Oligometástasis en cáncer de mama: estrategias y perspectivas para el control local del tumor primario y de las metástasis

El cáncer de mama metastásico, identificado en el momento del diagnóstico o desarrollado tras transcurrir cierto tiempo desde la aparición de la enfermedad primaria, presenta una naturaleza heterogénea. Los resultados obtenidos gracias a los avances farmacológicos nos motivan a explorar la suplementación del tratamiento empleando técnicas de abordaje local. Esta revisión está dirigida a analizar la información disponible en la literatura sobre dos aspectos fundamentales en el cáncer de mama. Por un lado, el control del tumor primario, tanto en la mama como en los ganglios linfáticos locorregionales, y por otro, el control local de las metástasis en función de su localización en los casos de enfermedad oligometastásica. Las principales estrategias para llevar a cabo dicho control local son la cirugía, la radioterapia, incluyendo la radioterapia estereotáctica corporal o la radioterapia de haz externo, y la ablación por radiofrecuencia. Las evidencias discutidas señalan que, a la espera de más resultados procedentes de ensayos controlados aleatorios y de estudios específicos de la enfermedad, las pacientes con oligometástasis deben ser evaluadas por un equipo multidisciplinar. Las metástasis únicas podrían ser candidatas para tratamiento local, cada vez más eficiente, y esto, en combinación con los avances en la terapia sistémica, podría resultar en un mejor control de la enfermedad. Todas estas alternativas deberían presentarse a las pacientes con la finalidad de seleccionar un tratamiento personalizado, con base en la evidencia científica y en las características propias de su enfermedad, que presuponga un resultado más eficaz.Metastatic breast cancer, identified at the time of diagnosis or developed after a certain period since the onset of the primary disease, presents a heterogeneous nature. The results obtained through pharmacological advances encourage us to explore supplementing the treatment using local management techniques. This review aims to analyze the available literature on two fundamental aspects of breast cancer. On the one hand, the control of the primary tumor, both in the breast and in the locoregional lymph nodes, and on the other hand, the local control of metastases depending on their location in cases of oligometastatic disease. The main strategies for carrying out such local control are surgery, radiotherapy, including stereotactic body radiotherapy or external beam radiotherapy, and radiofrequency ablation. The evidence discussed indicates that, pending further results from randomized controlled trials and disease-specific studies, patients with oligometastasis should be evaluated by a multidisciplinary team. Single metastases could be candidates for local treatment, increasingly efficient, and this, in combination with advances in systemic therapy, could result in better disease control. All these alternatives should be presented to patients with the purpose of selecting a personalized treatment, based on scientific evidence and the unique characteristics of their disease, which presupposes a more effective outcome.AstraZenecaLillyPfizerRoch

A Telehealth-Based Cognitive-Adaptive Training (e-OTCAT) to Prevent Cancer and Chemotherapy-Related Cognitive Impairment in Women with Breast Cancer: Protocol for a Randomized Controlled Trial

Background: Many women with breast cancer experience a great number of side effects, such as cognitive impairment, during and after chemotherapy that reduces their quality of life. Currently, research focusing on the use of non-pharmacological, and specifically telehealth interventions to prevent or mitigate them has been insufficient. Methods: This protocol describes a randomized controlled trial aimed at studying the preventive effects of a videoconferenced cognitive-adaptive training (e-OTCAT) program (ClinicalTrials.gov NCT04783402). A number of 98 eligible participants will be randomized to one of the following groups: (a) the experimental group receiving the e-OTCAT program during 12 consecutive weeks since the beginning of chemotherapy; and (b) the control group receiving and educational handbook and usual care. The primary outcome will be the cognitive function. Secondary measures will be psychological distress, fatigue, sleep disturbance, quality of life and occupational performance. The time-points for these measures will be placed at baseline, after 12 weeks and six months of post-randomization. Conclusion: This trial may support the inclusion of multidimensional interventions through a telehealth approach in a worldwide growing population suffering from breast cancer, emphasizing the prevention of cognitive impairment as one of the side effects of cancer and its treatments.Spanish Government FPU17/00939 FPU18/03575Instituto de Salud Carlos III FI19/0023

Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.

Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't;BACKGROUND Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women. METHODS / DESIGN This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. DISCUSSION This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01801527.The study was funded by a research project grant (FIS PI10/02749-02764) from the Health Institute Carlos III and PN I+D+I 2008–2011 (FEDER funds), a grant (Program FPU AP2010-6075) from Education Ministry, Madrid, Spanish Government and a grant of Andalusian Health Service, Junta de Andalucia (PI-0457-2010).Ye