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Palliative surgery of breast cancer

Adrienne G Waks, Eric P Winer
Importance: Breast cancer will be diagnosed in 12% of women in the United States over the course of their lifetimes and more than 250 000 new cases of breast cancer were diagnosed in the United States in 2017. This review focuses on current approaches and evolving strategies for local and systemic therapy of breast cancer. Observations: Breast cancer is categorized into 3 major subtypes based on the presence or absence of molecular markers for estrogen or progesterone receptors and human epidermal growth factor 2 (ERBB2; formerly HER2): hormone receptor positive/ERBB2 negative (70% of patients), ERBB2 positive (15%-20%), and triple-negative (tumors lacking all 3 standard molecular markers; 15%)...
January 22, 2019: JAMA: the Journal of the American Medical Association
J H Seo, S M Lee, S N Yu, J W Lee, J E Lee
We report the case of a breast cancer patient in whom a two-phase 18 F-sodium-fluoride (18 F-NaF) bone PET/CT was useful for detecting hidden bone metastases and assessing treatment response. The patient underwent a two-phase bone PET/CT to evaluate a newly developed lesion found on bone scintigraphy following surgery. In the perfusion and bone phase PET/CT images, focally increased perfusion and bony uptake were found in the sacrum and L5 vertebra, suggesting bone metastases of breast cancer. Therefore, the patient subsequently underwent palliative treatment...
January 18, 2019: Revista Española de Medicina Nuclear e Imagen Molecular
Yixuan Li, Yulan Peng, Xin He
RATIONALE: The term cystic breast lesions is a sonographic diagnosis, which can be categorized as simple, complicated or complex. The complex cysts are deemed as having a low risk of breast cancer. The highly aggressive invasive ductal carcinomas among complex cysts, in particular, are infrequent reported. PATIENT CONCERNS: A 56-year-old female with a breast complex cyst who, after fine-needle aspiration, complained about oozing with fluid as well as skin ulceration that did not heal...
December 2018: Medicine (Baltimore)
Stefano Guadagni, Karl Aigner, Odisseas Zoras, Francesco Masedu, Giammaria Fiorentini, Enrico Ricevuto, Marcello Deraco, Marco Clementi
The median overall survival of metastatic breast cancer (MBC) patients is still approximately 2 years. This is even lower in triple-negative breast cancer (TNBC) patients with concomitant lung metastases. These patients are often not suitable for surgery and not responsive to systemic chemotherapy. Isolated thoracic perfusion (ITP) followed by chemofiltration has been used for palliation in selected specialised centres. A retrospective observational study evaluating 162 MBC patients who underwent 407 ITP procedures was performed...
December 12, 2018: Updates in Surgery
Ambinintsoa H Ralaidovy, Chaitra Gopalappa, André Ilbawi, Carel Pretorius, Jeremy A Lauer
Background: Following the adoption of the Global Action Plan for the Prevention and Control of NCDs 2013-2020, an update to the Appendix 3 of the action plan was requested by Member States in 2016, endorsed by the Seventieth World Health Assembly in May 2017 and provides a list of recommended NCD interventions. The main contribution of this paper is to present results of analyses identifying how decision makers can achieve maximum health gain using the cancer interventions listed in the Appendix 3...
2018: Cost Effectiveness and Resource Allocation: C/E
Maho Ogawa, Tsutomu Namikawa, Toyokazu Oki, Jun Iwabu, Masaya Munekage, Hiromichi Maeda, Takahiko Tamura, Tomoaki Yatabe, Hiroyuki Kitagawa, Ken Dabanaka, Takeki Sugimoto, Michiya Kobayashi, Kazuhiro Hanazaki
The most common sites of breast cancer metastasis are the bone, liver, lung and brain, while gastrointestinal metastasis from breast cancer is rare. We herein present the case of a 68-year-old woman who was admitted to our department with nausea and appetite loss. The patient's medical history included right mastectomy with sentinel lymph node biopsy 5 years earlier for invasive lobular carcinoma, measuring 6.2 cm in greatest diameter, without lymphovascular invasion. Two years after the surgery, the patient developed brain metastasis and underwent metastasectomy to control the neurological symptoms, including unsteadiness and asthenia...
