Browsing by Author "Muller, Bettina"

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    Perioperative chemotherapy in locally advanced gastric cancer in Chile: from evidence to daily practice
    (2021) Muller, Bettina; Garcia, Carlos; Sola, Jose A.; Fernandez, Wanda; Werner, Patrick; Cerda, Mauricio; Slater, Jeannie; Benavides, Carlos; Arancibia, Jorge; Ascui, Rodrigo; Reyes, Felipe; Anne Stevens, Mary; Pablo Miranda, Juan; Buchholtz, Martin; Corvalan, Alejandro H.
    Gastric cancer (GC) is a leading cause of cancer death in Chile. Although recommended in international guidelines since 2006, perioperative chemotherapy was not available to patients in the public health system in Chile until 2016. We conducted an observational study to assess the feasibility of this strategy in public hospitals in Chile (Observational Study of Perioperative Chemotherapy in Locally Advanced Gastric Cancer - PRECISO). Patients with locally advanced, operable GC were offered to receive preoperative chemotherapy with Epirubicin + Cisplatin + Capecitabine (ECX) for three cycles followed by curative surgery. Staging included abdominal CT scan and laparoscopy if peritoneal carcinomatosis was suspected. Postoperative ECX for three cycles was recommended. Between August 2010 and March 2013, 110 patients were screened and 61 enrolled. Median age was 62 years (23-76 years) and most patients had good performance status at baseline (Eastern Cooperative Oncology Group performance status score (ECOG) 0: 42, ECOG 1: 19). Tumour site was proximal in 32 (52%) and medial and distal in 29 (48%) patients. All but four patients (n = 57, 93%) completed three cycles of preoperative chemotherapy. Fifty-six patients were operated and 54 (89%) had a curative resection. Thirty-three patients (54%) had pT0-2, and 18 (30%) had pN0 tumours, with two patients achieving a complete response. As of 20 December 2020, 39 patients died, 32 due to GC, one within 30 days of surgery, two due to intestinal obstruction at 5 and 3 months after surgery and four due to other causes. Five-year survival rate was 38%. We conclude that perioperative chemotherapy is feasible in public hospitals in Chile and should be offered to patients with locally advanced GC.
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    Socioeconomic, Clinical, and Molecular Features of Breast Cancer Influence Overall Survival of Latin American Women
    (2022) de Almeida, Liz Maria; Cortés Arancibia, Sandra; Vilensky, Marta; Valenzuela, Olivia; Cortes-Sanabria, Laura; de Souza, Mirian; Alonso Barbeito, Rafael; Abdelhay, Eliana; Artagaveytia, Nora; Daneri-Navarro, Adrian; Llera, Andrea S.; Muller, Bettina; Podhajcer, Osvaldo L.; Velazquez, Carlos; Alcoba, Elsa; Alonso, Isabel; Bravo, Alicia, I; Camejo, Natalia; Maria Carraro, Dirce; Castro, Monica; Cataldi, Sandra; Cayota, Alfonso; Cerda, Mauricio; Colombo, Alicia; Crocamo, Susanne; Del Toro-Arreola, Alicia; Delgadillo-Cristerna, Raul; Delgado, Lucia; Breitenbach, Marisa Dreyer; Fernandez, Elmer; Fernandez, Jorge; Fernandez, Wanda; Franco-Topete, Ramon A.; Gaete, Fancy; Gomez, Jorge; Gonzalez-Ramirez, Leivy P.; Guerrero, Marisol; Gutierrez-Rubio, Susan A.; Jalfin, Beatriz; Lopez-Vazquez, Alejandra; Loria, Dora; Miguez, Silvia; Moran-Mendoza, Andres de J.; Morgan-Villela, Gilberto; Mussetti, Carina; Nagai, Maria Aparecida; Oceguera-Villanueva, Antonio; Reis, Rui M.; Retamales, Javier; Rodriguez, Robinson; Rosales, Cristina; Salas-Gonzalez, Efrain; Segovia, Laura; Sendoya, Juan M.; Silva-Garcia, Aida A.; Vina, Stella; Zagame, Livia; Jones, Beth; Szklo, Moyses
    Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status not less than or equal to 1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (>= 60 years) (1.84) compared with younger (<= 40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.