BJMO - volume 6, issue 6, december 2012
M. Marsan , P. Neven MD, PhD, P. Vermeulen , L. Dirix MD, PhD, S. Van Laere PhD
TGF-β is a major regulator and driver of many biological processes, but its main function is inhibition of cell cycle progression and apoptosis, thus establishing a tumour-protective effect in early stages of malignant transformation. However, mutational alterations can occur at different levels of the TGF-β signaling cascade. These mutations, combined with the significant influence of the tumour microenvironment on this cascade, can cause a functional shift of TGF-β from being a tumour suppressor to becoming a tumour promoter in more advanced cancers. In most tumours this will ultimately contribute to the formation of metastatic laesions. In the clinical setting of breast cancer, TGF-β plays a significant role in the acquisition of endocrine resistance. Thus, therapeutic intervention of TGF-β signaling might deliver significant benefits in the treatment of cancer. (BELG J MED ONCOL 2012;6:188–193)
Read moreBJMO - volume 6, issue 3, june 2012
A. Smeets MD, PhD, B. Carly MD, V. Cocquyt , M. Vanhoeij , C. Bourgain MD, PhD, E. Lifrange , G Villeirs MD, PhD, M. De Ridder MD, PhD, M. Drijkoningen , J. Lamote , R. Van Den Broecke , M. Voordeckers , J. De Grève MD, PhD, P. Neven MD, PhD, M.R. Christiaens
The aim of this article is to highlight the recent changes in the surgical approach of the axilla in breast cancer patients. Axillary staging is dominated by the sentinel lymph node (SLN) biopsy, which is now widely practiced in clinically node negative patients. Most authors believe a SLN biopsy may even be performed in patients with a large or multifocal tumour, before neo-adjuvant systemic therapy, during pregnancy, after prior excisional biopsy and after prior mantle field radiotherapy of the breast. Intra-operative assessment of the SLN is recommended as it can identify half of all positive lymph nodes. It is generally accepted that it is safe to omit an axillary lymph node dissection (ALND) in patients with a negative SLN or with only isolated tumour cells (<0.2 mm) in the SLN. Moreover, in a subset of patients with a micro-/macrometastasis in the SLN it might not be necessary to perform a completion of ALND. We suggest to accept the option of omitting completion of ALND in frail patients with a positive sentinel lymph node on final pathology OR in these patients with, on final pathology, one or two positive SLNs AND a grade I or II tumour smaller than 4 cm AND adjuvant radiotherapy on the whole breast or chest wall. In conclusion, an increasingly tailored surgical approach is guiding the management of the axilla for women with early breast cancer. (BELG J MED ONCOL 2012;6:87–95)
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