Cytoreductive Surgery With or Without HIPEC After Neoadjuvant Chemotherapy in Ovarian Cancer: A Phase 3 Clinical Trial.

BACKGROUND: Cytoreductive surgery (CRS) and administration of hyperthermic intraperitoneal chemotherapy (HIPEC) have shown their efficacy in multiple malignancies and also could offer a prognostic benefit for patients with advanced ovarian cancer. METHODS: A prospective, single-center, parallel-group, randomized phase 3 clinical trial analyzed patients with a diagnosis of carcinomatosis from ovarian cancer treated with neoadjuvant systemic chemotherapy (NACT). In this trial, 71 patients were randomized to receive CRS alone (36 patients) or CRS with HIPEC (35 patients) using cisplatin (75 mg/m2 for 60 min at 42 °C). The primary end point was disease-free survival (DFS). Overall survival (OS), morbidity, and quality of life (QoL) were the secondary end points. RESULTS: During a median follow-up period of 32 months, the median DFS was 12 months in the control group (CRS) and 18 months in the experimental group (CRS and HIPEC). The findings showed HIPEC to be an independent protective factor against the development of recurrence (hazard ratio [HR], 0.12, 95 % confidence interval [CI], 0.02-0.89; p = 0.038). The median OS was 45 months in the control group and 52 months in the experimental group. The respective morbidity rates for any grade (1 to 5) were respectively 58.3 % and 45.7 % (p > 0.05), with a mortality rates of 2.8 % and 2.9 % (p > 0.05). In the dimensions evaluated, CRS with or without HIPEC had no impact on QoL. CONCLUSIONS: For patients who had advanced ovarian cancer treated with NACT, CRS and HIPEC was associated with better DFS and OS, but without a difference in postoperative morbidity, mortality, or in the QoL evaluation.

Inestabilidad hemodinámica debida a hematoma mamario en mujer anticoagulada / Haemodynamic instability due to breast haematoma in an anticoagulated patient

Introducción. Las urgencias por enfermedad mamaria son procesos infrecuentes, siendo las mastitis y los abscesos los más habituales. Los hematomas mamarios, a pesar de su baja frecuencia, pueden requerir un manejo terapéutico urgente. Caso clínico. Presentamos el caso de una mujer de 74 años, anticoagulada con acenocumarol debido a una fibrilación auricular crónica, que acudió a urgencias por una tumoración de crecimiento progresivo a nivel de la mama derecha tras una extensión del miembro superior derecho. En la exploración física se apreció inestabilidad hemodinámica de la paciente y un gran hematoma en mama derecha que se extendía a la pared torácica lateral. Estabilizada la paciente y corregida la coagulación se intentó la embolización radiológica del vaso sangrante, siendo esta infructuosa, por lo que finalmente se realizó un drenaje quirúrgico drenando un gran hematoma. Conclusión. Los hematomas mamarios grandes que provocan inestabilidad hemodinámica deben ser drenados quirúrgicamente, sin intentar medidas conservadoras previamente (AU)

Background. Emergencies in breast disease are rare, the most common being mastitis and abscesses. Breast haematomas, despite their low frequency, may require urgent therapeutic management. Case report. We present the case of a 74-year-old woman, receiving anticoagulation with acenocumarol due to a chronic atrial fibrillation, who presented to the local emergency department after having a sensation of clicking and pain in the pectoral region following right arm extension, accompanied by progressive growth of the ipsilateral breast. Physical examination revealed haemodynamic instability and a large haematoma in the right breast extending to the lateral chest wall. After stabilizing the patient and correcting the coagulation, an unsuccessful failed attempt was made to embolize the bleeding vessel. Finally, the patient underwent surgical drainage of a large hematoma. Conclusion. Large breast haematomas causing haemodynamic instability should be drained surgically, without prior attempts at conservative measures (AU)