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[PMID]:28922787
[Au] Autor:Blok EJ; Kroep JR; Meershoek-Klein Kranenbarg E; Duijm-de Carpentier M; Putter H; van den Bosch J; Maartense E; van Leeuwen-Stok AE; Liefers GJ; Nortier JWR; Rutgers EJT; van de Velde CJH; IDEAL Study Group
[Ad] Endereço:Departments of Surgery, Medical Oncology, and Medical Statistics, Leiden University Medical Center, Leiden, Netherlands; Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Internal Medicine, Reinier de Graaff Hospital, Delft, the Netherlands; Dutch
[Ti] Título:Optimal Duration of Extended Adjuvant Endocrine Therapy for Early Breast Cancer; Results of the IDEAL Trial (BOOG 2006-05).
[So] Source:J Natl Cancer Inst;110(1), 2018 Jan 01.
[Is] ISSN:1460-2105
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: The optimal duration of extended endocrine therapy beyond five years after initial aromatase inhibitor-based adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer is still unknown. Therefore, we conducted a clinical trial to compare two different extended endocrine therapy durations. Methods: In the randomized phase III IDEAL trial, postmenopausal patients with hormone receptor-positive breast cancer were randomly allocated to either 2.5 or five years of letrozole after the initial five years of any endocrine therapy. The primary end point was disease free survival (DFS), and secondary end points were overall survival (OS), distant metastasis-free interval (DMFi), new primary breast cancer, and safety. Hazard ratios (HRs) were determined using Cox regression analysis. All analyses were by intention-to-treat principle. Results: A total of 1824 patients were assigned to either 2.5 years (n = 909) or five years (n = 915) of letrozole, with a median follow-up of 6.6 years. A DFS event occurred in 152 patients in the five-year group, compared with 163 patients in the 2.5-year group (HR = 0.92, 95% confidence interval [CI] = 0.74 to 1.16). OS (HR = 1.04, 95% CI = 0.78 to 1.38) and DMFi (HR = 1.06, 95% CI = 0.78 to 1.45) were not different between both groups. A reduction in occurrence of second primary breast cancer was observed with five years of treatment (HR = 0.39, 95% CI = 0.19 to 0.81). Subgroup analysis did not identify patients who benefit from five-year extended therapy. Conclusion: This study showed no superiority of five years over 2.5 years of extended adjuvant letrozole after an initial five years of adjuvant endocrine therapy.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Neoplasias da Mama/terapia
Carcinoma Ductal de Mama/terapia
Carcinoma Intraductal não Infiltrante/terapia
Recidiva Local de Neoplasia/prevenção & controle
Segunda Neoplasia Primária/prevenção & controle
Nitrilos/administração & dosagem
Triazóis/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Inibidores da Aromatase/administração & dosagem
Neoplasias da Mama/química
Neoplasias da Mama/patologia
Carcinoma Ductal de Mama/química
Carcinoma Ductal de Mama/prevenção & controle
Carcinoma Ductal de Mama/secundário
Carcinoma Intraductal não Infiltrante/prevenção & controle
Quimioterapia Adjuvante/efeitos adversos
Intervalo Livre de Doença
Feminino
Seguimentos
Seres Humanos
Mastectomia Segmentar
Meia-Idade
Nitrilos/efeitos adversos
Pós-Menopausa
Receptores Estrogênicos/análise
Receptores de Progesterona/análise
Taxa de Sobrevida
Tamoxifeno/administração & dosagem
Fatores de Tempo
Triazóis/efeitos adversos
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Aromatase Inhibitors); 0 (Nitriles); 0 (Receptors, Estrogen); 0 (Receptors, Progesterone); 0 (Triazoles); 094ZI81Y45 (Tamoxifen); 7LKK855W8I (letrozole)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.1093/jnci/djx134


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[PMID]:29428039
[Au] Autor:Gusic LH; Walsh K; Flippo-Morton T; Sarantou T; Boselli D; White RL
[Ti] Título:Rationale for Mastectomy after Neoadjuvant Chemotherapy.
