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Breast endocrine surgery

Marta Venturelli, Giorgia Guaitoli, Claudia Omarini, Luca Moscetti
Endocrine treatment represents the cornerstone of endocrine-sensitive premenopausal early breast cancer. The estrogen blockade plays a leading role in the therapeutic management of hormone receptor-positive breast cancer together with surgery, radiotherapy, and selective antiestrogen treatments. For several years, selective estrogen receptor modulators, such as tamoxifen, have represented the mainstay of therapy. The role of amenorrhea has been extensively elucidated in the past year: the benefit observed with chemotherapy-induced amenorrhea has strengthened its therapeutic role...
2018: Breast Cancer: Targets and Therapy
Clark DuMontier, Kerri M Clough-Gorr, Rebecca A Silliman, Andreas E Stuck, André Moser
OBJECTIVES: To develop a predictive model and risk score for 10-year mortality using health-related quality of life (HRQOL) in a cohort of older women with early-stage breast cancer. DESIGN: Prospective cohort. SETTING: Community. PARTICIPANTS: U.S. women aged 65 and older diagnosed with Stage I to IIIA primary breast cancer (N=660). MEASUREMENTS: We used medical variables (age, comorbidity), HRQOL measures (10-item Physical Function Index and 5-item Mental Health Index from the Medical Outcomes Study (MOS) 36-item Short-Form Survey; 8-item Modified MOS Social Support Survey), and breast cancer variables (stage, surgery, chemotherapy, endocrine therapy) to develop a 10-year mortality risk score using penalized logistic regression models...
March 13, 2018: Journal of the American Geriatrics Society
Edward E Cornwell
On March 19-20, 2017; Howard University hosted a Festschrift inspired by Dr. Leffall's writings (Fig. 1). The celebrants highlighted the broad spectrum of Dr. Leffall's contributions in mentorship, leadership in American Surgery, breast cancer, endocrine cancer, pancreatic cancer, and familial polyposis coli. Perhaps most inspirational was the awe inspiring consistency the presenters demonstrated in describing the personal characteristics Dr. Leffall brings to his academic discourse: his encyclopedic knowledge and recall, his charm, eloquence, humility, and his total dedication to the patient, his students, and trainees...
December 12, 2017: American Journal of Surgery
Hiba El Hage Chehade, Kefah Mokbel
Data derived from pathological analysis, natural history, radiological characteristics, genomic profiling, and clinical outcome indicate that ductal carcinoma in situ (DCIS) is a heterogeneous disease; meaning that no single therapeutic strategy is best, but rather that treatment should be personalised and entail a rigorous multidisciplinary approach. The role of adjuvant endocrine therapy after surgical excision has been the subject of scientific debate in view of the in situ nature of this neoplasm. We reviewed the literature and summarised the evidence regarding the need for adjuvant endocrine therapy following complete surgical excision of DCIS through the identification of the most important outcomes, evaluation of quality of evidence, and assessment of the trade-offs involved...
March 2018: Anticancer Research
Antonella Palazzo, Silvia Dellapasqua, Elisabetta Munzone, Vincenzo Bagnardi, Manuelita Mazza, Giuseppe Cancello, Raffaella Ghisini, Monica Iorfida, Emilia Montagna, Aaron Goldhirsch, Marco Colleoni
BACKGROUND: Inflammatory breast cancer (IBC) is a rare and highly aggressive disease. A neoadjuvant regimen with chemotherapy and an antiangiogenic strategy was investigated. PATIENTS AND METHODS: Patients with primary or recurrent IBC who were candidates for neoadjuvant treatment received weekly carboplatin and paclitaxel plus bevacizumab every 3 weeks and oral metronomic cyclophosphamide for 6 months. Trastuzumab was added for patients with HER2+ tumors and endocrine therapy was added for patients with estrogen receptor and/or progesterone receptor ≥ 10% tumors...
