bluuebunny/crossref_metadata_2025_split huggingface dataset:
The margins effect: Residual tumor after breast conserving surgery
Authors: Meirovitz A. , Rennert H. S. , Peretz T. , Salmon A. , Rennert G. 
Published: March 2020

11045 Background: Resection of breast cancer with good surgical margins is one of the fundamental aspects of breast conserving surgery. Most studies have shown that women with positive margins after breast conserving surgery (BCS) fared worse compared to those with negative margins, regardless of chemotherapy or radiation therapy. Nowadays, when partial breast irradiation is gaining popularity, understanding the natural history of positive or close margins is particularly important. We studied the surgical process in a large cohort of Israeli women with breast cancer to estimate the frequency of tumor margin involvement in the primary and subsequent surgical procedure. Methods: The National Israeli Breast Cancer Detection Programs has been monitoring the detection process of all new cases of breast cancer in Israel since 1996. Full data on tumor histology and surgical procedures, including indication of margins in the pathology report were available for 16,925 malignant breast tumors. Margins were classified as positive margins (PM), close (= 2mm) (CM) or negative margins (greater then 2mm)(NM). Results: BCS was identified in 14,815 women with invasive cancer and 2,110 with pure ductal carcinoma in situ (DCIS). Only 7,751 (52.3%) of the 14,815 women with invasive cancer had NM, while 2,868 (19.4%) had CM and 4,196 (28.3%) had PM. Among those with PM, 2,276 (54.6%) had a re-operation within 6 months from the index surgery and 1,265 (55.6%) of them were found to be malignant; 58% of them were invasive cancers and 42% DCIS. Among the invasives on re-operation, 24.4% still had PM and another 12.1% had CM while among the DCIS 14.4% had PM and 17.6% had CM. Of the 717 women with DCIS and positive margins at first surgery, 67.9% had a second operation. Of them, 59.8% had malignancy, 8.8% of them invasive. Overall 10.6% of all invasive cancers and 3.7% of all DCIS had PM on relumpectomy within 6 month regardless of initial margin status. Conclusions: A relatively high proportion of all women undergoing BCS were found to have positive or close margins, even after re-operations. If a failure to reach clean margins is a reflection of an aggressive tumor phenotype, special attention should be given to these patients and treatment should be adjusted accordingly. No significant financial relationships to disclose.
Effects of different chemotherapy regimens and tamoxifen for HER2 over-expressed breast cancer adjuvant therapy
Authors: Zhang J. , Liu Y. , Hao X. , Fang Z. , Ning L. 
Published: March 2020

11048 Background: To evaluate effects of different adjuvant chemotherapy regimens and TAM in HER-2-overexpressed breast cancer patients. Methods: To study 1625 primary breast cancer cases after operation from 2002.7 to 2005.11 given adjuvant chemotherapy ,600 cases given CMF, 600 cases given CEF, and 425 cases given T-regimen (anthracyclines follow taxanes),1090 HR+ cases given tamoxifen. HER-2 expression were measured by immunohistochemistry (IHC). Median follow-up time is 42 months. Results: (1)3yr DFS of HER-2 over-expression is inferior to HER-2 negative ones in CMF group(p<0.05), no difference between HER-2- overexpressed and HER-2-negative group treated with either CEF or taxanes-based regimen (p>0.05). Subgroup analysis suggested: patients treated with CMF, 3yr DFS of HER-2 over-expression is inferior to HER-2-negative ones in node-positive subgroup, but no difference in node-negative ones; HER-2 expression has no influence on effects of CEF or T-regimen in node-positive or node-negative subgroup. (2) 425 HER-2 over-expressed patients(183 cases given CMF , 121 cases given CEF , and 121 cases given T-regimen): compared to CMF, anthracyclines and taxanes are more effective, but no difference between anthracyclines and T-regimen. (3) 235 patients with HER-2 over- expression and node-postive (72 cases given CMF , 68 cases given CEF, and 95 cases given T-regimen):, anthracyclines and taxanes are more effective than CMF, but no difference between anthracyclines and T-regimen. (4)3yr DFS is 91.23% in HER-2 over-expressed group and 93.42% in HER-2-negative group (p=0.04) with TAM. HER-2 over-expressed patients are resistant to TAM. (5) Subgroup analysis suggested that: 3yr DFS is 88.67% with HER-2 over-expression and 92.20% with HER-2-negative in postmenopausal node-positive subgroup(p=0.0069), postmenopausal patients with HER-2 over-expression and node-positve are resistant to TAM; no difference in either premenopausal or postmenopausal node-negative subgroup (p>0.05). Conclusions: No difference between Anthracyclines based and T-regimens for HER2 over-expressed patients with node-positive for 3yr DFS.Postmenopausal ER+/PR+ patients with HER2 over- expression are resistant to Tamoxifen endocrine therapy. No significant financial relationships to disclose.
Comparison of the effectiveness and complications of half and full doses of pegfilgrastim in breast cancer patients
Authors: Lower E. E. , Bartelt M. E. , Harman S. 
Published: March 2020

