bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors predicting tumor size at presentation in breast cancer patients
Authors: Rosenberg A. , Burke L. P. , Vos P. W. , Brinson M. 
Published: March 2020

10609 Background: Early diagnosis of breast cancer improves prognosis. A high percentage of women at our institution present with large breast cancers. Using tumor board records, we investigated the potential covariates associated with tumor size at presentation, including age, race, marital status, and insurance status in order to identify populations at risk for presenting with late stage disease. Methods: Data were obtained from tumor board records of University Health Systems, Greenville, NC, a regional referral center in rural Eastern North Carolina. We analyzed data from patients presenting between 1999 and 2005. Relationships between tumor size at diagnosis and explanatory variables (marital status, age, ethnicity, and insurance status) were explored. Results: 1568 patients with breast cancer were identified of which 32% were African American (AA), 67% were White (W), and 0.6% other. 8.3% of patients had Medicaid; 27%, Medicare; 53.5%, private insurance; 3.4%, HMO; and 6.1% were uninsured. Tumor size was 0.01 to 25 cm and highly skewed so that statistical inferences were conducted on the log of tumor size. Tumors of >5 cm were found in 13.8% of AA women as compared to 6.4% of W women. Overall tumor size in AA women was larger than in W women (p-value = .0000). Marital status was not statistically significant (p-value = .5148). A linear regression model for log tumor size at time of diagnosis using explanatory variables marital status, age, ethnicity, and insurance status showed that only race (p-value = .0000) and age (p-value = .0004) were statistically significant. Older patients presented with somewhat smaller tumors. Most of the variability in log tumor size remained unexplained (r-squared = 4%). Conclusions: AA women were more likely to present with large tumors. While Medicaid patients had larger tumors, insurance status was not statistically significant in the linear regression model due to partial confounding of insurance and race: 20.8% of AA women were on Medicaid compared to 2.6% of W women. No significant financial relationships to disclose.
Intraoperative radiotherapy impairs breast cancer cell motility induced by surgical wound fluid
Authors: Massarut S. , Baldassarre G. , Belletti B. , Colombatti A. , D'Andrea S. , Candiani E. , Perin T. , Reccanello S. , Roncadin M. , Vaidya J. S. 
Published: March 2020

10611 Background: Most recurrences after breast conserving surgery for cancer occur in the tissues around the original tumour. Wound-fluid has been shown to induce proliferation of breast carcinoma cells. We investigated whether intraoperative radiotherapy (IORT) using the targeted intraoperative radiotherapy (Targit) technique changes the effect of surgical wound fluid on the behaviour of breast cancer cells. Methods: Preoperative peripheral blood serums (A) and wound fluid (B) (first 24 hours’s drainage) from 30 unselected patients undergoing breast conserving surgery with (14) or without (16) IORT using the Targit technique was collected, processed and stored at −80°C. The breast carcinoma cell lines (MDA-MB231, MDA-MB-45 and SKBR-3) were used to evaluate the activity of A and B on cell proliferation (MTT-FACS analysis) and motility (chemotaxis) and invasion (Matrigel). Results: Wound fluid stimulated cell proliferation, cell motility and cell invasion significantly more than the preoperative serum from the same patient. Targit did not influence the effect of wound fluid on cell proliferation. However, Targit abrogated the effect wound fluid on cell motility and cell invasion. Conclusions: This work demonstrates that wound fluid after surgery for breast cancer stimulates cancer cell growth and motility. Targit appears to significantly abrogate the effect on cancer cell migration and invasion. This outcome may confer more benefits than could be expected from the tumoricidal activity of radiotherapy, and may stimulate the development of novel peri-operative treatments directed at compensating the possible harmful effects of surgery. No significant financial relationships to disclose.
Breast cancer in United Arab Emirates: Younger patients and more aggressive histology
Authors: Maarraoui A. M. , Utamachandani A. , Mattamona A. I. , Lazaro C. A. , Mathews L. S. , Saxen V. , Uttamchandani D. , Maarraoui Y. , Abdulatif H. , Attia N. M. 
Published: March 2020

