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Resumen Objetivo Revision bibliografica del diagnostico y tratamiento actual del angiosarcoma radioinducido de mama. Pacientes Presentamos dos casos de angiosarcoma radioinducido de mama comentandose los aspectos clinicos, diagnosticos y terapeuticos de interes. Conclusion El angiosarcoma de mama radioinducido es un tumor infrecuente que se presenta como complicacion tardia en pacientes sometidas a tratamiento conservador del cancer de mama mediante cirugia y radioterapia. La cirugia es el unico tratamiento curativo, aunque su elevada tasa de recaida local requiere de tratamiento multimodal para optimizar los resultados de control local.

Resumen Objetivo Revision bibliografica del diagnostico, tratamiento y supervivencia del carcinoma de mama metastasico que cursa con carcinomatosis peritoneal. Pacientes y metodos Presentamos el caso de una paciente en tratamiento en nuestro hospital comentandose los aspectos clinicos, diagnosticos y terapeuticos de interes. Conclusion Las metastasis del tracto gastrointestinal extra-hepaticas secundarias a tumor de mama son poco comunes (8-10%). La carcinomatosis peritoneal presenta una baja incidencia, habiendose descrito pocos casos en la literatura, siendo la mayoria de tipo lobulillar infiltrante. Nuestro caso tratado de carcinomatosis peritoneal de origen mamario ductal infiltrante lo hace aun mas infrecuente.

Resumen Introduccion La pandemia por COVID-19 ha modificado nuestra actividad asistencial habitual en los ultimos meses. Debido al colapso hospitalario se han suspendido consultas, pruebas diagnosticas e intervenciones quirurgicas, con el objetivo tambien de reducir la exposicion de pacientes al SARS-CoV-2 en el medio hospitalario. Sin embargo, esto ha provocado un retraso en la atencion de otros problemas sanitarios. Material y metodos Analizamos y comparamos los datos de la Unidad de Mama en un hospital de segundo nivel, en cuanto a la actividad del Programa de Diagnostico Precoz de Cancer de Mama (PDPCM), los diagnosticos de cancer realizados, asi como las pacientes intervenidas durante los meses de marzo a mayo de 2020, con respecto al mismo periodo del ano anterior. Resultados El numero de pacientes atendidas en el PDPCM en los meses de marzo a mayo de 2020 se ha reducido en un 91,7%, y las pacientes atendidas en el Servicio de Radiodiagnostico del hospital en un 54,2%. La actividad quirurgica tambien se ha visto mermada en un 57,69% con respecto al mismo periodo del ano anterior. Conclusiones La disminucion de la actividad del PDPCM y Radiologia conllevan a un retraso diagnostico que concluira con un aumento de lista de espera y demora en el tratamiento, lo que posiblemente derive en un diagnostico en estadios mas avanzados de la enfermedad.

Simple Summary Most solid tumors share mutations in TP53 that is thus considered one of the main cancer driver genes. Mutations in TP53 occur very early during tumor development, so their identification helps in diagnosing cancer. Furthermore, knowing in advance the TP53 mutation status might help guiding targeted treatments against this gene. However, this analysis is mainly performed in tissue samples, that is, solid biopsies, being an invasive technique. Contrarily, liquid biopsies, consisting of the analysis of blood samples, are non-invasive, can be performed repeatedly, helping in monitoring the patient evolution, and might be useful in early stages when the tumor is not yet detected by other technologies. Here, we review the main studies conducted on two types of liquid biopsies: circulating tumor cells and cell-free DNA. We discuss the main findings regarding TP53 mutation analysis, the clinical utility of this information and some controversies arising from the study of liquid biopsies compared to tissue samples, and we finish by suggesting future directions within this field. Abstract Being minimally invasive and thus allowing repeated measures over time, liquid biopsies are taking over traditional solid biopsies in certain circumstances such as those for unreachable tumors, very early stages or treatment monitoring. However, regarding TP53 mutation status analysis, liquid biopsies have not yet substituted tissue samples, mainly due to the lack of concordance between the two types of biopsies. This needs to be examined in a study-dependent manner, taking into account the particular type of liquid biopsy analyzed, that is, circulating tumor cells (CTCs) or cell-free DNA (cfDNA), its involvement in the tumor biology and evolution and, finally, the technology used to analyze each biopsy type. Here, we review the main studies analyzing TP53 mutations in either CTCs or cfDNA in the three more prevalent solid tumors: breast, colon and lung cancers. We evaluate the correlation for mutation status between liquid biopsies and tumor tissue, suggesting possible sources of discrepancies, as well as evaluating the clinical utility of using liquid biopsies for the analysis of TP53 mutation status and the future actions that need to be undertaken to make liquid biopsy analysis a reality for the evaluation of TP53 mutations.

