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The aim of this article is to discuss the challenges and new strategies in managing breast cancer patients, with a specific focus on radiation oncology and the importance of balancing oncologic outcomes with quality of life and post-treatment morbidity. A comprehensive literature review was conducted to identify advances in the management of breast cancer, exploring de-escalation strategies, hypofractionation schemes, predictors and tools for reducing toxicity (radiation-induced lymphocyte apoptosis, deep inspiration breath-hold, adaptive radiotherapy), enhancer treatments (hyperthermia, immunotherapy) and innovative diagnostic modalities (PET-MRI, omics). Balancing oncologic outcomes with quality of life and post-treatment morbidity is crucial in the era of personalized medicine. Radiotherapy plays a critical role in the management of breast cancer patients. Large randomized trials are necessary to generalize some practices and cost remains the main obstacle for many innovations that are already applicable.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/patologia , Radio-Oncologistas , Qualidade de VidaRESUMO
PURPOSE: Data on the benefit of stereotactic body radiation therapy (SBRT) in patients with breast cancer (BC) and bone metastases remain limited. The purpose of this study is to report our 10-year experience of bone SBRT, analyzing toxicity and prognostic factors for local control (LC); progression-free survival, and overall survival (OS). METHODS/PATIENTS: We analyzed all spine and non-spine bone SBRT performed in patients with BC during the 2012-2022 period at our institution. Treatments carried out with ablative intent in stereotactic conditions with dose/fraction ≥ 5 Gy in 5 or fewer sessions were considered. Demographic, treatment, and toxicity data were recorded according to CTCAEv4. Risk factors were assessed through univariate and multivariate analysis by Cox regression. RESULTS: 60 bone SBRT treatments were performed during the study period. 75% were spine SBRT and 25% were non-spine SBRT (median BED4Gy was 80 Gy4). The median age was 52.5 years (34-79). The median tumor volume was 2.9 cm3 (0.5-39.4). The median follow-up was 32.4 months (1.2-101.7). 1 and 2 years LC were 92.9 and 86.6%, respectively. 1 and 2 years OS were 100 and 90.6%, respectively. Multivariate analysis (MVA) associated volume of the treated lesion ≥ 13 cm3 with worse LC (p = 0.046; HR 12.1, 95%CI = 1.1-140.3). In addition, deferring SBRT > 3 months after lesion diagnosis to prioritize systemic treatment showed a significant benefit, improving the 2 years LC up to 96.8% vs. 67.5% for SBRT performed before this period (p = 0.031; HR 0.1, 95%CI = 0.01-0.8). Hormonal receptors, the total number of metastases, and CA15-3 value were significantly associated with OS in MVA. During follow-up, three non-spine fractures (5%) were observed. CONCLUSIONS: According to our data, bone SBRT is a safe and effective technique for BC. Upfront systemic treatment before SBRT offers a benefit in LC. Therefore, SBRT should be considered after prior systemic treatment in this population.
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Neoplasias Ósseas , Neoplasias da Mama , Radiocirurgia , Humanos , Pessoa de Meia-Idade , Feminino , Seguimentos , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Stereotactic body radiation therapy (SBRT) is a treatment modality with curative intent for oligometastatic cancer patients, commonly defined by a low-burden metastatic disease with 1-5 systemic metastases. Better knowledge of the clinical profile and prognostic factors in oligometastatic cancer patients could help to improve the selection of candidates who may obtain most benefits from SBRT. The objective of this study was to describe the clinical data and outcome in term of overall survival (OS) of patients with oligometastatic disease treated with SBRT over a 6-year period. METHODS: From 2013 to 2018, 284 solid tumor cancer patients with 1-5 oligometastases underwent SBRT at a large university-affiliated oncological center in Barcelona, Spain. Variables related to the patient profile, tumor, oligometastatic disease, and treatment were evaluated. RESULTS: A total of 327 metastatic tumors were treated with SBRT. In 65.5% of cases, metachronous tumors were diagnosed at least 1 year after diagnosis of the primary tumor. The median age of the patients was 73.9 years and 66.5% were males. The median follow-up was 37.5 months. The most common primary tumors were lung and colorectal cancer, with lung and bone as the most commonly treated metastatic sites. Ninety-three percent of patients showed a Karnofsky score (KPS) between 80 and 100. Adenocarcinoma was the most common histological type. The median overall survival was 53.4 months, with 1-, 2- and 5-year survival rates of 90.5%, 73.9% and 43.4%, respectively. Overall survival rates of breast (67.6 months, 95% CI 56.4-78.9), urological (63.3 months, 95% CI 55.8-70.8), and colorectal (50.8 months, 95% CI 44.2-57.4) tumors were higher as compared with other malignancies (20 months, 95% CI 11.2-28.8 months) (p < 0.001). Patients with Karnofsky score (KPS) of 90 and 100 showed a significantly better survival than those with impaired performance status (p = 0.001). CONCLUSION: SBRT appears to be well tolerated and safe approach in oligometastatic patients. Patients with good performance status and with primary breast, urological and colorectal cancer have higher OS compared with other malignancies. More studies are necessary to evaluate the prognostic factors in oligometastatic disease (OMD) in order to select patients who could benefit more from this therapeutic approach.
