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1.
Lancet Oncol ; 20(7): e390-e396, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31267973

RESUMO

Important results are emerging from clinical trials showing that surgery followed by chemotherapy might not be the optimal strategy to maximise a patient's chance of survival from triple-negative or HER2-positive breast cancers. Administering chemotherapy before surgery provides an opportunity to directly observe the efficacy of a particular chemotherapy regimen. Patients who have extensive residual invasive cancer after neoadjuvant chemotherapy are at a high risk of recurrence for metastatic disease, which, in turn, make these patients ideal candidates for clinical trials. Two important clinical trials, CREATE-X (UMIN000000843) and KATHERINE (NCT01772472), have shown improved disease-free survival with postoperative capecitabine and ado-trastuzumab emtansine in patients with either triple-negative or HER2-positive breast cancer who had residual disease after neoadjuvant chemotherapy. The opportunity for residual-disease guided therapy, as observed in these trials, is lost when patients undergo surgery first. In this Personal View, we discuss the clinical implications of the CREATE-X and KATHERINE trials and place them into context with other developments in the adjuvant setting of early-stage breast cancer. We suggest that neoadjuvant systemic therapy should be considered as the new standard of care for HER2-positive and oestrogen receptor negative breast cancer, even for patients who present with operable (T1 or T2) disease.


Assuntos
Neoplasias da Mama/química , Neoplasias da Mama/terapia , Receptor ErbB-2/análise , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Terapia Combinada/métodos , Feminino , Humanos , Terapia Neoadjuvante , Estadiamento de Neoplasias , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/química , Neoplasias de Mama Triplo Negativas/mortalidade , Neoplasias de Mama Triplo Negativas/patologia , Neoplasias de Mama Triplo Negativas/terapia
3.
Cleft Palate Craniofac J ; 55(9): 1277-1281, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29578807

RESUMO

OBJECTIVES: Numerous scales assessing the aesthetics of cleft lip repair exist. Most, including the Asher-McDade scale, use frontal and lateral views, while neglecting a basal view. We believe this view is important for properly assessing the aesthetics of repair. In this study, we evaluate the basal view in comparison to the Asher-McDade scale. METHODS: This scale was based on progressive columellar shortening and alar flaring/slumping. A panel of 4 plastic surgeons applied the basal and Asher-McDade scales to pictures of patients with repaired unilateral cleft lip in 56 multiethnic participants aged 5 years to 18 years; images were scored from 1 to 5 (best). Statistical analysis was done via Spearman correlation. RESULTS: Scores from plastic surgeons correlated strongly for each view. There was moderate correlation for the basal view with both nasal form and deviation scores ( P < .05). As expected, there were no strong correlations between the basal view and vermillion border or profile. DISCUSSION: The Asher-McDade scale has been used to evaluate cleft lift repairs but is limited due to its subjective nature. The basal view scale grades these repairs by using a scale of progressive columellar shortening and alar flaring/slumping, which provides an opportunity for quantification and standardization. Our results show that the basal view correlates with the Asher-McDade scale among raters, thus providing an objective and validated measure of cleft lip repair.


Assuntos
Atitude do Pessoal de Saúde , Fenda Labial/cirurgia , Estética , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Criança , Pré-Escolar , Fenda Labial/etnologia , Feminino , Humanos , Masculino , Fotografação , Reprodutibilidade dos Testes , Resultado do Tratamento
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