bluuebunny/crossref_metadata_2025_split huggingface dataset:
A decision tree to predict four or more positive axillary lymph nodes in breast cancer patients with positive sentinel node biopsy: Determining necessity for regional nodal irradiation in the absence of axillary dissection
Authors: Macrorie-Fairweather R. A. , Albuquerque K. , Yao K. , Sinacore J. 
Published: August 2020

e11540 Background: Regional nodal irradiation (RNI) is indicated for breast cancer patients with ≥ 4 positive axillary lymph nodes (ALN). The need for RNI is unclear for women with T1–2 tumors and 1–3 positive sentinel lymph nodes (SLN) who don’t undergo axillary lymph node dissection (ALND). In an effort to guide clinician decision-making and potentially spare patients combined toxicities of ALND and radiation, the purpose of this study was to create a decision tree of clinicopathologic variables to predict patients with ≥ 4 positive ALN. Methods: We reviewed the records of 197 women with T1–2 tumors and 1–3 positive SLN. All patients underwent a complete ALND to determine the number of positive ALN. The patients were divided into 2 groups: < 4 or ≥ 4 positive ALN. Ten clinicopathologic predictive variables were identified for analysis: patient age, size of tumor, histological type, tumor grade, number of metastatic SLN, largest SLN metastasis size, detection method, estrogen receptor, Ki67 and lymphovascular invasion (LVI). The analysis used Chi-Square Automatic Interaction Detection (CHAID SPSS), a non-parametric, stepwise “regression tree” analysis, with Bonferroni adjusted p-values to create a decision tree. Results: 141 (72%) patients had < 4 and 56 (28%) had ≥ 4 positive ALN. Three variables were selected into the CHAID tree based upon maximum predictability: LVI, the number of metastatic SLNs, and largest SLN metastasis size. 100% of patients (N=42) had < 4 positive ALN if negative for LVI and had only 1 positive SLN with a metastasis size < 0.2cm (p-value < 0.0432). For patients with LVI (N=77), 13 of 14 (93%) had < 4 positive ALN if the SLN metastasis size was ≤ 0.2cm (p < .0014). The highest prevalence of ≥ 4 positive ALN were patients with LVI and a SLN metastasis size > 0.2cm. Conclusions: The CHAID analysis more accurately predicted patients with < 4 positive ALN compared to those with ≥4. The decision tree provides a new tool for the clinician to determine the necessity for RNI without ALND. No significant financial relationships to disclose.
Fertility and pregnancy in patients under age 38 following chemotherapy for breast cancer
Authors: Katz D. , Mazeh H. , Divinsky L. , Temper M. , Ospovat I. , Salah A. , Hamburger T. , Galinsky D. , Uziely B. , Peretz T. 
Published: August 2020

e11541 Background: Chemotherapy improves breast cancer outcome, but may impact fertility. Post chemotherapy fertility rates range between 10–90% among studies. Fertility post chemotherapy is most often assessed by rate of menstruation resumption- an indirect method of evaluating childbearing potential. It is noteworthy that future pregnancy is a woman's first concern not menses preservation. Variability in fertility rates along with limited data on post chemotherapy pregnancies led us to undertake this single institute retrospective study evaluating fertility and pregnancy post chemotherapy in ≤ 38 y old breast cancer patients. Methods: We reviewed medical records of 222 consecutive stage II-IIIB breast cancer patients diagnosed, treated and followed at Sharette Institute of Hadassah-Hebrew University Medical Center from 1990–2004. Inclusion criteria included age ≤ 38 years, ≥3 cycles of standard metothrexate or adriamycine based chemotherapy, metastasis-free 12 months post chemotherapy initiation or one year following GnRH analog withdrawal. Patients diagnosed with infertility prior to breast cancer diagnosis (data present for part of patients), bilateral oophorectomy or patients surviving ≤3 years from diagnosis were excluded. Patient pregnancy preference was not recorded. Fertility was defined as resumption of recurrent menses or pregnancy anytime during follow up. In case of recurrence, date of recurrence diagnosis was assigned as date of last follow up. Results: Cohort included 65 patients. Mean age 32.5±4 ys (20.3–38.5) Almost all patients (95.4%), 38 ys or younger, preserve menses following chemotherapy, and 33.9% become pregnant. Most of patients who did not conceive post chemotherapy (66.1%), were under a familial status not promoting pregnancy; 44% of all women who did not give birth post chemotherapy had at least 3 offspring at the time of diagnosis and 83% out of all women who did not have any offspring by the end of follow up were single. Conclusions: This data suggest that pregnancy potential may be even higher than our actual finding, since pregnancy is most probably not attempted by multiparous or most single patients, whom cultural constrains affect their decisions. It seems prudent to offer the subgroup of unmarried women fertility preservation. No significant financial relationships to disclose.
A novel approach to identify sentinel lymph nodes using microbubbles and contrast enhanced ultrasound in preoperative breast cancer patients
Authors: Sever A. , Jones S. , Cox K. , Weeks J. , Mills P. , Fish D. , Jones P. 
Published: August 2020