10612 Background: Mafraq hospital is the largest tertiary hospital in UAE. We tested the hypothesis that breast cancer patients in UAE present at a younger age and with more aggressive tumor histology Methods: This is a retrospective study on breast cancer cases seen at Mafraq hospital between 1/00 and 12/05. Intent to treat analysis was used. Total of 372 patients were seen, 48 patients (12.9%) were UAE citizens and 324(87.1%) were non-citizens, 370 females and 2 males. We categorized patients according to their age at time of initial presentation, menopausal status, TNM stage, tumor grade, lymphatic and vascular invasion, ER, PR, Her-2 neu and P53 status. Mode of surgery is also reported. Results: Mean patients age at time of initial presentation is 48 years. 230 (62%) of patients were pre-menopausal and 140 (38%) were post-menopausal. Tumor stages at initial presentation were as follows, stage 0: 7 patients (0.2%), stage I:59 patients (15.9 %), stage II: 180 patients (48.6%), stage III: 71 patients (19.2%) and stage IV: 53 patients (14.3%). Staging was not completed in 2 patients as they followed elesewhere. Vascular invasion was reported in 118 case, 58 (49.2%) were positive and 60 (50.8%) were negative. Lymphatic vessel invasion was reported in 106 case, 84 (79.2%) were positive and 22 (20.8%) were negative. Tumor grades were reported in 265 case and were as follows GI: 33 (12.5%), GII: 121 (45.6%), GIII: 109 (41.1%) and G IV: 2 (0.8%). Tumor hormonal status was reported in 270 case and were as follows: ER+ and PR+ in 94 case (34.8 %), ER+ and PR- in 31 case (11.5%), ER− and PR+ in 25 case (9.3%) and ER− and PR− in 120 case (44.3%). ER and PR were unknown in 102 case. Her2 neu studies were performed in 157 case. Out of those 77 (49%) were positive and 80 (51%) were negative. P53 mutation was studied in 132 patients 33 (25%) were P53 positive and 99 (75%) were P53 negative. 346 patient underwent surgery, 233 patient had modified radical mastectomy and 113 (32.7%) had breast conserving surgery. Conclusions: Breast cancer in UAE tends to occur at a younger age compared to western countries. The majority of our patients are pre-menopausal. Tumors have more aggressive histology and biology. Most tumors show vascular and lymphatic invasion. P53 and Her-2 neu over-expression is relatively high. No significant financial relationships to disclose.
Detection of the AT1 and AT2 receptors of angiotensin II in malignant breast tumors and its correlation to cellular proliferation, hormonal profile and prognosis
Authors: Arrieta O. , Ceron-Lizarraga T. , Morales-Espinoza D. , Vizcaino G. , Gamboa A. , Pineda B. 
Published: March 2020

10632 Background: Angiotensin II (ANG II) is the main effector peptide of the Renin-Angiotensin-Aldosterone System. ANG II has multiple physiologic effects and recent studies have demonstrated that is an angiogenic factor in non-tumoral experimental models. We demonstrated that malignant glioma cells express both receptors and the blockage of AT1 inhibits tumoral growth in vivo, and induces apoptosis. Studies on the ANG II receptors’ subtypes in adenocarcinoma of the breast in mice have demonstrated high expression of AT1; nevertheless, their expression in breast cancer hasn’t been studied. The objective of this study was to determine the presence of the ANG II receptors AT1 and AT2 in human breast cancer and their association to vascularity, cellular proliferation, hormone receptors; as well as to the disease free survival. Methods: Malignant breast tumors (n = 78) from patients who underwent surgery were collected between 2000 and 2004. Patients with neoadjuvant chemotherapy or radiotherapy were excluded. The AT1 and AT2 receptor expression was performed by RT-PCR and immunohistochemistry. The control samples were 8 breast fibromas. Results: The median age of patients was 54.7 years, the pathological stage included stage I (15.5%), II (65.5%) and III (18.9%). The patients underwent radical mastectomy in 61.4 % and conservative surgery in 39%. The median survival was 82 ± 5 months. AT1 and AT2 expression was found in 66% and 55%, respectively The coexpression of AT1 and AT2 receptors was positive-positive in 55% o and negative-negative in 16% of the tumors (p = 0.045). None of the benign tumors showed AT1 and AT2 expression (p = 0.01). The associated factors survival were stage (p = 0.03, log rank = 0.05) and differentiation grade. The AT1 receptor expression was associated with presence of estrogen receptors (p = 0.05), mitosis index (p = 0.05), cellular proliferation index (p = 0.01) and vascular density (p = 0.05). Conclusions: There is an important expression of the ANG II receptors AT1 and AT2 in breast cancer. AT1 and AT2 participate in cellular proliferation mechanisms of breast cancer and may play an important role in its biology, thus making them potential therapeutic targets. No significant financial relationships to disclose.
Phase II trial of 4 cycles dose dense docetaxel (D) 100mg/m2 every 2 weeks with G-CSF support, followed by 3 cycles of 5-fluorouracil (F), epirubicin (E) and cyclophosphamide (C) every 3 weeks as neoadjuvant treatment of operable > 2cm breast cancer
Authors: Romieu G. , Bibeau F. , Culine S. , Gourgou-Bourgade S. , Guillemare C. , Kramar A. 
Published: March 2020

