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D Terribile

Publications and source records attributed to D Terribile.

13 recordsLinked to original sources
PubMed2006

Gastro-intestinal symptoms as clinical manifestation of peritoneal and retroperitoneal spread of an invasive lobular breast cancer: report of a case and review of the literature.

BACKGROUND: Distant spread from breast cancer is commonly found in bones, lungs, liver and central nervous system. Metastatic involvement of peritoneum and retroperitoneum is unusual and unexpected. CASE PRESENTATION: We report the case of a 67 year-old-woman who presented with gastrointestinal symptoms which revealed to be the clinical manifestations of peritoneal and retroperitoneal metastatic spread of an invasive lobular breast cancer diagnosed 15 years before. CONCLUSION: To the best of our knowledge, the case presented is the third one reported in literature showing a wide peritoneal and extraperitoneal diffusion of an invasive lobular breast cancer. The long and complex diagnostic work up which led us to the diagnosis is illustrated, with particular emphasis on the multidisciplinary approach, which is mandatory to obtain such a result in these cases. Awareness of such a condition by clinicians is mandatory in order to make an early diagnosis and start a prompt and correct therapeutic approach.

Aged↗
PubMed2005

Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy.

BACKGROUND: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. PATIENTS AND METHODS: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. RESULTS: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. CONCLUSIONS: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.

Aged↗
PubMed1999

Morphometric prognostic index in breast cancer.

OBJECTIVE: To assess the ability of the morphometric prognostic index (MPI) in predicting clinical outcome in a group of breast cancer patients with short-term follow-up and to assess the relationship between MPI and other prognosticators. STUDY DESIGN: The study group consisted of 63 cases of breast cancer. Follow-up data were available for 48 patients. MPI values were calculated, and degree of nuclear and tubular differentiation was investigated in each tumor. S-phase fraction (SPF), estrogen and progesterone receptors were also studied. RESULTS: The group of patients with MPI values < 0.60 had percent values of disease-free survival significantly higher than did those with MPI values > or = 0.60. Furthermore, significant direct correlations were found between MPI and degree of nuclear atypia and between MPI and SPF. Significant inverse relationships were found between MPI and tumor progesterone receptor levels and between MPI and degree of histologic tubular differentiation. CONCLUSION: The validity of MPI as a prognosticator in breast cancer was confirmed, even in a limited number of patients observed in short-term follow-up. MPI seems to be a reliable and economical prognosticator in selecting breast cancer patients for adjuvant chemotherapy.

Adenocarcinoma↗
PubMed1997

Methyl-p-hydroxyphenyllactate-esterase activity in breast cancer: a potentially new prognostic factor in short-term follow-up.

We assayed methyl-p-hydroxyphenyllactate esterase (MeHPLAase) activity in 48 cases of primary breast cancer. MeHPLAase activity did not show significant correlation with estrogen receptor and progesterone receptor levels. No significant relationship was found between enzymatic activity and tumor diameter, lymph node status, mitotic activity, degree of nuclear differentiation, and proportion of the S-phase fraction. During the follow-up period (median, 18.8 months; range, 6-69 months), recurrences were observed in 18 of 48 (37%) cases. The Weibull survival regression model using the enzymatic activity as a continuous covariate showed that levels of enzymatic activity were directly associated with the risk of recurrence (P = 0.02). Assuming the mean value of enzymatic activity as the cutoff value, we found a statistically significant relationship between high MeHPLAase activity and shorter recurrence-free survival. On multivariate analysis, MeHPLAase activity proved to be an independent factor for predicting a short period of recurrence-free survival.

Adult↗
PubMed1996

Breast cancer in women 70 years of age or older.

OBJECTIVES: To investigate the impact of age as a prognostic factor in older patients with breast cancer and to discuss the role of surgery in this category of patients. DESIGN: A retrospective study. SETTING: A tertiary care university teaching hospital. PARTICIPANTS: One hundred ninety patients aged 70 years or older (mean age: 75 years) were treated for breast cancer from 1967 through 1991. These patients were compared with 190 younger patients (mean age: 52 years) and matched on the basis of T and N categories (TNM staging system) and surgical procedures. MEASUREMENTS: Disease-free survival, breast cancer-specific survival. RESULTS: The 10-year actuarial breast cancer-specific survival was 66% for older patients and 56% for younger patients (P = .224). The 10-year actuarial disease-free survival was 54% for older patients and 45% for younger patients (P = .136). Univariate and multivariate survival analysis revealed that tumor size and nodal stage were significant prognostic factors for both older and younger patients. CONCLUSION: Treatment with curative intent, similar to that adopted in younger patients, is appropriate for women over the age of 70 with breast cancer.

Actuarial Analysis↗
PubMed1993

DNA flow cytometric analysis in patients with operable non-small cell lung carcinoma.