February 2, 2018: Clinical Breast Cancer
Sabino De Placido, Ciro Gallo, Michelino De Laurentiis, Giancarlo Bisagni, Grazia Arpino, Maria Giuseppa Sarobba, Ferdinando Riccardi, Antonio Russo, Lucia Del Mastro, Alessio Aligi Cogoni, Francesco Cognetti, Stefania Gori, Jennifer Foglietta, Antonio Frassoldati, Domenico Amoroso, Lucio Laudadio, Luca Moscetti, Filippo Montemurro, Claudio Verusio, Antonio Bernardo, Vito Lorusso, Adriano Gravina, Gabriella Moretti, Rossella Lauria, Antonella Lai, Carmen Mocerino, Sergio Rizzo, Francesco Nuzzo, Paolo Carlini, Francesco Perrone
BACKGROUND: Uncertainty exists about the optimal schedule of adjuvant treatment of breast cancer with aromatase inhibitors and, to our knowledge, no trial has directly compared the three aromatase inhibitors anastrozole, exemestane, and letrozole. We investigated the schedule and type of aromatase inhibitors to be used as adjuvant treatment for hormone receptor-positive early breast cancer. METHODS: FATA-GIM3 is a multicentre, open-label, randomised, phase 3 trial of six different treatments in postmenopausal women with hormone receptor-positive early breast cancer...
February 23, 2018: Lancet Oncology
Dong Hoon Suh, Miseon Kim, Kyung Hun Lee, Keun Yong Eom, Maj Kamille Kjeldsen, Mansoor Raza Mirza, Jae Weon Kim
In 2017, 10 topics were selected as major clinical research advances in gynecologic oncology. For cervical cancer, efficacy and safety analysis results of a 9-valent human papillomavirus (HPV) vaccine and long-term impact of reduced dose of quadrivalent vaccine were updated. Brief introduction of KEYNOTE trials of pembrolizumab, a monoclonal antibody that blocks the interaction between programmed death (PD)-1 and its ligands, PD-L1 and PD-L2, followed. Tailored surveillance programs for gynecologic cancer related with Lynch syndrome and update on sentinel lymph node mapping were reviewed for uterine corpus cancer...
March 2018: Journal of Gynecologic Oncology
Shinzaburo Noguchi, Matthew J Ellis, John F R Robertson, Jackie Thirlwell, Mehdi Fazal, Zhimin Shao
BACKGROUND: The international, phase III FALCON study (NCT01602380) in postmenopausal patients with hormone receptor-positive, locally advanced/metastatic breast cancer (LA/MBC) who had not received prior endocrine therapy, demonstrated statistically significant improvement in progression-free survival (PFS) for patients who received fulvestrant 500 mg vs anastrozole 1 mg. This subgroup analysis evaluated PFS in Asian (randomized in China, Japan, or Taiwan) and non-Asian patients from the FALCON study...
February 15, 2018: Breast Cancer: the Journal of the Japanese Breast Cancer Society
Lesley Fallowfield, Lucy Matthews, Shirley May, Valerie Jenkins, David Bloomfield
Chemotherapy side-effects can be substantial. There is increasing recognition that some oestrogen receptor positive (ER+ve), human epidermal growth factor receptor 2 negative (HER2-ve) patients with breast cancer derive no benefit from chemotherapy and experience only iatrogenic harm. Gene expression profiling tests help refine recurrence risk and likely chemotherapy benefit. EndoPredict® is one such test, which classifies risks of distant recurrence as low or high in patients treated with surgery and adjuvant endocrine therapy alone...
February 15, 2018: Psycho-oncology
Kazuo Matsuura, Toshiyuki Itamoto, Midori Noma, Masahiro Ohara, Etsushi Akimoto, Mihoko Doi, Takashi Nishisaka, Koji Arihiro, Takayuki Kadoya, Morihito Okada
The aim of the present study was to evaluate the significance of lung biopsy for the modification of the treatment strategy in breast cancer patients who develop lung nodules during follow-up after breast surgery. Of 53 consecutive patients who underwent lung biopsies in two institutions (Hiroshima University Hospital and Hiroshima Prefectural Hospital, Hiroshima, Japan) between 1997 and 2014, 45 underwent lung surgery and 8 underwent percutaneous or transbronchial tumor biopsy for lung nodules developing after curative surgery for breast cancer...