11058 Background: Pegfilgrastim (G-CSF) is a longer half-life synthetic growth factor used to reduce the incidence of infection following myelosuppressive chemotherapy but is associated with bone pain and hypergranulocytosis. Little data exists regarding efficacy and possible reduced toxicity with lower doses. Methods: A retrospective review identified early stage breast cancer pts who received reduced doses of G-CSF. Data collected prior to and after each dose of G-CSF included total white blood cell count (WBC), absolute granulocyte count (AGC),patient age, type and dose of chemotherapy, and stage of breast cancer. The occurrence of fever and infection was compared between the full and reduced dose groups. Pts completed a Likert scale (1–5) rating bone pain after each dose of G-CSF. Results: Thirty four pts received adjuvant treatment including adriamycin-cyclophosphamide (AC) followed by taxane (T) in 12, dose dense AC-T in 13, other regimens in 9. The median age was 53 years (range of 36 to 82). Thirty-two pts initially received 6 mcg but were reduced to 3mcg due to drug toxicity. Two pts received only 3mcg doses. There was a significant difference in the WBC post chemotherapy for the 98 treatments with 6 mcg (8400 (3000–49,600) cells/cu mm (Median (Range)) versus 116 treatments with 3 mcg (7600 (3000–18,900) cells/cu mm (p<0.02). There was no significant difference between the post chemotherapy AGC for the 6 mcg (6000 (2200–38,000) cells/cu mm versus the 3 mcg (5800 (1000–16,600) cells/cu mm. Six pts receiving 6 mcg had a post G-CSF WBC > 20,000 cells/cu mm vs none receiving 3 mcg (Fisher exact test, p<0.01). No WBC < 2,000 cells/cu mm or neutropenia of <1000 cells/cu mm was noted with either regimen. Reported fever and infection was not significantly different between the 6 and 3 mcg doses (Fever: 6 mcg 3/98 (3.1%) vs 3 mcg 5/116 (4.3%); Infections: 6 mcg 5/98 (5.1%) vs 3 mcg 7/116 (6.0%)). Bone pain was more severe after 6 mcg dose than the 3 mcg dose (P < 0.02). Conclusions: Although 6 mcg G-CSF was associated with a significantly higher total WBC, pts receiving 3 mcg G-CSF did not experience a difference in incidence of fever, infections, or neutropenia. However, lower doses were associated with significantly less bone pain and hypergranulocytosis. No significant financial relationships to disclose.
Radiomodification with fluor-pyrimidines in radiation therapy of breast cancer
Authors: Malyshev N. V. , Kostrova E. V. , Bochkova N. V. , Dosakhanov A. H. , Sirota V. B. 
Published: March 2020

11073 Background: to assess the effectiveness of fluor-pyrimidines used in altered fractionated radiation therapy (RT) of breast cancer. Methods: 122 breast cancer patients (stage II) were included in this trial. Mean age - 51.3 years. All of them were randomly assigned to three groups. The first group - 41 patients treated by preoperative course of extra-beam radiation therapy, with double daily fractionation by 2 Gy (time between fractions - 4.5 hours, 4 Gy per day, 8 days), total dose - 32 Gy. The second group - 39 patients treated by the same regimen of radiation therapy, but with the concurrent application of the factory-made papers, sodden with 5-fluorouracil, on the irradiated breast. Papers covered the breast for 8 days, and were removing only during irradiation (2 times a day). The third group - 42 patients treated by the same regimen of radiation therapy, but with the concurrent radiomodification by capecitabine (1000mg/sq.m. per os twice daily before each irradiation, 8 days). In all three groups the radiation therapy was always followed by radical mastectomy in 1–2 days. The endpoints were: frequency of clinical effect and of level 3–4 pathological response. Results: positive clinical effect (complete response and partial response) and stabilization of disease were observed in the first group in 34.1% and 65.9% of patients, in the second group in 33.3% and 66.7% and in the third group in 42.9% and 57.1%. Progression was never observed. There were no signs of pathological response in 17% of patients of the first group, in 5.1% of patients of the second group and in 16.7% of patients of the third group. Level 1–2 and level 3–4 pathological response were observed in the first group in 63.4% and accordingly in 19.6% of patients, in the second group in 12.8% and 46.2% of patients and in the third group in 57.2% and 23.8% of patients. Conclusions: Therefore, using of papers with 5-fluorouracil in preoperational RT of breast cancer demonstrated more frequent level 3–4 pathological response. Using of capecitabine, on the contrary, demonstrated the highest clinical effect, but lower rate of level 3–4 pathological response. No significant financial relationships to disclose.
Efficacy and safety of neoadjuvant chemotherapy of sequential doublets and dose dense plus trastuzumab in HER2-positive locally advanced breast cancer patients
Authors: Grande E. , Sanchez-Muñoz A. , García-Tapiador A. , Ortega-Granados A. , Jaén-Morago A. , Dueñas-García R. , Farnández-Navarro M. , Dueñas B. , Martínez-Ferrol J. , Grande E. , Sánchez-Rovira P. 
Published: March 2020

