Background: Among women presenting with de novo stage IV breast cancer, 35% to 60% undergo local therapy, presumably to avoid uncontrolled chest wall disease. Several studies suggest that resection of the primary tumor may prolong survival, but chest wall outcome data are notably lacking. The authors reviewed chest wall status, time to first progression (TTFP), and overall survival (OS) in this group of women.
Methods: Women presenting at the Lynn Sage Breast Center (1995-2005) with an intact primary tumor and stage IV breast cancer or postoperative diagnosis of distant metastases were identified. Logistic regression and Cox proportional hazards models, adjusted for relevant covariates, were used to examine associations between surgical treatment and chest wall status, TTFP, and OS.
Results: Of 111 eligible women, 47 (42%) underwent early resection of the primary tumor. Chest wall status was available for 103 women. Local control was maintained in 36 of 44 (82%) patients in the surgical group versus 20 of 59 (34%) patients without surgery (P = .001). TTFP was prolonged in the surgical group (adjusted hazards ratio [HR], 0.493; P = .015). The adjusted HR for OS in the surgical group was 0.798 (P = .520). Chest wall control was associated with improved OS regardless of whether surgical resection of the tumor was performed (HR, 0.415; P < .0002).
Conclusions: These data support the notion that improved local control may play a role in improving outcomes in women with stage IV breast cancer, and resection of in-breast tumors can help to achieve this. A randomized trial is needed to rule out selection bias as an explanation for these findings.
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http://dx.doi.org/10.1002/cncr.23870 | DOI Listing |
Transl Pediatr
December 2024
Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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Department of Cardiology, G.B. Pant Institute of Postgraduate Medical Education & Research and associated Maulana Azad Medical College, Room No. 133, First Floor, Academic Block, New Delhi, India.
Left ventricular (LV) pseudoaneurysm, a rare occurrence, develops when a ruptured ventricle is encapsulated by the pericardium or scar tissue. Unlike free intrapericardial rupture, which often results in cardiac tamponade and fatal outcome, there are instances where the cardiac rupture remains contained, forming a pseudoaneurysm and averting immediate tamponade. We describe a 43-year-old male who underwent successful surgical repair of LV rupture following inferior wall myocardial infarction that resulted in the formation of a large pseudoaneurysm.
View Article and Find Full Text PDFJACC Case Rep
January 2025
Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Massy, France.
Although relatively rare, cardiac metastases represent a significant clinical challenge because of their impact on cardiac function and overall patient prognosis. This case presents a rare and atypical presentation of a patient with ventricular arrhythmia revealing a metastatic cancer in the heart. A 59-year-old man with lung cancer was admitted for chest tightness and episodes of syncope.
View Article and Find Full Text PDFJACC Case Rep
January 2025
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
A 51-year-old man with a history of antibiotic therapy for syphilis 1 month ago presented with syncope. Computed tomography revealed circumferential aortic wall thickening complicating severe stenosis of left main coronary ostium. Abnormalities in serologic and cerebrospinal fluid tests led to the diagnosis of syphilitic aortitis and neurosyphilis.
View Article and Find Full Text PDFCureus
December 2024
Division of Respiratory Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, MYS.
Subcutaneous emphysema is a well-known complication of chest tube insertion that can become life-threatening. Severe cases often progress rapidly, necessitating prompt intervention to prevent complications such as airway obstruction and respiratory failure. We report the case of a 57-year-old man who developed extensive subcutaneous emphysema following chest tube insertion.
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