Is cardiac troponin T serum level an accurate surrogate for acute doxorubicin-related myocardial injury?
نویسندگان
چکیده
in patients receiving aromatase inhibitors is due to the discontinuation of tamoxifen treatment and not a direct effect of aromatase inhibitors. As we mentioned in our article [1], future clinical trials looking at the endometrial safety of endocrine treatments, particularly those trials involving sequential treatments with selective estrogen receptor modulators and aromatase inhibitors, should also take into account the potential effect on the uterus of a wash-out period after tamoxifen treatment. Only then can we determine whether tamoxifen-induced changes would eventually resolve over time or whether aromatase inhibitors can offer a protective effect on the endometrium of patients treated with tamoxifen. While there are data on how endo-metrial thickness decreases over time following discontinu-ation of tamoxifen treatment [2], a direct comparison with the decrease achieved in patients receiving aromatase inhibi-tors is not available. Likewise, whether a difference in uter-ine effects between steroidal and non-steroidal aromatase inhibitors exists or whether there is a difference between the three agents is not known. Furthermore, the potential of aromatase inhibitors to reverse tamoxifen-induced uterine changes should be confirmed through randomized clinical trials. Recently, the Intergroup Exemestane Study presented data similar to ours, showing the decrease in endometrial thickness and uterine volume in women receiving exemes-tane compared with tamoxifen [3]. The second issue raised by Cohen is whether the polyps visualized by transvaginal sonography in the present study were real endometrial polyps and not subendometrial fibroids. In our institution, color Doppler imaging is routinely performed to confirm the presence of a polyp. In a prospective observational study on 3099 consecutive patients referred for the assessment of the endometrium and myometrium, 182 polyps were detected and 139 of them had a clear feeding vessel. A distinct vascular pedicle from the myometrium reaching at least the middle of the endometrium (called the 'pedicle artery sign') was related to the presence of a polyp in 81% of the patients, or to any focal lesion in 94.2% of cases [4]. We also reported that this sign was observed in 32 of 687 patients without an endometrial polyp. However, 22 of the 32 patients with false-positive results had other intracavitary pathology: submucous fibroids (7%), hyperplasia (2.9%), endometrial cancer (1.8%) and persistent trophoblastic tissue (1.2%). Only in 5.8% of the patients with a positive test was the cavity normal. These findings were very similar for 310 tamoxifen-treated patients, where the 'pedicle artery test' had a sensitivity for detecting polyps of 89%, …
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ورودعنوان ژورنال:
- Annals of oncology : official journal of the European Society for Medical Oncology
دوره 16 8 شماره
صفحات -
تاریخ انتشار 2005