RESUMEN
PURPOSE: To analyze the long-term results of a pilot study assessing excision and brachytherapy as salvage treatment for local recurrence after conservative treatment of breast cancer. METHODS AND MATERIALS: Between December 1990 and March 2001, 36 patients with breast-only recurrence less than 3 cm in diameter after conservative treatment for Stage I or II breast carcinoma were treated with local excision followed by high-dose rate brachytherapy implants (30 Gy in 12 fractions over a period of 5 days). No patient was lost to follow-up. Special attention was paid to local, regional, or distant recurrences; survival; cosmesis; and early and late side effects. RESULTS: All patients completed treatment. During follow-up (range, 1-13 years), 8 patients presented metastases (2 regional and 6 distant) as their first site of failure, 1 had a differed local recurrence, and 1 died of the disease. Actuarial results at 10 years were as follows: local control, 89.4%; disease-free survival, 64.4%; and survival, 96.7%. Cosmetic results were satisfactory in 90.4%. No patient had Grade 3 or 4 early or late complications. Of the 11 patients followed up for at least 10 years, all but 1 still had their breast in place at the 10-year stage. CONCLUSIONS: High-dose rate brachytherapy is a safe, effective treatment for small-size, low-risk local recurrence after local excision in conservatively treated patients. The dose of 30 Gy of high-dose rate brachytherapy (12 fractions over a period of 5 days twice daily) was well tolerated. The excellent results support the use of breast preservation as salvage treatment in selected patients with local recurrence after conservative treatment for breast cancer.
Asunto(s)
Braquiterapia/métodos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Terapia Recuperativa/métodos , Adulto , Anciano , Neoplasias de la Mama/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Proyectos Piloto , Dosificación Radioterapéutica , España , Factores de Tiempo , Carga TumoralRESUMEN
La poliposis adenomatosa familiar (PAF) y su variante fenotípica,el síndrome de Gardner, constituyen una infrecuente patologíahereditaria autosómica dominante. Se caracterizan por eldesarrollo, generalmente durante la segunda y tercera década dela vida, de múltiples pólipos adenomatosos en el colon y en elrecto. Estos pólipos tienen un riesgo elevado de transformaciónmaligna subsiguiente, cosa que suele ocurrir en las décadastercera y cuarta de la vida. Las manifestaciones fenotípicas dela PAF pueden ser muy variadas. Así, además de los póliposcolorrectales, los individuos afectos pueden presentar manifestacionesextracolónicas, entre las que se destacan: póliposgastroduodenales, quistes dermoides y epidermoides, tumoresdesmoides, hipertrofia congénita del epitelio pigmentario de laretina, alteraciones óseas en los maxilares y en el esqueleto yanomalías dentarias. En este trabajo se revisan los aspectos másimportantes del complejo, mostrando un ejemplo del mismoen base a un caso clínico bien documentado. Cabe destacar laimportancia de las exploraciones odontoestomatológicas, entreotras, como medio para alcanzar el diagnóstico de presunción,cuya confirmación es vital para el enfermo
Familial adenomatous polyposis (FAP) and its phenotype variant,Gardners syndrome, constitute a rare autosomal dominantinherited disorder. They are characterised by the development,generally during the second and third decades of life, of multipleadenomatous polyps in the colon and rectum. These polyps havea high risk of subsequently becoming malignant, which normallyoccurs in the third and fourth decades of life. The phenotypicalfeatures of FAP can be very variable. As well as colorectal polyps,these individuals can present with extra-colonic symptoms,among which are particularly: gastro-duodenal polyps, dermoidand epidermoid cysts, desmoid tumours, congenital hypertrophyof the retinal pigment epithelium, disorders of the maxillaryand skeletal bones and dental anomalies. In this paper the mostimportant aspects of this syndrome are reviewed, showing anexample based on a well documented clinical case. The importanceof odonto-stomatological examinations should be pointed out,among others, as a means of reaching a presumptive diagnosis,whose confirmation is vital to the patient
Asunto(s)
Femenino , Adulto , Humanos , Osteoma/etiología , Poliposis Adenomatosa del Colon/diagnóstico , Neoplasias Maxilomandibulares/etiología , Cementoma/diagnóstico , Cementoma/etiología , Codón sin Sentido , Diagnóstico Diferencial , Quiste Epidérmico/diagnóstico , Quiste Epidérmico/etiología , Fibroma/diagnóstico , Fibroma/etiología , Síndrome de Gardner/complicaciones , Síndrome de Gardner/diagnóstico , Síndrome de Gardner/genética , Genes APC , Hipertrofia , Osteoma/diagnóstico , Linaje , Epitelio Pigmentado Ocular/anomalías , Pronóstico , Diagnóstico Precoz , Poliposis Adenomatosa del Colon/complicaciones , Poliposis Adenomatosa del Colon/genética , Proteína de la Poliposis Adenomatosa del Colon/genética , Neoplasias Maxilomandibulares/diagnósticoRESUMEN
Familial Adenomatous Polyposis (FAP) and its phenotype variant, Gardner's syndrome, constitute a rare autosomal dominant inherited disorder. They are characterised by the development, generally during the second and third decades of life, of multiple adenomatous polyps in the colon and rectum. These polyps have a high risk of subsequently becoming malignant, which normally occurs in the third and fourth decades of life. The phenotypical features of FAP can be very variable. As well as colorectal polyps, these individuals can present with extra-colonic symptoms, among which are particularly: gastro-duodenal polyps, dermoid and epidermoid cysts, desmoid tumours, congenital hypertrophy of the retinal pigment epithelium, disorders of the maxillary and skeletal bones and dental anomalies. In this paper the most important aspects of this syndrome are reviewed, showing an example based on a well documented clinical case. The importance of odonto-stomatological examinations should be pointed out, among others, as a means of reaching a presumptive diagnosis, whose confirmation is vital to the patient.