[So] Source:Am Surg;84(1):126-132, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Neoadjuvant chemotherapy (NAC) reduces tumor size, facilitating the use of breast conservation surgery (BCS). However, mastectomy remains the surgical outcome for certain women. The goal of this study was to determine the rationale for mastectomy after NAC, particularly in women eligible for BCS. Retrospective data were reviewed on patients who received NAC between February 2006 and August 2010 at our institution. Demographics and tumor characteristics were compared between patients who received BCS and mastectomy after NAC. Of 149 patients meeting inclusion criteria, 102 (68%) underwent BCS and 47 (32%) underwent mastectomy. Patient preference was the most common rationale for mastectomy (n = 19; 40%), followed by extent of disease (n = 13; 28%), presence of a breast cancer susceptibility gene (BRCA) mutation (n = 9; 19%), persistent positive margins (n = 5; 11%), and wound complications (n = 1; 2%). Of the 47 patients who underwent mastectomy, 37 (79%) were eligible for BCS after NAC. Larger pathologic tumor size (2.05 vs 1.25 cm, P = 0.04) and lobular histology [invasive lobular carcinomas, n = 12/17 (70%) vs invasive ductal carcinomas, n = 36/133 (27%); P < 0.01] were associated with increased rate of mastectomy. After NAC, patient preference, extent of disease, and the presence of a BRCA mutation account for the vast majority of mastectomies. Interestingly, most of these patients were shown to be candidates for breast conservation. This highlights the importance of educating patients about their surgical choice and the lack of evidence, showing a benefit to more extensive surgery.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Neoplasias da Mama
Carcinoma Ductal de Mama
Carcinoma Lobular
Tomada de Decisões
Mastectomia
Trastuzumab/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Biomarcadores Tumorais/sangue
Neoplasias da Mama/diagnóstico por imagem
Neoplasias da Mama/tratamento farmacológico
Neoplasias da Mama/genética
Neoplasias da Mama/cirurgia
Carcinoma Ductal de Mama/tratamento farmacológico
Carcinoma Ductal de Mama/genética
Carcinoma Ductal de Mama/cirurgia
Carcinoma Lobular/diagnóstico por imagem
Carcinoma Lobular/tratamento farmacológico
Carcinoma Lobular/genética
Carcinoma Lobular/cirurgia
Feminino
Seres Humanos
Mastectomia/métodos
Mastectomia Segmentar/métodos
Meia-Idade
Terapia Neoadjuvante/métodos
Invasividade Neoplásica
Estadiamento de Neoplasias
Educação de Pacientes como Assunto
Prognóstico
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Biomarkers, Tumor); P188ANX8CK (Trastuzumab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29390405
[Au] Autor:Shin YD; Choi YJ; Kim DH; Park SS; Choi H; Kim DJ; Park S; Yun HY; Song YJ
[Ad] Endereço:Department of Anesthesiology.
[Ti] Título:Comparison of outcomes of surgeon-performed intraoperative ultrasonography-guided wire localization and preoperative wire localization in nonpalpable breast cancer patients undergoing breast-conserving surgery: A retrospective cohort study.
[So] Source:Medicine (Baltimore);96(50):e9340, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study aimed to determine the efficacy of intraoperative ultrasonography-guided wire localization guided breast-conserving surgery (BCS) for nonpalpable breast cancer and compare it to conventional preoperative wire localization (PWL) guided surgery.We retrospectively analyzed the medical charts of 214 consecutive nonpalpable breast cancer patients who underwent BCS using intraoperative ultrasonography-guided wire localization by a surgeon (IUWLS) and PWL, between April 2013 and March 2017. Positive surgical margins, reexcision rates, and resection volumes were investigated.Of the total cohort, 124 patients underwent BCS with IUWLS and 90 patients with PWL. The following did not differ between the IUWLS and PWL groups: positive margin status, re-excision rate, conversion rate, permanent positive margin status, reoperation rate, median optimal resection volume (ORV), median total resection volume (TRV), and median closest tumor-free margin. Rather, median (range) widest tumor-free margin was significantly smaller in the IUWLS group (9 mm [5-12]) than in the PWL group (14 mm [9-20]; P = .003]). Median (range) calculated resection ratio (CRR) was significantly lower in the IUWLS group (1.67 [0.87-9.38]) than in the PWL group (4.83 [1.63-21.04]; P = .02).In nonpalpable breast cancer patients undergoing BCS, IUWLS showed positive resection margins and reexcision rates equivalent to those of the conventional PWL method. Additionally, excision volume and widest tumor-free margin were smaller with IUWLS, confirming that healthy breast tissue is less likely to be resected with this method. Our results suggest that IUWLS offers an excellent alternative to PWL, while avoiding PWL-induced patient discomfort.
