Evaluation of breast cancer treatment at a tertiary-level institution with Popular Health Insurance in Mexico [Evaluación del tratamiento del cáncer de mama en una institución del tercer nivel con el Seguro Popular, México]
Arce-Salinas C.,Oncologia Medica |
Lara-Medina F.U.,Oncologia Medica |
Alvarado-Miranda A.,Oncologia Medica |
Castaneda-Soto N.,Oncologia Medica |
And 6 more authors.
Revista de Investigacion Clinica | Year: 2012
Background. In our country, breast cancer represents a major health problem. Only 45% of all population has access to health services, the consequence is delay in diagnosis and treatment. In Mexico, 66% of all new cases of breast cancer are diagnosed in locally advanced stages. From May 2007 the Health System Protection Against Catastrophic Expenses, called Seguro Popular (SP), breast cancer was included in covering the treatment of this neoplasm in any patient without access to social security. Objective. To evaluate the results and impact of SP in the adjuvant and neoadjuvant treatment of a group of patients diagnosed with breast cancer at an institution of national reference. Material and methods. We analyzed a group of 259 patients in stages (I-IIIC). The clinical stages I and II (55 patients) were treated with adjuvant chemotherapy FAC - T (fluorouracil 500 mg/m 2, adriamycin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 (FAC) followed by 12 weeks of paclitaxel 80 mg/m 2 ± trastuzumab loading dose of 4 mg/kg followed by 2 mg/kg); 204 patients in locally advanced stages (HB-IIIC) received FAC-T ± trastuzumab followed by surgery. Adjuvant treatment consisted of endocrine therapy for hormone-sensitive patients and radiotherapy 50 cGy according to international standards. Results. The age at diagnosis was 47 years (range 23-68). 80% of them were locally advanced stages (HB-IIIC) and were treated in a neoadjuvant setting, 20% was in early stages, treated with surgery and adjuvant chemotherapy. The disease-free survival and overall survival at 30 months was 85.7 and 90% respectively. Overall pathologic complete response was obtained in 15% of cases. In the subgroup analysis showed that 41% of patients HER2 (+), 29% of triple-negative patients and 9% of hormone-sensitive tumors achieved complete pathological response (p = 0.0001). Conclusion. This is the first analysis of efficacy of adjuvant and neoadjuvant treatment in breast cancer since the introduction of popular secure non-entitled population. It is clear that treatment efficacy is similar to that reported in the literature, with 15% of pRC and survival to 30 months in 94-80%. The coverage of health expenditures treats a larger number of patients optimally. Along with this, efforts should be made to reduce the high frequency of diagnosis at advanced stage.
Torres-Lobaton A.,Ginecologia Oncologica |
Torres-Lobaton A.,Hospital General Of Mexico Od |
Lara-Gutierrez C.,Hospital General Of Mexico Od |
Torres-Rojo A.,Cirugia Oncologica |
And 9 more authors.
Ginecologia y Obstetricia de Mexico | Year: 2010
Background: Pelvic exenteration offers the last chance of cure for some patients with cervical cancer recurrent after radiation therapy. Objective: To analyze factors associated with recurrence and survival after pelvic exenterations, based on a 40 years institutional experience. Material and method: Retrospective, logitudinal and closed study from files of patients who survived to exenterative procedures at Oncology Department at the Hospital General de México, from January 1966 to December 2006, were screened in order to know risk factors predicting recurrence and survival in a follow up for at least three years. Results: Prognostic factors in 161 patients eligible for this analysis were: diagnosis of recurrence prior 1 year 44/96 (45.8%) vs. 27/41 (65.8%) diagnosis after this time (p = 0.03), central recurrences 32/38 (84.2%) vs. 14/49 (28.5%) infiltration of lateral wall of the pelvis (0.0001), patients with 35 years old or less had a better prognosis when compared with the others: 23/33 (69%) vs. 60/128 (46%), (0.01); Infiltration of urinary bladder and or rectal wall 30/75 (40%) vs. 53/86 (61%) absence of these (0.006), tumor involving myometrium with or without adnexal metastases 6/25 (24%) vs. 77/136 (56%) absence of these reports (0.002), presence of three or more positive lymph nodes 5/16 (31%) vs. 56/90 (62%) absence of lymph nodes metastasis (0.02) and findings of hydronephrosis 2/15 (13.3%) vs. 13/19 (68.4%) of normal reports (0.01). Conclusions: Better evolution in this series was for patients who had central recurrences.
Subareolar injection: A potential cause of false negative in the selective biopsy of the sentinel node in breast cancer [Inyección subareolar: potencial causa de falso negativo en la biopsia selectiva de ganglio centinela en cáncer de mama]
Rioja Martin M.E.,Medicina Nuclear |
Ortega Perez G.,Cirugia Oncologica |
Cabanas Montero L.J.,Cirugia Oncologica |
Munoz-Madero V.,Cirugia Oncologica |
Cabanas Navarro L.,Cirugia Oncologica
Revista Espanola de Medicina Nuclear | Year: 2011
Sentinel node biopsy has become the standard practice in lymph node staging in breast cancer in early stages. However, uncertainty remains regarding the best method of radiotracer/dye injection. Currently, the subareolar injection is being widely used because of its technical simplicity and higher rates of SN location versus the so-called deep techniques (peritumoral, intratumoral) that require greater specialization and greater use of resources in the non-palpable lesions.We present a case of a discrepancy between the two techniques that could have caused a false negative. © 2010 Elsevier España, S.L. y SEMNIM.