RESUMEN
PURPOSE: The administration of a dose boost to the tumor bed after breast-conserving surgery has proven to reduce local recurrence. Intra-operative electron radiotherapy (IOERT) offers an alternative method to deliver a boost with several advantages, such as direct visualization of the tumor bed, less inter- and intrafraction motion and a reduction in the number of medical appointments. The objective of our study is to assess chronic toxicity and long-term outcome for our patients after IOERT boost. MATERIAL AND METHODS: Forty-six patients treated at our institution between July 2013 and June 2020 with IOERT boost during Breast-Conserving Surgery and consecutive whole breast irradiation were prospectively analyzed. A 10-12 Gy boost was prescribed to 42 patients and 4 patients received a 20 Gy boost. An analysis for overall survival, local relapse and distant progression was performed. Acute and chronic toxicity was assessed by CTCAE 4.0. RESULTS: The median age was 64.5 years (40-90). The median follow-up was 62 months (4-86). We had no local recurrences but 2 patients (4.3%) presented a distant recurrence. Mean pathological tumor size was 16 mm (6-52). 84.8% (39) of the patients had invasive ductal carcinoma. 52.2% (24) presented histological grade II. 52.2% (24) were Luminal A like, 21.7% (10) Luminal B like, 13% (6) HER2 positive, 13% (6) triple negative. No Grade 3-4 chronic toxicity was observed. Grade 1-2 fibrosis was evidenced in 13% (6) of the patients, 4.3% (2) patients presented fat necrosis, 6.5% (3) presented seroma, 4.3% (2) had localized pain, 2.2% (1) presented localized hematoma and 2.2% (1) presented localized edema. CONCLUSIONS: IOERT boost in breast cancer treatment during BCS is a safe option with low chronic toxicity. The recurrence rates are comparable to published data and emphasize that IOERT as boost is an effective treatment.
Asunto(s)
Neoplasias de la Mama/radioterapia , Mama/efectos de la radiación , Carcinoma Ductal de Mama/radioterapia , Electrones/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/secundario , Carcinoma Ductal de Mama/cirugía , Femenino , Fibrosis/patología , Humanos , Periodo Intraoperatorio , Mastectomía Segmentaria , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Complicaciones Posoperatorias , Estudios Prospectivos , Traumatismos por Radiación/patología , Dosificación Radioterapéutica , Resultado del TratamientoRESUMEN
BACKGROUND: Of women diagnosed with metastatic breast cancer (MBC), 20% to 30% survive ≥5 years. We evaluated data from a large breast cancer program to identify features associated with MBC survival. PATIENTS AND METHODS: Women diagnosed with MBC in or after 1999 were included. Long-term MBC survival was defined as ≥5 years from date of MBC diagnosis (n = 122), short-term MBC survival as ≤2 years (n = 191). Differences were assessed using t tests, Wilcoxon-Mann-Whitney tests, χ2, and Fisher exact tests. Odds ratios (ORs) were calculated using multivariate logistic regression models. RESULTS: Long-term survivors were significantly (P < .05) younger, premenopausal, partnered, had estrogen receptor (ER)-positive, progesterone receptor-positive, and HER2-positive disease, lower Charlson Comorbidity Index, lower rates of visceral metastases, and higher household income. After adjustment for potential confounders, de novo MBC, premenopausal status, ER-positive status, and HER2-positive status remained significantly positively associated with long-term survival (respectively: OR, 2.68 [95% confidence interval (CI), 1.48-4.88]; OR, 1.96 [95% CI, 1.02-3.79]; OR, 3.74 [95% CI, 1.72-8.14]; OR, 2.88 [95% CI, 1.61-5.14]). Triple-negative status, visceral with bone metastases, and brain metastases remained negatively associated with long-term survival (respectively: OR, 0.12 [95% CI, 0.05-0.29]; OR, 0.18 [95% CI, 0.07-0.47]; OR, 0.16 [95% CI, 0.04-0.60]). Partner status and household income were significant in univariate but not multivariate analyses. CONCLUSION: Diagnosis of de novo MBC, premenopausal status, ER-positive status, and HER2-positive status were positively associated whereas triple-negative status, brain metastases, and visceral with bone metastases were inversely associated with long-term survival. These findings can be applied to better prognosticate survival for MBC patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/mortalidad , Neoplasias Encefálicas/mortalidad , Neoplasias de la Mama/mortalidad , Sobrevivientes/estadística & datos numéricos , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/metabolismo , Neoplasias Óseas/secundario , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/secundario , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/tratamiento farmacológico , Carcinoma Lobular/metabolismo , Carcinoma Lobular/mortalidad , Carcinoma Lobular/secundario , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Background: Invasive breast cancer is the most common carcinoma in women, 23% of all cancers in the world. It is classified according to its histological pattern and expression of immunohistochemical markers; 75% are ductal type. The incidence of metastases is 10 to 80% of the cases according to their immunophenotype, the main sites of metastases are bone, visceral and brain. Clinical case: A 64 years old lady with a history of radical left mastectomy due to unspecified breast cancer in 2000, received chemotherapy, radiation therapy and tamoxifen. After her discharge from hospital, the patient remained unattended. In 2014 she started with dysphagia, in 2016 was documented esophageal stricture by panendoscopy, three endoscopic dilations were performed, in the last one she presented incidental perforation. An esophagectomy was performed; the pathological study reported metastasis of ductal carcinoma of the breast. Conclusions: Ductal carcinoma of the breast rarely metastasizes to the digestive tract but, its probability must have this and insist on monitoring of patients after their cancer treatment.
Introducción: el cáncer de mama es la neoplasia maligna más común en mujeres, 23% a nivel mundial. Se clasifica según su patrón histológico y expresión de marcadores de inmunohistoquímica; hasta 75% son de tipo ductal. La incidencia de metástasis es de 10 a 80% según su inmunofenotipo, ocurren principalmente en hueso, vísceras y cerebro. Caso clínico: mujer de 64 años, con antecedente de mastectomía radical izquierda por carcinoma de mama no especificado en el 2000, recibió quimioterapia, radioterapia y tamoxifeno. Posterior a su alta hospitalaria la paciente permaneció sin vigilancia. En el 2014 inició con disfagia a sólidos, en el 2016 se documentó estenosis esofágica por panendoscopía, le realizaron tres dilataciones endoscópicas, en la última con perforación incidental. Se realizó esofagectomía; el estudio de patología reportó metástasis de carcinoma ductal de mama. Conclusiones: el carcinoma ductal de mama raramente da metástasis a tubo digestivo, no obstante, su probabilidad se debe tener presente e insistir en la vigilancia de las pacientes después de concluir su tratamiento contra el cáncer.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Neoplasias Esofágicas/secundario , Carcinoma Ductal de Mama/patología , Neoplasias Esofágicas/patología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
INTRODUCTION: We assessed the association between overweight, obesity, and morbid obesity with the incidence of the most aggressive breast cancer subtypes in women. METHODS AND MATERIALS: A cross-sectional study was performed. We conducted a record review to identify the following aspects: body mass index, sociodemographic features, tumor characteristics, and reproductive and molecular aspects. Descriptive statistics and univariate analysis were performed to identify the association between the molecular subtypes and the study variables. In addition, we used multivariate analysis to identify the association between obesity and the presence of metastatic lymph nodes. RESULTS: We included 1446 women with an average age of 52.5 ± 12.1 years. Of the 1446 patients, 47% were premenopausal and 75% were overweight. Univariate analysis indicated a statistically significant association between obesity and advanced disease stage, as well as nulliparity and multiparity. Similar results were found for women with morbid obesity. Model 1 of the multivariate analysis showed an association between the presence of metastatic lymph nodes and obesity (odds ratio [OR], 1.6; P = .008) and histologic grade 2 or 3 (OR, 2.4; P = .003). Using model 2, an association was identified between an advanced disease stage and 2 factors: morbid obesity (OR, 1.9; P = .02) and positive human epidermal growth factor receptor 2 (OR, 1.8; P = .045). CONCLUSION: We found that obesity is associated with the more advanced stages of breast cancer. Further studies are needed to evaluate the role of obesity in breast cancer progression in women.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Obesidad/complicaciones , Sobrepeso/complicaciones , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Índice de Masa Corporal , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/epidemiología , Carcinoma Ductal de Mama/etiología , Carcinoma Ductal de Mama/metabolismo , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Metástasis Linfática , México/epidemiología , Persona de Mediana Edad , Clasificación del Tumor , Invasividad Neoplásica , Estadificación de NeoplasiasRESUMEN
Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.