[Mh] Termos MeSH primário: Neoplasias da Mama/diagnóstico por imagem
Neoplasias da Mama/cirurgia
Mastectomia Segmentar
Ultrassonografia Mamária/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Cuidados Intraoperatórios
Margens de Excisão
Meia-Idade
Cuidados Pré-Operatórios
Reoperação
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009340


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[PMID]:29390317
[Au] Autor:Zhang A; Li J; Qiu H; Wang W; Guo Y
[Ad] Endereço:School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences.
[Ti] Título:Comparison of rigid and deformable registration through the respiratory phases of four-dimensional computed tomography image data sets for radiotherapy after breast-conserving surgery.
[So] Source:Medicine (Baltimore);96(50):e9143, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The aim of this study was to compare the geometric differences in gross tumor volume (GTV) and surgical clips propagated by rigid image registration (RIR) and deformable image registration (DIR) using a four-dimensional computed tomography (4DCT) image data set for patients treated with boost irradiation or accelerated partial breast irradiation after breast-conserving surgery (BCS). METHODS: The 4DCT data sets of 44 patients who had undergone BCS were acquired. GTV and selected clips were manually delineated on end-inhalation phase (CT0) and end-exhalation phase (CT50) images of 4DCT data sets. Subsequently, the GTV and selected clips from CT0 images were transformed and propagated to CT50 images using RIR and DIR, respectively. The geometric differences in GTV and surgical clips from DIR were compared with those of RIR. RESULTS: The mean Dice similarity coefficient (DSC) index was 0.860 ±â€Š0.042 for RIR and 0.870 ±â€Š0.040 for DIR for GTV (P = .000). The three-dimensional distance to the center of mass (COM) of the GTV from RIR was longer than that from DIR (1.22 mm and 1.10 mm, respectively, P = .000). Moreover, in the anterior-posterior direction, displacements from RIR were significantly greater than those from DIR for both GTV (0.70 mm and 0.50 mm, respectively) and selected clips (upper clip, 0.45 mm vs 0.20 mm; inner clip, 0.55 mm vs 0.30 mm; outer clip, 0.40 mm vs 0.20 mm; lower clip, 0.50 mm vs 0.25 mm) (P = .000). However, in the left-right and superior-inferior directions, there were no significant displacement differences between RIR and DIR for GTV and the selected clips (all P > .050). CONCLUSION: DIR can improve the overlap for GTV registration from CT0 to CT50 images from 4DCT scanning. Furthermore, DIR is superior to RIR in reflecting the displacement of GTV and selected clips in the anterior-posterior direction induced by respiratory movement.
[Mh] Termos MeSH primário: Neoplasias da Mama/diagnóstico por imagem
Neoplasias da Mama/cirurgia
Tomografia Computadorizada Quadridimensional
Mastectomia Segmentar
Planejamento da Radioterapia Assistida por Computador
[Mh] Termos MeSH secundário: Adulto
Neoplasias da Mama/patologia
Feminino
Seres Humanos
Meia-Idade
Respiração
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009143


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[PMID]:27770345
[Au] Autor:Whitworth P; Beitsch P; Mislowsky A; Pellicane JV; Nash C; Murray M; Lee LA; Dul CL; Rotkis M; Baron P; Stork-Sloots L; de Snoo FA; Beatty J
[Ad] Endereço:Nashville Breast Center, Nashville, TN, USA. patwhitworth@gmail.com.
[Ti] Título:Chemosensitivity and Endocrine Sensitivity in Clinical Luminal Breast Cancer Patients in the Prospective Neoadjuvant Breast Registry Symphony Trial (NBRST) Predicted by Molecular Subtyping.
[So] Source:Ann Surg Oncol;24(3):669-675, 2017 Mar.
