The side effects of oncological treatment, which appear during or after therapy, are sometimes very annoying for patients and are not adequately treated by physicians. Among the symptoms experienced by breast cancer patients are hot flushes, which result from a natural or cancer therapy-induced menopause. The intensity of hot flushes in breast cancer patients may be more severe than those experienced by women undergoing a natural menopause. Taking into account the incidence of breast cancer and long-lasting hormone-suppression therapies, the problem of hot flushes will affect many women. Hormonal replacement therapy, the most effective therapeutic means for alleviating hot flushes, is usually contraindicated for breast cancer patients. For intense and severe hot flushes, pharmacological treatment using agents from a group of selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors such as venlafaxine or citalopram may be introduced. Other agents from different pharmacological groups, such as clonidine, gabapentin, or pregabalin, have also proved to be effective in treating hot flushes. The efficacy of phytoestrogens has not been proven in randomized clinical trials. The importance of the placebo effect in decreasing vasomotor symptoms has also been reported in many research papers. Educating breast cancer patients in lifestyle changes which decrease the frequency and intensity of vasomotor symptoms can offer significant help too. This paper reviews the current state of research in order to assess the options for the treatment of hot flushes in breast cancer survivors.
Asparagine synthetase (EC 6.3.5.4) activity was increased 4‐ and 8‐fold when maize (Zea mays L.) seedlings were kept in darkness for 24 h and 7 days, respectively; this increase was abolished by cycloheximide. Irradiation of the dark adapted seedlings with a pulse of red light resulted in a 4‐fold decrease of the enzyme activity within 48 h, which was raised again following a far‐red light pulse. Co‐action of light and benzyladenine, reported for the light‐inducible enzymes, was proved to hold also for the light‐repressible asparagine synthetase. The induction of asparagine synthetase activity in the dark is abolished by glucose, suggesting the possible involvement of the enzyme in the contrae of metabolic fluxes of –carbon and nitrogen through assimilatory pathways.
IMPT used conventional fractionation in 17 (65%), SBRT in 8 (31%), and hyperfractionation in 1 (4%) patients. IMRT utilized hyperfractionation in 14 (78%), conventional in 3 (17%) and 1 (6%) SBRT. IMPT was found to have significantly lower rates of physician-reported overall grade 3 (G3) acute toxicities 31% vs 73% in IMRT (pZ0.01). This included dysphagia (4% vs 39%, pZ0.01), mucositis (8% vs 39%, pZ0.001), and dermatitis (12% vs 33%, pZ0.03). Commonly treated sites were 52% mucosal (nZ23), 14% neck/nodal sites (nZ6), and 32% both mucosal and neck sites (nZ14), and 2% (nZ1) cutaneous only treatment. IMPT patients with mucosal site RR had lower chances of G3 dysphagia (5% vs 40%, pZ0.01) and lower G3 mucositis (9% vs 47%, pZ0.02); and those with neck nodal/neck RR had lower chances of G3 dermatitis (18% vs 56%, pZ0.16). OS at 2-year was 69% with IMPT compared to 58% with IMRT cohort (pZ0.26). 2-year LR was 9.5% with IMPT vs 6.5% with IMRT (pZ0.66). 2-year DFS was 54% with IMRT compared to 46% with IMPT, respectively (pZ0.94). Conclusion: RR is a safe and effective treatment option in the management of recurrent HNC. IMPT RR was found to carry reduced rates of grade 3 toxicity compared to IMRT. IMPT appears to confer a similar rate of OS, DFS and LR compared to IMRT, although these results warrant further exploration in the form of larger prospective studies with longer follow up.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.