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Offenburg, Germany

Cuzick J.,Queen Mary, University of London | DeCensi A.,Oncologia Medica | DeCensi A.,Italian National Cancer Institute | Arun B.,University of Texas M. D. Anderson Cancer Center | And 10 more authors.
The Lancet Oncology | Year: 2011

In March, 2010, a group of breast cancer experts met to develop a consensus statement on breast cancer prevention, with a focus on medical and therapeutic interventions. We present the conclusions in this Review. First we agreed that the term chemoprevention is inappropriate and suggested that the term preventive therapy better represents this feature of management. Two selective oestrogen-receptor modulators-tamoxifen and raloxifene-are so far the only medical options approved by the US Food and Drug Administration for preventive therapy. Of these tamoxifen has greater efficacy and can be used in premenopausal women, but raloxifene has fewer side-effects. Two newer drugs in this class, lasofoxifene and arzoxifene, also show efficacy and possibly a better overall risk-benefit profile, but need further assessment. Aromatase inhibitors might be more efficacious, and results of prevention trials are eagerly awaited. Newer agents, notably bisphosphonates and metformin, have shown promise in observational studies and need to be assessed in randomised prevention trials. Other agents, such as aspirin, other non-steroidal anti-inflammatory drugs, COX-2 inhibitors, retinoids, rexinoids, and dietary components have limited effects or are in the early phases of investigation. New contralateral tumours in women with breast cancer might be generally useful as a model for prevention, as has been seen for tamoxifen. If valid such a model would facilitate the design of simpler, cheaper, and better-focused trials for assessing new agents. © 2011 Elsevier Ltd.

Eichler C.,Holweide Hospital | Dahdouh F.,Brustzentrum | Sauerwald A.,Hospital Duren GmbH | Warm M.,Witten/Herdecke University
Journal of Medical Case Reports | Year: 2013

Introduction. Post-mastectomy seromas are a common problem in modern oncological surgery. Occurrence rates of up to 59% have been reported in the literature. High-risk patients, that is, those who have received previous surgeries, radiation or chemotherapy, present a particular challenge. Several surgical techniques, including progressive tension suture application, have shown promise. Noninvasive measures such as fibrin-based adhesives have thus far not been able to prevent seroma occurrence effectively. A recent study using a lysine-derived urethane adhesive named TissuGlu®, however, showed promising results in patients after abdominoplasty. Case presentation. We used TissuGlu® to treat a high-risk 64-year-old female patient with a history of breast cancer and severe post-mastectomy seroma. The postsurgical period showed successful seroma suppression, without any adverse effects or complications. Conclusions: This type of adhesive should be evaluated as an alternative, less-invasive option for preventing seroma in patients after a mastectomy. © 2013 Eichler et al.; licensee BioMed Central Ltd.

A case on which a medical expert opinion was requested demonstrates how cancer-therapy-related fatigue may be misjudged. Fatigue is a particularly distressing and persistent form of often leaden tiredness and exhaustion, which is not explained by a prior, particular exertion, nor can be improved by adequate sleep and rest. This leads to physical, emotional and mental exhaustion, which may occur combined, but also solely. Even normal everyday activities such as eating, cleaning up, climbing stairs or shopping deprive the patients of all energies. Fatigue is the most common side effect of cancer treatment, which usually improves with time after treatment, but may persist for months and even years. Then it has negative impacts on all levels of life. A long-lasting fatigue must be distinguished from depression, the typical treatment of which is not only ineffective for fatigue and may even increase it. Although known in oncology for decades, beyond this specialty it is given too little attention with serious consequences for patients.

Harbeck N.,Ludwig Maximilians University of Munich | Schmitt M.,Ludwig Maximilians University of Munich | Meisner C.,University of Tubingen | Friedel C.,Ludwig Maximilians University of Munich | And 10 more authors.
European Journal of Cancer | Year: 2013

Aim: Final 10-year analysis of the prospective randomised Chemo-N0 trial is presented. Based on the Chemo-N0 interim results and an European Organisation for Research and Treatment of Cancer (EORTC) pooled analysis (n = 8377), American Society of Clinical Oncology (ASCO) and Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) guidelines recommend invasion and metastasis markers urokinase-type plasminogen activator (uPA)/plasminogen activator inhibitor-1 (PAI-1) for risk assessment and treatment decision in node-negative (N0) breast cancer (BC). Methods: The final Chemo-N0 trial analysis (recruitment 1993-1998; n = 647; 12 centres) comprises 113 (5-167) months of median follow-up. Patients with low-uPA and PAI-1 tumour tissue levels (n = 283) were observed. External quality assurance guaranteed uPA/PAI-1 enzyme-linked immunosorbent assay (ELISA) standardisation. Of 364 high uPA and/or PAI-1 patients, 242 agreed to randomisation for CMF chemotherapy (n = 117) versus observation (n = 125). Results: Actuarial 10-year recurrence rate (without any adjuvant systemic therapy) for high-uPA/PAI-1 observation group patients (randomised and non-randomised) was 23.0%, in contrast to only 12.9% for low-uPA/PAI-1 patients (plog-rank = 0.011). High-risk patients randomised to cyclophosphamide-methotrexate-5-fluorouracil (CMF) therapy had a 26.0% lower estimated probability of disease recurrence than those randomised for observation (intention-to-treat (ITT)-analysis: hazard ratio (HR) 0.74 (0.44-1.27); plog-rank = 0.28). Per-protocol analysis demonstrated significant treatment benefit: HR 0.48 (0.26-0.88), p = 0.019, disease-free survival (DFS) Cox regression, adjusted for tumour stage and grade. Conclusions: Chemo-N0 is the first prospective biomarker-based therapy trial in early BC defining patients reaching good long-term DFS without adjuvant systemic therapy. Using a standardised uPA/PAI-1 ELISA, almost half of N0-patients could be spared chemotherapy, while high-risk patients benefit from adjuvant chemotherapy. These 10-year results validate the long-term prognostic impact of uPA/PAI-1 and the benefit from adjuvant chemotherapy in the high-uPA/PAI-1 group at highest level of evidence. They thus support the guideline-based routine use of uPA/PAI-1 for risk-adapted individualised therapy decisions in N0 breast cancer. © 2013 Elsevier Ltd. All rights reserved.

Thill M.,Klinik fur Gynakologie und Geburtshilfe | Barinoff J.,Klinik fur Gynakologie und Geburtshilfe | Hoellen F.,Universitatsklinikum Schleswig Holstein | Faridi A.,Brustzentrum
Gynakologe | Year: 2016

In recent years there has been an intensive discussion about how to define a negative surgical resection margin. Despite the impact of radiation and systemic therapy a positive margin in breast surgery is associated with an increased risk of local recurrence. Thus, a positive margin confirmed by the pathologist results in further surgery that is troublesome for the patient in several ways and can also delay the initiation of adjuvant treatment. Therefore, the field of intraoperative margin assessment was intensively investigated and methods and technologies have been developed to support the breast surgeon in the operating theater. Some of these developments, such as frozen sections, touch imprint cytology, intraoperative ultrasound and radiofrequency spectroscopy are now established in the clinical routine. Others, such as near-infrared optical imaging, X-ray diffraction, high-frequency ultrasound and micro-computed tomography (CT) are still in the experimental stage. This article illustrates the current status of defining a negative surgical margin and gives an overview of the various and innovative technologies for intraoperative margin assessment. © 2015, Springer-Verlag Berlin Heidelberg.

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