10636 Background: Docetaxel is one of the most active chemotherapy agents used in breast cancer. Given the effectiveness of Taxotere in the treatment of metastatic breast cancer, it is now being extensively evaluated in the treatment of early stage disease. Recently, we initiated in our institution a study, which showed that the bi-weekly administration of 4 cycles of docetaxel was feasible with G-CSF (lenograstim) support. This phase II trial was initiated to evaluate the pCR rate of docetaxel as a single agent followed by FEC 100 in the neoadjuvant setting. Methods: Eligible patients (pts) with histologically proven breast cancer, measurable lesions >2 cm were scheduled to receive 4 cycles of chemotherapy with a day 1 bolus of (D) 100 mg/m2 every 14 days + corticoids for 3 days starting the day before first infusion as premedication and primary prophylaxis with G-CSF: followed by 3 cycles of a continuous infusion of F 500 mg/m2, E 100 mg/m2 and C 500 mg/m2 day 1 (FEC100). The primary endpoint was the pCR rate using the classification of Sataloff. Results: From 12/2003 to 12/2004, we treated 45 pts with median age 45 [25–63]. To date, 43 pts with WHO PS 0 were evaluable with T2: 22, T3: 19, T4: 2 pts and 18/21/5/1 N0/N1/N2/N3. Among 43 eligible pts, 2 stopped because of toxicity (after the 2nd and 4th cycles) and 1 patient refused to continue after 3 cycles. During the first treatment sequence with D, grade 3–4 toxicities (%pts): neutropenia (13), grade 3: cutaneous (24), myalgies (4), and arthalgies (2), and grade 2 neurotoxicity (31). During the second treatment sequence with FEC, grade 3–4 toxicities (% pts) were: neutropenia (95), grade 3: thrombocytopenia (5), myalgies (2), mucitis (2), grade 2 neurotoxicity (24). The conservative surgery rate was 67% and 3 pts needed a secondary mastectomy. The pCR rate was 50% (95% CI 34%– 66%) (26% T-A) among 42 evaluable pts. Conclusion: This regimen allows conservative surgery in more than half of all patients and we conclude from these findings that 4 cycles of dose-dense D followed by 3 cycles of FEC is an active induction regimen with a tolerable toxicity profile. No significant financial relationships to disclose.
Efficacy and tolerability of biweekly paclitaxel combined with cisplatin in the treatment of metastatic breast cancer (MBC) patients previously treated with anthracyclines
Authors: Donat D. A. , Pesic J. , Trifunovic J. , Muzikravic L. , Tesanovic S. , Donat D. D. 
Published: March 2020

10642 Background: Our aim was to assess the efficacy and tolerability of paclitaxel combined with cisplatin in the treatment of MBC patients previously treated with anthracyclines either as adjuvant treatment or as first-line chemotherapy for MBC. Methods: The study included 168 patients divided in two groups: 64 patients in group I who received adjuvant FAC and 104 patients in group II who received CMF as adjuvant therapy and FAC for MBC as first-line treatment. Participants received paclitaxel 90 mg/m2 on day 1 and cisplatin 60 mg/m2 on day 2 q/2w. Total number of cycles per patient was 3–9. Results: Evaluation was made after 3 cycles of chemotherapy. Obtained RR was: in group I, CR in 4 (6.26%), PR in 30 (46.87%), SD in 5 (7.81%), and PD in 25 (39.06%) patients, with ORR in 34 (53.13%) patients. In group II, the obtained results were: CR in 3 (2.88%), PR in 36 (34.6%), SD in 6 (5.77%), and PD in 59 (56.75%) patients, with ORR in 39 (37.49%) patients. Patients with CR received 3 more cycles and patients with PR received 3 or 6 therapies depending on the obtained results. Treatment evaluation of PR patients in group I after cycle 6 resulted with CR only in 1 (1.56%) patient and in group II showed CR in 2 (1.92%) patients. In those patients 3 more therapies were applied. Difference between the two groups in ORR is highly significant: p < 0.04. Hematological toxicity grades 3 and 4 in both groups were rare and similar. Conclusions: The application of biweekly paclitaxel combined with cisplatin in our patients’ population is efficacious with good tolerability. In group I the obtained results in ORR was 53.13%, which is statistically significantly (p < 0.04) better than in group II with ORR: 37.49%. No significant financial relationships to disclose.
Is the Berg axillary lymph node categorization useful in the 3D Era
Authors: Saito A. I. , Vargas C. , Benda R. , Morris C. G. , Mendenhall N. P. 
Published: March 2020

