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1.
Breast Cancer Res Treat ; 93(3): 199-205, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16142444

RESUMO

BACKGROUND: The favorable prognosis associated with tubular carcinoma of the breast has led some studies to propose less aggressive treatments for patients with this disease. This study aims to address the extent of therapy needed for tubular patients. METHODS: A retrospective review identified 73 cases of tubular carcinoma treated at the Massachusetts General Hospital between 1980 and 2002. Primary treatment was conservative surgery (CS) plus radiation therapy (RT) in 67%, CS without RT in 18%, and mastectomy in 15%. Median follow-up time was 90.5 months. The published literature of 529 conservatively treated tubular carcinomas was reviewed along with the 62 conservative cases from this series. : No patients developed distant metastasis or died from this disease. Local failure occurred in three (4%) of the cases, after 13, 84 and 121 months. All three had initially been treated with CS + RT. Five cases were node-positive, three of which were associated with a primary tumor smaller than 1 cm. Thirteen women, with a median age of 74, were treated by CS without RT and none recurred. A literature review showed that adjuvant RT reduces local failure following CS for tubular carcinoma. CONCLUSIONS: Tubular carcinoma is associated with an excellent prognosis, but long-term follow-up is essential for detecting local failures and a small primary tumor size does not preclude nodal involvement. Adjuvant RT reduces the incidence of local failure following CS for tubular carcinoma, however, elderly women treated by CS may have a very low risk of local recurrence without adjuvant RT.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Feminino , Humanos , Análise por Pareamento , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
2.
Int J Radiat Oncol Biol Phys ; 62(2): 386-91, 2005 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-15890579

RESUMO

PURPOSE: To evaluate and quantify the effect of irradiated lung volume, radiation dose, and paclitaxel chemotherapy on the development of radiation pneumonitis (RP) in breast cancer patients with positive lymph nodes. METHODS AND MATERIALS: We previously reported the incidence of RP among 41 patients with breast cancer treated with radiotherapy (RT) and adjuvant paclitaxel-containing chemotherapy. We recorded the central lung distance, a measure of the extent of lung included in the RT volume, in these patients. We used this measure and the historical and observed rates of RP in our series to model the lung tolerance to RT in patients receiving chemotherapy (CHT) both with and without paclitaxel. To evaluate the risk factors for the development of RP, we performed a case-control study comparing paclitaxel-treated patients who developed RP with those who did not, and a second case-control study comparing patients receiving paclitaxel in addition to standard CHT/RT (n = 41) and controls receiving standard CHT/RT alone (n = 192). RESULTS: The actuarial rate of RP in the paclitaxel-treated group was 15.4% compared with 0.9% among breast cancer patients treated with RT and non-paclitaxel-containing CHT. Our mathematical model found that the effective lung tolerance for patients treated with paclitaxel was reduced by approximately 24%. No statistically significant difference was found with regard to the dose delivered to specific radiation fields, dose per fraction, central lung distance, or percentage of lung irradiated in the case-control study of paclitaxel-treated patients who developed RP compared with those who did not. In the comparison of 41 patients receiving RT and CHT with paclitaxel and 192 matched controls receiving RT and CHT without paclitaxel, the only significant differences identified were the more frequent use of a supraclavicular radiation field and a decrease in the RT lung dose among the paclitaxel-treated patients. This finding indicates that the major factor associated with development of RP was paclitaxel treatment. CONCLUSIONS: The use of paclitaxel chemotherapy and RT in the primary treatment of node-positive breast cancer is likely to increase the incidence of RP. In patients treated with paclitaxel, reducing the percentage of lung irradiated by 24% should reduce the risk of RP to 1%, according to our calculations of lung tolerance. Future clinical trials using combination CHT that includes paclitaxel and RT should carefully evaluate the incidence and severity of RP and should also accurately monitor the extent of lung included within the RT volume to develop safe guidelines for the delivery of what is becoming standard therapy for node-positive breast cancer.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Pulmão/efeitos dos fármacos , Paclitaxel/uso terapêutico , Pneumonite por Radiação/etiologia , Estudos de Casos e Controles , Quimioterapia Adjuvante , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Pneumonite por Radiação/epidemiologia , Dosagem Radioterapêutica , Estatística como Assunto
3.
J Clin Oncol ; 23(9): 1951-61, 2005 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-15774788