February 2018: Molecular and Clinical Oncology
Stefanie Corradini, Montserrat Pazos, Stephan Schönecker, Daniel Reitz, Maximilian Niyazi, Ute Ganswindt, Simone Schrodi, Michael Braun, Martin Pölcher, Sven Mahner, Nadia Harbeck, Jutta Engel, Claus Belka
BACKGROUND: The objective of the present study was to evaluate the effectiveness of postoperative radiotherapy after breast conserving surgery (BCS) in DCIS in a large patient population treated in clinical practice. METHODS: Data were provided by the population-based Munich Cancer Registry. Between 1998 and 2014, 1048 female patients with diagnosis of DCIS and treated at two Breast Care Centres were included in this observational study. The effectiveness of postoperative radiotherapy and variables predicting the use of radiotherapy were retrospectively analysed...
February 9, 2018: Radiation Oncology
Asako Fujiwara, Kenichi Sakurai, Shigeru Fujisaki, Hitomi Kubota, Yukiko Hara, Shuhei Suzuki, Keita Adachi, Ryouichi Tomita, Katsuhisa Enomoto, Tomohiro Hirano
We report a case of neuroendocrine ductal carcinoma in situ of the breast. The tumor was shown to be an intra-cystic tumor on performing ultrasonography. The patient was a 40-year-old woman. Amorphous calcifications were detected on her right breast on performing mammography during breast cancer screening. Ultrasonography indicated that the tumor was 9mm in diameter, and displayed features of an intra-cystic tumor. A vacuum-assisted core needle biopsy for breast tumor led to a diagnosis. The pathological diagnosis was mastopathy...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Gen Tsujio, Shinichiro Kashiwagi, Yuka Asano, Wataru Goto, Koji Takada, Tamami Morisaki, Satoru Noda, Tsutomu Takashima, Naoyoshi Onoda, Masahiko Ohsawa, Kosei Hirakawa, Masaichi Ohira
A breast cancer with tumors smaller than or equal to 5mm in diameter is treated as a microscopic lesion and axially lymph node metastasis is considered to be rare. A 52-year-old female was found to have an abnormal shadow on mammography. An ultrasonography revealed a poorly defined and irregular shaped mass with calcification, 4mm in diameter, in the AC area of her left breast. We performed vacuum-assisted biopsy and diagnosed with invasive ductal carcinoma. Under a preoperative diagnosis of left breast cancer with cT1aN0M0, stage I , Luminal A like, we underwent partial mastectomy with sentinel lymph node biopsy...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Qiang Wang, Jun Jiang, Guoguang Ying, Xiao-Qing Xie, Xia Zhang, Wei Xu, Xuemin Zhang, Erwei Song, Hong Bu, Yi-Fang Ping, Xiao-Hong Yao, Bin Wang, Shilei Xu, Ze-Xuan Yan, Yanhong Tai, Baoquan Hu, Xiaowei Qi, Yan-Xia Wang, Zhi-Cheng He, Yan Wang, Ji Ming Wang, You-Hong Cui, Feng Chen, Kun Meng, Zhaoyi Wang, Xiu-Wu Bian
The 66 kDa estrogen receptor alpha (ERα66) is the main molecular target for endocrine therapy such as tamoxifen treatment. However, many patients develop resistance with unclear mechanisms. In a large cohort study of breast cancer patients who underwent surgery followed by tamoxifen treatment, we demonstrate that ERα36, a variant of ERα66, correlates with poor prognosis. Mechanistically, tamoxifen directly binds and activates ERα36 to enhance the stemness and metastasis of breast cancer cells via transcriptional stimulation of aldehyde dehydrogenase 1A1 (ALDH1A1)...
February 2, 2018: Cell Research
A Sudlow, H Tuffaha, A T Stearns, I A Shaikh
Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015...
