Luiz Carlos Teixeira

The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention.

Background:Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival Methods:Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected Results:Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. Conclusion:CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.

Association between immunohistochemical expression of topoisomerase IIalpha, HER2 and hormone receptors and response to primary chemotherapy in breast cancer.

The aim of this study was to evaluate the association between immunohistochemical expression of topoisomerase IIα, HER2 and hormone receptors and response to primary anthracycline-based chemotherapy in locally advanced breast cancer. We analyzed 109 medical charts of patients treated with primary anthracycline-based chemotherapy in the Womens Integral Health Care Center from 1996 to 2004. The clinical and pathological response to primary chemotherapy was associated with topoisomerase IIα and HER2 expression and hormone receptor negativity. Statistical analysis was performed using chi-squared, Fishers exact test and Mann-Whitney test. No statistical association between clinical response and expression of topoisomerase IIa, HER2 and hormone receptor negativity was found. However, there was an association between complete pathological response and hormone receptor negativity (P = 0.0289). The present study suggested that these markers should not be considered predictors of response to primary anthracycline-based chemotherapy, and prospective studies must be designed for this purpose.

Concomitant Cisplatin Plus Radiotherapy and High–Dose-Rate Brachytherapy Versus Radiotherapy Alone for Stage IIIB Epidermoid Cervical Cancer: A Randomized Controlled Trial

PURPOSE The benefits of chemoradiotherapy (CRT) for cervical cancer compared with radiation (RT) alone seem to diminish in later-stage disease. However, these modalities have not been directly compared for disease-free interval (DFI) and overall survival (OS) of women with stage IIIB cervical cancer. PATIENTS AND METHODS We conducted a randomized controlled clinical trial comparing DFI and OS of 147 women with stage IIIB squamous cervical cancer who received either cisplatin plus RT (CRT) or RT alone (72 patients in the CRT group and 75 patients in the RT-only group). RESULTS The CRT group had significantly better DFI (hazard ratio [HR], 0.52; 95% CI, 0.29 to 0.93; P = .02). However, patients in the CRT group did not have significantly better OS than those in the RT-only group (HR, 0.67; 95% CI, 0.38 to 1.17; P = .16). Toxicity was graded according to criteria of the Radiation Therapy Oncology Group. The organs affected (excluding hematologic effects) did not differ significantly between groups. Also, late toxicity events and organs affected were not significantly disproportionate between the study groups. CONCLUSION For stage IIIB cervical cancer, the addition of cisplatin offers a small but significant benefit in DFI, with acceptable toxicity.

Avaliação do Parceiro Sexual e Risco de Recidivas em Mulheres Tratadas por Lesões Genitais Induzidas por Papilomavírus Humano (HPV)

