A simple prognostic model using performance status and presence of liver metastases was developed. It allowed the assignment of patients into three subgroups with different outcomes. Treatment strategies could be adapted for each subgroup. We think that this prognostic model could be useful and should be validated in other patient series.
Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the thirdline setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations Adv Ther (2011) 28(Suppl.6):50-65. 51 with HER2 antagonists are associated with significant clinical activity.
We present the case of a 60-year-old man with a primary pulmonary melanotic schwannoma treated with surgery and who developed an orbital and myocardial relapse 2 years after the initial diagnosis. Melanotic schwannomas are rare pigmented tumours that tend to arise from the peripheral nerves near the midline. A primary lung presentation, as in our case, is extremely rare. In more than half of cases, the Carney triad of myxomas of the heart, skin and breast, spotty pigmentation and endocrine hyperactivity is present. A thorough pathological study is pivotal for a correct diagnosis. The main differential diagnosis is with metastases of malignant melanoma. The biological behaviour is unpredictable. Treatment should include radical surgery if possible; the role of chemotherapy and radiotherapy is uncertain due to the rarity of the tumour.
This study assessed the psychometric properties of the Impact of Event Scale (IES) in a Spanish sample at increased risk of hereditary cancer and the contribution of socio-demographic and clinical characteristics to predict cognitive intrusions and avoidance. A total of 766 patients participated in this cross-sectional study. Psychometric analyses of the IES were performed using exploratory and confirmatory factor analyses. The influences of socio-demographic and clinical characteristics were determined using multiple linear regression analyses. The exploratory analysis supported the original two-factor solution of the IES, and the confirmatory analysis added the cross-factor loading for item 12, characteristic for this population. Related to the socio-demographic and clinical variables, patient affected by cancer (β = -.19), sex (β = .15), previous psychiatric treatment (β = -.10), and age (β = -.08), were significant predictors of the intrusion subscale. Patient affected by cancer (β = -.19), sex (β = .13), and previous psychiatric treatment (β = -.14) were significant predictors of the avoidance subscale. Keywords: Cognitive symptoms; psychometrics; genetic counseling; hereditary cancer; emotional distress. Escala del Impacto del Estresor (EIE): Propiedades psicométricas en una muestra española con riesgode cáncer hereditario Resumen: Este estudio evaluó las propiedades psicométricas de la Escala de Impacto del Estresor (EIE) en una muestra española con alto riesgo de cáncer hereditario, y la contribución de las características sociodemográficas y clínicas para predecir cogniciones de intrusión y evitación. Un total de 766 pacientes participaron en un diseño transversal. Los análisis psicométricos se realizaron a través de análisis factoriales exploratorios y confirmatorios. La influencia de las características sociodemográficas y clínicas se determinó llevando a cabo regresiones múltiples. El análisis exploratorio confirmó la solución original bifactorial del EIE, y el análisis confirmatorio añadió la carga factorial cruzada del ítem 12, que caracteriza a esta población. En las características sociodemográficas y clínicas, paciente afecto de cáncer (β = -.19), sexo (β = .15), antecedentes de tratamiento psiquiátrico (β = -.10), y edad (β = -.08), fueron predictores significativos de la subescala de intrusión. Paciente afecto de cáncer (β = -.19), sexo (β = .13), y antecedentes de tratamiento psiquiátrico (β = -.14) fueron predictores significativos de la subescala de evitación. Palabras clave: síntomas cognitivos; psicometría; consejo genético; cáncer hereditario; malestar emocional.
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