Surgery following neoadjuvant therapy in patients with HER2-positive locally advanced or inflammatory breast cancer participating in the NeOAdjuvant Herceptin (NOAH) study.

AIM: To describe surgical outcomes in patients with HER2-positive locally advanced (LABC) or inflammatory breast cancer (IBC) participating in the NeOAdjuvant Herceptin (NOAH) study (ISRCTN86043495). PATIENTS AND METHODS: A total of 235 patients with HER2-positive disease were randomized to neoadjuvant trastuzumab plus chemotherapy (doxorubicin plus paclitaxel, followed by paclitaxel, followed by cyclophosphamide, methotrexate and fluorouracil) or neoadjuvant chemotherapy alone. Of these patients, 228 received their allocated treatment (115 received trastuzumab plus chemotherapy and 113 received chemotherapy alone) and were potentially eligible for surgery. Mastectomy was required for all patients with IBC and was recommended for all patients with LABC. However, breast-conserving therapy could be considered for patients with peripheral neoplasms measuring ≤ 4 cm in diameter at diagnosis, with a favorable ratio of tumor to breast volume, or at the patient's request if there had been a good response to treatment. RESULTS: As previously reported, the addition of trastuzumab to neoadjuvant chemotherapy improved the overall, complete and pathological complete response to therapy and significantly improved event-free survival (the primary endpoint of the study). Trastuzumab also enabled more patients to have breast conserving surgery (BCS) (23% versus 13% respectively) without an apparent detrimental effect on local disease control (no patient treated with trastuzumab plus chemotherapy had experienced a local recurrence after BCS at the time of analysis). CONCLUSIONS: Although this was not an aim of the trial, neoadjuvant trastuzumab given concurrently with chemotherapy enabled 23% of patients with HER2-positive LABC/IBC to avoid mastectomy (including a small number of patients with IBC).

Guía de práctica clínica sobre la bronquiolitis aguda: descripción de la metodología utilizada / Acute bronchiolitis clinical practice guidelines: Description of the metodological process

Una guía de práctica clínica es un conjunto de recomendaciones desarrolladas de forma sistemática para ayudar a los profesionales y a los pacientes a tomar decisiones sobre la atención sanitaria más apropiada, y a seleccionar las opciones diagnósticas o terapéuticas más adecuadas para abordar un problema de salud o una condición clínica específica. La bronquiolitis aguda es la infección del tracto respiratorio inferior más frecuente en el lactante, pero existen controversias en cuanto al manejo de esta. Es por este motivo que se selecciona la bronquiolitis como entidad para la elaboración de una guía de práctica clínica. Describimos el proceso metodológico utilizado para la elaboración de la guía de práctica clínica sobre la bronquiolitis aguda (AU)

A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patient decisions about appropriate health care, and to select the most appropriate diagnostic or therapeutic options to address a health problem or a specific clinical condition. Acute bronchiolitis is the most common lower respiratory tract infection in infants. In spite of its hight prevalence, there is still controversy regarding its management. Therefore bronchiolitis is selected for the development of a CPG. We describe the methodological process used to develop the CPG on acute bronchiolitis (AU)

Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica / Acute bronchiolitis clinical practice guideline: recommendations for clinical practice

Existen controversias científicas en cuanto al manejo de la bronquiolitis aguda que generan una gran variabilidad en el abordaje de esta entidad. Una Guía de Práctica Clínica (GPC) es un conjunto de recomendaciones desarrolladas de forma sistemática para ayudar a los profesionales y a los pacientes a tomar decisiones basadas en la evidencia. Se ha seleccionado un grupo de grupo de trabajo (GT) formado por expertos que ha elaborado las preguntas clínicas a responder. Se ha realizado una búsqueda sistemática de la evidencia disponible sobre la bronquiolitis aguda y se ha evaluado. Posteriormente se ha resumido la información obtenida en tablas de evidencia y se han redactado unas recomendaciones a partir de éstas. El GT ha redactado un total de 46 preguntas clínicas agrupadas en apartados (diagnóstico, exploraciones complementarias, tratamiento, monitorización, prevención y evolución), que dan lugar a 133 recomendaciones. La GPC sobre la bronquiolitis aguda ofrece la oportunidad de unificar la práctica clínica habitual, basándose en la evidencia científica, lo que podría racionalizar el consumo de recursos sanitarios, mejorando la calidad asistencial y la equidad de acceso y utilización de los servicios (AU)

There are scientific controversies about the management of acute bronchiolitis that generate a great variability in the approach to this entity. A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patients to make decisions based on evidence. A working group (WG) of experts has been selected and they have developed the clinical questions. A systematic search for evidence on the acute bronchiolitis has been done and the evidence has been assessed. The information obtained has been summarized in evidence tables and recommendations have been done from them. The WG has produced a total of 46 clinical questions grouped into sections (diagnosis, complementary tests, treatment, monitoring, prevention and evolution), resulting in 133 recommendations. The CPG on acute bronchiolitis provides an opportunity to unify clinical practice based on scientific evidence, which could rationalize the use of health resources, improving health care quality and equity of access to services (AU)

[Acute bronchiolitis clinical practice guidelines: Description of the metodological process]. / Guía de práctica clínica sobre la bronquiolitis aguda: descripción de la metodología utilizada.