e11543 Background: In patients with early invasive breast cancer, surgical excision of sentinel lymph nodes (SLN) has been shown to be a safe and accurate first-line technique to stage the axilla. In animal models, superficial lymphatics can be imaged using ultrasound and intradermal microbubbles. We investigated the ability of contrast enhanced ultrasound to identify SLN preoperatively in breast cancer patients. Methods: We recruited 46 consecutive consenting patients with primary breast cancer. Pre-operatively; patients received periareolar intra-dermal injection of microbubble contrast agent, breast lymphatics were visualised by ultrasound and followed to identify putative axillary SLN. In 41 patients, we aimed to place guide-wires in the SLN. Patients then underwent standard operative tumour excision, SLN biopsy and histopathological analysis. Results: Microbubble enhancement identified putative SLN in 5 successive patients. In 36 patients, putative SLN were visualised and guide-wires deployed. Operative findings confirmed the wired lymph nodes (LN) were SLN. In 2 cases, SLN contrast enhancement failed but guide-wires were placed into prominent grey-scale imaged LN. These wired LN were not SLN. In 3 patients, the procedure failed. Contrast enhanced ultrasound correctly identified SLN in 36 of 41 patients (88%). Five patients were found to have metastasis. In all metastatic cases, SLN were correctly identified and localised with guide-wires pre-operatively. Conclusions: Microbubbles readily enter breast lymphatics and contrast enhanced ultrasound may represent a practical method to identify SLN. Improvements in percutaneous techniques may facilitate ultrasound guided SLN excision in the breast clinic and could reduce the numbers of patients requiring axillary surgery. No significant financial relationships to disclose.
Correlation of tumor size on preoperative breast MRI and pathologic tumor size in Asian patients
Authors: Lee S. , Kim S. , Kang H. , Lee E. , Kim E. , Ko K. , Kwon Y. 
Published: August 2020

e11546 Background: As many Asian patients want breast conserving therapy (BCT), use of magnetic resonance imaging (MRI) increase in preoperative diagnosis for breast cancer. But the impact of MRI on these patients has not been unclear. Methods: From January 2008 to July 2008, 423 patients underwent breast cancer surgery in National Cancer Center, Korea. We enrolled 357 patients consecutively in this retrospective study; 290 patients (non-MRI group) with preoperative mammography (MMG) and ultrasonography (US) vs. 66 patients (MRI group) with additional MRI to MMG, US and excluded 67 patients (42 patients with preoperative chemotherapy, 8 patients with ipsilateral recurrence, 17 patients whose MRI showed no residual lesion after excisional biopsy). We examined MRI effect on mastectomy rate, intraoperative conversion from BCT to mastectomy, positive margin rate in frozen specimen in both group. In MRI group, we evaluated the correlation between tumor size on US, MRI and pathologic tumor size. Results: Mean age of this study was 48.89 years (Non-MRI group: 50.70 years vs. MRI group: 46.33 years, p=0.001). The rate of mastectomy wasn’t different in both groups (Non-MRI group: 13.7% vs. MRI group: 19.4%, p=0.252). Intraoperative conversion to mastectomy was performed frequently in MRI group. (Non-MRI group: 1.7% vs. MRI group: 7.5%, p=0.023). But positive margin rate in frozen specimen was similar in both groups (Non-MRI group: 23.2% vs. MRI group: 34.0%, p=0.111). In MRI group, mean tumor size on MRI, US was 3.07cm, 1.98cm respectively. Mean pathologic tumor size was 2.67cm. The tumor size on MRI correlated strongly with the pathologic tumor size. The correlation coefficient was 0.732 (p=0.0001). But the tumor size on US didn’t correlate with the pathologic tumor size (p=0.066). In twenty nine patients whose MMG showed suspicious microcalcification, tumor size on MRI also correlated strongly with pathologic tumor size. The correlation coefficient was 0.693 (p=0.0001). But US didn’t show the correlation with the pathologic tumor size in these patients. Conclusions: Preoperative breast MRI didn’t give the impact on breast cancer surgery in Asian patients and could overestimate the size of tumor. But it could strongly correlate with the pathologic tumor size in Asian patients. No significant financial relationships to disclose.
Is there a survival benefit with adjuvant chemotherapy for patients with stage I (T1N0) triple negative breast cancer?
Authors: Luu T. H. , Lau S. , Nelson R. , Ottochian M. , Garcia A. , Somlo G. 
Published: August 2020