10643 Background: The Berg muscle-based categorization of axillary lymph node location has been used extensively by pathologists and surgeons to describe the extent of axillary node dissection in breast cancer patients, but its reproducibility with different arm positions and its utility in 3-D radiation treatment planning have not been tested. Methods: CT scans were obtained in 16 patients in 2 positions: historic position (HP), arms 90 degrees to the body axis; standard position (SP), arms above head. The volume, contents, and location of each Berg lymph node level (LNL) and the location of lymph nodes, surgical clips, pectoral muscles, and vascular structures relative to reference points were compared between the two scans. Results: Relative to T3, the LNL positions in SP were shifted from HP as follows: Level I, 23.1 mm anteriorly, p < 0.01; Level II, 7.5 mm medially, p = 0.04; Level III, 18.8 mm medially, p = 0.05. The pectoralis major and minor muscles were displaced medially (23.9 mm, p < 0.01 and 7.5 mm, p = 0.09) and anteriorly (18.2 mm, p < 0.01 and 11.2 mm, p < 0.01). At Level I, the axillary vessels (18.0 mm, p < 0.01), subscapular artery (25.4mm, p < 0.01) and lateral thoracic artery (8.4 mm, p < 0.01) were displaced anteriorly. With arm position change, lymph node position moved with vessel position rather than muscle position. Discrepancies were also observed in the number and location of lymph nodes (60%) and clips (66%) in given LNL’s between arm positions. Conclusions: Surgeons, radiologists, and radiation oncologists alike should be aware that lymph node position relative to muscle boundaries will vary significantly with arm position changes, making objective comparisons of information collected in different arm positions unreliable. This has significant implications for radiation treatment planning. No significant financial relationships to disclose.
Does HER2/neu expression affect adjuvant treatment choices in routine clinical practice?
Authors: Pagani O. , Ruggeri M. , Rusca T. , Graffeo R. , Gallerani E. , Locatelli M. , Conti Beltraminelli M. , Longhi S. , Mazzucchelli L. , Goldhirsch A. 
Published: March 2020

10667 Background: HER2/neu (HER2) amplification is a recognized independent prognostic and predictive factor. We retrospectively examined the correlation between HER2 expression and adjuvant therapy in patients (pts) with early breast cancer (EBC) at our Institution (IOSI). Materials and Methods: From January 2003, 326 consecutive pts with EBC have been treated at IOSI and all clinical and pathological data have been prospectively collected into a specifically designed data base (CARMA). HER2 expression was assessed by the c-erbB-2 oncoprotein antibody (NCL-L-CB11) in 309 pts (95%). FISH was not routinely performed. Endocrine responsiveness (ER+) is defined as Er and/or PgR expression by immunohistochemistry. Results: Overall, 58 pts (19%) had HER2+ disease. FISH was performed in 15 pts (24%) with doubtful antibody overexpression (2+) and did not confirm HER2 amplification in 4 cases (27%). Nodal involvement was not assessed in 1 HER2+ (2%) and in 12 HER2- pts (5%) due to advanced age. Menopausal status did not differ in HER2 positive and negative pts (29% and 27% premenopausal pts, respectively). The distribution of adjuvant chemotherapy (CT) according to tumour characteristics in HER2 positive and negative pts was as follows: An anthracycline-containing regimen was chosen in 88% of HER2+ pts receiving adjuvant CT as compared to 70% of HER2- pts. Outside of a clinical trial adjuvant Tamoxifen was given to 57% of HER2+/ER+ pts as compared to 75% of HER2−/ER+ pts. Conclusions: Overall, HER2+ pts showed less endocrine responsiveness (64% versus 88%) and more extensive nodal involvement (43% versus 30% with >3 positive nodes) as compared to HER2− pts. A greater proportion of HER2+ women received adjuvant CT, irrespective of other prognostic and predictive factors. In particular, a significant higher proportion of HER2+ pts with minimal nodal involvement (1–3 positive nodes) and ER+ disease received CT as compared to the equivalent HER2- subset (45% versus 26%, respectively). [Table: see text] No significant financial relationships to disclose.
A clinical phase II study of combination Cisplatinum and Vinorelbine followed by Docetaxel as first-line chemotherapy in metastatic breast cancer
Authors: El-Saghir N. S. , Otrock Z. , Abdel Khalik Z. , Yassine H. , Khalifeh M. , Bitar N. , Charafeddine M. , Jalloul R. , Dandashi A. , Shamseddine A. 
Published: March 2020

