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Biomedical subjects

L Balducci

Publications and source records attributed to L Balducci.

At least 55 records · Page 3Linked to original sources
PubMed1997

The Role of Selective Lymphadenectomy in Breast Cancer.

BACKGROUND: Axillary node dissection is considered a standard staging procedure in patients with breast cancer. The procedure is associated with significant morbidity and provides pathologists with many lymph nodes to evaluate. METHODS: A total of 174 women participated in a trial that included preoperative lymphoscintigraphy and intraoperative lymphatic mapping using a combination of a vital blue dye and radiocolloid mapping. RESULTS: The intraoperative lymphatic mapping correctly identified a sentinel lymph node (SLN) in 160 (92%) of 174 patients. One skip metastasis (0.7%) occurred in 136 women who had a subsequent complete node dissection. CONCLUSIONS: Lymphatic mapping and SLN biopsy using a combination of mapping techniques provide accurate nodal staging for women with breast cancer. With this technique, approximately 70% to 80% of women with no axillary metastases could be spared the morbidity of a complete node dissection.

Journal Article↗
PubMed1997

Menopausal Status and the Impact of Early Recurrence on Breast Cancer Survival.

BACKGROUND: Breast cancer represents the leading form of invasive cancer among American women, killing nearly 50,000 annually. Several prognostic factors that are associated with survival include age, race, menopausal status, and the stage of disease at presentation. METHODS: Patient characteristics were collected based on a systematic chart audit of demographic features and medical, family, and social histories. We studied the survival of 220 patients with recurrent disease out of 1,429 consecutive patients with breast cancer seen over a 15-year period. RESULTS: Patients with a disease-free interval following diagnosis of less than 24 months were more frequently premenopausal and hormone receptor-negative than those with a disease-free interval of 24 months or greater. Patients with early recurrence had a shorter survival than patients with late recurrence. Menopausal status, nodal involvement, receptor status, and the site of recurrent disease were independent predictors of survival following recurrence. CONCLUSIONS: Premenopausal women with early recurrence of breast cancer experience a significantly shorter survival than those with late recurrence, even after adjustment for hormone receptor status and site of recurrence. This effect was not seen in postmenopausal women.

Journal Article↗
PubMed1997

Cancer chemotherapy in older adults. A tolerability perspective.

The incidence of cancer increases with age. Since the geriatric population is growing, we will be confronted with an increasing number of patients with cancer who are > 65 years of age. The purpose of this review is to address the use of cancer chemotherapy in older persons with respect to its tolerability. We performed a review of the literature using 'Medline' and the bibliographies of pertinent publications. Information about cancer treatment in older adults was extracted with particular attention to chemotherapy-related toxicity in patients aged > 65 years. Comorbid disease, polypharmacy/drug interactions, psychosocial issues and age-related physiological changes are major issues in caring for older patients with cancer. Since older individuals may have a greater number of comorbid illnesses, treatment should be initiated on the basis of physiological rather than chronological age. Comparative studies show that chemotherapy-related toxicity is similar in older and younger patients, with the exception of haematological toxicity, which may be more severe in older patients, and cardiotoxicity, which is more frequent in the elderly. Other evidence suggests that gastrointestinal and neurotoxicities may also be more severe in older individuals. The dosages of chemotherapeutic agents that are primarily renally excreted may require adjustment in older patients. Haematological reserve is decrease in older individuals, and drugs that cause myelosuppression must be used with care. The use of haemopoietic growth factors in geriatric patients is currently being investigated.

Aged↗
PubMed1997

Cancer in the elderly. Epidemiologic and clinical implications.

Cancer is a major problem for the older population. The incidence of most malignancies increases with age, with cancer being the second most common cause of death in persons older than 65. With the decline in deaths related to cardiovascular diseases, cancer is becoming an even more prominent cause of death among the elderly. Despite the advances in cancer prevention and treatment over the past 20 years for persons under 50, the mortality has not improved for older persons. In this article we explore the interactions of cancer and age that may be of interest to the practitioner, after reviewing the epidemiology of cancer in the elderly.

Age Distribution↗
PubMed1997

Organ preservation. An effective and safe form of cancer treatment.

In this article we review the current strategies for organ preservation in the treatment of cancer. Organ preservation with functional integrity is particularly beneficial for older patients because the need for complex functional rehabilitation and for the care of permanent stomas may be avoided.

Aged↗
PubMed1997

Prostate cancer.

Prostate cancer is the most common cancer in American men and the second leading cause of death in men aged 65 years or older. This article reviews the epidemiology and the principles of screening and management of prostate cancer.

Aged↗
PubMed1996

Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.

OBJECTIVES: To identify the sentinel lymph node(s) (SLN[s]) (the first node[s] draining the primary tumor in the regional lymphatic basin) in patients with invasive breast cancer and to test the hypothesis that the histologic characteristics of the SLN predict the histologic characteristics of the remaining lymph nodes in the axilla. DESIGN: A prospective trial. PARTICIPANTS: Sixty-two patients with newly diagnosed invasive breast cancers. INTERVENTION: Patients underwent intraoperative lymphatic mapping using a combination of a vital blue dye and filtered technetium-labeled sulfur colloid. The SLN was identified and removed, followed by a definitive cancer operation, including a complete axillary node dissection. MAIN OUTCOME MEASURE: The metastatic distribution in the axilla was determined in patients with occult nodal disease. RESULTS: The SLN was successfully identified in 57 (92%) of 62 patients using the 2 lymphatic mapping procedures. After localization, 18 patients (32%) were found to have metastatic disease, and the SLN tested positive in all 18 patients. There were no "skip" metastases, defined as an SLN that tested negative with higher nodes that tested positive. In 12 (67%) of 18 patients with metastatic disease, the SLN was the only site of disease. The metastatic distribution significantly favored SLN involvement. Among subjects with discordant nodal involvement, the probability of observing the distribution of SLN involvement by chance is very small (P<.001). CONCLUSIONS: This study confirms that lymphatic mapping is technically possible in the patient with breast cancer and that the histologic characteristics of the SLN probably reflect the histologic characteristics of the rest of the axillary lymph nodes. The procedure also allows the pathologist to focus the histologic examination on 1 or 2 nodes, potentially increasing the yield of positive dissections and the accuracy of staging.