Asunto(s)
Carcinoma Ductal de Mama/secundario , Erisipeloide/patología , Neoplasias Inflamatorias de la Mama/patología , Neoplasias Cutáneas/secundario , Anciano , Mama , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/patología , Diagnóstico Diferencial , Erisipeloide/diagnóstico , Eritema/patología , Femenino , Humanos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , TóraxRESUMEN
SUMMARY Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.
Asunto(s)
Humanos , Femenino , Anciano , Neoplasias Cutáneas/secundario , Carcinoma Ductal de Mama/secundario , Erisipeloide/patología , Neoplasias Inflamatorias de la Mama/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Tórax , Mama , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Diagnóstico Diferencial , Erisipeloide/diagnóstico , Eritema/patologíaRESUMEN
INTRODUCTION: This study aimed to describe the efficacy of fulvestrant 500 mg in postmenopausal women with estrogen receptor (ER)-positive advanced/metastatic breast cancer who had disease progression after receiving anti-estrogen therapy in clinical practice, getting real-world data. MATERIALS AND METHODS: Multicenter, retrospective, observational study conducted in Spain. Postmenopausal women with locally advanced/metastatic ER-positive breast cancer who received treatment with fulvestrant 500 mg after progression with a previous anti-estrogen therapy were eligible. The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), clinical benefit rate (CBR), duration of clinical benefit (DoCB), and safety profile. RESULTS: A total of 263 women were evaluated (median age, 65.8 years). At a median follow-up of 21.5 months, median PFS and OS were 10.6 and 43.2 months, respectively. PFS according to 1st, 2nd, 3rd, and ≥ 4th lines were 11.5, 10.6, 9.9, and 8.5 months, respectively (p = 0.0245). PFS in patients with visceral involvement was 10 months vs 10.6 months in patients without visceral involvement (p = 0.6604), 9.6 months in patients with high Ki67 vs 10 months in patients with low Ki67 (p = 0.7224), and 10.2 months in HER2+ patients vs 10.3 months in HER2- patients (p = 0.6809). The CBR was 56.5% and the DoCB was 18.4 months. The most frequently adverse events were injection site pain (10.3%) and musculoskeletal disorders (7.6%). CONCLUSIONS: Fulvestrant 500 mg administered in clinical practice was shown to be effective (PFS, 10.6 months; CBR, 56.5%) and well tolerated, in accordance with previous trials.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Resistencia a Antineoplásicos , Estradiol/análogos & derivados , Posmenopausia , Anciano , Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/metabolismo , Carcinoma Lobular/secundario , Estradiol/uso terapéutico , Femenino , Estudios de Seguimiento , Fulvestrant , Humanos , Metástasis Linfática , Persona de Mediana Edad , Pronóstico , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Estudios RetrospectivosRESUMEN
On rare occasions, skin lesions are the first local of metastatic manifestation of internal malignancies. In case of no previous diagnosis of these tumors, the approach of suspicious skin lesions becomes a challenge, especially in differentiating cutaneous metastases and adnexal primary neoplasms. Currently, besides epidemiologic, dermoscopic and histopathologic aspects, the evaluation also integrates immunohistochemical exams and cell markers such as p40 and p63, highly specific for skin metastases. This article describes the case of cutaneous metastases as the sole obvious sign of breast cancer in a previously asymptomatic woman. The diagnosis was made by the finding of neoplastic cells in the dermis and immunohistochemistry compatible with ductal carcinoma.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Neoplasias Cutáneas/secundario , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Neoplasias de Anexos y Apéndices de Piel/patología , Piel/patologíaAsunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Neoplasias de la Retina/secundario , Anastrozol , Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/terapia , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Nitrilos/uso terapéutico , Radiocirugia , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Neoplasias de la Retina/metabolismo , Neoplasias de la Retina/terapia , Triazoles/uso terapéuticoRESUMEN
PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/secundario , Modelos Logísticos , Ganglios Linfáticos/patología , Anciano , Axila , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/cirugía , Femenino , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/cirugía , Persona de Mediana Edad , Invasividad Neoplásica , Micrometástasis de Neoplasia , Estadificación de Neoplasias , Biopsia del Ganglio Linfático Centinela , Carga TumoralRESUMEN
INTRODUCTION: Metaplastic breast carcinoma (MBC) is a rare and aggressive histologic subtype of breast cancer comprising approximately 0.5% to 5.0% of all invasive breast cancers with a poor prognosis and limited therapeutic options. PATIENTS AND METHODS: We investigated MBC at our institution to evaluate outcomes and investigate the molecular profile of our cohort to determine the presence of mutations for which there are targeted therapies. RESULTS: We found our cohort to consist mainly of the matrix-producing variant (72%) with 48% having the stereotypical estrogen receptor-negative/progesterone receptor-negative/human epidermal growth factor receptor-2-negative phenotype. While the overall survival of our cohort was an average of 1679 days (4.6 years), we had a surprising number of patients with second primaries (40%) and distant metastases (40%), yet few recurrences (12%). Molecular analysis of the tumors indicated that one gene mutation, CSFIR, was significantly associated with outcome (P = .021); however, the cohort was defined by frequent mutations in ERBB4 (36%), PIK3CA (48%), and FLT3 (60%), for which there are now targeted therapies. CONCLUSION: While surgery is the appropriate first step in the management of this aggressive malignancy, the collection of data pertaining to the use of targeted agents, although anecdotal, may provide clues to better treatment for these patients.
Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias de la Mama/clasificación , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Metaplasia/patología , Recurrencia Local de Neoplasia/patología , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/metabolismo , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/secundario , Fosfatidilinositol 3-Quinasa Clase I/genética , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Metaplasia/genética , Metaplasia/metabolismo , Clasificación del Tumor , Invasividad Neoplásica , Recurrencia Local de Neoplasia/genética , Estadificación de Neoplasias , Pronóstico , Receptor ErbB-2/metabolismo , Receptor ErbB-4/genética , Receptores del Factor Estimulante de Colonias/genética , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Estudios Retrospectivos , Tasa de Supervivencia , Tirosina Quinasa 3 Similar a fms/genéticaRESUMEN
Abstract: On rare occasions, skin lesions are the first local of metastatic manifestation of internal malignancies. In case of no previous diagnosis of these tumors, the approach of suspicious skin lesions becomes a challenge, especially in differentiating cutaneous metastases and adnexal primary neoplasms. Currently, besides epidemiologic, dermoscopic and histopathologic aspects, the evaluation also integrates immunohistochemical exams and cell markers such as p40 and p63, highly specific for skin metastases. This article describes the case of cutaneous metastases as the sole obvious sign of breast cancer in a previously asymptomatic woman. The diagnosis was made by the finding of neoplastic cells in the dermis and immunohistochemistry compatible with ductal carcinoma.
