RESUMO
Angiosarcoma of the breast is a rare malignant tumour. It can be primary or secondary in women who have been treated of a ductal carcinoma of the breast. There are some differences between both them. We present two clinical cases secondary to radiotherapy and a review of the literature, discussing about aetiology, incidence, diagnostic, treatment and prognostic of this tumours.
Assuntos
Braquiterapia , Neoplasias da Mama/etiologia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirurgia , Hemangiossarcoma/etiologia , Mastectomia Segmentar , Segunda Neoplasia Primária/etiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Feminino , Hemangiossarcoma/patologia , Humanos , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologiaRESUMO
OBJECTIVE: To compare the efficiency of adjuvant therapy with aromatase inhibitors or with tamoxifen in postmenopausal women with operable breast cancer and positive estrogen receptors. MATERIAL AND METHODS: A cost-utility analysis was performed based on a Markov model, from the Spanish National Health Care System perspective, comparing the treatment with exemestane (EXE: 25 mg/day) or tamoxifen (TAM: 20 mg/day) after 2-3 years of monotherapy with TAM; anastrozole (ANA, 1 mg/day) or TAM (20 mg/day) without previous TAM therapy; and letrozole (LET: 2.5 mg/day) or placebo after 5 years of monotherapy with TAM. The follow-up of a hypothetical cohort of women starting treatment at 63 years of age was simulated during 10 and 20 years. The probabilities of transition between health states and quality adjusted life years (QALYs) were obtained from the literature, and the unit costs (euro corresponding to 2004) from a Spanish database. RESULTS: After 10 and 20 years of follow-up, more QALYs per patient would be gained with the EXE scheme (0.230-0.286 and 0.566-0.708, respectively) than with ANA (0.114 and 0.285) and LET (0.176 and 0.474). The cost of gaining one QALY was lower with the EXE scheme (50,801-62,522 euro and 28,849- 35,371 euro, respectively) than with ANA (104,272 euro and 62,477 euro) and LET (91,210 euro and 49,460 euro). The result was stable for the cost per life-year gained (LYG) and in the sensitivity analysis. CONCLUSIONS: The EXE scheme after TAM is more cost-effective than the ANA and LET schemes.
Assuntos
Androstadienos/economia , Antineoplásicos Hormonais/economia , Neoplasias da Mama/economia , Quimioterapia Adjuvante/economia , Simulação por Computador , Antagonistas de Estrogênios/economia , Estrogênios , Modelos Teóricos , Neoplasias Hormônio-Dependentes/economia , Nitrilas/economia , Receptores de Estrogênio/análise , Tamoxifeno/economia , Triazóis/economia , Anastrozol , Androstadienos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/economia , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/química , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Estudos de Coortes , Análise Custo-Benefício , Antagonistas de Estrogênios/uso terapêutico , Honorários Farmacêuticos , Feminino , Seguimentos , Humanos , Letrozol , Cadeias de Markov , Pessoa de Meia-Idade , Proteínas de Neoplasias/análise , Neoplasias Hormônio-Dependentes/química , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Neoplasias Hormônio-Dependentes/cirurgia , Nitrilas/uso terapêutico , Pós-Menopausa , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tamoxifeno/uso terapêutico , Triazóis/uso terapêuticoRESUMO
Se hace un estudio de los resultados obtenidos en 39 pacientes que presentaban pie varo equino congenito, en los cuales se utilizo la tecnica de Turco; de estos casos 10 lo presentaban en ambos pies, para un total de 58 pies operados. Los casos elegidos fueron de edades compreendidas entre los diez meses y los seis anos, aunque la mayoria se encontraba por debajo de los dos anos