10683 Background: Many chemotherapeutic options exist for metastatic breast cancer (MBC) but there is no standard regimen. We tested a sequential combination regimen using Cisplatinum and Vinorelbine (PVn) followed by Docetaxel as first-line chemotherapy in a phase II clinical trial. This is the first study using a non-anthracycline sequential combination chemotherapy of PVn with Docetaxelin MBC. Methods: Thirty-five patients were enrolled. Cisplatin 80 mg/m2, which was given on day 1 and Vinorelbine 30 mg/m2 on days 1 and 8 q3 weeks for 4 cycles. After the 4th cycle, responding patients received Docetaxel 75 mg/m2 every 21 days for a maximum of 4 cycles. Patients were evaluated every two cycles and those who had no response were offered other therapy. Patients who showed progression after 2 cycles of PVn were offered Docetaxel but were considered off protocol. Three patients were excluded from analysis because of death unrelated to treatment. Results: After a median follow up of 14 months (range 1–36), 32 patients (91.4%) completed the study. Overall response rate was 53.1%. Complete remission was seen in 5 pts (15.6%), partial response in 12 patients (37.5%), stable disease in 6 patients (18.75%), and progressive disease in 9 patients (28.1%). 20 patients (62.5%) were alive at 12 months. Median time to disease progression was 8 months (range 1–24). At 24 months 37.5% (12 patients) were alive. Response rates to PVn were not significantly improved by sequential addition of Docetaxel. A total of 183 cycles were administered with a median of 6 cycles per patient. Delay of chemotherapy because of Grade II neutropenia occurred in 41/183 cycles (22.4%). Febrile neutropenia was observed in 4 patients (2.2%). Grade II anemia was observed in 40/183 cycles (21.8%) and Grade III in 24/183 cycles (13.1%). Grade II nephrotoxicity occurred in 12 cycles (6.5%) and Grade III vomiting was observed in 31/183 cycles (16.9%). No treatment-related mortality has been reported. Conclusions: Sequential PVn-Docetaxel is a feasible and effective non-anthracycline option as first-line chemotherapy in patients with MBC. More effective Docetaxel may be better used upfront and followed by PVn. This regimen has acceptable toxicity as well. No significant financial relationships to disclose.
Pegfilgrastim in dose-dense, sequential adjuvant chemotherapy for patients with breast cancer (BC)
Authors: Stickeler E. , Földi M. , Kummle A. , Hinke A. , Hartmann P. C. , Woll J. , Watermann D. O. , Gitsch G. 
Published: March 2020

10708 Background: Large randomized trials in the US and Europe have recently shown, that increased dose density of adjuvant chemotherapy leads to a relevant and significant prolongation of disease-free and overall survival in breast cancer. Dose density refers to the administration of drugs with a shortened intertreatment interval. G-CSF support is an essential requirement for increasing dose intensity. We explored the feasibility of pegylated filgrastim (Neulasta) in this setting. Methods: Patients (pts) up to the age of 60 with a confirmed histology of breast cancer and lymph node involvement were recruited into the study. A dose-dense chemotherapy, consisting of 3 x 4 sequential single drug cycles of epirubicin 90 mg/m2, paclitaxel 175 mg/m2, and cyclophosphamide 600 mg/m2 was planned on a two-weekly schedule (similar to Citron et al., J Clin Oncol, 21 (2003): 1431–1439). Pegfilgrastim was to be administered on day 2 of each cycle, 24 h after chemotherapy application. Results: Seventeen pts with a mean age of 49 years were enrolled into this feasibility study. 76% of pts had pN2–3 stage, 65% G2 and 35% G3 tumors, 71%/47% a positive estrogen/progesterone receptor status, respectively. All but one pt were HER2-negative. The full number of 12 cytotoxic courses could be administered in all but one patient due to an anaphylactic reaction against paclitaxel. A total of nine weeks of treatment delay was recorded in 6 of the remaining 16 patients (38%), resulting in an overall mean relative dose intensity of 95.9% (range 80– 100%). Pegfilgrastim was given during 85% of the 198 courses. Febrile or grade 4 neutropenia were not recorded, grade 3 neutropenia in one cycle (6%) without G-CSF support. Antibiotic treatment was necessary in only 18% of pts. Median peak WBC count during the complete treatment course was 28,150/μl, no values above 100,000/μl were recorded. Bone pain was reported in 4 patients (24%) and occurred in a total of 6 cycles (3%). Conclusions: Pegfilgrastim can be used safely and seems to achieve the required supportive efficiency in a dose dense sequential chemotherapy schedule for locally advanced BC. [Table: see text]