[Is] ISSN:1534-4681
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Hormone receptor-positive (HR+) tumors have heterogeneous biology and present a challenge for determining optimal treatment. In the Neoadjuvant Breast Registry Symphony Trial (NBRST) patients were classified according to MammaPrint/BluePrint subtyping to provide insight into the response to neoadjuvant endocrine therapy (NET) or neoadjuvant chemotherapy (NCT). OBJECTIVE: The purpose of this predefined substudy was to compare MammaPrint/BluePrint with conventional 'clinical' immunohistochemistry/fluorescence in situ hybridization (IHC/FISH) subtyping in 'clinical luminal' [HR+/human epidermal growth factor receptor 2-negative (HER2-)] breast cancer patients to predict treatment sensitivity. METHODS: NBRST IHC/FISH HR+/HER2- breast cancer patients (n = 474) were classified into four molecular subgroups by MammaPrint/BluePrint subtyping: Luminal A, Luminal B, HER2, and Basal type. Pathological complete response (pCR) rates were compared with conventional IHC/FISH subtype. RESULTS: The overall pCR rate for 'clinical luminal' patients to NCT was 11 %; however, 87 of these 474 patients were reclassified as Basal type by BluePrint, with a high pCR rate of 32 %. The MammaPrint index was highly associated with the likelihood of pCR (p < 0.001). Fifty-three patients with BluePrint Luminal tumors received NET with an aromatase inhibitor and 36 (68 %) had a clinical response. CONCLUSIONS: With BluePrint subtyping, 18 % of clinical 'luminal' patients are classified in a different subgroup, compared with conventional assessment, and these patients have a significantly higher response rate to NCT compared with BluePrint Luminal patients. MammaPrint/BluePrint subtyping can help allocate effective treatment to appropriate patients. In addition, accurate identification of subtype biology is important in the interpretation of neoadjuvant treatment response since lack of pCR in luminal patients does not portend the worse prognosis associated with residual disease in Basal and HER2 subtypes.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias da Mama/classificação
Neoplasias da Mama/tratamento farmacológico
Perfilação da Expressão Gênica
Tipagem Molecular/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Inibidores da Aromatase/uso terapêutico
Neoplasias da Mama/genética
Neoplasias da Mama/metabolismo
Hidrocarbonetos Aromáticos com Pontes/administração & dosagem
Quimioterapia Adjuvante
Tomada de Decisão Clínica
Ciclofosfamida/administração & dosagem
Doxorrubicina/administração & dosagem
Feminino
Seres Humanos
Imuno-Histoquímica
Hibridização in Situ Fluorescente
Mastectomia Segmentar
Meia-Idade
Terapia Neoadjuvante
Nitrilos/administração & dosagem
Estudos Prospectivos
Receptor ErbB-2/metabolismo
Receptores Estrogênicos/metabolismo
Receptores de Progesterona/metabolismo
Sistema de Registros
Tamoxifeno/administração & dosagem
Taxoides/administração & dosagem
Resultado do Tratamento
Triazóis/administração & dosagem
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE IV; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Aromatase Inhibitors); 0 (Bridged-Ring Compounds); 0 (Nitriles); 0 (Receptors, Estrogen); 0 (Receptors, Progesterone); 0 (Taxoids); 0 (Triazoles); 094ZI81Y45 (Tamoxifen); 15H5577CQD (docetaxel); 1605-68-1 (taxane); 2Z07MYW1AZ (anastrozole); 7LKK855W8I (letrozole); 80168379AG (Doxorubicin); 8N3DW7272P (Cyclophosphamide); EC 2.7.10.1 (ERBB2 protein, human); EC 2.7.10.1 (Receptor, ErbB-2)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1245/s10434-016-5600-x


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[PMID]:29384945
[Au] Autor:Huang Y; Wu H; Luo Z
[Ad] Endereço:Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
[Ti] Título:A retrospective study of optimal surgical management for occult breast carcinoma: Mastectomy or quadrantectomy?