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Neoplasias Colorretais , Neoplasias Pulmonares , Segunda Neoplasia Primária , Radiocirurgia , Masculino , Humanos , Idoso , Feminino , Resultado do Tratamento , Prognóstico , Radiocirurgia/efeitos adversos , Segunda Neoplasia Primária/etiologia , Neoplasias Colorretais/patologia , Estudos Retrospectivos , Neoplasias Pulmonares/patologiaRESUMO
PURPOSE: To evaluate treatment outcomes in patients with early-stage breast cancer (ESBC) treated with targeted intraoperative radiation therapy (IORT) administered as accelerated partial breast irradiation (APBI). METHODS: Between December 2014 and May 2019, 50 patients diagnosed with ESBC were treated with a 50 kilovoltage (kV) X-ray source with a single dose of 20 Gy using the Intrabeam® radiotherapy delivery system. All patients were followed prospectively to assess local control (LC), disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), radiation-induced toxicity, and cosmetic outcomes. We also evaluated the prognostic implications of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). RESULTS: Median follow-up was 53 months. Mean patient age was 70 years. The mean duration of radiation delivery was 22.25 min. Two patients developed a recurrence. One death was recorded. Elevated pretreatment NLR levels were a significant risk factor for mortality (p = 0.0026). The most common treatment-related toxicities were breast induration (30%) and seroma (18%). Five-year LC, DFS, CSS, and OS rates were 97.1%, 93.9%, 100%, and 94.4%, respectively. Cosmesis was excellent or good in most cases (94%). CONCLUSION: These findings confirm the effectiveness of a single dose of 20 Gy of IORT with the Intrabeam device as APBI. The toxicity profile was good with excellent cosmesis. These results provide further support for the clinical use of APBI in well-selected patients.
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Neoplasias da Mama , Lesões por Radiação , Idoso , Mama/efeitos da radiação , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia Segmentar , Dosagem Radioterapêutica , Raios XRESUMO
The aim of this study was to compare the sensitivity of the serological level of anti-p53 antibodies in breast cancer patients and to correlate its expression level with patient age, histological stage and grade of tumor differentiation. Total p53 protein expression (mutant and wild-type) was also determined in the breast cancer tissues using immunohistochemistry (IHC). The serological levels of mutant p53 expression were found to be age-dependent, reaching the highest level at 50 years of age. Faint or low detection was observed in patients ≤30 years of age. Anti-p53-antibodies were detected in patients ≤40 and ≥61 years of age. The serological levels of mutant p53 protein were highly detected in all stages of breast cancer, including the early stages. However, anti-p53 antibodies reached a high level of detection only in stage III breast carcinomas. No expression was found in patients with benign breast disease. The detection of p53 mutations was dependent on the grade of tumor differentiation, achieving the highest level in the poorly differentiated breast carcinomas. Results from IHC were highly correlated with serological p53 mutational analysis. Our findings indicate that mutant p53 in serum is a promising novel parameter for the evaluation of cellular biology and the prognosis of breast cancer from its early stages using blood samples. Anti-p53 antibodies were demonstrated to be less sensitive in this study. It is also possible to use the expression of mutant p53 protein as a molecular marker to differentiate benign breast disease from breast carcinoma prior to surgery.