e11547 Background: Chemotherapy is the only systemic modality for patients with breast cancer lacking expression of estrogen, progesterone, and HER2 receptors (triple negative), a group comprising 15% of all breast cancers. The majority of such patients present with nodal metastases. The median time to distant recurrence is short: at 2.6 years, and median time to death is 4.2 years. (Dent R, et al. Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence, Clin Cancer Res 2007; 13(15) August, 2007). The benefit from proceeding with adjuvant chemotherapy for ≤2cm, node negative triple negative breast cancer remains undefined. Patients and Methods: A retrospective chart review was conducted to assess the benefit of adjuvant chemotherapy for overall survival for stage I (T1N0) triple-negative breast cancer treated from 1996 to 2006 at City of Hope and USC. ER, PR, and HER2 status (as assessed by fluorescent in-situ hybridization (FISH) or immunohistochemistry) were reviewed and confirmed. Overall survival was defined as time from date of diagnosis to date of death. All patients received standard surgery ± radiation. Results: A total of 100 stage I triple-negative breast cancer patients were identified. The median age at diagnosis was 56 (range 27–91). Of the 100 patients, 59 received adjuvant chemotherapy: 38 received anthracycline-based, 17 received non-anthracycline-based regimens and 4 were unknown. Median length of follow-up was 4.0 years. No difference in overall survival was found in patients who received adjuvant chemotherapy (p-value = 0.94). Similarly, there was no difference between patients who received non-anthracycline-based chemotherapy versus those given anthracycline-based chemotherapy (p-value=0.17). The group of patients who received adjuvant chemotherapy were younger (51.8 y.o versus 61.5 y.o (p=0.0004)) and had larger tumor size (13.6mm versus 10.2mm (p=0.0002)). Lack of statistical significance may be related to the limited sample size. Conclusion: We did not find a statistically survival benefit of adjuvant chemotherapy in 100 triple negative stage I breast cancer patients. Further studies are needed to clarify the role of adjuvant chemotherapy in this group of patients. No significant financial relationships to disclose.
Effects of Shugan-Liangxue prescription combined with anastrozole (ANA) on bone metabolism of ovariectomy (OVX) rats
Authors: Li P. , Liu S. X. 
Published: August 2020

e11551 Background: A randomized double-blind clinical trial has confirmed traditional Chinese medicine (TCM) Shugan-Liangxue prescription could relieve hot flashes in breast cancer with endocrine therapy. The purpose of this study was to observe the effects of TCM combined with ANA on serum estradiol (E2 ) level and bone metabolism. Methods: The postmenopausal animal model was successful after OVX and testified by vaginal smear method. Sixty 6-month SD rats were randomly divided into control, TCM, ANA, ANA+TCM, alendronate sodium (AL), and sham groups. After 16 weeks intragastric administration, the bone mineral density (BMD) of femur and lumbar vertebra were measured by dual energy X-ray absorptiometry. The serum E2, osteocalcin (BGP), and prostaglandin E2 (PGE2) were detected by radioimmunoassay and pyridinoline (PYD) was by ELISA. Results: Serum E2 level decreased in TCM, ANA, and ANA+TCM groups compared with the control (P<0.05, P<0.01, P<0.001), BMD had no significant difference compared with the control. In ANA+TCM group, BGP (bone formation index) increased, PYD (bone absorption index) and PGE2 declined significantly compared with ANA group (P<0.05, P<0.05, P<0.01). PYD decreased greatly in TCM and AL groups compared with the control (P<0.001, P<0.001). Conclusions: TCM combined with ANA decreased serum E2 level, but did not decline BMD of OVX rats. It could also elevate BGP and decrease PYD level in serum. It was possible that TCM combined with ANA could alleviate musculoskeletal pain through PGE2 decrease. The effect of TCM reducing PYD was similar with AL. [Table: see text] No significant financial relationships to disclose.
Weight gain after adjuvant TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy for node-positive breast cancer
Authors: Suh Y. , Oh S. , Song B. , Jung S. 
Published: August 2020