Fresh surgical specimens of tumors from 60 patients with previously untreated non-small cell lung carcinoma (NSCLC) who underwent radical surgery between January 1991 and October 1992 were investigated by means of flow-cytometry. The nuclear DNA measurement was carried out using a Facscan (Becton, Dickinson, USA). Analysis of the DNA content was performed in all 60 patients whilst cell cycle analysis was possible in 41 cases (68.3%). Forty-two of the 60 cases (70%) were aneuploid and 18 (30%) were diploid. The overall mean value of DNA index was 1.5. Diploid NSCLC were compared with aneuploid tumors: no significant differences in age distribution, sex ratio, histology and staging were found between the two groups (P > 0.05). An S-phase proportion of more than 10% was found in 30 out of 41 patients (73.2%). Early cancer deaths were reported in four patients (6.6%): the aneuploidy rate was very close in these patients (75%) and in the remaining surviving patients (69.6%). An S-phase proportion of more than 10% was found in 100% of early cancer deaths and in 70.2% of the remaining cases; such a difference seems of some importance although it was not statistically significant (P = 0.071). In conclusion, flow-cytometry studies seem to be a useful tool in the understanding of the biological behavior of patients with NSCLC. In the present prospective report there were no significant correlations between DNA measurements and clinical outcome, however, these results suggest that a high S-phase proportion should be seen as a possible prognostic indicator.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

[Axillary lymphadenectomy].

Axillary lymphadenectomy represents one of the historical hallmarks in the surgical strategy for breast cancer treatment. In recent years the role of axillary dissection is becoming matter for a renewed debate: up to date better therapeutic results together with new biologic acquisitions and progresses in early diagnosis have been influencing current indications and extension of axillary lymphadenectomy; also, cosmetic and financial considerations play a relevant role. This is the background of a large number of studies investigating the possibility of a more limited applications of axillary dissection provided that oncologic results remain unchanged. In this context sentinel node biopsy is one of the most promising lines of research. It can be stated that, as far as early stages are concerned, a trend towards more conservative resection techniques that started with the first quadrantectomies two decades ago, is now involving axillary dissection too. Possibly, in the next future, an elective axillary lymphadenectomy will not be performed any more if the presence of positive nodes will not be preliminarily ascertained. Nevertheless such conservative strategy can not be recommended to date, until the technique of sentinel node biopsy will be optimized and its results confirmed by randomized trials.

Axilla↗
PubMedDate not supplied

The impact of the new organization on the management of breast cancer.

The radical change in the health care service now going on for some years requires the commitment of medical specialists, as well as the acquisition of an adequate knowledge of the economic implications associated to the therapeutic choice. Among primary objectives of health care management in the field of breast cancer, the best cost-effective strategy and the rationalization and standardization of diagnostic and therapeutic approaches, should be identified. Problems related to breast cancer are examined for effective, efficient and economic optimization.

Breast Neoplasms↗
PubMedDate not supplied

Breast cancer: new trends of clinical research.

In breast physiopathology, in spite of the crop of information and clinical studies, a number of questions are still unsolved. The adequacy of research sources and the transmission of information to clinical practice through consistent and validated efficacy evidences are required to ensure the treatment quality. In this article the different specialist approaches and the main themes debated in the interdisciplinary approach to breast cancer are considered: the genetical risk factors, the role of diagnostic imaging, the mapping and assessment of sentinel lymph node, the role of nodal radiation therapy following mastectomy.

Breast Neoplasms↗
PubMedDate not supplied

Therapeutic and prognostic problems in lung cancer with mediastinal lymph node involvement.

From January 1st, 1978 to 31st December, 1981, 28 patients with lung cancer and mediastinal lymph node metastases, underwent surgery. In four patients, only exploration was performed, in five patients, an incomplete resection and in 19 patients, a complete resection (resectability rate 86%). In the first two groups of patients, survival never exceeded two years. In the 'complete resection' group, 78% of the patients survived for one year, 61% for two years and 47% for three years. Patients with adenocarcinoma had a higher three year survival rate than those with squamous cell carcinoma (60% vs. 37%). No 30-day mortality was observed. All patients were treated postoperatively with MACC + BCG. The prognosis of lung cancer classified as N2 is strongly influenced by a series of factors some of which are included in the TNM system. In any case, it would still appear that the best treatment for this kind of tumor is radical surgical resection followed by adjuvant radiotherapy and/or multichemotherapy.

Adenocarcinoma↗
PubMedDate not supplied

Conservation surgery for breast cancer.

Advances in early diagnosis of breast cancer have allowed most patients to come to treatment at an early stage (in the US in 1993, 75% of cases were stage I-II). In these cases, conservation surgery has played in the last two decades the role of first choice thearpy following randomized studies which definitely showed the same safety and effectiveness as compared to conventional mastectomy. In time, indications for breast conservation therapy underwent modifications as for the size and site of primary tumor, and the presence of concomitant metastases to ipsilateral axillary lymph nodes. Absolute contraindications are still a multicentric diseases, and the presence of diffuse microcalcifications, while tumors over 3 cm in diameter may be amenable to conservation therapy with primary chemotherapy, retroareolar tumors can be resected with central quadrantectomy and clinically evident axillary metastases do not influence local treatment. There are still open problems as for the extent of peritumoral parenchymal excision, indications for complementary radiotherapy and axillary lymphadenectomy.

Breast Neoplasms↗