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• The CREATE-X study:
  • Randomly assigned 910 patients:
    • With HER2 negative breast cancer and residual disease after undergoing neoadjuvant chemotherapy to:
      • Standard postsurgical treatment and capecitabine or placebo
  • The primary end point was:
    • Disease-free survival (DFS)
  • Secondary end points included:
    • Overall survival (OS)
  • DFS was longer in the capecitabine group than in the control group:
    • 74.1% vs. 67.6% of the patients were alive and free from recurrence or second cancer at 5 years
  • Among patients with triple-negative disease:
    • DFS was 69.8% in the capecitabine group versus 56.1% in the control group
    • The OS rate was 78.8% versus 70.3%
• Residual disease after completion of neoadjuvant chemotherapy:
  • Is associated with worse outcomes
• References:
  • Masuda N, Lee SJ, Ohtani S, Im YH, Lee ES, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Eng J Med. 2017;376(22):2147-2159.
  • Symmans WF, Wei C, Gould R, Yu X, Zhang Y, Liu M, et al. Long-term prognostic risk after neoadjuvant chemotherapy associated with residual cancer burden and breast cancer subtype. J Clin Oncol. 2017;35(10):1049-1060.

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncology #BreastCancer #CASO #CenterforAdvancedSurgicalOncology

• The 21-gene recurrence score assay:
  • Is a gene-expression assay:
    • That provides prognostic and predictive information in hormone receptor positive breast cancer
  • The recurrence score based on the 21-gene assay ranges from:
    • 0 to 100:
      • Is predictive of chemotherapy benefit:
        • When it is higher than 25

• Both tamoxifen and aromatase inhibitors:
  • Have been shown to:
    • Reduce recurrence rates and improve survival in postmenopausal women
  • Although chemotherapy has been shown to be beneficial in many patient subsets:
    • The 21-gene recurrence score was developed:
      • To help ascertain which patients with:
        • ER-positive, node-negative breast cancer:
          • Would be most likely to benefit from chemotherapy in addition to adjuvant tamoxifen
  • In patients with an intermediate recurrence score:
    • The benefit of chemotherapy is unclear
• The Trial Assigning IndividuaLized Options for Treatment (Rx) [TAILORx] trial:
  • Is a randomized prospective trial:
    • That randomized women with ER-positive breast cancer:
      • With a score of 11 to 25 to:
        • Chemotherapy plus endocrine therapy to endocrine therapy alone
    • This trial is closed to accrual, and the results of this trial for this cohort are pending:
      • However:
        • Outcomes data from a subset of 1626 patients with a recurrence score of less than 10:
          • Were recently published
      • These patients were assigned to:
        • Receive endocrine therapy alone without chemotherapy
      • This study reported a 5-year local recurrence rate of:
        • 0.5% in women with a recurrence score of:
          • Less than 10
      • Furthermore:
        • At 5 years:
          • The invasive disease–free survival was:
            • 93.8%
          • The rate of freedom from recurrence of breast cancer at a distant site was:
            • 99.3%
          • At distant or local site was:
            • 98.7%
          • Overall survival rate of:
            • 98%
      • The authors concluded that a favorable gene expression profile:
        • Is associated with a very low rate of recurrence:
          • At 5 years with endocrine therapy alone
• References:
  • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Dowsett M, Forbes JF, et al. Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet. 2015;386(10001):1341-1352.
  • Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 2015;373(21):2005-2014.
  • Sparano JA et al, N Engl J Med 2018 Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med 2018;379(2):111-121.
  • Paik S, Tang G, Shak S, Kim C, Baker J, Kim W, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol; 2006;24(23):3726-3734.

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #CASO #CenterforAdvancedSurgicalOncology #BreastCancer #OncotypeDx

👉The thyroid gland, located at the base of the neck, is shaped like a butterfly, and produces hormones that regulate heart rate, blood pressure, body temperature, and weight.

👉In thyroid cancer does not cause any symptoms most of the time in the initial stages, but as it grows it can cause:

• A lump (nodule) that can be felt through the skin of the neck
• Voice changes, including increasing hoarseness
• Difficulty to swallow
• Pain in the neck and throat
• Swollen lymph nodes in the neck

👉Thyroid cancer is classified into different subtypes based on the types of cells found in the tumor:

• Papillary thyroid cancer.
• Follicular thyroid cancer.
• Anaplastic thyroid cancer.
• Medullary thyroid cancer.

Dr. Rodrigo Arrangóiz from Center for Advanced Surgical Oncology, is an expert in the treatment of this disease

#Arrangoiz #ThyroidSurgeon #ThyroidCancer #HeadandNeckSurgeon #CancerSurgeon #SurgicalOncologist #CASO #CenterforAdvancedSurgicalOncology #PalmettoGeneralHospital

👉The most common type of thyroid cancer is papillary thyroid cancer, which accounts for >90% of new diagnoses.

👉Fortunately, papillary thyroid cancer is associated with >95% five-year survival rate. (source: https://seer.cancer.gov)

• Fue pionero en México de la:
  • Cirugia tiroidea minimamente invasiva
  • La cirugia minimamente invasiva radio-guiada de paratiroides

•  Su entrenamiento es el siguiente:
  • Tumores de Cabeza y Cuello / Cirugía Endocrina – Fox Chase Cancer Center

• Tumores de Cabeza y Cuello / Cirugía Endocrina – IFHNOS / Memorial Sloan Kettering Cancer Center

👉The number of new thyroid cancer cases has increased over recent years, especially the number of small, low-risk papillary thyroid cancers.

