Breast Cancer in the Elderly: Treatment of 1500 Patients
Radiotherapy Unit, University o Florence, Florence, Italy. The Breast Journal
(Impact Factor: 1.41).
01/2007; 12(4):353-9. DOI: 10.1111/j.1075-122X.2006.00275.x
There is a significant difference in the extent of treatment offered to the elderly with breast cancer; in the United States, while 98% of patients less than 65 years of age receive standard treatment, 81% of those older than 65 years were treated according to protocol. This study's goal was to evaluate disease-specific survival and local-regional recurrence in breast cancer patients more than 65 years of age at diagnosis. A total of 1500 patients with invasive breast carcinoma were treated consecutively from May 1971 to July 2002 at the University of Florence, Florence, Italy. All patients were more than 65 years of age. The median age was 70.6 years (range 65.1-87.3 years). The median follow-up was 8.7 years (range 1-30 years). The crude probability of survival (or relapse occurrence) was estimated using the Kaplan-Meier method and survival (or relapse occurrence) comparisons were carried out using Cox proportional hazard regression models. The Cox regression model by stepwise selection showed as independent prognostic factors for disease-specific survival (DSS), the occurrence of a local relapse (p < 0.0001), pN status (p < 0.0001), the type of surgery (p < 0.0001), and the use of radiotherapy (p < 0.0006) and chemotherapy (p = 0.01). For local disease-free survival (LDFS), the Cox regression model by stepwise selection showed that mastectomy (p < 0.0001), histotype (p < 0.0001), pN status (p < 0.0001), and pT status (p = 0.001) were the only independent prognostic factors. Age was not a prognostic factor for DSS nor LDFS. We suggest treating patients with appropriate treatment for their prognostic factors.
Available from: Scott Thomas
- "The latter is limited to patients with tumors over-expressing steroid hormone receptors such as estrogen receptors (ER) and progesterone receptors (PR). In the Western world, about 65% of patients present with tumors that express either one receptor (ER or PR), or both, with a higher percentage of older patients presenting with ER-positive tumors  . "
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ABSTRACT: Histone deacetylase (HDAC) inhibitors are a novel class of anti-tumor agents with a potential role in the treatment of breast cancer. In ER-positive cells, treatment with selective and non-selective HDAC inhibitors has been associated with a transcriptional down-regulation (and possibly protein modification via the HSP90 chaperone function) of ER and its response genes. In ER-negative cell lines, HDAC inhibitors have been shown to re-establish ER expression. In addition, HDAC inhibitors have been reported to modulate the progesterone receptor. Despite the opposing effects in ER-positive and ER-negative breast cancer cells, the addition of an HDAC inhibitor potentiated and restored the efficacy of anti-estrogen therapy in preclinical models. This has led to the initiation of several clinical trials combining HDAC inhibitors with anti-estrogen therapy. In this review, we will summarize the relationship between estrogen signaling and HDACs, examine how HDAC inhibitors impact this relationship and synergize with anti-estrogens to inhibit tumor growth, and discuss the clinical possibilities and potential of this new approach.
Cancer letters 02/2009; 280(2):184-91. DOI:10.1016/j.canlet.2008.12.026 · 5.62 Impact Factor
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ABSTRACT: Summary form only given. For approximately ten years, MIT has supported an undergraduate project laboratory which teaches microfabrication process design. The project laboratory attempts to engage the students in projects which have a end goal of fabrication of a specific novel device, often with an end user that is supporting the laboratory portion of the course. In this paper, we will present the most recent results of teaching this course in the Spring '98 semester. The project this semester was to fabricate an array of micromechanical contactors which could be used in the high-speed testing of integrated circuits. We will describe the execution of the course in detail. A detailed description of the final device design and fabrication will be given with the measured results. We will summarize the lessons learned, particularly in relation to organizing a team of students on one project, and the nuances of working with an industrial sponsor in a course environment
University/Government/Industry Microelectronics Symposium, 1999. Proceedings of the Thirteenth Biennial; 02/1999
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ABSTRACT: Lung cancer is the third most common cancer but accounts for more deaths per year than breast, prostate, and colon cancer combined. Traditionally, age older than 80 years was a relative contraindication to pulmonary resection. Recently, multiple studies have validated the safety and efficacy of pulmonary resections in octogenarians. The purpose of this study was to review the authors' regional teaching hospital's experience with lung resections in octogenarians. A retrospective analysis of 20 octogenarians who underwent pulmonary resection for lung cancer from 1999 to 2004 was performed. Average age was 82.1 years. Ten patients (50%) were male. Seventeen patients (85%) had at least one comorbidity. Ten patients (50%) had stage I disease, with squamous cell being the most common histologic type (35%). Lobectomy, performed in 12 patients (60%), was the most common technique of resection. There was a 45 per cent overall complication rate and a 20 per cent major complication rate. The overall perioperative mortality rate was 10 per cent. Survival probability estimates show overall survival at 1 year to be 59 per cent and at 2 years to be 39 per cent. Overall median survival was 21.1 months. We conclude that octogenarians can undergo anatomic resections for lung cancer with acceptable morbidity and survival.
The American surgeon 02/2007; 73(1):22-4. · 0.82 Impact Factor
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