Objective Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients. Methods The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. Conclusion Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program. Impact The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.

BACKGROUND Therapeutic exercise is already much used as a means of ameliorating some of the side effects of cancer treatment. Recent studies have examined its preventive potential with respect to the appearance of treatment-related toxicity. Toxicity-induced cardiac damage - indeed, even temporary adverse effects on the heart - can increase the risk of functional decline, which can in turn lead to disease recurrence and death. OBJECTIVE The present trial will examine whether the ATOPE (Tailored Therapeutic Exercise and Recovery Strategies) program, performed before treatment starts for recently diagnosed breast cancer (ATOPE-B), can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed by similar patients who have already begun treatment (ATOPE-I), using a mobile app, ATOPE+, to determine women’s therapeutic exercise assimilation. METHODS The ATOPE intervention consists of 6 bouts of general preparatory exercise plus 12-18 bouts of tailored, high intensity exercise (whole-body and locoregional exercises), and the following of post-exercise recovery strategies (stretching and breathing exercises). A total of 120 female patients recently diagnosed with stage 1-IIIb breast cancer and awaiting surgery followed by chemotherapy and/or radiotherapy, and at risk of cardiotoxicity as described by the American Society of Clinical Oncology Guidelines, will be randomised 1:1 to either ATOPE-B or ATOPE-I. In a small feasibility study performed before the main trial, and lasting one full cycle of the ATOPE program, measurements related to recruitment rate, satisfaction with the application, satisfaction with the ATOPE-B and ATOPE-I programs, adherence to the program, the retention of subjects, safety, and adverse effects will be explored. In the main trial, which is designed to examine the efficacy of these interventions, the major outcome variable will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. This, along with other clinical, physical, and anthropometric outcomes, and biological and hormonal variables, will be assessed after diagnosis, 3 days before the third chemotherapy session, 1 year after treatment ends, and 3 years after treatment ends. RESULTS Not aplicable CONCLUSIONS The left ventricular ejection fraction is modified by cancer treatment. Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority. If the ATOPE-B intervention returns better cardioprotection results than ATOPE-I, it may be recommendable that patients yet to begin treatment for breast cancer, follow this program. CLINICALTRIAL ClinicalTrials.gov, NCT03787966

Simple Summary: Most solid tumors share mutations in TP53 that is thus considered one of the main cancer driver genes. Mutations in TP53 occur very early during tumor development, so their identification helps in diagnosing cancer. Furthermore, knowing in advance the TP53 mutation status might help guiding targeted treatments against this gene. However, this analysis is mainly performed in tissue samples, that is, solid biopsies, being an invasive technique. Contrarily, liquid biopsies, consisting of the analysis of blood samples, are non-invasive, can be performed repeatedly, helping in monitoring the patient evolution, and might be useful in early stages when the tumor is not yet detected by other technologies. Here, we review the main studies conducted on two types of liquid biopsies: circulating tumor cells and cell-free DNA.We discuss the main findings regarding TP53 mutation analysis, the clinical utility of this information and some controversies arising from the study of liquid biopsies compared to tissue samples, and we finish by suggesting future directions within this field. Abstract: Being minimally invasive and thus allowing repeated measures over time, liquid biopsies are taking over traditional solid biopsies in certain circumstances such as those for unreachable tumors, very early stages or treatment monitoring. However, regarding TP53 mutation status analysis, liquid biopsies have not yet substituted tissue samples, mainly due to the lack of concordance between the two types of biopsies. This needs to be examined in a study-dependent manner, taking into account the particular type of liquid biopsy analyzed, that is, circulating tumor cells (CTCs) or cell-free DNA (cfDNA), its involvement in the tumor biology and evolution and, finally, the technology used to analyze each biopsy type. Here, we review the main studies analyzing TP53 mutations in either CTCs or cfDNA in the three more prevalent solid tumors: breast, colon and lung cancers. We evaluate the correlation for mutation status between liquid biopsies and tumor tissue, suggesting possible sources of discrepancies, as well as evaluating the clinical utility of using liquid biopsies for the analysis of TP53 mutation status and the future actions that need to be undertaken to make liquid biopsy analysis a reality for the evaluation of TP53 mutations.