- Klíčová slova
- subkutánní tuková nekróza,
- MeSH
- hyperkalcemie diagnóza komplikace krev MeSH
- lidé MeSH
- novorozenec MeSH
- tuková nekróza * diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- antibakteriální látky terapeutické užití MeSH
- biochemická analýza krve MeSH
- hyperkalcemie diagnóza terapie MeSH
- kardiopulmonální resuscitace MeSH
- lidé MeSH
- novorozenec MeSH
- tuková nekróza * diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: We previously confirmed the non-inferiority of accelerated partial breast irradiation (APBI) with interstitial brachytherapy in terms of local control and overall survival compared with whole-breast irradiation for patients with early-stage breast cancer who underwent breast-conserving surgery in a phase 3 randomised trial. Here, we present the 5-year late side-effects and cosmetic results of the trial. METHODS: We did this randomised, controlled, phase 3 trial at 16 centres in seven European countries. Women aged 40 years or older with stage 0-IIA breast cancer who underwent breast-conserving surgery with microscopically clear resection margins of at least 2 mm were randomly assigned 1:1, via an online interface, to receive either whole-breast irradiation of 50 Gy with a tumour-bed boost of 10 Gy or APBI with interstitial brachytherapy. Randomisation was stratified by study centre, menopausal status, and tumour type (invasive carcinoma vs ductal carcinoma in situ), with a block size of ten, according to an automated dynamic algorithm. Patients and investigators were not masked to treatment allocation. The primary endpoint of our initial analysis was ipsilateral local recurrence; here, we report the secondary endpoints of late side-effects and cosmesis. We analysed physician-scored late toxicities and patient-scored and physician-scored cosmetic results from the date of breast-conserving surgery to the date of onset of event. Analysis was done according to treatment received (as-treated population). This trial is registered with ClinicalTrials.gov, number NCT00402519. FINDINGS: Between April 20, 2004, and July 30, 2009, we randomly assigned 1328 women to receive either whole-breast irradiation (n=673) or APBI with interstitial brachytherapy (n=655); 1184 patients comprised the as-treated population (551 in the whole-breast irradiation group and 633 in the APBI group). At a median follow-up of 6·6 years (IQR 5·8-7·6), no patients had any grade 4 toxities, and three (<1%) of 484 patients in the APBI group and seven (2%) of 393 in the whole-breast irradiation group had grade 3 late skin toxicity (p=0·16). No patients in the APBI group and two (<1%) in the whole-breast irradiation group developed grade 3 late subcutaneous tissue toxicity (p=0·10). The cumulative incidence of any late side-effect of grade 2 or worse at 5 years was 27·0% (95% CI 23·0-30·9) in the whole-breast irradiation group versus 23·3% (19·9-26·8) in the APBI group (p=0·12). The cumulative incidence of grade 2-3 late skin toxicity at 5 years was 10·7% (95% CI 8·0-13·4) in the whole-breast irradiation group versus 6·9% (4·8-9·0) in the APBI group (difference -3·8%, 95% CI -7·2 to 0·4; p=0·020). The cumulative risk of grade 2-3 late subcutaneous tissue side-effects at 5 years was 9·7% (95% CI 7·1-12·3) in the whole-breast irradiation group versus 12·0% (9·4-14·7) in the APBI group (difference 2·4%; 95% CI -1·4 to 6·1; p=0·28). The cumulative incidence of grade 2-3 breast pain was 11·9% (95% CI 9·0-14·7) after whole-breast irradiation versus 8·4% (6·1-10·6) after APBI (difference -3·5%; 95% CI -7·1 to 0·1; p=0·074). At 5 years' follow-up, according to the patients' view, 413 (91%) of 454 patients had excellent to good cosmetic results in the whole-breast irradiation group versus 498 (92%) of 541 patients in the APBI group (p=0·62); when judged by the physicians, 408 (90%) of 454 patients and 503 (93%) of 542 patients, respectively, had excellent to good cosmetic results (p=0·12). No treatment-related deaths occurred, but six (15%) of 41 patients (three in each group) died from breast cancer, and 35 (85%) deaths (21 in the whole-breast irradiation group and 14 in the APBI group) were unrelated. INTERPRETATION: 5-year toxicity profiles and cosmetic results were similar in patients treated with breast-conserving surgery followed by either APBI with interstitial brachytherapy or conventional whole-breast irradiation, with significantly fewer grade 2-3 late skin side-effects after APBI with interstitial brachytherapy. These findings provide further clinical evidence for the routine use of interstitial multicatheter brachytherapy-based APBI in the treatment of patients with low-risk breast cancer who opt for breast conservation. FUNDING: German Cancer Aid.