e11552 Background: Despite of its proven therapeutic efficacy, TAC (docetaxel, Doxorubicin and cyclophosphamide) regimen as an adjuvant chemotherapy has some serious adverse effects such as fluid retention and neutropenia. Even though dexamethasone is known to be given for three days to the patients having TAC chemotherapy to prevent severe fluid retention, most patients have ironically been complaining of much weight gain more than 15% increase after the use of dexamethasone. We tried to determine abbreviated use of dexamethasone is better to decrease the extent of weight gain after TAC chemotherapy. Methods: Eighty node-positive patients between Jan. 2006 and Oct. 2007 were randomly assigned either into 24-hr (group A: 10 mg dexamethasone the night before TAC, and 10 mg dexamethasone (bid) were given for the day 1) or 72-hr dexamethasone premedication (group B) only after getting informed consent since all the protocols were reviewed by IRB. We compared the incidence of severe weight gain (more than 15%) on completion of six cycles in two groups. No patient was found to have heart or kidney problem before the commencement of chemotherapy. Results: Each group was comprised of 40 patients. All patients underwent 6 cycles. Mean age of each group was 48.5 (A) and 50.3 (B) years. The incidence of severe weight gain was 47.3 % in Group A, and 78.4 % in Group B. There was no difference in the duration of recovering from weight gain in both groups (A: 6.52 months vs. B: 7.02 months). No other hematologic complications seemed different between two groups. Conclusions: Though larger scale prosepctive randomized trials should be required to get the definitive conclusion on this matter, we think that current dexamethasone premedication may aggravate weight gain than to prevent it. If shorter schedule is as much effective as longer one, abbreviated and reduced dexamethasone premedication is more helpful for patients having TAC chemotherapy. No significant financial relationships to disclose.
Trastuzumab and vinorelbine (TV) in early stages of breast cancer
Authors: Ferrario C. , Wong A. , Bouganim N. , Gao T. , Aloyz R. , Panasci L. C. 
Published: August 2020

e11556 Background: HER-2+ breast cancers (BCs) have a higher relapse rate, even for early stages of disease. The combination of trastuzumab and vinorelbine (TV) displays a high degree of synergism both preclinically and in metastatic BC patients that typically tolerate TV remarkably well. Occasionally, patients refuse standard treatment with chemotherapy and trastuzumab because of toxic side effects. In our institution, some of these patients accepted to receive treatment with TV. Methods: We retrospectively collected data on patients with stage I-III BCs, treated with TV as the only chemotherapy regimen. Most patients received TV on a weekly basis (one week off for V every 3–4 weeks) for ∼6 months, followed by 6 more months of T only. Results: Between May 2003 and June 2008, 23 patients were started on weekly TV. Median age was 66. Five patients received TV as preoperative treatment for BCs with the following clinical stages: IIB (1); IIIA (1); IIIB (3). The other 18 patients were pathologically staged as: stage I (11); IIA (5); IIIB (2). All cancers were HER2+; 65% of patients also received hormonal treatment for ER/PR+ disease. 3 patients had been previously treated for BC, and received TV as “adjuvant” treatment after a local relapse. Only one of these patients had previously received chemotherapy, while none had received prior T. No pathological complete response was found at surgery after preoperative TV. TV was very well tolerated, with one patient developing febrile neutropenia, 4 patients grade 3–4 uncomplicated neutropenia, and no other grade 3–4 events. During therapy, 5 patients had an asymptomatic 10–20% drop in the LVEF (Grade 1). Follow-up MUGA scans at 1 year after TV so far failed to show any significant abnormality. At an average follow-up of 26 months, one patient died for non-BC related causes, and all the other 22 patients are disease-free. Conclusions: TV is safe and very well tolerated, with no significant cardiac toxicity in our patient population. Preliminary follow-up data suggest that TV may be an acceptable alternative (neo-)adjuvant therapy for patients refusing “toxic” chemotherapy. Further studies prospectively testing TV as adjuvant treatment should be considered for patients with stage 1A BC, for which no standard treatment is clearly defined. No significant financial relationships to disclose.
Neoadjuvant dose-dense docetaxel, carboplatinum, and trastuzumab (ddTCH) chemotherapy for HER2 overexpressing breast cancer
Authors: Bayraktar S. , Bayraktar U. D. , Reis I. M. , Pegram M. , Welsh C. , Silva O. , Franchesci D. , Gomez C. R. , Hurley J. 
Published: August 2020

