breast cancer in routine clinical practice.

PURPOSE: The aim of this study is to evaluate the long-term outcome of patients with locally advanced breast cancer treated with neoadjuvant systemic chemotherapy (NST) in routine clinical practice. METHODS: Four hundred and nine patients were identified between January 1999 and December 2011. All patients received NST followed by surgery, adjuvant treatments and radiotherapy, as appropriate. RESULTS: At Kaplan-Meier analysis, patients with surgical stage III disease were more likely to develop distant metastasis and die from breast cancer (p < 0.001). Luminal A and luminal B/HER2-negative patients had better prognosis; moreover, patients with hormone receptor (HR)-positive tumors had a significantly longer DRFS (p < 0.0049) and OS (p < 0.0001) compared with patients with HR-negative tumors as well as patients who underwent breast-conserving surgery (DRFS and OS: p < 0.001). In multivariate analysis, HR negativity (p < 0.001 for both DRFS and OS), mastectomy (DRFS: p = 0.009; OS: p = 0.05) and stage III disease (DRFS: p < 0.001; OS: p = 0.003) were associated with shorter DRFS and OS. CONCLUSIONS: HR negativity, mastectomy and pathological stage III disease are the variables independently associated with a worse outcome in our cohort of patients. These data are of high interest since they derive from a very heterogeneous group of patients, treated with different neoadjuvant/adjuvant regimens outside of clinical trials and with a long follow-up period.

[Primary lymphoma of the breast]. / Linfomi primari della mammella.

Primary non-Hodgkin's lymphoma of the breast accounts for fewer than 3% of extranodal lymphomas. As compared to extranodal lymphomas in other sites they are characterised by more rapid progression and a worse prognosis. The aim of the study was to investigate 5 cases of primary lymphoma of the breast and review previous studies in a search for any preoperative characteristics that could assist in the management of lymphoma of the breast. All patients (n = 5) who were diagnosed with lymphomatous involvement of the breast between 1996 and 2004 were evaluated retrospectively. All patients staged IE (breast involvement only) or IIE (limited to the breast and ipsilateral armpit) were included. Most of the primary breast lymphomas were of intermediate grade. Patients received some combination of surgery, radiation, and chemotherapy. The mean follow-up was 48 months (range 24 to 72 months). All 5 patients survived at least 6 years from the time of diagnosis. Long-term survival in patients with primary non-Hodgkin's lymphoma of the breast is possible. The clinical outcome of patients with breast lymphoma depends on the histology and appears to parallel that of patients with lymphoma of similar histology involving other sites.

[Thyroid metastasis from renal carcinoma. Clinical case]. / Metastasi tiroidea da carcinoma renale. Caso clinico.

Metastatic thyroid tumours are uncommon among reported clinical cases, but are more frequent in autopsy series. The most common sites of the primary tumours are the breast (21%), kidney (12%) and lung (11%) and in some cases are detected only at autopsy. The clinical presence of thyroid tumefaction, whether associated or not with compressive symptoms, in a patient with a history of surgical treatment for renal cell carcinoma should lead to the suspicion of a metastatic nodule. The most important diagnostic technique is cytological examination after fine needle aspiration biopsy, combined with immunohistochemical staining. Total thyroidectomy, whether associated or not with radiation therapy, is the procedure of choice in these cases, when possible, above all in the presence of regional symptoms. In spite of treatment, however, the prognosis of metastatic disease is very poor. Therapeutic measures allow a mean survival of 34 months in the various reported series. The authors report the case of a 66-year-old female patient who had undergone left-side nephrectomy for a renal cell carcinoma 7 years earlier. The woman presented an increased thyroid volume mainly on the right side, with signs of tracheal compression. Ultrasonography of the thyroid gland and fine needle aspiration cytology showed malignant features. Scintigraphy strongly suggested the presence of a cold nodule in the right lobe. Subsequently, total thyroidectomy was performed and the histological examination revealed that the nodule was composed of tumour cells with abundant clear cytoplasm and round nuclei; with the characteristics of the renal cell carcinoma resected 7 years previously. Since computed tomography revealed secondaries in the lungs, the patient is still being managed with chemotherapy, with arrest of the metastatic progression, and is in a fairly good clinical condition.