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The objective of this pilot project was to investigate whether the breast fine needle aspiration (FNA) technique is a useful tool for determining the increased risk of breast cancer in patients with non-palpable breast lesions. FNA is a minimally invasive technique that isolates mammary epithelial cells from breast cells in the suspicious region. In this study, two FNA samples were collected from 12 patients. The level of HER2/neu expression at the mRNA level (in serum) was measured in each patient. As gene amplification is characteristic of cancer cells and may assist in diagnosis and prognostic assessment, it is crucial that gene amplification of HER2/neu in patients with non-palpable breast lesions is compared to breast biopsy results. In serum, the level of HER2/neu was determined by ELISA assay. Gene amplification was determined by PCR and confirmed by IHC employing monoclonal ERRB2 in the FNA sample. The results indicate that FNA has a good correlation with breast biopsy. FNA combined with mammographic imaging is a strong tool for determining favorable treatment options for patients.
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El Instituto Nacional de Estadística y Censos (INDEC), dependiente de la Secretaría de Programación Económica del Ministerio de Economía y Obras y Servicios Públicos, reinicia con esta obra la publicación del Anuario Estadístico de la República Argentina. De esta manera se da respuesta a la creciente demanda de información actualizada tanto del sector público como del privado. El Anuario consta de un capítulo de información general y geográfica sobre el país y de ocho capítulos que agrupan estadísticas sobre distintos aspectos demográficos, sociales y económicos, incluido las cuentas nacionales, cuyo detalle se encuentra en el índice general. Los cuadros contienen datos anuales para el total del país y, según los temas, también desagregados por provincia. El contenido de este Anuario está asimismo disponible en soporte magnético
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Argentina , Características da População , Estatísticas de Saúde , Coeficiente de Natalidade , Indicadores Econômicos , Pobreza/estatística & dados numéricos , Condições Sociais/estatística & dados numéricos , Mortalidade/tendências , Estatísticas de Assistência Médica , Estatísticas Vitais , Escolaridade , Habitação/estatística & dados numéricos , Mortalidade Materna/tendências , Mortalidade Infantil , Mortalidade Infantil/tendências , Comércio/estatística & dados numéricos , Clima , Financiamento da Assistência à Saúde , Seguro/estatística & dados numéricos , Seguro de Vida/estatística & dados numéricos , Seguro de Acidentes/estatística & dados numéricos , Seguradoras/estatística & dados numéricos , Previdência Social/estatística & dados numéricos , Caça/estatística & dados numéricos , Mineração/estatística & dados numéricos , Economia/estatística & dados numéricos , Combustíveis Fósseis/estatística & dados numéricos , Eletricidade , Meios de Transporte/estatística & dados numéricos , Orçamentos/estatística & dados numéricos , Impostos , Produto Interno Bruto , Petróleo/estatística & dados numéricos , Indústria Química/estatística & dados numéricos , Agricultura/estatística & dados numéricos , Emprego/estatística & dados numéricos , Educação/estatística & dados numéricos , /estatística & dados numéricos , Direito Penal/estatística & dados numéricosRESUMO
El Instituto Nacional de Estadística y Censos (INDEC), dependiente de la Secretaría de Programación Económica del Ministerio de Economía y Obras y Servicios Públicos, reinicia con esta obra la publicación del Anuario Estadístico de la República Argentina. De esta manera se da respuesta a la creciente demanda de información actualizada tanto del sector público como del privado. El Anuario consta de un capítulo de información general y geográfica sobre el país y de ocho capítulos que agrupan estadísticas sobre distintos aspectos demográficos, sociales y económicos, incluido las cuentas nacionales, cuyo detalle se encuentra en el índice general. Los cuadros contienen datos anuales para el total del país y, según los temas, también desagregados por provincia. El contenido de este Anuario está asimismo disponible en soporte magnético