Electrochemotherapy in the Treatment of Cutaneous Metastases from Breast Cancer: A Multicenter Cohort Analysis.

BACKGROUND: The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin with temporary permeabilization induced by locally administered electric pulses. Preliminary experience with ECT in BC patients is encouraging. METHODS: A total of 125 patients with BC skin metastases who underwent ECT between 2010 and 2013 were enrolled onto a multicenter retrospective cohort study. The treatment was administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to Common Terminology Criteria for Adverse Events 4.0. Cox regression analysis was used to identify predictive factors. RESULTS: Response was evaluable in 113 patients for 214 tumors (median 1 per patient, range 1-3). The overall response rate after 2 months was 90.2 %, while the complete response (CR) rate was 58.4 %. In multivariate analysis, small tumor size (P < 0.001), absence of visceral metastases (P = 0.001), estrogen receptor positivity (P = 0.016), and low Ki-67 index (P = 0.024) were significantly associated with CR. In the first 48 h, 10.4 % of patients reported severe skin pain. Dermatologic toxicity included grade 3 skin ulceration (8.0 %) and grade 2 skin hyperpigmentation (8.8 %). Tumor 1-year local progression-free survival was 86.2 % (95 % confidence interval 79.3-93.8) and 96.4 % (95 % confidence interval 91.6-100) in the subgroup of those with CR. CONCLUSIONS: In this study, small tumor size, absence of visceral metastases, estrogen receptor positivity, and low Ki-67 index were predictors of CR after ECT. Patients who experienced CR had durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC.

Indications for, and limitations of, the retroangular flap in facial reconstruction according to its vascular mapping.

We have used the retroangular flap for the reconstruction of facial defects after excision of tumours. Important variables such as vascular mapping, type of anaesthesia, duration of stay in hospital, and the diagnosis and treatment of complications were taken into account in assessing its effectiveness. We studied 187 patients, 103 men and 84 women, who were treated with the retroangular flap, and the morphological and cosmetic results analysed. There are many vascular variations of the flap The patients were followed up for a median of 12 (range 12-125) years and their reconstructions were successful. The technique can be considered as one of first methods of choice for the reconstruction of cutaneous defects of the middle third of the face.

[Malignant fibrous histiocytoma. Case report]. / Istiocitoma fibroso maligno. Caso clinico.

Malignant fibroous histiocytoma (MFH) is an aggressive soft tissue sarcoma, that most frequently occurs in the muscles of the extremities and in abdominal or in retroperitoneal space of young adults. It is seldom confined to the skin and subcutaneous tissue. It is rarely diagnosed before excision and pathological exam, and has an unfavorable prognostic in some cases. This work reports the case of a 94 years old patient with originally cutaneous MFH stressing the importance of the early diagnosis.

Repair of the pharyngocutaneous fistula with a fasciocutaneous island flap pedicled on the superficial temporalis artery.

The case of an 84-year-old man with a pharyngocutaneous fistula after radiotherapeutic treatment and total laryngectomy for a squamous cell carcinoma was reported. Treatment with local flaps failed and normal flaps were not likely to succeed because of general and locally poor conditions considering that intensive radiotherapy had been administered. We therefore decided to use a fasciocutaneous island flap from the temporoparietal region pedicled on the parietal branch of the superficial temporalis artery. We obtained efficient and stable repair of the lesion both from a cosmetic and a functional point of view. We were forced to use this procedure for lack of another choice; however, we think that this could become a useful option in covering substance loss in this area when simpler solutions are not available.

Free to total prostatic specific antigen ratio as a new diagnostic tool in prostatic carcinoma.

One hundred seventy-one patients with clinical suspicion of prostate cancer were initially selected and underwent total and free PSA determination, digital rectal examination and transrectal ultrasonography. Sixty-five had total PSA values between 4 to 20 ng/ml. In these patients in addition to the free to total PSA ratio, the sensitivity, specificity, positive predictive value, true and false negative predictive value were evaluated, comparing these findings with histopathological characterization. Receiver Operating Characteristic Analysis was also performed. No statistically significant differences were evidenced between benign and neoplastic prostates comparing total PSA values, while significant differences were found by comparing both free PSA and the free to total PSA ratio (p < 0.01). Our experience demonstrates that using a 0.20 free to total PSA ratio cut-off, it is possible avoid 44.4% of following clinical tests, and biopsies could be saved in almost 40% of patients with a considerable cost-benefit ratio.

The retroangular flap for nasal reconstruction.

Many techniques can be used for nasal reconstruction. This paper describes the preliminary results of our study and shows a one-stage method for partial nasal reconstruction performed with a fasciocutaneous island flap with a retrograde blood supply based on the angular artery. This flap is called the retroangular flap. Six patients had been treated from January of 1993 to January of 1994. The technique is illustrated, and the correlated complications and results are also shown. The flap's color and texture have always been satisfactory. In one patient, the thickness of the flap required a secondary defatting. No sequelae were observed in the donor site.