Aggressive treatment for hepatic metastases from breast cancer: results from a single center.

BACKGROUND: Breast cancer (BC) is the most common cancer among women worldwide. It has been estimated that approximately 12-20 % of patients will develop liver metastases from breast cancer (BCLM) and that in approximately 5 % of cases the liver is the only metastatic site. Patients with isolated BCLM have the poorest prognosis with a median survival ranging from 19 to 26 months. METHODS: A total of 26 women with isolated BCLM and without any sign of disease progression after a cycle of chemotherapy were retrospectively reviewed. Women were treated with hepatic resection (HR) for unilobar disease or surgical "open" RFA for bilobar disease. Data were collected on either original BC or BCLM and from patients follow-up. RESULTS: Overall survival from BC diagnosis was 47.69 ± 22.25 months (range 33-84, median 45.5 months); it was 52.25 ± 14.57 months (range 33-84, median 48.5 months) for the HR patients and 43.79 ± 27.14 months (range 9-101, median 39 months) for the RFA patients. Overall survival from BCLM treatment was 21.12 ± 12.78 months (range 9-64, median 15.5 months); in detail it was 29.42 ± 14.53 months (range 12-64, median 29.5 months) for the resected patients and 14 ± 4.45 months (range 9-24, median 13.5 months) for patients treated by RFA with a strongly significant survival difference for operated patients (p = 0.001). Overall disease-free survival from BCLM was 15.96 ± 13.16 months (range 3-64, median 12 months), disease-free survival for resected patients was 23.22 ± 16.2 months (range 8-64, median 18.5 months), and for patients treated by RFA was 9.64 ± 4.22 months (range 3-18, median 9 months; Fig. 1). Overall 1, 2, and 5 years (actuarial) survival was respectively 80.7, 57, and 31 %. Given in details for the two groups, they were respectively 100, 66.6 and 34 % (actuarial) for the resected group patients and 64.2, 21.4, and 11.5 % (actuarial) for the RFA patients. Fig. 1 Kaplan-Meier analysis of survival after BC and BCLM treatment. GROUP 1 = resection; GROUP 2 = RFA. Overall survival from breast cancer treatment (months) p = 0.082 ns. Overall survival from BCLM treatment (months) p = 0.001 CONCLUSIONS: Aggressive treatment on isolated BCLM may improve survival for these patients.

The assessment of daytime sleep propensity: a comparison between the Epworth Sleepiness Scale and a newly developed Resistance to Sleepiness Scale.

INTRODUCTION: The Epworth sleepiness scale (ESS) is widely used as a way of measuring subjective sleep propensity in research and clinical practice. Psychometric studies do not rule out the presence of more than one latent dimension underlying the items. OBJECTIVE: Aims of the present study were to: (a) evaluate psychometric proprieties of the ESS by means of classic psychometric techniques; (b) compare them with those from a newly developed resistance to sleepiness scale (RSS); (c) evaluate, following the latent trait theory, whether the items of both ESS and RSS could be conceptualized as different levels of an interval variable representative of a single latent trait related to sleep propensity. METHODS: One hundred and forty-six inpatients suffering from different sleep disorders filled in both the RSS and ESS in a sleep disorder centre. RESULTS: Indexes of fit derived by the application of the extended logistic model are consistent with the idea that each ESS item can be conceptualized as different levels of an interval variable representative of a single latent trait. However, most of the ESS items are found to be located at the opposite extremes of this continuum. CONCLUSIONS: The under representation of situations characterized by an intermediate soporific nature in the ESS could limit ESS sensitivity to detect intermediate variations of sleep propensity.