- MeSH
- brachyterapie škodlivé účinky MeSH
- časové faktory MeSH
- celková dávka radioterapie MeSH
- duktální karcinom prsu patologie radioterapie chirurgie MeSH
- intraduktální neinfiltrující karcinom patologie radioterapie chirurgie MeSH
- kombinovaná terapie MeSH
- kosmetické přípravky * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lobulární karcinom patologie radioterapie chirurgie MeSH
- mastektomie škodlivé účinky MeSH
- nádory prsu patologie radioterapie chirurgie MeSH
- následné studie MeSH
- prognóza MeSH
- radiodermatitida diagnóza etiologie MeSH
- segmentální mastektomie škodlivé účinky MeSH
- senioři MeSH
- staging nádorů MeSH
- stupeň nádoru MeSH
- tuková nekróza diagnóza etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Nontraumatic rapid growing giant fat necrosis of the breast mimicking breast tumors is a rare clinical manifestation. The imaging features of the fat necrosis which range from benign to malign findings may be better explained with associated aetiology. The present paper reports a 54-year old woman with a rapid growing, fibrous, and hard giant mass originating in the subareolar region of the left breast. Mammography and magnetic resonance imaging demonstrated a heterogeneous, well circumscribed mass in 12 × 12 cm size in the left breast. The lesion was suspected as a malignant tumor and underwent core biopsy. The histopathology examination of the biopsy revealed mononuclear cells, foamy, vacuolated, and bubbly cells containing fat. Excision biopsy of the mass was performed and the final pathological diagnosis was confirmed as fat necrosis. The wide clinical and radiologic manifestations of fat necrosis are still difficult to diagnose even with the new diagnostic modalities and a great proportion of these lesions need a biopsy to diagnose.
- MeSH
- diferenciální diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mamografie MeSH
- nádory prsu diagnóza MeSH
- nemoci prsů diagnóza patologie MeSH
- tuková nekróza diagnóza patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Autoři prezentují kazuistiku neobvyklé lokalizace málo častého patologického stavu, který při nejednotnosti názvosloví bývá označován nejčastěji jako mezenteriální panikulitida. Prezentovaný případ imponoval v CT obraze jako extramurální tumor žaludku či tumor omenta. Na základě neustupujícího nálezu bylo indikováno operační řešení, diagnózu určilo histologické vyšetření resekátu. Autoři uvádějí stručné charakteristiky a diferenciální diagnostiku mezenteriální panikulitidy.
The authors report the case of unusual localisation of mesenteric panniculitis, which is an extremely rare pathological condition. A 54-year-old women with weight loss, fatigue and high erythrocyte sedimentation rate underwent computer tomography examination. The scan showed an ill-defined mass mimicking either extramural tumor of stomach or tumor of small omentum. Treatment was surgical, definitive diagnosis was histological. The clinical, pathological, therapeutic and imaging features are reviewed.
- MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- fibróza diagnóza patologie MeSH
- lidé MeSH
- lipodystrofie diagnóza patologie terapie MeSH
- mezenterium patologie MeSH
- panniculitis diagnóza patologie terapie MeSH
- tuková nekróza diagnóza patologie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