👉It is clear now that treating these small cancers aggressively with surgery results in more potential harm to patients than if the small cancer was simply watched.

👉Because of this, simply watching, known as active surveillance, became a promising alternative to surgery for these low-risk cancers in select patients.

👉Active surveillance involves closely monitoring the thyroid cancer over time, instead of treating it with immediate surgery.

👉Prior studies have shown that active surveillance is safe in papillary thyroid cancers measuring 1 cm or smaller and confined to the thyroid without any lymph node involvement or spread outside of the neck.

👉However, little is known about outcomes of active surveillance for patients with larger cancers measuring 1 to 2 cm and confined to the thyroid.

👉This study compared outcomes of active surveillance for these patients to this with cancers less than 1 cm.

👉The authors also examined outcomes of patients who had surgery for these small cancers.

👉THE FULL ARTICLE TITLE:
Sakai T et al 2019 Active surveillance for T1bN0M0 papillary thyroid carcinoma. Thyroid 29:59–63. Epub 2019 Jan 8. PMID: 30560718.

👉The study included patients who were followed at the Cancer Institute Hospital in Tokyo, Japan, since 1995.

👉Among 406 patients with papillary thyroid cancer less than 1 cm, 360 (89%) underwent active surveillance and 46 (11%) underwent surgery.

👉Among 392 patients with papillary thyroid cancer 1 to 2 cm, 331 (84%) underwent active surveillance and 61 (16%) underwent surgery.

👉The patients in the active surveillance program were followed with physical exam, neck ultrasound and chest X-rays every 6 to 12 months after diagnosis.

👉These patients were evaluated for increase in cancer size, development of spread to the lymph nodes and spread to other parts of the body.

👉The follow-up was 7.3 – 7.9 years.

👉If progression of the cancer was seen or the patient changed their mind, surgery was performed.

👉The authors found that the 5- and 10-year rates of progression were similar in patients with papillary thyroid cancer less than 1 cm compared with those with 1 cm to 2 cm cancers during active surveillance.

👉A total of 11 patients with 1 to 2 cm cancers had surgery after active surveillance and none had the cancer come back.

👉Of the patients with 1 to 2 cm cancers who had immediate surgery, 8 had the cancer come back.

👉The rate of cancer coming back was significantly higher for cancers ≥ 1.5 cm than < 1.5 cm in this group.

👉WHAT ARE THE IMPLICATIONS OF THIS STUDY?
1. This study showed that patients with 1 to 2 cm papillary thyroid cancers had similar progression rates to patients with less than 1 cm cancers during active surveillance. 2. Additionally, delayed surgery was not associated with any harm in these patients. 3. These findings are important as they show that active surveillance of small thyroid cancers, especially those less than 15 mm in size, is safe. 4. Expanding active surveillance to larger cancers would decrease the number of thyroid surgeries and subsequent complications. However, more research is still needed to determine exactly which thyroid cancer patients are ideal for active surveillance, considering age, other health issues and the expertise of treatment team.

#Arrangoiz #ThyroidSurgeon #ThyroidExpert #CancerSurgeon #HeadandNeckSurgeon #CASO #CenterforAdvancedSurgicalOncology #PalmettoGeneralHospital

#Arrangoiz #CancerSurgeon

Society of Breast Imaging recently recently guidelines on management of unilateral axillary adenopathy in patients who have recently received Covid vaccine.
Also, here’s a newly published paper on this topic we are encountering commonly in clinical practice.

https://www.clinicalimaging.org/article/S0899-7071(21)00020-6/fulltext?fbclid=IwAR3iAs7iJCdrMI7dL9-aeayrABRJPYOP1qZA8MMhPO8s7PFKcU8uwPUaAFw

👉The first guidelines ever released for screening mammography for older survivors of breast cancer (>75 years) recommend that routine mammography be discontinued for women whose life expectancy is less than 5 years but that screening continue for those whose life expectancy is more than 10 years.

👉For women who have a life expectancy of 5 to 10 years, the guidelines recommend that consideration be given to discontinuing mammography.

👉Overall, the guidelines encourage shared decision making that is individualized for each woman after weighing the benefits and harms associated with surveillance mammography and patient preferences.

👉The panel also recommended that patients with clinical findings and symptoms receive ongoing clinical breast examinations and diagnostic mammography and that patients be reassured that these practices will continue.

👉Guidelines on breast cancer screening for healthy women already “acknowledge the limitations of mammograms and the need to consider one’s health status and preferences when making decisions on how and when to stop routine mammograms.

https://jamanetwork.com/journals/jama/article-abstract/2768782

#Arrangoiz #CancerSurgeon #BreastSurgeon #BreastCancer #SurgicalOncologist

https://www.liebertpub.com/doi/pdf/10.1089/ct.2019%3B31.20-22

#Arrangoiz

#CirugiadeTumoresdeCabezayCuello

#CirugiaEndocrina

#CirugiaOncologica

#HeadandNeckSurgery

#EndocrineSurgery

#SurgicalOncology