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Neoplasias Cutáneas/secundario , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Piel/patología , Inmunohistoquímica , Neoplasias de Anexos y Apéndices de Piel/patología , Diagnóstico DiferencialRESUMEN
Breast carcinoma (BC) corresponds to 23 % of all cancers in women, with 1.38 million new cases and 460,000 deaths worldwide annually. Despite the significant advances in the identification of molecular markers and different modalities of treatment for primary BC, the ability to predict its metastatic behavior is still limited. The purpose of this study was to identify novel molecular markers associated with distinct clinical outcomes in a Brazilian cohort of BC patients. We generated global gene expression profiles using tumor samples from 24 patients with invasive ductal BC who were followed for at least 5 years, including a group of 15 patients with favorable outcomes and another with nine patients who developed metastasis. We identified a set of 58 differentially expressed genes (p ≤ 0.01) between the two groups. The prognostic value of this metastasis signature was corroborated by its ability to stratify independent BC patient datasets according to disease-free survival and overall survival. The upregulation of B3GNT7, PPM1D, TNKS2, PHB, and GTSE1 in patients with poor outcomes was confirmed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in an independent sample of patients with BC (47 with good outcomes and eight that presented metastasis). The expression of BCL2-associated agonist of cell death (BAD) protein was determined in 1276 BC tissue samples by immunohistochemistry and was consistent with the reduced BAD mRNA expression levels in metastatic cases, as observed in the oligoarray data. These findings point to novel prognostic markers that can distinguish breast carcinomas with metastatic potential from those with favorable outcomes.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Proteínas Asociadas a Microtúbulos/genética , Proteínas Asociadas a Microtúbulos/metabolismo , Persona de Mediana Edad , N-Acetilglucosaminiltransferasas/genética , N-Acetilglucosaminiltransferasas/metabolismo , Clasificación del Tumor , Invasividad Neoplásica , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Prohibitinas , Proteína Fosfatasa 2C/genética , Proteína Fosfatasa 2C/metabolismo , ARN Mensajero/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Proteínas Represoras/genética , Proteínas Represoras/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tasa de Supervivencia , Tanquirasas/genética , Tanquirasas/metabolismo , Adulto JovenRESUMEN
BACKGROUND: Breast Cancer (BCa) is the most common malignant tumour in Mexican women. In BCa, several studies have linked ß2-adrenergic receptor activation with increased tumour growth and progression as related with Epinephrine-NorEpinephrine (E-NE) stimulation. The aim of this study was to describe Beta-Blocker (BB) treatment related with reduction of the risk of metastasis in Mexican patients with BCa. MATERIALS AND METHODS: We collected data of 120 patients seen at the High-Specialty Naval General Hospital in Mexico City (HOSGENAES), all of these with a histopathological diagnosis of BCa. Four groups of patients were divided as follows: without Systemic Arterial Hypertension (SAH); with SAH treatment with non-selective BB; with SAH treatment with selective BB, and with SAH treatment with other antihypertensive drugs. Chi-square, Mantel- Haenszel, Student t, and ANOVA tests were performed for data analysis. RESULTS: On average, patients were 54.8±11.8 years of age. Risk factors such as smoking and consuming alcohol exhibited a frequency of 33 and 36.5% respectively. Clinical stages III- IV were found in 50% of patients, while, 30% of patients had arterial hypertension (n=29 and N=96, respectively) and 17.5% used BB. One hundred percent of patients with arterial hypertension treated with BB for ß1 - and ß2 -adrenergic-receptors did not present metastasis globally, but patients treated with ß1 BB presented 30% of metastasis while patients treated with no BB or without SAH had around 70% of metastasis. CONCLUSIONS: In Mexican patients with BCa and SAH treated with non-selective (ß1- and ß2-adrenergic receptors) BB, a decrease in the risk for metastasis was observed at the time of diagnosis.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Conducta de Reducción del Riesgo , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/secundario , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Hipertensión/patología , Metástasis Linfática , México , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , PronósticoRESUMEN
