Cancer progression is associated with an evolving tissue interface of direct epithelial-tumor microenvironment interactions. In biopsies of human breast tumors, extensive alterations in molecular pathways are correlated with cancer staging on both sides of the tumor-stroma interface. These interactions provide a pivotal paracrine signaling to induce malignant phenotype transition, the epithelial-mesenchymal transition (EMT). We explored how the direct contact between platelets-fibrin bundles primes metastasis using platelet-rich plasma (PRP) as a source of growth factors and mimics the provisional fibrin matrix between actively growing breast cancer cells and the tumor stroma. We have demonstrated PRP functions, modulating cell proliferation that is tumor-subtype and cancer cell-type-specific. Epithelial and stromal primary cells were prepared from breast cancer biopsies from 21 women with different cancer subtypes. Cells supplemented with PRP were immunoblotted with anti-phospho and total Src-Tyr-416, FAK-Try-925, E-cadherin, N-cadherin, TGF-β, Smad2, and Snail monoclonal antibodies. Breast tumor cells from luminal B and HER2 subtypes showed the most malignant profiles and the expression of thrombin and other classes of proteases at levels that were detectable through FRET peptide libraries. The angiogenesis process was investigated in the interface obtained between platelet-fibrin-breast tumor cells co-cultured with HUVEC cells. Luminal B and HER2 cells showed robust endothelial cell capillary-like tubes ex vivo. The studied interface contributes to the attachment of endothelial cells, provides a source of growth factors, and is a solid substrate. Thus, replacement of FBS supplementation with PRP supplementation represents an efficient and simple approach for mimicking the real multifactorial tumor microenvironment.
Studies showing evidence that early functional rehabilitation process is a safe practice for women having surgery for breast cancer, as well as the present research, are of interest to health professionals who care for these patients and contribute to the wider global clinical community.
Objective: The objective is to evaluate the effect of limiting shoulder range of motion (ROM) for 15 or 30 days on surgical complications and on shoulder ROM, pain, and upper limb function of breast cancer patients following conservative oncoplastic surgery.Materials and Methods: A randomized clinical trial was conducted with 60 women with breast cancer who underwent conservative oncoplastic surgery. The day after surgery, all patients started an exercise protocol with shoulder exercises limited to 90 degrees. Two weeks after surgery they were randomized into Free ROM Group (n = 30) or Limited ROM Group (n = 30). The Free ROM Group was allowed to perform shoulder exercises with unlimited ROM; the Limited ROM Group continued with shoulder movement restricted at 90 degrees until 30 days after surgery, at which time they were also allowed free ROM. The primary outcome was the incidence of postoperative complications (dehiscence, seroma, infection, and necrosis) and secondary outcomes were shoulder ROM, pain, and upper limb function.Results: No difference in the incidence of postoperative scar complications between groups was noted. There was no difference between the groups in shoulder joint amplitude, pain, or upper limb function. Conclusions:The free ROM exercise protocol 15 days post surgery was safe concerning cicatricial complications.
OBJECTIVE: To compare skin sensitivity in patients diagnosed with breast cancer undergoing cycles of chemotherapy with taxanes, applied three different techniques, acupuncture needles, acupuncture with silicon tablets (Stiper) and kinesiotherapy. DESIGN: Randomized, controlled, open, parallel clinical trial. Inclusion criteria: women undergoing chemotherapy with taxanes from the 1st cycle onwards both neoadjuvant and adjuvant with stages I to III. Excluded were women with pre-existing diseases such as cancer in locoregional or distant activity, previous joint pain, rheumatologic diseases, and not undergoing chemotherapy containing Anthracyclines and/or Cisplatin, and those who had acupuncture in another service in the last three. METHODS: This study was carried out at the Oncomastology, Outpatient Clinic of the Mastology Discipline of the Gynecology Department of the Federal University of São Paulo (UNIFESP). 102 patients diagnosed with breast cancer. Excluded 39 patients,63 volunteers were selected and randomized, allocated to three groups (Group S:Stiper n=26, Group A Acupuncture n=18: and Group C: Kinesiotherapy n=19) to undergo treatment once a week for ten consecutive weeks. Signed the Informed Consent Form and agreed to participate in the project (ICF). INTERVENTION: Division of the groups, GS - non-invasive acupuncture technique (silicon pads covered with acrylic blanket) are used for stimulation of acupuncture points on the meridians. GA: acupuncture applied the technique with sterile, disposable systemic needles, (measuring 0.25mm x 30mm) for stimulation of the acupuncture points on the meridians. GC Kinesiotherapy, a physiotherapy technique consisting of upper and lower limb exercises and lower limb proprioception training and sensitivity improvement with vibration. GS, GA, performed acupuncture on the acupoints (B11Dazhu, SI14 Jianwaishu, CV12 Zhongwan, GB34 Yanglingquan, SP6 Sanyinjiao, LR3 Taichong), frequency of 1 time per week, for 10 consecutive weeks, duration of 30 minutes per session. To evaluate Sensitivity, the stesiometer was used, consisting of microfilaments thickness and the force (in grams) needed to bend the filaments, the colors and values are: green (0.05 g), blue (0.2 g), violet (2.0 g), dark red (4.0 g), orange (10.0 g) and magenta red (300 g).The evaluation of quality of life FACT/GOG-Ntx before and after treatment. RESULTS: The qualitative demographic characteristics of patients at the chemotherapy. Neoadjuvant Chemotherapy was predominantly in the three groups: GS(88.5%), GA(83.3%)and GC(89.5%), p=0.83. Cancer type CINE (Non-special Invasive Carcinoma), GS(92.6%), GA (93.8%) and GC (94.4%), p= 0.58. Diabetes Melittus GS(84.6%), GA(77.8%) and GC(79.8%), p=0.82 and Systemic Hypertension GS(72%), GA(72.2%) and GC(52.6%), p=0, 32. The C6D upper limb skin sensitivity assessment (p < 0.04 intergroup GS, GA and GC). T1D (p < 0.03 intergroup GS, GA and GC), corresponds to the forearm region. FACT/GOG-Ntx quality of life questionnaire in the domains (PWB, FWB and TaxS), Taxane Trial Outcome Index (TOI) comparing 1st session with 10th session p< 0.02, TaxS (Evaluates Symptoms of Chemotherapy Induced Peripheral Neuropathy) comparing 1st session with 10th session p< 0.03. Taxane total score) comparing 1st session with 10th session, p< 0.03. CONCLUSION: The C6 right hand and T1 right forearm sensitivity changes showed improvement in skin sensitivity after the intragroup intervention. FACT/GOG-Ntx questionnaire showed worsening of symptoms, physical, functional and peripheral neuropathy symptoms induced by chemotherapy compared to before and after. The cutaneous sensitivity of hands and feet remained stable and improved in the upper limbs, but chemotherapy had a negative impact on the quality of life, requiring further studies to evaluate the neuropathy of these patients. Keywords: Acupuncture, Chemotherapy, Quality of Life, Integrative and Complementary Practices.Table 1. Characteristics of skin sensitivity between groupsTable 1. Characteristics of skin sensitivity between groups Citation Format: ROBERTA P. COSTA LUZ, Carmen S. Alliz, Samantha K. Lopes de Almeida Rizzi, Cinira Haddad, Christiano Bittencourt Machado, Afonso Nazário, Gil Facina. COMPARATIVE ANALYSIS BETWEEN ACUPUNCTURE AND EXERCISE IN IMPROVING DERMAL SENSITIVITY DURING PACLITAXEL-CONTAINING CHEMOTHERAPY: A RANDOMIZED CLINICAL TRIAL [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-18-01.
Introduction: The continuous advance in the early detection and treatment of breast cancer has significantly reduced mortality and, consequently, increased the number of survivors with treatment side effects that act on the quality of life, such as lymphedema, loss of upper limb strength, shoulder dysfunction, decreased functional capacity, flexibility, and joint mobility. Exercise therapy is a recognized practice for the rehabilitation of these disorders; however, acupuncture needs to be better evaluated to compare its equivalence with classical therapy. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing strength, lymphedema and quality of life. Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement in upper limb muscle strength over time in all groups, except for abduction and internal rotation movements. During treatment, there was no increase in the number of patients with lymphedema and there was no statistical difference between the groups. Regarding the EORTC QLQ-C30 quality of life questionnaire, nine of the fifteen factors analyzed showed significant differences between sessions. The factors that did not have significant differences between the three groups were Social Function, Nausea and Vomiting, Dyspnea, Loss of Appetite, Constipation and Diarrhea. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in upper limb muscle strength, lymphedema and quality of life, proved to be effective, without difference between groups, which leads to the conclusion that acupuncture didn’t show superiority of results when compared with exercise therapy, thus being an effective approach for the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Samantha K. Lopes de Almeida Rizzi, Afonso Nazário, Simone Elias. Effect of acupuncture and exercise therapy on muscular strength, lymphedema and quality of life in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-10.
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