The paper presents the results of a survey of 254 patients of reproductive and menopausal age who after the completion of the surgical, in some patients also chemo-radiotherapY., received tamoxifen for breast cancer for different lengths of time. All patients underwent ultrasound examination of pelvic organs and determination of the content of estradiol, follicle-stimulating and luteinizing hormones in the serum. It was showed that with tamoxifen therapy ovarian cysts were diagnosed in 50 women with preserved menstrual cycle (73.5%) and 31 - in menopause (16.6%). Detection of cysts in 72% of patients of reproductive age and 19.3% of menopausal age was accompanied by increased production of estradiol. Cyst formation and hyperproduction of estradiol appeared mainly during the first year of tamoxifen; in the future they could disappear, which made it possible to observe such patients and not immediately made a decision about the need for pharmacological or surgical suppression of ovarian function.
Materials and methods. The effect of melatonin (MLT) and metformin (MTF) on the efficacy of neoadjuvant hormone therapy with toremifene was investigated in 54 patients with estrogen receptor-positive, locally advanced breast cancer (ER + BC). The average age of women was 67 years. The patients had no diabetes mellitus. The first group of patients (n = 19) received toremifene 120 mg per day, the second group (n = 16) - toremifene in combination with MLT 3 mg orally every night, the third group (n = 19) - toremifene in combination with MTF 850 mg twice daily. Randomization was performed - 1: 1: 1. The duration of therapy in all study groups was 4 months. After the end of treatment, all patients were undergone surgery. Further adjuvant treatment depended on the results of the postoperative pathomorphological conclusion. The primary endpoint was a decrease in the Ki-67% level (a surrogate marker for the effectiveness of hormone therapy), the secondary endpoints were the objective response, a pathological response in the tumor and lymph nodes, and the quality of life. Results. In all patients (n = 54), the frequency of decrease Ki-67 level and the frequency of objective response were 57% and 50%, respectively. At the same time, the incidence of Ki-67% level decrease in the «toremifene» group was 42%, in the «toremifene+MLT» group - 56%, in the «toremifene+MTF» group - 74%. Multifactor analysis showed that the addition of MTF to toremifene increases the chances of reducing Ki-67 compared with control 4.2 times (RR 4.23 [95% CI 1,04417,139], p = 0.043). It is important that only in the patients of the «toremifene+MTF» group a significant correlation was found between the Ki-67 index decrease in the tumor and the BMI value above the norm (p = 0.015). A complete pathomorphological response in the tumor and lymph nodes was not achieved in any patient. The objective response in the study groups was 31.6%, 86.7% and 47.3%, respectively. The addition of MLT to hormone therapy with toremifene significantly increased the frequency of the objective response from 31.6% to 86.7% (x2 = 10.32, p = 0.001). The inclusion into neoadjuvant hormone therapy with toremifene of MLT or MTF did not reduce the quality of life of patients, while in 50% of patients in the «toremifene+MLT» group there was an improvement in sleep.
The aim of the study was to evaluate a 3-year distant treatment outcomes of patients with early breast cancer who had undergone sentinel lymph node biopsy. Methods. A total of 681 patients with early cT1-2N0M0 breast cancer treated in the N.N. Petrov research institute of oncology form 2012 till 2016 were retrospectively enrolled in the study. Radioisotopes were used to identify sentinel nodes. In case a macrometastatic lesion was found (>2mm) ALND was performed. Subsequent adequate systemic treatment and radiotherapy were administered in accordance with the pTNM status, biologic subtype and age. Results. A 3-year overall survival equaled 99.3% (SE 0.4%), recurrence-free survival was 99.2% (SE 0.4%). Survival of patients without nodal involvement reached 100%, whereas for patients with metastatic nodes it was 97.4% (SE 1.8%). The threshold for the number of the affected nodes significantly influencing survival equaled 1 (р=0,0187). Overall survival of patients with 0 to 1 positive lymph nodes was 99.7% (SE 0.3%), with more than 1 node involved - 95.7% (SE 0.3%) (р=0,00444). Conclusion. Overall 3-year survival of patients with early breast cancer approaches 100%. Sentinel lymph node biopsy allows avoiding unnecessary and traumatizing axillary dissection and improves the quality of life.
There are presented the immediate and long-term results of neoadjuvant endocrine therapy versus chemotherapy in ER+ breast cancer and chemotherapy (carboplatin + taxane) at triple-negative tumor subtype. We marked a tendency of improving a 10-year disease-free survival at luminal A subtype in patients who received endocrine therapy compared with chemotherapy (72.8% vs. 53.9%; p=0.062). Only 5.9% of patients with ER+ /HER2+ co-expression, who received target therapy, reached complete regression (pCR). There was a greater frequency of pCR, among patients with triple-negative breast cancer who received neoadjuvant chemotherapy with paclitaxel + carboplatin.
Purpose: To analyze the results of treatment and the quality of medical care for breast cancer patients with breast reconstruction using thoracodorsal flap (TDF). Material and methods: The study was conducted on the basis of the N.N. Petrov National Medical Research Center of Oncology at the Department of Breast Tumors for the period 2016-2017. When using the reconstruction of the breast with the help of TDF the feature was the complete intersection of the muscle in the anterior-axillary line before closing the defect of the breast tissue but with the preservation of the thoracodorsal vascular sheaf. Surgical treatment was provided to 67 patients with breast cancer including after neoadjuvant therapy. Results: One-time reconstruction was performed in 16 (23.8%) patients under the organ-preserving surgery, mastectomy in two (2.9%) patients and mastectomy with implant placement in 27 (40.2%) patients. Delayed reconstruction of the breast: TDF in combination with the implant - 20 (29.8%), the use of TDF without an implant - 2 (2.9%) patients. Complications were observed in 6 (8.9%) patients. Conclusion: Reconstruction of the breast with TDF is the method of choice and priority for patients who underwent radiation therapy with a lack of integumentary tissues to cover the implant. TDF is a «good» plastic material and could be used in patients with severe defect of breast shape after organ-preserving surgery and mastectomy. TDF is characterized by a low incidence of complications. The use of TDF does not worsen the rehabilitation of patients and does not shift the timing of adjuvant treatment.
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