The aggressiveness of invasive ductal carcinoma (IDC) of the breast is associated with increased IL17 levels. Studying the role of IL17 in invasive breast tumor pathogenesis, we found that metastatic primary tumor-infiltrating T lymphocytes produced elevated levels of IL17, whereas IL17 neutralization inhibited tumor growth and prevented the migration of neutrophils and tumor cells to secondary disease sites. Tumorigenic neutrophils promote disease progression, producing CXCL1, MMP9, VEGF, and TNFα, and their depletion suppressed tumor growth. IL17A also induced IL6 and CCL20 production in metastatic tumor cells, favoring the recruitment and differentiation of Th17. In addition, IL17A changed the gene-expression profile and the behavior of nonmetastatic tumor cells, causing tumor growth in vivo, confirming the protumor role of IL17. Furthermore, high IL17 expression was associated with lower disease-free survival and worse prognosis in IDC patients. Thus, IL17 blockade represents an attractive approach for the control of invasive breast tumors.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Quimiotaxis de Leucocito/fisiología , Interleucina-17/fisiología , Linfocitos Infiltrantes de Tumor/inmunología , Proteínas de Neoplasias/fisiología , Neutrófilos/inmunología , Animales , Neoplasias de la Mama/química , Neoplasias de la Mama/inmunología , Neoplasias de la Mama/mortalidad , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/inmunología , Carcinoma Ductal de Mama/mortalidad , Citocinas/biosíntesis , Citocinas/genética , Citocinas/metabolismo , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Humanos , Interleucina-17/análisis , Interleucina-17/antagonistas & inhibidores , Interleucina-17/inmunología , Linfocitos Infiltrantes de Tumor/metabolismo , Neoplasias Mamarias Experimentales/inmunología , Neoplasias Mamarias Experimentales/patología , Ratones , Ratones Endogámicos BALB C , Proteínas de Neoplasias/análisis , Proteínas de Neoplasias/antagonistas & inhibidores , Proteínas de Neoplasias/inmunología , Neutrófilos/metabolismo , Pronóstico , Células Th17/inmunologíaRESUMEN
Metastatic breast cancer as initial onset represents between 20 and 30 % of cases and is considered an incurable disease. The goal of its treatment is palliative, looking for increasing the survival while reducing the symptoms. Maintenance chemotherapy studies for metastatic breast cancer have demonstrated to prolong the progression-free survival, with unclear results in terms of overall survival. The main objectives of our study were the progression-free survival and overall survival in patients with recurring or metastatic breast cancer treated with capecitabine in the maintenance chemotherapy setting compared with patients not receiving maintenance chemotherapy. As secondary objectives, the frequency of dose-limiting toxicities and response rate were determined. A non-probabilistic sampling was used, through expert selection of patients from the recurring/metastatic breast cancer survey cared within the period from January 1, 2007, to December 21, 2012. A total of 77 patients were included. Clinical data of advanced/recurrent breast cancer patients that were treated with capecitabine were recorded. The study achieved its primary objective, since the progression-free survival was prolonged for the maintenance therapy group: 6.6 versus 18.1 months, p < 0.001. The absolute benefit was 11.5 months. Likewise, there was a benefit in the overall survival of 21.03 versus 29 months, p = 0.015, with an absolute benefit of 7.97 months. The toxicity profile was favorable in the maintenance group. The maintenance chemotherapy with capecitabine in patients treated at the National Medical Center Siglo XXI Oncology Hospital extends the overall survival and progression-free survival with a good toxicity profile.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Capecitabina/uso terapéutico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/mortalidad , Carcinoma Lobular/secundario , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