November 2018: Molecular and Clinical Oncology
Hong Pan, Kai Zhang, Ming Wang, Lijun Ling, Wenbin Zhou, Shui Wang
BACKGROUND: Many elderly breast cancer patients might just receive palliative local surgery, especially those with locally advanced breast cancer (LABC). However, palliative tumor removal might lead to perioperative residual tumor growth. In this study, we aimed to determine the survival effect of palliative local surgery without definitive axillary surgery for LABC in elderly patients. PATIENTS AND METHODS: Patients age 70 years or older diagnosed with T3/4M0 breast cancer, who received no surgery, mastectomy, or lumpectomy without axillary surgery, were identified in the Surveillance, Epidemiology, and End Results cancer database from 1973 to 2014...
September 27, 2018: Clinical Breast Cancer
Masaya Kai, Makoto Kubo, Hitomi Kawaji, Kanako Kurata, Hitomi Mori, Mai Yamada, Masafumi Nakamura
The role of the resection of primary tumour in stage IV breast cancer is unclear. Systemic therapy is recommended to prolong the survival and improve the quality of life (QOL). However, even if the systemic therapy is effective to control distant metastasis, sometimes the local lesion worsens, especially in the aggressive subtypes such as HER2-positive breast cancer. In uncontrollable tumours, the wound bed can bleed, weep and get infected, leading to dismal QOL. Our study describes two cases of patients with HER2-positive stage IV breast cancer who underwent palliative mastectomy which resulted in improvement of QOL...
September 25, 2018: BMJ Supportive & Palliative Care
Caitlin Yee, Yasir Alayed, Leah Drost, Irene Karam, Danny Vesprini, Claire McCann, Hany Soliman, Liying Zhang, Edward Chow, Stephanie Chan, Justin Lee
BACKGROUND: Management of locally-advanced breast cancer is determined by multiple factors, but in patients without distant metastases often involves neoadjuvant systemic therapy, surgery and radiation. If the primary tumour remains unresectable following systemic therapy, radiotherapy may be used for tumour shrinkage prior to surgery. When metastatic disease is present, locoregional radiotherapy is generally reserved for management of tumour-related symptoms. We reviewed our experience of high-dose radiotherapy for unresected locally-advanced breast cancer...
October 2018: Annals of Palliative Medicine
Digpal V Dharkar, Sonia Moses
Couple of decades ago, Palliative Mastectomy for locally advanced breast cancers was common, if not frequent surgical procedure in the surgical armamentarium. The advent of better understanding of tumor biology and better multidisciplinary management has certainly narrowed down its role. However there are situations where it is still a potent option. In the subset of patients where palliative mastectomy is to be performed, it is important to aim for clear surgical margins, with good clearance at the third dimension, i...
July 2018: Indian Journal of Palliative Care
Kartick Rastogi, Sandeep Bhaskar, Shivani Gupta, Sandeep Jain, Daleep Singh, Pawan Kumar
Context: Brain metastasis is one of the most feared complications of cancer that poses significant mortality and morbidity in patients with advanced cancer. The incidence is rising because of greater use of magnetic resonance imaging and spectroscopy; and increased survival from recent advances in immunotherapy and modern radiotherapy techniques. Despite all, the prognosis remains poor. Aims: This study aimed to analyze prognostic factors and overall survival in patients with brain metastases...
July 2018: Indian Journal of Palliative Care
Adam Gyedu, Cameron E Gaskill, Kwabena Agbedinu, Daniela Rebollo Salazar, T Peter Kingham
BACKGROUND AND OBJECTIVES: Outcome data after surgery for cancer in Sub-Saharan Africa are insufficient. We aimed to describe the presentation and outcomes of patients with solid cancers managed at a tertiary hospital in Ghana. METHODS: Records of cancer patients admitted to Komfo Anokye Teaching Hospital general surgery wards from 2013 to 2016 were reviewed for data on presentation, staging, management, and mortality. Patients discharged alive were followed-up by biannual telephone calls to establish their postdischarge status...
September 2018: Journal of Surgical Oncology
Hideaki Takahashi, Mizuho Isogawa
Brain metastases are usual in breast cancer with poor prognosis and few available therapeutic options. The efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) against brain metastases from EGFR mutation-positive non-small cell lung cancer (NSCLC) showed promising antitumor activity, on the other hand, the main treatment of breast cancer brain metastases (BCBMs) is only local therapy such as surgery or radiotherapy. The goal of treatment includes stabilizing or improving neurological function and palliating neurological symptom...
