Background: Adjuvant chemotherapy for Luminal B-like breast cancers usually includes anthracycline-based regimens. However, some patients are reluctant to receive chemotherapy because of side-effects, especially alopecia, and ask for a “less intensive” or personalized approach. Patients and methods: We conducted a phase II feasibility trial to evaluate pegylated liposomal doxorubicin (PLD, Caelyx^®) as adjuvant chemotherapy. Patients who received surgery for pT1–3, any N, and luminal B-like early-stage breast cancer (EBC) candidates for adjuvant chemotherapy were included. PLD was administered intravenously at 20 mg/m² biweekly for eight courses. Endocrine therapy was given according to menopausal status. Trastuzumab was administered in HER2-positive disease. The primary endpoint was to evaluate the feasibility of this regimen, defined as the ability of a patient to achieve a relative dose intensity (RDI) of at least 85% of the eight cycles of treatment. Secondary endpoints included adverse events (AEs), tolerability, breast cancer-free survival, disease-free survival, and overall survival. Results: From March 2016 to July 2018, 63 patients were included in the trial. Median age was 49 years (range: 33–76), with mostly pre- and peri-menopausal (65%) and stage I–II (94%). Only 5% of patients had HER2-positive EBC. Median RDI was 100% (range: 12.5–100%; interquartile range, IQR: 87.5–100%). The proportion of patients meeting the primary endpoint was 84% (95% confidence interval, CI: 73–92%). Overall, 55 out of 63 enrolled patients completed treatment (87%, 95% CI: 77–94%). Most common AEs were palmar-plantar erythrodysesthesia (12.2%), fatigue (10.4%), and mucositis (8.5%). Only 13% of patients had G3 AEs. None had alopecia. After a median follow-up of 3.9 years (range: 0.3–4.7) two distant events were observed, and all patients were alive at the date of last visit. Conclusions: The trial successfully met its primary endpoint: the regimen was feasible and well tolerated and could be considered for further evaluation as a treatment option for patients with contraindications to standard anthracyclines or requiring a personalized, less intensive approach.

With rising global aging, healthcare systems face challenges from multimorbidity, functional decline, and cognitive impairment. Multidomain interventions offer a promising approach to promoting healthy aging. This systematic review and meta-analysis evaluated the effects of multidomain interventions (≥3 domains) on motor-functional, cognitive, and psychological outcomes in older adults without moderate/severe dementia. Following PRISMA guidelines, PubMed and Embase were searched up to April 30, 2024. Eligible studies included clinical trials or observational studies involving adults ≥60 years receiving multidomain interventions versus control/standard care. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Thirty-eight studies (57 comparisons) were included (median age: 75.3 intervention, 75.1 control; >60% female). Intervention lasted 2-36 months (median 6.0). All studies targeted the physical domain, 78.9% cognitive, 81.6% nutritional, and 84.2% additional domains. Motor-functional outcomes improved significantly (e.g., Short Physical Performance Battery: SMD = 0.40, 95% CI 0.14 to 0.66; Cardiovascular Health Study frailty criteria: SMD = -0.14, 95% CI -0.23 to -0.05), with diminishing effects over time. Other indicators (e.g., handgrip strength), showed modest improvements. Cognitive improvements were limited to Montreal Cognitive Assessment (MoCA; SMD = 0.23, 95% CI 0.06 to 0.40). Psychological benefits included reduced depressive symptoms (Geriatric Depression Scale: SMD = -0.35, 95% CI -0.57 to -0.12). Effect estimates for Timed Up and Go and RBANS were attenuated in sensitivity analysis excluding high-risk-of-bias studies. Multidomain interventions improve motor-functional and psychological well-being. Moderate cognitive benefits are observed primarily using the MoCA. These findings support large-scale implementation in geriatric care and highlight the need for strategies to sustain long-term effectiveness.

Background: The reconstruction of large breasts carries a heightened risk profile. While skin-reducing mastectomy (SRM) techniques facilitate the correction of breast ptosis, they are frequently associated with a high incidence of vascular complications. This study compares two SRM techniques—the horizontal incision and the classic inverted T incision—by examining their clinical and surgical outcomes. Methods: We retrospectively analyzed data from 24 patients (30 breasts) who underwent SRM with immediate prosthetic reconstruction between 2019 and 2023 at the European Institute of Oncology in Milan, Italy. Our comparison focused on breast aesthetic outcome, reconstruction quality, complication rates (early and late), and patient satisfaction, utilizing the BREAST-Q questionnaire to gauge the latter. Results: Among the 24 patients included in the study, 16 (20 breasts) were treated with the inverted T technique, and 8 (10 breasts) with the horizontal incision approach. A higher overall complication rate was observed with the inverted T technique compared to the horizontal method, with early complications outnumbering late ones. The most common issues were recurrent seroma and skin necrosis leading to implant exposure. Notably, there were no cases of implant infection. Although the horizontal incision technique achieved slightly higher patient satisfaction scores, the difference was not statistically significant. Discussion: The inverted T and horizontal incision techniques each have unique benefits and drawbacks. Our findings indicate enhanced patient satisfaction and reduced complication rates with the horizontal incision technique. The selection of the technique should be customized based on the patient’s individual risk factors, tissue quality, and preferences.