[So] Source:Medicine (Baltimore);96(52):e9490, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The diagnosis and treatment for occult breast carcinoma (OBC) remain controversial because of no detectable primary lesions. We aimed to analyze optimal surgical management for OBC.A total of 26 female patients diagnosed with OBC, which were based on available criteria, were collected at a single clinic center from January 2005 to May 2016. We classified all patients into 4 groups: group A1, mastectomy with axillary lymph node dissection (ALND) + radiotherapy (RT); group A2, mastectomy with ALND; group B1, quadrantectomy with ALND + RT; group B2, quadrantectomy with ALND. Patient characteristics, disease-free survival, and overall survival were compared between groups.There were 14 cases in group A1, 5 cases in group A2, 4 cases in group B1, and 3 cases in group B2. Baseline characteristics were similar among groups. Compared with OBC patients treated with quadrantectomy, the disease-free survival (DFS) and overall survival (OS) rate of those treated with mastectomy had significantly improved (A1 vs. B1, DFS: hazard ratio [HR] 0.018, 95% confidence interval [CI] 0.001-0.241, P = .002; OS: HR 0.002, 95% CI 0.000-0.102, P = .002). Patients treated with radiotherapy had higher local recurrence and OS rate compared with patients treated with no radiotherapy on univariate survival analysis (A1 vs. A2, DFS: HR 0.018, 95% CI 0.001-0.240, P = .002; OS: HR 0.005, 95% CI 0.000-0.170, P = .003).The diagnosis of OBC will need continuous improvement with advances of diagnostic breast imaging. Modified radical mastectomy + RT is still a safe and effective choice.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Neoplasias da Mama/cirurgia
Mastectomia/métodos
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Neoplasias da Mama/mortalidade
Neoplasias da Mama/radioterapia
Feminino
Nível de Saúde
Seres Humanos
Mastectomia Radical Modificada/métodos
Mastectomia Segmentar/métodos
Menopausa
Saúde Mental
Meia-Idade
Recidiva Local de Neoplasia
Estadiamento de Neoplasias
Radioterapia Adjuvante
Estudos Retrospectivos
Análise de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009490


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[PMID]:29323648
[Au] Autor:Vaidya JS; Bulsara M; Wenz F; Tobias JS; Joseph D; Baum M
[Ad] Endereço:Division of Surgery and Interventional Science, University College London, London W1W 7EJ, UK. Electronic address: jayant.vaidya@ucl.ac.uk.
[Ti] Título:Targeted radiotherapy for early breast cancer.
[So] Source:Lancet;391(10115):26-27, 2018 01 06.
[Is] ISSN:1474-547X
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Neoplasias da Mama/radioterapia
Mastectomia Segmentar
[Mh] Termos MeSH secundário: Seres Humanos
Radioterapia
Radioterapia Adjuvante
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE


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[PMID]:29205077
[Au] Autor:Ejlertsen B; Offersen BV; Overgaard J; Christiansen P; Jensen MB; Kroman N; Knoop AS; Mouridsen H
[Ad] Endereço:a Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark.
[Ti] Título:Forty years of landmark trials undertaken by the Danish Breast Cancer Cooperative Group (DBCG) nationwide or in international collaboration.
[So] Source:Acta Oncol;57(1):3-12, 2018 Jan.
[Is] ISSN:1651-226X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Over the past 40 years the Danish Breast Cancer Cooperative Group (DBCG) has made significant contributions to improve outcome and to make treatment of patients with early breast cancer more tolerable through nationwide and international trials evaluating loco-regional and systemic treatments. These trials have been instrumental to establish standards for the treatment of early breast cancer. METHODS: The DBCG 82 trials had a global impact by documenting that the significant gain in loco-regional recurrence from postmastectomy radiation added to systemic therapy was associated with a reduction in distant recurrence and mortality in high-risk pre- and postmenopausal patients. The DBCG trials comparing breast conserving surgery and radiotherapy with mastectomy and more recently the trial of internal mammary node irradiation also had a major impact of practice. The trials initiated by the DBCG 40 years ago on tamoxifen and cyclophosphamide based chemotherapy became instrumental for the development of adjuvant systemic therapy not only due to their positive results but by sharing these important data with other members of the Early Breast Cancer Trialist' Collaborative Group (EBCTCG). Trials from the DBCG have also been important for highlighting the relative importance of anthracyclines and taxanes in the adjuvant setting. Furthermore, DBCG has made a major contribution to the development of aromatase inhibitors and targeted adjuvant treatment for human epidermal growth factor receptor 2 positive breast cancers. RESULTS: The substantial impact of these treatment improvements is illustrated by a 46.7% 10-year overall survival of early breast cancer patients treated in 1978-1987 compared to 71.5% for patients treated 2008-2012. CONCLUSIONS: The trials conducted and implemented by the DBCG appear to have a major impact on the substantial survival improvements in breast cancer.
