RESUMEN
This pilot study was designed to investigate lymphatic transport in the arms of women after breast cancer treatment without lymphedema and with mild and severe arm lymphedema. Nineteen breast cancer survivors [6 without (Group 1), 6 with mild (Group 2) and 7 with severe (Group 3) lymphedema] were examined. Lymphatic transport in the arm and to axillary lymph nodes were evaluated using quantitative radionuclide lymphscintigraphy. The radioactivity ratio between the operated and unoperated axillae (axillary ratio), and both lymphatic transport and tracer disappearance rates (TDR) from the injection sites were calculated. We found that axillary ratio and lymphatic transport were significantly higher in Groups 1 and 2 compared to 3 and that TDR was not affected in any Group. Additionally, lymphscintigraphy revealed presence of functional axillary lymph nodes within the operated axilla in women without or with mild lymphedema, while in women with severe lymphedema, no axillary lymph nodes were visualized. We conclude from our subjects that breast cancer survivors who did not develop or had mild arm lymphedema have functional lymphatic transport and lymph nodes in the axillary area on the operated side. This suggests that efficient collateral circulation and/or peripheral lymphovenous communications has developed in these subjects which may be preventative for the development of severe lymphedema.
Asunto(s)
Brazo , Neoplasias de la Mama/patología , Ganglios Linfáticos/patología , Linfedema/patología , Anciano , Axila , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Sistema Linfático/patología , Sistema Linfático/fisiopatología , Linfedema/diagnóstico por imagen , Linfedema/etiología , Linfocintigrafia , Persona de Mediana Edad , Proyectos PilotoRESUMEN
High serum VEGF and bFGF levels are independent prognostic factors of poor prognosis in NHL patients. There is growing evidence that both angiogenesis and haemostatic aberrancies are integral parts of the pathobiology of cancer growth and dissemination. The purpose of the study was: (a) to analyze relations of VEGF and bFGF serum levels, fibrinogen and D-dimer plasma levels with lymphoma Ann Arbor Staging System (AASS) and International Prognostic Index (IPI) and, (b) to evaluate correlations between serum levels of angiogenic cytokines and plasma levels of coagulation-fibrinolysis factors in 52 previously untreated NHL patients included to the study. The control group consisted of 23 healthy volunteers. Serum VEGF, bFGF and plasma D-dimer levels were measured by enzyme-linked immunosorbent assay (ELISA). Plasma levels of fibrinogen were determined on Behring Coagulation System (BCS) equipment. In lymphoma group serum VEGF and bFGF levels were significantly higher than in the control. Differences in concentrations of VEGF, bFGF between II, III and IV stage of disease acc. AASS were not statistically significant. Plasma levels of fibrinogen and D-dimer were elevated in lymphoma patients when compared with the control. Fibrinogen plasma levels were similar in all stages. The D-dimer level was significantly higher in patients with IV stage in comparison to stage II and III. Statistically significant differences of VEGF and bFGF serum levels were observed only between intermediate/high and high risk groups acc. IPI. Fibrinogen plasma levels were significantly higher in high risk group than in low risk group. D-dimer plasma levels were significantly higher in high risk group than in low risk group and low/intermediate group. We observed positive correlation between serum level of VEGF and plasma level of fibrinogen, and between serum level of bFGF and plasma level of fibrinogen. There was also negative correlation between serum level of VEGF and plasma level of D-dimer, and between serum level of bFGF and plasma level of D- dimer. Our study indicates that D-dimer level, but not VEGF, bFGF and fibrinogen correlates with AASS and IPI in NHL patients. Significant correlations between levels of VEGF/bFGF and fibrinogen/D-dimer suggest specific interactions between angiogenic and coagulation-fibrinolysis system.
Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fibrinógeno/análisis , Factor 2 de Crecimiento de Fibroblastos/sangre , Linfoma no Hodgkin/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The aim of this study was to assess disability, psychological distress and quality of life in Polish breast cancer survivors with arm lymphedema. One thousand sets of questionnaires consisting of WHO-DAS II, GHQ-30, EORTC QLQ-C30 and QLQ-BR23 were sent to members of the Polish Federation of Breast Cancer Survivors Clubs "Amazonki." The response rate was 28.3% of whom 31.70% reported arm lymphedema. The WHO-DAS II survey showed that patients with arm lymphedema had a higher overall disability score (45.04 versus 38.80 in group without arm lymphedema; p=0.01) and higher mean values in the scales of understanding and communicating, getting around, life activities at home, getting along with people, participating in society. The EORTC QLQ-C30 survey showed that patients with lymphedema had lower mean values in physical (0.55 versus 0.65; p=0.001), emotional (0.47 versus 0.57; p=0.01), social (0.59 versus 0. 73; p=0.002), cognitive and role functioning, increased fatigue, pain, insomnia, dyspnea, nausealvomiting and financial problems. The EORTC QLQ-BR23 data demonstrated worse future perspectives and an increase in breast and arm symptoms, and the GHQ-30 survey produced higher psychological distress (scores 15.18 versus 11.24; p=0.004). In conclusion, breast cancer survivors with arm lymphedema were more disabled, experienced a poorer quality of life and had increased psychological distress in comparison to survivors without this condition.