11089 Background: Neoadjuvant therapy for breast cancer constitutes an excellent test to evaluate the sensitivity to chemotherapeutic agents and/or new biological agents against specific targets as trastuzumab and Her2. Furthermore, pathologic complete response (pCR) is a surrogate marker for disease-free and overall survival. Methods: The objective was to determine the efficacy in terms of pCR rates and the safety profile of the doublets plus trastuzumab schedule administered for the neoadjuvant setting of locally advanced breast cancer patients. A total of 20 patients with histologically confirmed locally invasive Her2-positive breast carcinoma were included. The median age was 43. Mean tumour size was 5.1 cm. Treatment consisted of a first sequence with epirubicin 90 mg/m2 and cyclophophamide 600 mg/m2 for 3 cycles, and a second sequence with paclitaxel 150 mg/m2 and gemcitabine 2500 mg/m2 for six cycles. All drugs were administered on day 1, every two weeks with prophylactic growth factor supports. Weekly trastuzumab was administered at a dose of 2mg/kg (4 mg/kg loading dose), concomitantly with paclitaxel and gemcitabine. Subsequently, patients underwent surgery and received radiotherapy and/or adjuvant hormonal therapy according to institutional practice Results: Objective clinical response was achieved in all patients. 10 (50%) pCR were obtained. With a median follow up of 18.2 months (3–38), 17 patients (85%) are alive without disease progression, and 3 (15%) showed recurrence and 1 of whom died. Treatment was well tolerated, 1 patient experienced 1 episode of grade 4 neutropenia and 2 patients had grade 3 neutropenia. 1 patient discontinued the treatment due to hypersensitivity reaction to paclitaxel. Asymptomatic decrease in cardiac ejection fraction with subsequent normalization was seen in 1 case. Conclusions: Despite of the small number of patients, results have shown a high pCR rate in this group of breast cancer patients with poor prognostic. The schedule seems to be feasible and tolerable and further studies with the doublet sequences plus trastuzumab are warranted on the neoadjuvant Her2 positive breast cancer patients No significant financial relationships to disclose.
Anthracycline-containing regimen in early breast cancer: Analysis of toxicity
Authors: Jagiello-Gruszfeld A. I. , Lowczak A. , Zbrzezniak-Smilgiewicz J. , Szablowska-Siwik S. , Licznerska G. , Wasilewska-Tesluk E. 
Published: March 2020

