Eficacia de anastrozol como endocrinoterapia neoadyuvante en pacientes postmenopáusicas con cáncer de mama, estadios II y III

La terapia neoadyuvante con inhibidores de la aromatasa (AI) representa una nueva estrategia terapéutica en pacientes con tumores ER+ y HER2-. Estudios recientes demostraron que los tratamientos con IA tienen una eficacia similar a la quimioterapia convencional, aunque reducen significativamente los efectos adversos. El objetivo del presente estudio fue evaluar la eficacia del tratamiento neoadyuvante utilizando el IA anastrozol. Se consideran indicadores de respuesta al tratamiento la determinación de los niveles de Ki67, las respuestas tumorales, las respuestas patológicas completas y el porcentaje de tratamientos de cirugía conservadora. En 32 pacientes se observó que la administración de anastrozol durante 24 semanas determinó una respuesta franca evidenciada por disminución del tamaño del tumor, disminuyendo el estadio clínico en un 56% y aumentando el ratio de cirugías conservadoras de mama en un 77%. El PR (-), fue identificado como marcador tumoral relacionado con mala respuesta al tratamiento. En la variante histológica lobulillar clásica, todos los casos tratados evidenciaron una reducción significativa del tamaño del tumor.The neoadjuvant therapy with aromatase inhibitors (AI) represents a novel therapeutics strategy in patients with ER+ and HER2- tumors. Recent studies demonstrated that treatments with AI have a similar efficacy than conventional chemotherapy, although its significantly reduced adverse effects. The goal of the present study was to evaluate the neoadjuvant treatment efficacy using the AI anastrozole. The Ki67 levels determination, tumoral responses, complete pathologic responses and percentage of conservative surgery treatments are considered as indicators of response to treatment. In 32 patients, the administration of anastrozole for 24 weeks was observed to determine a frank response evidenced by decrease in tumor size, decreasing the clinical stage in 56% and increasing the ratio of breast conservative surgeries in 77%. The PR (-), was identified as tumoral marker related to treatment poor response. Into the classical lobular histological variant, all the treated cases evidenced a significant tumor size reduction.Fil: Spuri, Paola. Hospital Regional Diego Paroissien; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; ArgentinaFil: Bonansone, Natalia. Fundacion Escuela de Medicina Nuclear  (fuesmen);Fil: Real, Nilda. Hospital Regional Diego Paroissien; ArgentinaFil: Rizzo, Germán. Hospital Regional Diego Paroissien; ArgentinaFil: Maure, Mercedes. Hospital Regional Diego Paroissien; ArgentinaFil: Ciani, Susana. Hospital Regional Diego Paroissien; ArgentinaFil: Monge, Cristina. Hospital Regional Diego Paroissien; ArgentinaFil: Valdemoros, Paula. Hospital Regional Diego Paroissien; ArgentinaFil: Gamarra Luques, Carlos Diego. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; ArgentinaFil: Perelló, Silvana. Instituto de Medicina Complementaria; ArgentinaFil: Ciocca, Leonardo. Hospital Italiano; ArgentinaFil: Gomez Guash, Soledad. Hospital Municipal de Chivilcoy; ArgentinaFil: Villalobos, Walter. Hospital Regional Diego Paroissien; Argentin

Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor