Detección selectiva del ganglio centinela tras administración intratumoral del radiotrazador, en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante en relación con el grado de respuesta tumoral / Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumour response

Objetivo. Nuestro objetivo fue analizar el rendimiento de la biopsia selectiva del ganglio centinela valorando la detección gammagráfica tras la administración intratumoral del radiofármaco en pacientes con cáncer de mama que recibieron quimioterapia neoadyuvante. Material y métodos. Sesenta pacientes con diagnóstico de carcinoma infiltrante de mama, estadios T1-T3, que recibieron tratamiento con quimioterapia neoadyuvante fueron sometidas posteriormente a cirugía mamaria y biopsia del ganglio centinela mediante administración intratumoral del radiofármaco. Resultados. Se consiguió la detección gammagráfica de algún ganglio centinela en 55/60 pacientes (91,6%). Cuando se excluyeron los casos con reinyección periareolar del radiofármaco por falta de migración, la detección fue del 70% (42/60). Cuando se comparó la detección o no del ganglio centinela en estas 42 pacientes, no se encontraron diferencias en función de la edad, lateralidad-localización de la lesión, tamaño pre y posquimioterapia, grado histológico del tumor o perfil inmunohistoquímico. Sí existieron diferencias significativas al comparar los grupos según el grado de respuesta patológica del tumor, valorado tanto con el sistema de Miller-Payne (no detección 44,4%-detección 16,7%, p = 0,003) como con el sistema residual cancer burden (72,2%-28,6%, p<0,01). Conclusiones. La detección gammagráfica del ganglio centinela tras administración intratumoral del radiofármaco en pacientes con cáncer de mama que recibieron quimioterapia neoadyuvante estuvo por debajo del valor óptimo, siendo necesaria en ocasiones la reinyección periareolar, lo que podría estar en relación con una alteración de las vías de drenaje linfático. Existió una significativa relación inversa entre detección del ganglio centinela y el grado de respuesta patológica tumoral (AU)

Purpose. Our objective was to analyse the accuracy of the sentinel node biopsy, taking into consideration the scintigraphy detection rate after the intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy. Materials and methods. The study included 60 patients with a diagnosis of invasive breast carcinoma, stage T1-T3, who received treatment with neoadjuvant chemotherapy, and were subsequently subjected to breast surgery and sentinel node biopsy after intra-tumour administration of the radiopharmaceutical. Results. Scintigraphic detection of some sentinel node was achieved in 55/60 patients (91.6%). When those cases that received a second injection of the radiopharmaceutical, performed peri-areolarly due to a lack of tracer migration, were excluded, the detection rate dropped to 70% (42/60). When the detection of sentinel node, or its absence, was compared in those 42 patients, no differences were found with age, laterality-location of the lesion, size pre- and post-neoadjuvant chemotherapy, histological grade, or immunohistochemical profile. There were significant differences when comparing the groups according to the degree of pathological tumour response, both with the Miller-Payne system (non-detection 44.4%-detection 16.7%, p = 0.003) as well as the residual cancer burden (72.2%-28.6%, p<0.01). Conclusions. The scintigraphic detection of the sentinel node after intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy was below the optimal value, and sometimes a further, peri-areolar, injection was necessary, probably in relation to an alteration in the lymphatic drainage pathways. There was a significant inverse relationship between the detection of the sentinel node and level of pathological tumour response (AU)

Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumour response. / Detección selectiva del ganglio centinela tras administración intratumoral del radiotrazador, en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante en relación con el grado de respuesta tumoral.

PURPOSE: Our objective was to analyse the accuracy of the sentinel node biopsy, taking into consideration the scintigraphy detection rate after the intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy. MATERIALS AND METHODS: The study included 60 patients with a diagnosis of invasive breast carcinoma, stage T1-T3, who received treatment with neoadjuvant chemotherapy, and were subsequently subjected to breast surgery and sentinel node biopsy after intra-tumour administration of the radiopharmaceutical. RESULTS: Scintigraphic detection of some sentinel node was achieved in 55/60 patients (91.6%). When those cases that received a second injection of the radiopharmaceutical, performed peri-areolarly due to a lack of tracer migration, were excluded, the detection rate dropped to 70% (42/60). When the detection of sentinel node, or its absence, was compared in those 42 patients, no differences were found with age, laterality-location of the lesion, size pre- and post-neoadjuvant chemotherapy, histological grade, or immunohistochemical profile. There were significant differences when comparing the groups according to the degree of pathological tumour response, both with the Miller-Payne system (non-detection 44.4%-detection 16.7%, p = 0.003) as well as the residual cancer burden (72.2%-28.6%, p<0.01). CONCLUSIONS: The scintigraphic detection of the sentinel node after intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy was below the optimal value, and sometimes a further, peri-areolar, injection was necessary, probably in relation to an alteration in the lymphatic drainage pathways. There was a significant inverse relationship between the detection of the sentinel node and level of pathological tumour response.

