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Olivia IONESCU

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Articole semnate de acelasi autor in Revista Medicala Romana:

Breast conservative surgery. A surgical procedure which combines oncological safety and esthetic effect

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REVISTA MEDICALA ROMANA - Romanian Medical Journal, Vol. LXIII, Nr. 2, An 2016
ISSN 1220-5478  |  e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

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Breast conservative surgery. A surgical procedure which combines oncological safety and esthetic effect

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ABSTRACT 

In the last twenty years, the surgical treatment of breast cancer (BC) has known a substantial progress, evolving from radical mastectomy – a mutilating procedure commonly performed in until 1970s – to breast conservative surgery (BCS) which allows the removal of the entire breast parenchyma saving the skin envelope of the mammary gland, and sentinel lymph node biopsy that helped reducing the complication rate associated with radical axillary dissection. As it has been proved that BCS and radical mastectomy are associated with similar survival rates, BCS or “skin sparing mastectomy” is nowadays considered to be an oncologically safe procedure in locally advanced BC if the surgical resection criteria is respected: negative surgical margins of resection with an entire removal of all the malignant breast tissue and the maintain of aesthetic result. Moreover, owing to the development of novel oncoplastic techniques and the fact that performing BCS allows the preservation of the skin and sometimes the nipple-areola complex (NAC), BCS techniques such as the skin – sparing mastectomy and nipple-areola complex mastectomy are currently considered mainstay treatment of early stage BC without compromising the oncological safety of mastectomy.

Keywords: breast cancer, conservative mastectomy

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TRIPLE NEGATIVE BREAST CANCER. CURRENT THERAPEUTIC OPTIONS IN THE NEOADJUVANT SETTING

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REVISTA MEDICALA ROMANA - Romanian Medical Journal, Vol. LXIII, Nr. 1, An 2016
ISSN 1220-5478  |  e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

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TRIPLE NEGATIVE BREAST CANCER. CURRENT THERAPEUTIC OPTIONS IN THE NEOADJUVANT SETTING

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ABSTRACT 

At present, breast cancer (BC) has the highest incidence among the most common forms of cancer in women, almost one million women being diagnosed annually worldwide. However, in recent years BC has registered a low mortality rate mainly in developed, high-income countries. The triple negative breast cancer (TNBC) is a subtype of BC which is characterized by the absence of protein expression of the two hormone receptors-estrogen (ER) and progesterone (PgR) after immunohistochemistry (IHC) analysis and the lack of overexpression of the human epidermal growth factor receptor 2 (HER2) after IHC or in situ fluorescence hybridization technique. More than 170,000 of women are currently diagnosed with TNBC (ER–/PR–/HER2) representing 12-20% of all BC. TNBCs are recognized to have a poor prognosis which translates into a relative low disease-free survival rate for women who receive either neoadjuvant or adjuvant chemotherapy as well as a low progression-free survival rate for women who develop distant metastases. Furthermore, biologically, they are much more aggressive than the other types of BC and, owing to their triple “negativity”, a targeted therapy with anti-hormon agents or transtuzumab (anti HER2) cannot be utilized. The aim of this paper is to make a review of the current scientific evidence with regard to the new chemotherapeutic agents used in the neoadjuvant setting as well as the role of surgical treatment in women diagnosed with TNBC.

Keywords: breast cancer, triple negative, chemotherapy, neoadjuvant

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AXILLARY LYMPH NODE DISSECTION IN BREAST CANCER PATIENTS. THE ROLE OF SENTINEL LYMPH NODE BIOPSY

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REVISTA MEDICALA ROMANA - Romanian Medical Journal, Vol. LXII, Nr. 4, An 2015
ISSN 1220-5478  |  e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

Indexată BDI  |  IDB Indexed

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DOAJ
Ebsco Host - Medline
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Committe on Publication Ethics

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PREMIU NAȚIONAL AUTORI

RMJ și AMR oferă anual Premiul Național pentru Știință și Cercetare - pentru autorii celor mai bune articole științifice publicate [...]

Plagiatul – în actualitate

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AXILLARY LYMPH NODE DISSECTION IN BREAST CANCER PATIENTS. THE ROLE OF SENTINEL LYMPH NODE BIOPSY

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ABSTRACT

Rationale. Since its introduction in the early 1990s, sentinel lymph node biopsy (SLNB) is regarded as the standard treatment for patients with clinically negative axillary lymph nodes (LNs) on initial presentation. Classically, when the SLN biopsy is negative, the axillary LN dissection (ALND) is no further necessary. On the other hand, performing complete ALND in case of a positive SLNB is controversial, recent data from randomized controlled studies suggesting that, in these cases, the tumor biology has a greater impact on the adjuvant treatment decision than the completion of an ALND.

Objective. The aim of this review is to ascertain whether axillary LN surgery has survival benefits in women with early breast cancer and SLN involvement, either micro-metastatic or macro-metastatic. Moreover, it tries to assess the value of SLN biopsy before and after primary systemic chemotherapy and its role in the staging of the axilla in locally recurrent breast cancer.

Materials and method. We searched Pubmed, Medline, the Cochrane Register of Controlled Trials and G.I.N (Guidelines International Network) databases for English language articles about the need of ALND in women with both positive and negative SLNs using controlled vocabulary (e.g. “breast cancer”) and key words (e.g “sentinel lymph node”, “axilla dissection”). The analysis was restricted to retrospective studies and randomized controlled trials focusing on survival benefits in terms overall (OS) or disease-free survival (DFS).

Conclusions. There is increasing evidence which indicates that ALND can be avoided in a specific group of patients with early breast cancer, even though the SLNB is positive. A correlation between the clinico-pathological features of the breast cancer and the probability of residual disease in the axilla, could allow the selection of cases in which ALND can be omitted. In the context of neo-adjuvant chemotherapy, it is not yet established if positive SLNs could be converted to negative SLNs after chemotherapy as the rate of false-negative results is still high.

Keywords: sentinel lymph node, breast cancer, biopsy, axillary dissection

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