HER2 overexpression occurs in 25% of breast cancers and seems to correlate with poor prognosis. HER2 overexpression may predict tamoxifen failure and different response rates to chemotherapeutic agents such as the taxanes and anthracyclines. The detection of HER2 and its overexpression is performed using fluorescent in situ hybridisation (FISH) and/or immunohistochemistry (IHC). Trastuzumab [Herceptin (H)] is a humanised IgG monoclonal antibody specific for the growth factor receptor HER2. Pre-clinical trials using monoclonal antibodies have shown inhibition of breast tumour growth in athymic nude mice. Phase II and III clinical trials have evaluated the efficacy and safety of Herceptin in women with metastatic breast cancer in combination with other agents and as a single agent. Currently, Trastuzumab and paclitaxel is the only combination indicated for the treatment of patients with metastatic breast cancer whose tumours overexpress HER2. It is also indicated as a single agent in women with HER2-overexpressing metastatic breast cancer that has progressed after previous chemotherapy. Herceptin is a well-tolerated drug and the side-effects that are commonly seen with chemotherapy, such as neutropenia, alopecia and mucositis, are rarely observed. The main risk factors for cardiotoxicity are concurrent or previous anthracycline exposure. The potential role of Herceptin in the adjuvant setting is currently being evaluated.
Letters to the Editor 187 used. The case for oral systemic corticosteroids is as yet unproven. Necrotic tissue should be removed. Pneumonia is common in severe cases.7 In conclusion, TEN is a rare side-effect of indomethacin therapy. Awareness of this association is important for two reasons: TEN is potentially lethal and indomethacin is widely used in the UK.
Giant juvenile fibroadenomas in patients with hemihypertrophy are exceptionally rare. We present a very interesting case of a 13 year old girl with hemihypertrophy of the left side presenting with recurrent giant juvenile fibroadenomas of the left breast. The giant fibroadenomas occurred twice in the left breast over two years. The first had a diameter of 12 cm and was excised through an inframammary incision. The second occurred a year later, had a diameter of 11 cm, and was associated with three smaller fibroadenomas. These lesions were removed through a single periareolar incision. The procedures were complicated by keloid scarring but the results were improved with steroid impregnated tape dressing and local methylprednisolone injection. This report adds to our experience in managing patients with recurrent giant juvenile fibroadenomas complicated by hemihypertrophy and raises awareness to anticipate keloid scarring.
This study demonstrates that local anesthetic delivery via a surgical drain provides improved pain control compared to direct skin infiltration following axillary node dissection. This is likely to be important for the management of acute pain in the immediate post-operative period; however, further studies may be required to validate this in specific patient subgroups, e.g., breast-conserving surgery versus mastectomy.
There is currently an ongoing debate regarding the time to surgery (TS) following neoadjuvant chemotherapy in patients with breast cancer and its effect on survival outcomes. There are three retrospective studies suggesting that the ideal interval is as low as 21 days, 40 days and up to 8 weeks. To date, to the best of our knowledge, there is no consensus available on the ideal time interval to surgery following neoadjuvant chemotherapy in breast cancer patients in the published literature. The present study aimed to evaluate the influence of TS of ≥28 days and its effect on survival outcomes. For this purpose, patients with breast cancer (n=61), during the time period between January, 2012 and December, 2016, were categorised into two cohorts based on the TS following the completion of neoadjuvant chemotherapy. Patients in group 1 (n=8) had a TS of ≤28 days, and those in group 2 had a TS of ≥29 days (n=53). Overall survival and locoregional recurrence-free survival were compared between both groups. A total of 61 patients with breast cancer who had received neoadjuvant chemotherapy followed by surgery and fulfilled the inclusion criteria were included in the study. The median follow-up time was 29 months. There was no observed association between age, tumour biology, the chemotherapy regimen, type of surgery, pathological response and the TS. The mortality rates were zero in group 1 and 18.9% in group 2. Locoregional recurrence rates were zero in group 1 and 9.4% in group 2. On the whole, the findings of the present study support a shorter duration (≤28 days) of TS following neoadjuvant chemotherapy for optimal survival outcomes.
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