Overall survival in metastatic breast cancer patients: a single-centre analysis (2000-2005)

Background: Recent epidemiological studies suggest that chemotherapy has not contributed to a marked improvement of patient outcome during the last decades. In most randomized trials which investigated the efficacy of a 1st-line schedule for metastatic breast cancer (MBC), the median survival ranged between 18 and 24 months. The goal of the present study was to analyse the survival of patients with MBC treated in a single university outpatient clinic. Methods: Patients who had received their complete anti-cancer treatment for MBC in our outpatient clinic between 2000 and 2005 were analyzed for treatment and survival. Results: 232 patients [median age of 53, range 27-87 yrs; ER and/or PgR positive (HR+) n=174 (75%); HER2 over-expression (HER2+) n=79 (34%)] were included in the analysis. Endocrine sensitive patients received 1-2 (58.6%), 3-4 (37.4%) and 5-6 (2.3%) hormonal regimens. Of all patients 53.4% received up to 3 cytostatic agents in palliative intent, 4-6 regimens were applied in 22.1% and 12.9% received more than 6 subsequent regimens during the course of their disease. The median overall survival (OS) from time of diagnosis of metastatic disease was 44 months. Patients with HR positive tumours survived 46 months, whereas the survival of those with HR negative tumours was 34 months (p=0.07). HER2+ patients who received trastuzumab survived for a median of 44 months. Visceral involvement was associated with a shorter survival as compared to non-visceral disease (34 vs. 57 months, p<0.05). Thirty-one patients underwent loco-regional procedures as resection of metastases (n=14, 6.0%) or radiofrequency ablation (n=17, 7.3%). Conclusion: These data show a selective patient population in a single-centre setting, that report improved survival rates. Whether innovative medicine, a step by step escalation of all treatment modalities according to standard guidelines and individualized clinical requirements and a multidisciplinary treatment approach contribute to these good outcomes is debatable. Key words: metastatic breast cancer, survival, chemotherapy, endocrine therapy, therapy sequence

Cardiac Output Measurements in Septic Patients: Comparing the Accuracy of USCOM to PiCCO

USCOM is an ultrasound-based method which has been accepted for noninvasive hemodynamic monitoring in various clinical conditions (USCOM, Ultrasonic cardiac output monitoring). The present study aimed at comparing the accuracy of the USCOM device with that of the thermodilution technique in patients with septicemia. We conducted a prospective observational study in a medical but noncardiological ICU of a university hospital. Septic adult patients (median age 55 years, median SAPS-II-Score 43 points) on mechanical ventilation and catecholamine support were monitored with USCOM and PiCCO (n = 70). Seventy paired left-sided CO measurements (transaortic access = COUS-A) were obtained. The mean COUS-A were 6.55 l/min (±2.19) versus COPiCCO 6.5 l/min (±2.18). The correlation coefficient was r = 0.89. Comparison by Bland-Altman analysis revealed a bias of −0.36 l/min (±0.99 l/min) leading to a mean percentage error of 29%. USCOM is a feasible and rapid method to evaluate CO in septic patients. USCOM does reliably represent CO values as compared to the reference technique based on thermodilution (PiCCO). It seems to be appropriate in situations where CO measurements are most pertinent to patient management