11104 Background: The anthracycline-containing regimens is considered to be more beneficial to patients (pts) with early breast cancer (EBC). However at this moment is not clear which kind of regimen should be used in adjuvant setting. Methods: In our center, from Jan 2004 to Sep 2006, 248 breast cancer pts, who were qualified to the adjuvant chemotherapy received FEC100 (104 pts), AC (126 pts). or sequentially AC- taxans (18). Pts with many poor prognostic factors (N+, T3, G3, HER2/neu 3+) received 6 cycles of FEC100 or AC-taxans. Pts with better prognosis (Intermediate Risk Group according St.Gallen’s guidelines for 2005) received usually 4 cycles of AC. Besides, in most cases, internet access to the adjuvantonline! program was used during making decision. ER-ve or PR-ve positive pts received sequentially hormonal treatment. The radiotherapy (if needed) was delivered at the end of the chemotherapy. Results: During the treatment, toxicity of the chemotherapy was evaluated by NCI CTC v. 3. There was no toxic deaths. Median follow-up period was 19 months (range: 6–36). The febrile neutropenia was observed in 4 pts in FEC100 and in 5 pts in AC group. There was also no significant differences in the grade 3 or 4 neutropenia, anemia, thrombocytopenia and alopecia. In 3 pts treated with FEC100 and 1 with AC, cardiotoxicity grade 2 or 3 was diagnosed. Grade 2 or 3 asthenia was frequent in FEC100 group (44% vs 21% vs11%). In all pts prophylaxis of nausea/vomiting was used. However pts treated with FEC100 needed more 5HT3. Vomiting grade 2 or 3 were observed significantly more often in pts who received FEC100 (58% vs 26% vs 23%). Only at 1 pts in each group the chemotherapy was interrupted due to toxicity (asthenia gr 3, vomiting gr 3 and weight loss gr 2). The relative dose intensities of FEC100 and AC were 87% and 96% of planned doses, respectively. Conclusions: The acute symptoms of toxicity were important for breast cancer pts who received the adjuvant chemotherapy. According the adjuvantonline! 6 cycles of FEC100 were more effective than 4 cycles of AC. Nevertheless tolerability of AC is better. Many pts prefer only the hormonal treatment, even if it is not the optimal option, in fear of nausea or vomiting. The ongoing clinical trials should further define the best choice of anthracycline-containing regimen in the adjuvant setting. No significant financial relationships to disclose.
Effect of new anti-neoplastic agent, MK615, from Japanese apricot, ume, on growth of breast cancer cells in vitro
Authors: Nakagawa A. , Sawada T. , Okada T. , Ohsawa T. , Adachi M. , Kubota K. 
Published: March 2020

11105 Background: MK615 is an extract mixture from Japanese apricot, UME. In this study, the anti-neoplastic effects of MK615 against breast cancer cells were investigated. Methods: Two breast cancer cell lines, MDA-MB-468 (MDA) and MCF7, were cultured with (600, 300, 150 μg/ml) or without MK615. After 72 hours of incubation, growth inhibition was evaluated by MTT assay, and the mechanism of the anti-neoplastic effect of MK615 was evaluated by cell cycle- and apoptosis assay. Results: MK615 inhibited the growth of MDA and MCF7 in a dose-dependent manner. The percentage growth inhibition of MDA at dosages of 600, 300, and 150 μg/ml was 59.2%, 52.4%, and 23.3%, respectively, and that for MCF7 was 83.5%, 52.7%, and 16.6%, respectively. Cell cycle analysis showed that MK615 increased the proportion of cells in G2-M phase in both MDA (7.8% to 11.7%) and MCF7 (8.1% to 18.7%), and finally both cell lines became apoptotic. The proportion of apoptotic cells increased with incubation time. Conclusions: MK615 effectively inhibits the growth of breast cancer cells in vitro, possibly by cell cycle modification and apoptosis induction. No significant financial relationships to disclose.
Clinical and pathological response to taxanes (T) and anthracycline (AC) based neoadjuvant chemotherapy (NAC) in locally advanced breast cancer (LABC): A retrospective analysis from a single institution in North India
Authors: Gupta S. , Vaid A. K. , Prakash N. , Talwar V. , Doval D. C. , Prakash P. , Patole K. D. , Dewan A. K. , Chaturvedi H. K. , Kumar K. , Sharma J. B. 
Published: March 2020

11107 Background: In India LABC remains a common presentation of breast cancer (BC). Pathological complete response (pCR) achievement is crucial for increasing survival in LABC. Taxanes and anthracyclines are amongst agents with highest activity in BC. We retrospectively evaluated clinical and pathological responses in LABC patients (pts) treated with T and AC based chemotherapy. Methods: 32 LABC pts with clinical stage IIB, IIIA, IIIB, IIIC who had received T & AC based NAC between October 2002 and October 2006 were evaluated. Patients received doxorubicin 60mg/m2 (21 pts) or epirubicin 75 mg/m2 (11 pts) and docetaxel 75 mg/m2 (all pts) 3 weekly for 3–4 cycles followed by surgery. Most pts received same chemotherapy as adjuvant and also radiation therapy and hormonal treatment depending upon ER, PgR status. Results: Baseline characteristics of 32 pts: median age 50 years (range 26–65); all female; performance status 0–1; clinical stage IIB (3 pts), IIIA (9 pts), IIIB (16 pts), IIIC (4 pts); node positive (25 pts), hormone receptor positive (17 pts), unknown (1 pt); 29 pts received 3 cycles of NAC, 3 pts received 4 cycles of NAC. Growth factor was used in all patients. 31 pts underwent MRM; 5 pts had clinically complete response (16%), 22 pts had partial response (69%), 4 pts had stable disease (12%), 1 pt had progressive disease (3%); pathological complete response was seen in 4 pts (12 %). There were 2 events of febrile neutropenia; grade 3 or 4 neutropenia was seen in 26 pts (81%). There was no significant thrombocytopenia, cardiovascular event and hypersensitivity reaction. Conclusions: Our analysis indicates that T and AC based chemotherapy is well tolerated and effective in Indian pts with LABC with response rates similar to international studies. No significant financial relationships to disclose.
Doxorubicin (Dox), cyclophosphamide (Cyc) and weekly docetaxel (Doc) as first-line treatment of advanced breast cancer (ABC)
Authors: Ibrahim T. , Serra P. , Vertogen B. , Marangolo M. , Amadori D. 
Published: March 2020