Subcutaneous trastuzumab: drug development and current position

HER2-positive breast cancer, accounting for 15 % of the total breast cancer patient population, carries in itself a bad prognosis, which has now become much better after the advent of anti-HER2 drugs. HER2-targeted therapy has significantly improved disease free- and overall survival in HER2-positive breast cancer, and has rendered better disease control both in the early and advanced disease setting. Trastuzumab treatment duration is often prolonged and poses significant time and resource challenges both on the treatment institutions and on the patient. The recent development of a subcutaneous formulation has meant a significant advance in this respect. We review the drug development of the compound and the current evidence on its use (AU)

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Subcutaneous trastuzumab: drug development and current position.

HER2-positive breast cancer, accounting for 15 % of the total breast cancer patient population, carries in itself a bad prognosis, which has now become much better after the advent of anti-HER2 drugs. HER2-targeted therapy has significantly improved disease free- and overall survival in HER2-positive breast cancer, and has rendered better disease control both in the early and advanced disease setting. Trastuzumab treatment duration is often prolonged and poses significant time and resource challenges both on the treatment institutions and on the patient. The recent development of a subcutaneous formulation has meant a significant advance in this respect. We review the drug development of the compound and the current evidence on its use.

Análisis descriptivo de los trastornos y problemas psicológicos en pacientes con cáncer de mama / No disponible

Objetivos: Analizar la proporción de pacientes con cáncerde cáncer de mama derivadas a la Unidad de Psico-Oncologíaprocedentes de la Unidad de Patología Mamaria del Serviciode Hematología y Oncología Médica del Hospital Clínico Universitariode Valencia durante el periodo 2005-2007, asícomo el diagnóstico psicológico de estas pacientes.Método: Las pacientes fueron derivadas por su especialista,mediante hoja de interconsulta. La recogida de datos fuediaria mediante hoja de trabajo creada para tal fin, incorporandoesta información a la base de datos del hospital.Resultados: A la Unidad de Psico-Oncología se derivaron189 pacientes procedentes de la Unidad de Patología Mamaria,lo que representa el 15,25% de pacientes; sin embargopara Unidad de Psico-Oncología representa el 42% de todoslos pacientes atendidos en primera visita durante el periodo.Su media de edad, fue de 51,58 años (rango 30-77). Se realizaron772 visitas sucesivas a estas pacientes, lo que representael 59% de todas las visitas sucesivas realizadas, la media devisitas fue de 4 por paciente.En cuanto a los diagnósticos psicológicos, el 50% presentódiagnóstico DSM-IV. Los diagnósticos psicológicos más frecuentesfueron los trastornos adaptativos con un 53% del total.Conclusiones: Un tercio de pacientes con cáncer de mamafueron derivadas a la Unidad de Psico-Oncología, siendo estaproporción menor a los datos referidos en la bibliografía.Respecto a los diagnósticos psicológicos la mitad de estas pacientespresentaron diagnóstico DSM-IV siendo los más frecuenteslos trastornos adaptativos, posiblemente, esta alta prevalenciade patología puede deberse a la selección realizada.En cuanto a la Unidad de Psico-Oncología, la atención apacientes con cáncer de mama representó más de la mitad denuestra actividad asistencial...(AU)

Objectives: To analyze the proportion of breast cancer patientsreferred to the Psychooncology Unit from the BreastPathology Unit, Department of Hematology and Oncology,University Clinic Hospital, Valencia during the period 2005 –2007, as well as the psychological diagnosis of these patients.Methods: Patients were referred by their consultant. Datawere collected daily on a specifically-designed form, incorporatingthis information into the hospital data base.Results: One hundred eighty-nine patients were referredfrom the Breast Pathology Unit (representing 15.25% of theirpatients) to the Psychooncology Unit (corresponding to 42%of all patients seen at this Unit as a first visit during the sameperiod). The mean age was 51.58 years (range 30-77). Thepatients received 772 successive visits, representing 59% of allsuccessive visits made, with a mean of 4 visits per patient.Regarding psychological diagnosis, 50% presented DSMIV.The most frequent diagnosis was adjustment disorder,comprising 53% of the total.Conclusions: One third of breast cancer patients were referredto the Psychooncology Unit; this proportion is lower thanthat found in the literature.Regarding psychological diagnosis, half these patients presentedDSM-IV, the most frequent diagnosis was adjustmentdisorder, this high prevalence possibly being due to the sampleselected.For the Psychooncology Unit, care for breast cancer patientsrepresents half of our welfare activities. We believe it isessential to establish referral criteria that favor the detection ofemotional problems amenable to psychooncologic intervention(AU)