e11557 Background: Neoadjuvant chemotherapy for locally advanced breast cancer was shown to improve the complete pathologic (pCR) and clinical response (cCR) as well as the disease free survival (DFS). Docetaxel, cisplatin, and trastuzumab given every 21 days in her2-positive breast cancer demonstrated a pCR rate of 23%. The concept of dose dense chemotherapy regimens has attracted much attention and we hypothesized that dose-dense regimen would further improve pCR, cCR and would maintain the safety profile while being a suitable regimen for outpatient administration. Methods: 48 patients with stage II/III HER2-positive breast cancer were prospectively enrolled on a clinical trial of a neoadjuvant regimen consisting of docetaxel 70 mg/m2 on days 1, 15, 29, and 43; carboplatinum at an AUC of 6 on days 1, 15, 29, and 43; trastuzumab 4 mg/kg on day 1 and 2 mg/kg weekly x 10 starting on day 8; peg-filgastrim 6 mg on days 2, 16, 30, and 44. Results: The median age was 50 years (range 30–78). 52% of patients were premenopausal, 63% and 22% were of Hispanic and African descent, respectively. Estrogen receptor was positive in 52% patients and median tumor size was 5 cm at the time of diagnosis. TNM stage distribution at presentation: T1 2%, T2 25%, T3 57%, T4 16%; N0 29%, N1 46%, N2 16%, N3 7%; M0 100%. pCR in breast; axilla; and both breast and axilla was observed in 19 of 44 patients (43.2%; 95% CI 28.3% - 59.0%); in 29 of 44 patients (65.9%; 95% CI 50.1% - 79.5%); and in 16 of 44 patients (36.4%; 95% CI 22.4% - 52.2%), respectively. No grade 4 or 5 toxicity occurred. The most frequent grade 3 toxicities were hand-foot syndrome (7%), neutropenia (4%), nausea/vomiting (2%), and bone pain (2%). Grade 2 cardiotoxicity was seen in 8% of patients and no grade 3 cardiotoxicity was observed. Conclusions: This neoadjuvant regimen was well tolerated and yielded a good pCR rate for this high risk group of patients. No significant financial relationships to disclose.
Neoadjuvant trastuzumab in a sequential nonanthracycline-based regimen for patients with stage II-III breast cancer
Authors: Carillio G. , Aiello R. , Alì M. , Mazzola A. , Scandurra G. , Taibi E. , Chiarenza M. , Fallica G. , Caruso F. , Caruso M. 
Published: August 2020

e11559 Background: Recently, some studies have demonstrated benefit from adding trastuzumab to neoadjuvant anthracycline-containing chemotherapy for HER2-positive breast cancer patients. However, trastuzumab can increase cardiotoxicity, particularly when combined with anthracyclines. This represents a relevant issue for patients who usually need to receive radiotherapy or further systemic treatment. Methods: In the late 2007 we started a phase II study for testing activity and safety of neoadjuvant trastuzumab in association with sequential chemotherapy, based on favourable in vitro combination index, proven efficacy, and moderate cardiotoxicity. Weekly trastuzumab for 18 weeks was combined with cisplatin 80 mg/m2 on day 1 and vinorelbine 25 mg/m2 on days 1+8 q3w for 3 courses, followed by docetaxel 100 mg/m2 q3w for further 3 courses. Peg- filgrastim was administered to prevent neutropenia. Adjuvant trastuzumab q3w was planned for one year. Eligible patients had stage II-III core-biopsied breast carcinoma with overexpressed or amplified HER2/neu. Adequate cardiac function with LVEF ≥ 50% was required for trastuzumab administration. Primary end-point was pathologic complete responses (pCR) rate. The study is registered on the European Clinical Trials Database. Results: Among 17 enrolled patients, 15 were evaluable for primary end-point. Median age was 50 years (range 23–70), stage II and III breast cancer in 4 and 13 patients, respectively, with 4 cases of stage IIIB (2 T4b and 2 T4d), and 2 women with synchronous bilateral cancer. Neoadjuvant regimen yielded 6/15 pCR (40%). Only 3/12 patients treated with lymphadenectomy due to initial clinically suspected axillary nodes presented pN+, but none of them had more than 3 positive nodes. In two cases we observed a total pCR, involving both primary tumor and axillary nodes. Treatment was safe, with only 2 events of short G4 non febrile neutropenia on 97 chemotherapy cycles. Alopecia was moderate at the end of treatment, without any case of complete hair loss. No significant cardiac dysfunction was recorded during the neoadjuvant therapy. Conclusions: The present sequential non anthracycline-based chemotherapy associated with weekly trastuzumab showed promising results in neoadjuvant setting. No significant financial relationships to disclose.