OBJETIVO: estudar se a avaliacao e o tratamento em parceiros de mulheres com lesoes induzidas por HPV estao relacionados com a ocorrencia de recidivas postratamento nestas mulheres. SUJEITOS E METODOS: estudo clinico de coorte reconstituido com 144 mulheres tratadas por lesoes genitais induzidas por HPV e cujos parceiros foram avaliados, comparadas com outras 288 mulheres tratadas por lesoes semelhantes e cujos parceiros nao foram examinados, controladas por data do atendimento, idade, grau das lesoes genitais e tipo de tratamento, todos atendidos e seguidos no CAISM, UNICAMP, entre julho de 1993 e marco de 2000. Foi avaliada a semelhanca entre os grupos com relacao as variaveis de controle. Depois, estudada a associacao entre a avaliacao do parceiro ou a presenca ou nao de lesoes por HPV nos mesmos, com relacao a ocorrencia de recidivas nas mulheres, do grau destas lesoes recidivadas e do tempo livre de doenca, atraves de analise estatistica uni e multivariada com regressao logistica, utilizando os testes exato de Fisher, t de student e, para analise de sobrevivencia, o teste de Wilcoxon. RESULTADOS: a ocorrencia de recidivas nas mulheres foi de 9,0% quando seus parceiros foram avaliados contra 5,9% para aquelas cujos parceiros nao foram examinados, sendo esta diferenca nao significante. Os grupos estudados foram semelhantes com relacao as variaveis de controle, ou seja, a idade, a idade na menarca, no inicio sexual e primeiro parto, o tempo de atividade sexual, o numero de parceiros sexuais, de gestacoes, partos e abortos, o habito de fumar, o grau da lesao genital e o tipo de tratamento realizado. Nenhuma destas variaveis apresentou associacao com a ocorrencia de recidivas na analise uni e multivariada com regressao logistica. Entre as mulheres cujos parceiros foram avaliados e estes apresentaram lesoes por HPV, observou-se 1,5 vezes mais recidivas (12,5% contra 7,3%) que aquelas cujos parceiros foram negativos, mas esta diferenca nao foi significativa. Um tempo de estabilidade conjugal menor ou igual que 12 meses relatado pelo homem esteve associado a duas vezes mais recidivas (14,9% contra 6,2%) nas suas parceiras em comparacao com aquelas cujos parceiros relataram um tempo maior. O grau da lesao recidivada e o tempo livre de doenca nao estiveram associados a presenca ou nao de lesoes nos homens. CONCLUSOES: a avaliacao do homem neste estudo nao trouxe beneficios a mulher em relacao ao risco de recidivas de lesoes genitais induzidas por HPV. A presenca de lesoes por HPV nos parceiros nao se correlacionou com a ocorrencia de recidivas, com o grau das lesoes recidivadas e com o tempo livre de doenca nas mulheres. Estas observacoes nao suportam a hipotese de que os homens nao avaliados seriam uma importante causa de recidivas nas parceiras. Abstract

Randomized clinical trial on the preservation of the medial pectoral nerve following mastectomy due to breast cancer: impact on upper limb rehabilitation

CONTEXT AND OBJECTIVE Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the pectoral nerves and their effects. The aim of this study was to compare muscle strength and mass of the pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the medial pectoral nerve (MPN). DESIGN AND SETTING Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil. METHODS The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fishers exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance. RESULTS In the MPN preserved group, 81% of the women did not lose any PMM strength, compared with 31% in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8). CONCLUSIONS Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups. CLINICAL TRIAL REGISTRATION NUMBER ANZCTR - 00082622.

Primary melanoma of the uterine cervix figo stage III B

The primary malignant melanoma of the uterine cervix is rare, usually diagnosed at an advanced stage and with poor prognosis. The diagnosis is made through histological evaluation and confirmed by special staining procedures. Radical surgery has been used and advocated. However in its advanced stages chemotherapy, immunotherapy or radiotherapy can be employed. A case of a patient with malignant melanoma of the uterine cervix, Stage IIIb, is presented in addition to a clinical and pathological discussion.

HER2 expression in Brazilian patients with estrogen and progesterone receptor-negative breast carcinoma

The aim of the study was to evaluate the relationship between clinical and pathological factors and survival in patients with double negative HER2-overexpressing carcinoma and triple negative carcinoma. One hundred and sixty-one (161) patients diagnosed with breast cancer negative for estrogen receptor (ER) and progesterone receptor (PR) were included. Of the total, 58 patients had double negative HER2-overexpressing (ER/PR-negative and HER2-positive) and 103 had triple negative (ER-negative, PR-negative and HER2-negative). ER and PR expression was assessed through immunohistochemistry (IHC) and HER2 expression was measured by immunohistochemistry and Fluorescent in situ Hybridization (FISH) analysis in tissue microarray. More than 80% had stages II and III disease and histologic grade III and nuclear grade 3. Patients with triple negative breast carcinoma had undifferentiated histologic types in 11% of cases and vascular invasion in 14.5%. Both groups had more than 50% visceral metastases. HER2 expression (p=0.42) and vascular invasion (p=0.05) did not interfere with survival. Survival of patients with Stages I-II disease was significantly longer than in those with Stage III disease both for double negative HER2-overexpressing carcinomas (p<0.0001) and triple negative carcinomas (p=0.03). The study shows that hormone receptor-negative breast carcinomas were undifferentiated and diagnosed at advanced stages and that HER2 expression was not associated with overall survival.