Axilla↗
PubMed1996

Current management of breast cancer.

Breast cancer accounts for more than 25 percent of all new cases of cancer in women. Family physicians have an important role in the management of patients who are diagnosed with breast cancer. The clinical staging system is a two-phase postsurgical process that assesses relevant prognostic factors and directs selection of adjuvant therapy after surgery. In stage I or II breast cancer, a patient's chances of disease recurrence and death depend on the number of cancer-positive regional lymph nodes at the time of diagnosis. Survival rates in patients with metastatic disease vary with the location and type of metastases. Whether surgery, chemotherapy or radiation therapy is chosen, patients and their families need continuous advice and support, especially when the cancer is advanced.

Breast Neoplasms↗
PubMed1996

Patients' attitudes regarding out-of-hospital blood transfusion.

BACKGROUND: While the administration of blood transfusions outside of the hospital has become more prevalent, little is known about patients' attitudes regarding this practice. STUDY DESIGN AND METHODS: Twenty-nine adult patients who regularly received blood transfusions in a hospital's outpatient clinic and had never received home transfusions were surveyed. Linear analogue and categorical monetary scales were used to evaluate their responses to a series of questions. RESULTS: At the time of the survey, 27 study participants (93%) did not want home transfusions, and 21 (72%) thought home transfusions posed a greater risk than hospital based transfusion. More than half (56%) of the participants were unwilling to pay more for a home transfusion for themselves than for an outpatient hospital-based transfusion. Participants were willing to pay more for a home blood transfusion for a hypothetical patient requesting transfusions at home. The lack of available transportation and poor patient health were identified as important factors in determining how much more they would be willing to pay for transfusions at home. CONCLUSION: While blood transfusions at home may become more accessible, many patients may prefer to receive their transfusions in the hospital, probably because home transfusions are thought to pose a greater risk. A patient's health and the availability of transportation were determined to be important factors in decisions about how much more money to spend for transfusions at home than for those in an outpatient hospital setting.

Adult↗
PubMed1996

Non-Hodgkin's Lymphoma in the Elderly.

BACKGROUND: The incidence of non-Hodgkin's lymphoma in the elderly continues to increase. There has been a tendency among some treating physicians to minimize appropriate workup and treatment, which may product a negative effect on outcomes. METHODS: Several characteristics of non-Hodgkin's lymphoma in the elderly are reviewed, including classification and staging, pathophysiology, clinical presentation, and treatment strategies. RESULTS: The Working Formulation remains the principal classification used. In order and younger individuals, the prevalence of histologic subtypes and the stage at presentation are similar. Regardless of the regimen chosen, doxorubicin or mitoxantrone should be included if optimal responses are to be obtained. New purine analogs extend the therapeutic armamentarium. CONCLUSIONS: Advanced age and comorbidities can impair the capability for treatments to control non-Hodgkin's lymphoma. To enhance results, more studies that focus on the elderly are needed on drug combinations and the new purine analogs.

Journal Article↗
PubMed1996

Age and the Risk of Breast Cancer Recurrence.

BACKGROUND: Various parameters assist in the definition of prognosis and in the choice of therapy for breast cancer. This study evaluates the effects of prognostic factors on disease outcome in elderly women. METHODS: A retrospective cohort analysis was performed on 1,267 consecutive patients with locoregional breast cancer, including 374 patients 65 years of age or older, who were referred to a university cancer center over an eight-year period. Information on prognostic factors, disease outcome, and survival was analyzed. RESULTS: Women 65 years of age or older were more likely to have early-stage cancers, lower histologic grade, higher hormone receptor levels, and lower S-phase fractions. They experienced a longer time to disease recurrence and overall longer survival than their younger counterparts. CONCLUSIONS: Advancing age should not be considered an unfavorable risk factor for breast cancer. Prognosis and treatment should be based on disease stage and histologic and biologic parameters rather than patient age.

Journal Article↗
PubMed1995

Carcinomatous meningitis: clinical manifestations and management.

Carcinomatous meningitis (CM) is a cause of significant morbidity and mortality in patients with cancer. During the past 15 years, diffuse leptomeningeal metastases of extracranial malignant tumors have been increasingly reported [Wasserstrom et al. 1982, Theodore and Gendelman 1981, Little et al. 1974, Olson et al. 1974, Yaphey et al. 1978, Sorensen et al. 1984], CM is increasing in frequency because of improved survival of patients with systemic anti neoplastic therapies and increased awareness of this problem among physicians. In this review, we will be discussing the epidemiology, etiology, pathology, pathophysiology, clinical manifestations, diagnosis and management of carcinomatous meningitis, as well as the status of recent basic and clinical investigations.

Carcinoma↗