January 24, 2018: Annals of the Royal College of Surgeons of England
Melinda Pattanasri, Kenneth Elder, Carolyn Nickson, Samuel Cooke, Dorothy Machalek, Allison Rose, Arlene Mou, John P Collins, Allan Park, Richard De Boer, Claire Phillips, Vicki Pridmore, Helen Farrugia, G Bruce Mann
BACKGROUND: Adjuvant therapy for breast cancer is routinely discussed and recommended in multi-disciplinary meetings (MDMs). Current literature explores how treatments received by patients differ from national guidelines; however, it does not explore whether treatment is concordant with MDMs. This study provides an Australian perspective on the uptake of MDM recommendations and reasons for non-concordance. METHODS: A retrospective cohort study of patients with breast cancer presented at The Royal Melbourne Hospital MDM in 2010 and 2014 to investigate the concordance between MDM recommendations and treatment received...
January 23, 2018: ANZ Journal of Surgery
Masashi Sakagami, Tomohiro Hirano, Shuhei Suzuki, Keita Adachi, Hitomi Kubota, Yukiko Hara, Katsuhisa Enomoto, Ryouichi Tomita, Shigeru Fujisaki, Kenichi Sakurai
We report a case of advanced breast cancer with liver metastasis(T2N1M1, Stage IV )achieving a significant improvement of QOL by multi-disciplinary therapy. The patient was 37-year-old woman who had breast lump and axillary lymph nodes swelling with liver metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, negative for estrogen receptor and progesterone receptor, and positive for HER2/neu protein expression. The Ki-67 positive cell index was 40%. She received 16 courses of DOC plus HER plus PER(docetaxel 75mg/m / 2, trastuzumab 6 mg/kg, pertu- zumab 450mg/body, and received 4 courses of EC(epirubicin 90mg/m / 2, cyclophosphamide 600 mg/m2)...
January 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Kenichi Sakurai, Shigeru Fujisaki, Hitomi Kubota, Yukiko Hara, Shuhei Suzuki, Keita Adachi, Ryouichi Tomita, Katsuhisa Enomoto, Tomohiro Hirano
We report an elderly patient with locally advanced breast cancer who received long-term fulvestrant therapy.The patient was a 75-year-old woman who presented with a right breast lump.She noticed the tumor 4 years and 6 months ago, but she had not visited any hospital.However, her daughter brought her to our hospital.The tumor was 73mm in diameter.A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, positive for estrogen receptor(ER)and progesterone receptor(PgR), and negative for HER2/neu...
January 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Kenichi Sakurai, Shigeru Fujisaki, Hitomi Kubota, Yukiko Hara, Shuhei Suzuki, Keita Adachi, Ryouichi Tomita, Katsuhisa Enomoto, Tomohiro Hirano
We report a case of synchronous and unilateral breast cancers in a 51-year-old female.A focal asymmetric right breast density was detected on breast cancer screening mammography.Ultrasonography showed a low echoic mass, 9mm in diameter, in the B area, and a second low echoic mass in the CD area of her right breast.A core needle biopsy of the B area mass led to a diagnosis of an invasive lobular carcinoma, positive for estrogen receptor(ER)and progesterone receptor(PgR), and negative for HER2/neu.One -percent of the tumor cells were Ki-67 positive...
January 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Daniele Generali, Silvia Paola Corona, Lajos Pusztai, Roman Rouzier, Giovanni Allevi, Sergio Aguggini, Manuela Milani, Carla Strina, Albane Frati
INTRODUCTION: Neoadjuvant hormonal therapy is generally considered a valid option for hormone receptor positive breast cancer (BC) patients who are unfit for chemotherapy or surgery. AIMS: Whilst numerous studies analyzed efficacy of neoadjuvant chemotherapy (CT) or endocrine therapy (HT) alone in hormone receptor positive patients, there is a lack of research looking at the usefulness of a preoperative combinatorial approach of CT and HT in this patient subgroup...
March 2018: Journal of Cancer Research and Clinical Oncology
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