Ovarian germ cell cancer: clinicopathologic analysis and outcome of 31 cases.

Aims The aim of the study was to evaluate some clinicopathologic characteristics and the outcome of patients with ovarian germ cell cancer (OGCC) treated with cisplatin-based chemotherapy. Methods It was a clinical retrospective study. The clinical charts of 31 patients with OGCC assisted at the Department of Obstetrics and Gynecology of the State University of Campinas, Brazil, from January 1986 to June 1997 were reviewed. Results Ten patients had dysgerminoma and 21 patients nondysgerminomatous tumors. Women with dysgerminoma and nondysgerminomatous tumors did not present differences regarding surgical staging, age, ascites or residual tumor after the initial surgery. Frozen section, performed in 16 patients, showed some discrepancy with paraffin histology diagnosis in 8 patients. Platinum-based chemotherapy was used in 5/10 patients with dysgerminoma and in 17/21 patients with nondysgerminomatous tumors, with a 5-year survival of 100% for the dysgerminoma and 53% for the nondysgerminomatous group. Conclusions Women with dysgerminoma and nondysgerminomatous tumors did not present differences regarding clinicopathologic characteristics. The prognosis for patients with dysgerminoma was better than for those with nondysgerminomatous tumors. Frozen section had a high error rate in diagnosing OGCC intraoperatively.

Relação entre tumores ovarianos epiteliais borderline e francamente invasores: epidemiologia, histologia e prognóstico

Purpose: to determine some epidemiological, diagnostic and prognostic aspects in women with borderline and invasive epithelial ovarian tumors. Methods: the charts of 198 women treated at CAISM/UNICAMP from 1986 to 1996 were revised. For statistical assessment, c2, Fishers exact and t Students tests were used when appropriate, followed by survival curves by the Kaplan-Meyer method, compared by the log-rank test. The mean follow-up was 50 months (11 to 168). Results: the overall rate of borderline tumors was 12% (24 cases), and for invasive carcinoma, 88% (174 cases). The mean age of the patients with borderline tumors was significantly lower than that of those with invasive carcinoma (43 ± 14.8 years vs. 52 ± 12.6 years, p<0.002). The most frequent histologic types were the serous (81 cases: 41%) and the mucinous (46 cases: 23%) tumor. The women with borderline tumors had their diseases diagnosed in earlier stages when compared with the invasive carcinoma patients (p<0.0001). The frozen biopsy, performed on 77 patients, showed a high agreement with the paraffin fixed tissue in the invasive carcinoma cases. However, in borderline tumors, the rate of failure was higher (13%) and the major rate of failure was in mucinous tumors. Regarding prognosis, the survival rate was significantly higher in borderline tumors (p<0.001). Conclusions: women with epithelial ovarian tumors were younger, presented the disease at earlier stages, and had a better prognosis when compared with those with invasive carcinoma.

Estrogen receptors in breast cancer - therapeutic response to the treatment of recurrences

The authors analyze estrogen receptors in 501 cases of breast cancer and the therapeutic response achieved with treatment of patients who relapsed. The method utilized to determine the presence of estrogen receptor was cytosol protein‐counting and Dextran coated charcoal (DCC) saturation analysis. Patients were treated with chemotherapy when the primary tumor was estrogen‐receptor negative. If receptor was present, anti‐estrogen drug (Tamoxifen) was added. Patients previously treated with the anti‐estrogen presented a better response to anti‐estrogen therapy and a lower recurrence rate. Recurrences were more frequent in estrogen receptor negative cases and better responses to treatment were found in estrogen receptor positive ones.