A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patient decisions about appropriate health care, and to select the most appropriate diagnostic or therapeutic options to address a health problem or a specific clinical condition. Acute bronchiolitis is the most common lower respiratory tract infection in infants. In spite of its high prevalence, there is still controversy regarding its management. Therefore bronchiolitis is selected for the development of a CPG. We describe the methodological process used to develop the CPG on acute bronchiolitis.

[Acute bronchiolitis clinical practice guideline: recommendations for clinical practice]. / Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica.

There are scientific controversies about the management of acute bronchiolitis that generate a great variability in the approach to this entity. A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patients to make decisions based on evidence. A working group (WG) of experts has been selected and they have developed the clinical questions. A systematic search for evidence on the acute bronchiolitis has been done and the evidence has been assessed. The information obtained has been summarized in evidence tables and recommendations have been done from them. The WG has produced a total of 46 clinical questions grouped into sections (diagnosis, complementary tests, treatment, monitoring, prevention and evolution), resulting in 133 recommendations. The CPG on acute bronchiolitis provides an opportunity to unify clinical practice based on scientific evidence, which could rationalize the use of health resources, improving health care quality and equity of access to services.

Daily clinical practice of fresh tumour tissue freezing and gene expression profiling; logistics pilot study preceding the MINDACT trial.

PURPOSE: The 70-gene prognosis-signature is a prognostic tool for early breast cancer analysis. In addition to scientific evidence, implementation of the signature in clinical trials and daily practice requires logistical feasibility. The aim of our study was to test logistics for gene expression profiling on fresh frozen tumour tissue in the preparation for the prospective, multinational Microarray In Node-negative Disease may Avoid ChemoTherapy (MINDACT) trial. METHODS: Sixty-four patients were included in six European hospitals. Fresh frozen tumour samples were shipped on dry ice to Agendia B.V., where RNA was isolated and subsequently hybridised on the 70-gene prognosis-signature (MammaPrint). RESULTS: Tumour samples were obtained in 60 of 64 patients. Among the 60 samples, 11 contained insufficient tumour cells (<50%) and three contained insufficient RNA quality. All 46 samples eligible for genomic profiling were successfully hybridised, and the results were reported on average within 4-5d. CONCLUSION: Gene expression profiling on fresh frozen tissue is feasible in daily clinical practice.

Fibromatosis agresiva de localización mamaria: una rara entidad / Aggressive fibromatosis of the breast: a rare entity

Presentamos 2 pacientes con un tumor mamario cuyo diagnóstico, tras su extirpación quirúrgica, ha sido el de fibromatosis agresiva de localización mamaria. Es característica la falta de microcalcificaciones en la mamografía, y el diagnóstico suele realizarse tras la extirpación de la tumoración. El tratamiento de elección es la exéresis quirúrgica amplia del tumor. El estudio patológico pone de manifiesto una proliferación de células fibroblásticas sin atipia ni mitosis, que se organizan en fascículos largos o haces que rodean los lobulillos y conductos lobulillares. En cuanto a la evolución clínica, la característica más importante es la alta tendencia a la recidiva (AU)

Cáncer de mama en España: algunos resultados de una encuesta multicéntrica / Breast cancer in Spain: some results from a multicenter survey

Mediante una encuesta remitida a los miembros de la Sociedad Española de Senología, se ha intentado analizar retrospectivamente las características de presentación, diagnóstico y tratamiento del cáncer de mama en España. Se recibió respuesta por parte de 7 socios, aportando en su conjunto datos sobre 10.858 cánceres de mama. Las series fueron muy variadas tanto en casuística aportada (rango 68-3.860) como en numero de casos tratados/año (rango 32-387).El análisis de estas serie mostró una máxima incidencia del cáncer de mama en la década 51-60 años, siendo el tumor palpable el motivo mas común de consulta, seguido del chequeo para diagnóstico precoz. El 10 por ciento de los casos fueron tumores no infiltrantes y en el 54,7 por ciento de la series no existió afectación ganglionar axilar. En más del 50 por ciento de casos se recurrió a cirugía conservadora, y para la estidificación inicial y posterior seguimiento, son muchos los centros que siguen protocolos clásicos, intensivos (AU)