RESUMO

PURPOSE: It has been hypothesized that tumors with high interstitial fluid pressure (IFP) and/or hypoxia respond poorly to chemotherapy (CT) because of poor drug delivery. Preclinical studies have shown that paclitaxel reduces the IFP and improves the oxygenation (pO(2)) of tumors. Our aim is to evaluate the IFP and pO(2) before and after neoadjuvant CT using sequential paclitaxel and doxorubicin in patients with breast cancer tumors of >/= 3 cm. PATIENTS AND METHODS: Patients were randomly assigned, according to an institutional review board-approved phase II protocol, to receive neoadjuvant sequential CT consisting of either four cycles of dose-dense doxorubicin at 60 mg/m(2) every 2 weeks followed by nine cycles of weekly paclitaxel at 80 mg/m(2) (group 1) or vice versa, with paclitaxel administered before doxorubicin (group 2). Patients were re-evaluated clinically and radiologically. The IFP (wick-in-needle technique) and pO(2) (Eppendorf) were measured in tumors at baseline and after completing the administration of the first and second drug. RESULTS: IFP and pO(2) were measured in 54 patients at baseline and after the first CT. Twenty-nine and 25 patients were randomly assigned to groups 1 and 2, respectively. Paclitaxel, when administered first, decreased the mean IFP by 36% (P = .02) and improved the tumor pO(2) by almost 100% (P = .003). In contrast, doxorubicin did not have a significant effect on either parameter. This difference was independent of the tumor size or response measured by ultrasound. CONCLUSION: Paclitaxel significantly decreased the IFP and increased the pO(2), whereas doxorubicin did not cause any significant changes. Tumor physiology could potentially be used to optimize the sequence of neoadjuvant CT in breast cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Doxorrubicina/administração & dosagem , Esquema de Medicação , Líquido Extracelular/efeitos dos fármacos , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Consumo de Oxigênio/efeitos dos fármacos , Paclitaxel/administração & dosagem
4.
Int J Radiat Oncol Biol Phys ; 55(5): 1209-15, 2003 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-12654429

RESUMO

PURPOSE: To evaluate the risk factors for lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. METHODS AND MATERIALS: Between 1982 and 1995, 727 Stage I-II breast cancer patients were treated with breast conservation therapy at Massachusetts General Hospital. A retrospective analysis of the development of persistent arm edema was performed. Lymphedema was defined as a >2-cm difference in forearm circumference compared with the untreated side. The median follow-up was 72 months. Breast and regional nodal irradiation (BRNI) was administered in 32% of the cases and breast irradiation alone in 68%. RESULTS: Persistent arm lymphedema was documented in 21 patients. The 10-year actuarial incidence was 4.1%. The median time to edema was 39 months. The only significant risk factor for lymphedema was BRNI. The 10-year risk was 1.8% for breast irradiation alone vs. 8.9% for BRNI (p = 0.001). The extent of axillary dissection did not predict for lymphedema even within the subgroups of patients defined by the extent of irradiation. Most patients underwent Level I or II dissection. In this subgroup, the lymphedema risk at 10 years was 10.7% for BRNI vs. 1.0% for breast irradiation alone (p = 0.0003). CONCLUSION: Nodal irradiation was the only significant risk factor for arm lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. Our data suggest that this risk is low with Level I/II dissection and breast irradiation. However, even after the addition of radiotherapy to the axilla and supraclavicular fossa, the development of lymphedema was only 1 in 10, lower than generally recognized.


Assuntos
Neoplasias da Mama/cirurgia , Irradiação Linfática/efeitos adversos , Linfedema/etiologia , Mastectomia Segmentar/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Radioterapia de Alta Energia/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Axila , Boston/epidemiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Quimioterapia Adjuvante , Terapia Combinada , Ciclofosfamida/administração & dosagem , Fracionamento da Dose de Radiação , Doxorrubicina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Humanos , Tábuas de Vida , Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Terapia Neoadjuvante , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Primárias Múltiplas/cirurgia , Estudos Retrospectivos , Fatores de Risco , Tamoxifeno/administração & dosagem , Resultado do Tratamento
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