11516 Background: The breast is one of the leading cancer sites in women. ABC is essentially incurable with standard therapy and have a median survival of approximately 2 years. Dox, Cyc and Doc showed better efficacy results but also an increased rate of neutropenia and febrile neutropenia with respect to FAC (which is considered one of the most used standard option). The substitution of 5- fluorouracil with docetaxel resulted in an increase in the efficacy parameters but showed a higher hematological toxicity. One possible approach to reduce the rate of neutropenia is the administration of weekly docetaxel wich demostrated efficacy in ABC. Methods: ABC patients (pts) were enrolled in an open, single arm, non-randomized phase I escalation trial in 3 to 6 pts/cohorts. MTD dose was identified on the basis of DLT defined according to WHO grade classification of toxicity.*The treatment schedule was: Doc 20 mg/m2 (or 25, depending on dose level assignment) on day 1, 8, 15; Dox 40 mg/m2 (or 50, depending on dose level assignment) and Cyc 500 mg/m2 on day 1, every four weeks. Results: Eleven pts, median age 56 yrs, were enrolled. Five pts were allocated to dose level 20/50 (Doc/Dox) and six pts to dose level 20/40. At the dose level 20/50 febrile neutropenia (DLT) occurred in 2 pts. Other 3 pts experienced neutropenia WHO grade 4 (not DLT). Six patients were allocated at previous dose level and MTD was defined at Doc 20 mg/m2 in combination with Dox 40 mg/m2 and Cyc 500 mg/m2 Conclusions: We didn’t observe toxic deaths and all the toxicity was limited and resolved. The accrual was stopped and we are waiting for one patient to end the treatment in order to analyse the final data and to design the phase II study a the dose Doc 20 mg/m2 (days 1, 8 and 15) in combination with Dox 40 mg/m2 and Cyc 500 mg/m2 (day 1) every 4 weeks. No significant financial relationships to disclose.
A simple technique for cranio-spinal irradiation in young pediatric patients
Authors: Prabhakar R. V. , Julka P. 
Published: March 2020

12501 Background: Craniospinal irradiation (CSI) is a complex radiotherapy technique. The implementation of craniospinal radiation makes atleast one junction between orthogonal cranial and spinal radiation fields. The traditional problem with CSI has been the concern over the dose delivered to the junctional area. We are presenting a simple technique of CSI which is easy to plan, treat and delivers a uniform dose to the entire cord. Methods: Ten patients of medulloblastoma suitable for CSI were taken in this study. All patients underwent CT based treatment planning. The patients were immobilized in prone position using the combination of uniframe and vacloc. CT scanning was performed for all the patients with 5 mm slice thickness. The cranium was treated with a dose of 36 Gy in 20# over 4 weeks and the spine with a dose of 30Gy in 20# over 4 weeks. Subsequently, the cranium was boosted to a dose of 20 Gy in 10 fractions over 2 weeks. For the cranial region, parallel opposed fields were used with half beam block provided by asymmetric jaws with the central axis in the caudal edge of the field. Subsequently, the gantry was brought to head top position and the couch was brought vertically down. The field length was opened to desired position to treat the spine by asymmetric jaws. In treatment planning system, doses were prescribed to the reference point placed in the cranial and spinal field. The maximum, minimum and mean dose to each anatomical structure was computed from dose volume histogram by summing the cranial and the spinal treatment plans. The junctional dose was calculated with special emphasis on field junction. Results: The results showed that the junction between the cranial and the spinal fields received relatively uniform dose. The hot spots in the cranial field were reduced by applying field in field technique. The daily setup time required for the treatment was considerably reduced with this technique. Patient with spinal field less than 30 cm from C2-C3 junction to the S1-S2 junction are ideally suited for this technique. Conclusions: Our technique of craniospinal irradiation is simple and technically sound. This technique can be applied for young pediatric patients undergoing CSI. The technique effectively deals with craniospinal irradiation No significant financial relationships to disclose.