June 2018: Chinese Clinical Oncology
Mediget Teshome
The role of operative therapy in stage IV breast cancer continues to evolve with advances in therapy and improvements in survival among this population. Traditionally surgery was performed with palliative intent to alleviate symptoms related to the intact breast primary. Several retrospective studies have challenged this paradigm, demonstrating survival advantage with surgery in de novo metastatic disease. Prospective studies are ongoing and maturing data. A comprehensive approach to local therapy following systemic therapy may be beneficial to achieve improved survival outcome associated with stage IV- no evidence of disease and to decrease local failure in inflammatory breast cancer...
August 2018: Surgical Clinics of North America
Leah L Zullig, Gretchen Kimmick, Valerie Smith, Katie Little, Hayden B Bosworth, Sarah Gonzales, Megan M Oakes, Rebecca A Shelby, Lynda Owen, Ivy P Altomare
OBJECTIVE: Geriatric screening tools assess functional limitations and inform clinical decision-making for older adults with cancer. Our objective was to evaluate the feasibility and effectiveness of a screener in community-based oncology clinics. MATERIALS AND METHODS: Eligible patients were from two rural, underserved community-based cancer clinics; within 12 months of a cancer diagnosis (breast, lung, colorectal, pancreas, esophageal); aged ≥60 years; and not exclusively pursuing palliative care...
June 27, 2018: Journal of Geriatric Oncology
Naren Ramakrishna, Sarah Temin, Sarat Chandarlapaty, Jennie R Crews, Nancy E Davidson, Francisco J Esteva, Sharon H Giordano, Jeffrey J Kirshner, Ian E Krop, Jennifer Levinson, Shanu Modi, Debra A Patt, Jane Perlmutter, Eric P Winer, Nancy U Lin
Purpose To update the formal expert consensus-based guideline recommendations for practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2-positive advanced breast cancer to 2018. Methods An Expert Panel conducted a targeted systematic literature review (for both systemic treatment and CNS metastases) and identified 622 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events. In 2014, the American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts, and conducted a systematic review of the literature...
September 20, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Balkees Abderrahman, V Craig Jordan
The signing of the National Cancer Act in 1971 was designed to take laboratory discoveries rapidly from the bench to the bedside. A "war on cancer" had been declared. Combination cytotoxic chemotherapy was predicted to cure all cancers, based on the stunning success in treating childhood leukemia. Breast cancer treatments were primitive; radical mastectomy and radiation were standard of care for disease that had not spread. Ablative endocrine surgery (oophorectomy, hypophysectomy, and adrenalectomy) was a palliative last option for metastatic breast cancer...
August 1, 2018: Endocrinology
Trevor J Royce, Muhammad M Qureshi, Minh Tam Truong
BACKGROUND: The changing use of radiation as a first-line cancer therapy in the United States is poorly characterized. This study aims to report radiotherapy utilization and fractionation patterns during the first course of cancer treatment. METHODS: We extracted all solid tumor cases from 2004 to 2014 in the National Cancer Data Base, which captures only the first course of treatment. Patients were subcategorized by disease site: breast, central nervous system (CNS), gastrointestinal, genitourinary, gynecologic, head and neck (HN), musculoskeletal, skin, or thoracic...
June 11, 2018: Journal of the American College of Radiology: JACR
Samdeep K Mouli, Ramona Gupta, Neil Sheth, Andrew C Gordon, Robert J Lewandowski
Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease...
March 2018: Seminars in Interventional Radiology
Neal Shah, Afroz S Mohammad, Pushkar Saralkar, Samuel A Sprowls, Schuyler D Vickers, Devin John, Rachel M Tallman, Brandon P Lucke-Wold, Katherine E Jarrell, Mark Pinti, Richard L Nolan, Paul R Lockman
In women, breast cancer is the most common cancer diagnosis and second most common cause of cancer death. More than half of breast cancer patients will develop metastases to the bone, liver, lung, or brain. Breast cancer brain metastases (BCBM) confers a poor prognosis, as current therapeutic options of surgery, radiation, and chemotherapy rarely significantly extend life and are considered palliative. Within the realm of chemotherapy, the last decade has seen an explosion of novel chemotherapeutics involving targeting agents and unique dosage forms...
June 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
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