scholarly journals ASSESSMENT OF THE POSTERIOR APPROACH FOR SURGICAL TREATMENT OF SPINAL METASTATIC BREAST CANCER

2020 ◽  
Vol 28 (1) ◽  
pp. 22-25
Author(s):  
Mariana Demétrio de Sousa Pontes ◽  
Breno de Paula Faleiros Pires ◽  
Felipe de Paula Albuquerque ◽  
Carlos Fernando Pereira da Silva Herrero
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Surgical Treatment ◽  
Posterior Approach ◽  
Spinal Metastasis ◽  
Pedicle Screws ◽  
Metastatic Breast ◽  
Posterior Fixation ◽  
Level Of Evidence ◽  
Posterior Portion

ABSTRACT Objective: To assess the clinical and radiological aspects of patients with spinal metastatic breast cancer who underwent surgical treatment by posterior approach. Methods: This is a retrospective and descriptive study. Clinical assessment included the patient’s sex, age, surgical treatment employed and complications. Radiological assessment comprised the study of the morphopathological characteristics of the lesions. Results: Data from 44 patients (93.2% female) submitted to surgical treatment of spinal metastasis were collected. The average age of diagnosis was 56.79 years. Decompression and posterior fixation with pedicle screws were performed in 43.1% of patients, while 36.3% underwent decompression and posterior fixation with pedicle screws associated with corpectomy and replacement with intersomatic device filled with bone cement. In 20.4%, kyphoplasty was the chosen procedure. Eighteen percent of patients had surgical complications, and the thoracic spine was most affected by the tumor. Conclusion: The clinical and radiological presentation of this group of patients is variable. The posterior portion of the vertebrae was more affected than the anterior. Although surgical treatment by posterior approach does not have the objective of curing the underlying disease, it can present favorable results, with higher rate of complication in major surgeries. Level of evidence IV, Therapeutic Studys.

scholarly journals Locoregional Surgery in Metastatic Breast Cancer: Do Concomitant Metabolic Aspects Have a Role on the Management and Prognosis in this Setting?

2020 ◽  
Vol 10 (4) ◽  
pp. 227
Author(s):  
Maria Ida Amabile ◽  
Federico Frusone ◽  
Alessandro De Luca ◽  
Domenico Tripodi ◽  
Giovanni Imbimbo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Medical Treatment ◽  
Cancer Progression ◽  
Metastatic Breast ◽  
Treatment Decision ◽  
Careful Consideration ◽  
Level Of Evidence ◽  
Systemic Treatments ◽  
Metastatic Setting

Although they cannot be considered curative, the new therapeutic integrated advances in metastatic breast cancer (MBC) have substantially improved patient outcomes. Traditionally, surgery was confined to palliation of symptomatic or ulcerating lumps. Data suggest, in some cases, a possible additive role for more aggressive locoregional surgical therapy in combination with systemic treatments in the metastatic setting, although a low level of evidence has been shown in terms of improvement in overall survival in MBC patients treated with surgery and medical treatment compared to medical treatment alone. In this light, tumor heterogeneity remains a challenge. To effectively reshape the therapeutic approach to MBC, careful consideration of who is a good candidate for locoregional resection is paramount. The patient’s global health condition, impacting on cancer progression and morbidity and their associated molecular targets, have to be considered in treatment decision-making. In particular, more recently, research has been focused on the role of metabolic derangements, including the presence of metabolic syndrome, which represent well-known conditions related to breast cancer recurrence and distant metastasis and are, therefore, involved in the prognosis. In the present article, we focus on locoregional surgical strategies in MBC and whether concomitant metabolic derangements may have a role in prognosis.

Surgical treatment and outcomes of metastatic breast cancer to the spine

2011 ◽  
Vol 18 (10) ◽  
pp. 1336-1339 ◽  
Author(s):  
Brian P. Walcott ◽  
Gregory L. Cvetanovich ◽  
Zachary R. Barnard ◽  
Brian V. Nahed ◽  
Kristopher T. Kahle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Surgical Treatment ◽  
Metastatic Breast

Improved outcome and selection bias in primary breast surgery for patients with metastatic breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1098-1098
Author(s):  
Lejla Hadzikadic Gusic ◽  
John Falcone ◽  
Kandace P. McGuire ◽  
Atilla Soran ◽  
Emilia Diego ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Metastatic Breast Cancer ◽  
Surgical Treatment ◽  
Metastatic Disease ◽  
Primary Tumor ◽  
Breast Surgery ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Surgery Group

1098 Background: Retrospective studies showing improved survival in patients with metastatic breast cancer (MBC) who undergo surgical treatment of the primary tumor have been criticized for bias in favor of younger, healthier women with lower disease burden. We attempted to identify these biases in our population. Methods: Our institutional cancer registry was queried for patients with MBC from 1994-2010. Demographics, clinical, radiologic and pathologic staging, as well as treatments and outcomes were recorded. Surgical and non-surgical groups were compared for differences in overall survival (OS) and clinicopathologic variables, including comorbidities, using uni- and multivariate analysis. Results: Ninety-one patients with metastatic disease identified within 3 months of initial diagnosis were eligible. 53% (48 pts) had primary breast surgery and 47% (43 pts) did not undergo surgery. Patients in the surgery group were younger on univariate analysis (mean age 53 vs. 62, p<0.01). Neither BMI (mean 30 vs. 29 kg/m²) nor Charlson comorbidity score (mean 6 in both groups) were significantly different, p=NS. Bone metastases were more common in the surgery group (48 vs. 26%) and multiple metastases in the non-surgery group (35 vs. 17%), p<0.05. Patients in the non-surgery group had ≥ 1 visceral metastasis when compared to the surgery group (62 vs. 35%), p<0.05. Higher OS was demonstrated in the surgery group both with Kaplan Meier curves (p<0.05) and univariate analysis (mean 3 vs. 2 yrs, 95% CI 2.6, 3.7), p<0.05. Survival was higher in the surgery group (p<0.01), at 1 year, but this difference did not persist at 3 and 5 years. On multivariate analysis, only difference in age remained significant (p<0.01). Conclusions: Our study supports existing data that women with MBC who have surgical treatment of the primary tumor have an improved survivorship. However, it also suggests a bias towards increased use of surgery in patients who are younger with smaller burden of metastatic disease. We did not find a bias in favor of healthier patients. Further study to determine the mechanism and magnitude of benefit of primary tumor extirpation is still needed.

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