[Mh] Termos MeSH primário: Neoplasias da Mama/mortalidade
Neoplasias da Mama/terapia
[Mh] Termos MeSH secundário: Antineoplásicos Hormonais/uso terapêutico
Antineoplásicos Imunológicos/uso terapêutico
Axila/cirurgia
Neoplasias da Mama/patologia
Quimioterapia Adjuvante
Ensaios Clínicos como Assunto
Dinamarca/epidemiologia
Fracionamento de Dose
Feminino
Seres Humanos
Cooperação Internacional
Excisão de Linfonodo
Metástase Linfática/radioterapia
Mastectomia
Mastectomia Segmentar
Estudos Multicêntricos como Assunto
Recidiva Local de Neoplasia/mortalidade
Recidiva Local de Neoplasia/terapia
Prognóstico
Radioterapia Adjuvante
Receptor ErbB-2/antagonistas & inibidores
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents, Hormonal); 0 (Antineoplastic Agents, Immunological); EC 2.7.10.1 (Receptor, ErbB-2)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1080/0284186X.2017.1408962


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[PMID]:29202621
[Au] Autor:Jensen MB; Laenkholm AV; Offersen BV; Christiansen P; Kroman N; Mouridsen HT; Ejlertsen B
[Ad] Endereço:a Danish Breast Cancer Cooperative Group (DBCG) Secretariat and Statistical Office , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark.
[Ti] Título:The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007-2016.
[So] Source:Acta Oncol;57(1):13-18, 2018 Jan.
[Is] ISSN:1651-226X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Since 40 years, Danish Breast Cancer Cooperative Group (DBCG) has provided comprehensive guidelines for diagnosis and treatment of breast cancer. This population-based analysis aimed to describe the plurality of modifications introduced over the past 10 years in the national Danish guidelines for the management of early breast cancer. By use of the clinical DBCG database we analyze the effectiveness of the implementation of guideline revisions in Denmark. METHODS: From the DBCG guidelines we extracted modifications introduced in 2007-2016 and selected examples regarding surgery, radiotherapy (RT) and systemic treatment. We assessed introduction of modifications from release on the DBCG webpage to change in clinical practice using the DBCG clinical database. RESULTS: Over a 10-year period data from 48,772 patients newly diagnosed with malignant breast tumors were entered into DBCG's clinical database and 42,197 of these patients were diagnosed with an invasive carcinoma following breast conserving surgery (BCS) or mastectomy. More than twenty modifications were introduced in the guidelines. Implementations, based on prospectively collected data, varied widely; exemplified with around one quarter of the patients not treated according to a specific guideline within one year from the introduction, to an almost immediate full implantation. CONCLUSIONS: Modifications of the DBCG guidelines were generally well implemented, but the time to full implementation varied from less than one year up to around five years. Our data is registry based and does not allow a closer analysis of the causes for delay in implementation of guideline modifications.
[Mh] Termos MeSH primário: Neoplasias da Mama/terapia
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Antineoplásicos
Neoplasias da Mama/metabolismo
Neoplasias da Mama/patologia
Quimioterapia Adjuvante
Dinamarca
Fracionamento de Dose
Feminino
Seres Humanos
Excisão de Linfonodo
Mastectomia Segmentar
Radioterapia Adjuvante
Receptor ErbB-2/antagonistas & inibidores
Sistema de Registros
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); EC 2.7.10.1 (ERBB2 protein, human); EC 2.7.10.1 (Receptor, ErbB-2)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1080/0284186X.2017.1404638


  10 / 7287 MEDLINE  
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[PMID]:29173257
[Au] Autor:Khayat E; Brackstone M; Maxwell J; Hanrahan R; Richardson J; Kapala M; Arnaout A
[Ad] Endereço:From the Division of Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Khayat, Brackstone); the Division of Surgical Oncology, Nebraska Medical Center, Omaha, NE (Maxwell); the Department of Surgery, Royal Victoria Regional Health Centre, Barrie, Ont. (H
[Ti] Título:Training Canadian surgeons in oncoplastic breast surgery: Where do we stand?
[So] Source:Can J Surg;60(6):369-371, 2017 12.
[Is] ISSN:1488-2310
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:SUMMARY: Breast-conserving surgery with adjuvant radiation therapy is widely accepted as a universal standard of care for women with early-stage breast cancer. Oncoplastic breast-conserving surgery (OPS) techniques have emerged in recent years, facilitating the achievement of better cosmetic results while adhering to good oncological principles. Compared with the rest of the international community, Canada has been fairly slow in its clinical uptake of OPS. This commentary discusses how Canada can increase its capacity for OPS.
[Mh] Termos MeSH primário: Neoplasias da Mama/cirurgia
Mastectomia Segmentar/educação
[Mh] Termos MeSH secundário: Canadá
Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180117
[Lr] Data última revisão:
180117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE



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