PURPOSE: Over the last decade a dramatic improvement in the treatment and prognosis of human epidermal growth factor receptor-2 (HER2) positive metastatic breast cancer (MBC) has been achieved. This study aimed to describe pattern, timing of metastases, and time to progression (TTP) of MBC patients (pts) treated with multiple lines of therapy with trastuzumab and/or lapatinib. METHODS: Clinical-pathologic features, treatment-lines and metastatic sites were collected from the institutional database; TTP was evaluated for each treatment-line. A meta-analysis of treatment-line estimates was performed; Q test and I (2)-index were used to detect and estimate heterogeneity. Cox's proportional hazards model and Fine and Gray's proportional subhazards model in a competing risks setting were used to detect differences in hazard rate and to estimate relative risks. RESULTS: 112 pts were analyzed. The median number of treatment-lines administered was 6 (range 1-17) and 524 (86 %) disease progression events were observed (median follow up 4.2 years). Distribution of metastases at baseline remained consistent across all lines. Having a given site affected by metastasis was a major risk factor of progression in that site. Hormone-receptor-positive pts resulted more likely to progress on bone (HR = 1.88). Elderly pts were less likely to progress on CNS (HR = 0.73). Median TTP resulted superior to 5 months up to the 6th line of treatment, reaching a plateau at the 9th treatment-line. CONCLUSIONS: These data suggest that risk factors for progression in HER2 positive MBC do not significantly differ between various distributions of metastases, and that MBC pts benefit from anti-HER2 therapy even in late treatment-lines.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Quinazolinas/uso terapéutico , Trastuzumab/uso terapéutico , Adulto , Anciano , Neoplasias Óseas/secundario , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/secundario , Carcinoma Lobular/metabolismo , Carcinoma Lobular/secundario , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/secundario , Progresión de la Enfermedad , Femenino , Humanos , Lapatinib , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Receptor ErbB-2/antagonistas & inhibidores , Receptor ErbB-2/metabolismo , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Colonic metastasis of breast cancer are extremely infrequent, being ductal subtype the most rarely affects the digestive tract, compared to lobular subtype. We present a case report of a colonic metastasis of ductal breast cancer; found in the context of a screening colonoscopy. Besides we perform an article research about digestive tract metastasis of primary breast cancer, finding very few published cases among the literature about this ductal subtype behavior.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Neoplasias del Colon/secundario , Anciano , Neoplasias del Colon/diagnóstico , Colonoscopía , Femenino , HumanosRESUMEN
Metastatic tumors to the pituitary gland are an unusual complication typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor. Prognosis of patients with breast cancer metastasis is poor and depends on the primary neoplastic extension. We report a 54 year-old woman with breast cancer metastasis to the pituitary stalk first diagnosed because of visual disturbance with no other symptoms. Pituitary gland stalk metastasis is a very uncommon find and this case report includes a literature review.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Neoplasias Hipofisarias/secundario , Hormona Adrenocorticotrópica/análisis , Carcinoma Ductal de Mama/diagnóstico , Proteínas Portadoras/metabolismo , Femenino , Glicoproteínas/metabolismo , Humanos , Imagen por Resonancia Magnética , Proteínas de Transporte de Membrana , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnósticoRESUMEN
Metastatic tumors to the pituitary gland are an unusual complication typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor. Prognosis of patients with breast cancer metastasis is poor and depends on the primary neoplastic extension. We report a 54 year-old woman with breast cancer metastasis to the pituitary stalk first diagnosed because of visual disturbance with no other symptoms. Pituitary gland stalk metastasis is a very uncommon find and this case report includes a literature review.
Os tumores hipofisários malignos são raros e geralmente se constituem de metástases de neoplasias disseminadas. Câncer de mama e pulmão são os sítios primários mais frequentes e o prognóstico depende do grau de comprometimento da doença. Este é o relato do caso de uma mulher de 54 anos que apresentou uma lesão tumoral restrita à haste hipofisária, que se revelou como metástase do câncer de mama previamente conhecido. O acometimento da haste hipofisária é muito raro, motivo pelo qual descrevemos o caso com a revisão da literatura específica.