bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accelerated partial breast irradiation using a strut-based brachytherapy device: A multi-institutional initial report on acute and late toxicity with greater than 24-month follow-up.
Authors: Strasser Jon F. , Jacob Dayee , Koprowski Christoper D. , Attai Deanna J. , Butler Ernest , Finkelstein Steven E. , Han Ben , Hong Robert , Komarnicky Lydia T. , Kuske Robert R. , Lyden Maureen , Mahalingam Sudha B. , Mantz Constantine , Morcovescu Serban , Nigh Stephen S. , Perry Kerri , Pollock Jondavid , Reiff Jay E. , Scanderbeg Daniel , Yashar Catheryn M. 
Published: February 2017

149 Background: Accelerated partial breast irradiation (APBI) is commonly used in early-stage breast cancer. The SAVI Collaborative Research Group is a multi-institutional group created to study outcomes in patients who received APBI utilizing strut-based brachytherapy. This analysis reports the acute and late toxicities for patients with greater than 2-year follow-up (F/U) from this study. Methods: 904 APBI patients (ductal carcinoma in situ [n=267] or invasive breast cancer [n=637]), received HDR brachytherapy (34 Gy in 10 fractions) using the SAVI device (Cianna Medical). Patients with dosimetry and documented follow-up were evaluated within 6 weeks of treatment for early adverse events (AEs), and at 1 year, 2 years, and beyond for late AEs. Dosimetric parameters were evaluated with respect to toxicity and will be presented. Results: In 212 patients (median age 62.9 years, range 40-88) all with follow-up greater than 24 months, the median tumor size was 12mm. As of last follow-up (>24 months) cumulative rates of erythema and hyperpigmentation of grade 2 or higher were 1.4% and 0.5%. The incidence of grade 2 or higher telangiectasia, seroma and fat necrosis were 2.8%, 2.8%, and 0.5% respectively. Conclusions: Adverse events for APBI with SAVI are low in incidence, low in grade and compare favorably to other HDR APBI methods.
Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: Results of a multivariate analysis.
Authors: Matuschek Christiane , Boelke Edwin , Bojar Hans , Roth Stephan L. , Peiper Matthias , Speer Vanessa , Janni Johann Wolfgang , Audretsch Werner , Nestle-Kraemling Carolin , Sauer Rolf , Budach Wilfried 
Published: February 2017

154 Background: An earlier published series of neoadjuvant radio-chemotherapy (NRT-CHX) in locally advanced noninflammatory breast cancer (LABC) has now been updated with a follow-up of more than 15 years. Long-term outcome data and predictive factors for pathologic complete response (PCR) were analyzed. Methods: 315 LABC patients (cT1-cT4 /cN0-N1) were treated during 1991-1998 with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with an electron boost in 214 cases afterwards or—in case of breast conservation—a 10-Gy interstitial boost with 192Ir afterloading before EBRT. Chemotherapy was administered prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. The update of all follow up ended in November 2011. Age, tumor grade, nodal status, hormone receptor status, simultaneous vs. sequential CHX and the time interval between end of RT and surgery were examined in multivariate terms with as endpoint pCR and overall survival. Results: The total PCR rate after neoadjuvant RT-CHX reached 29.2 % with LABC breast conservation becoming possible in 50.8%. In initially node-positive cases (cN+), a complete nodal response (pN0) after NRT-CHX was observed in 56% (89/159). The multivariate analysis revealed that a longer time interval to surgery increased the probability for a pCR (HR 1,17 [95% CI 1,05-1,31], p<0,01). However, in large tumors (T3-T4) a significantly reduced pCR rate (HR 0.89 [95% CI 0.80 to 0.99], p = 0.03) could be obtained. Importantly, a pCR was the strongest prognostic factor for long-term survival (HR 0.28 [95% CI 0.19-0.56], p<0.001). Conclusions: A PCR identifies patients with a significant better prognosis for long-term survival. However, a long time interval to surgery (> 2 months) increases the probability of a pCR after NRT-CHX.
Pleomorphic lobular carcinoma in situ: A distinct entity of controversial significance.
Authors: De Brot Marina , Muhsen Shirin , Andrade Victor P. , Koslow Mautner Starr , Murray Melissa , Giri Dilip D. , Sakr Rita A. , Brogi Edi , King Tari A. 
Published: February 2017

177 Background: Pleomorphic lobular carcinoma in situ (PLCIS) is an increasingly diagnosed variant of lobular carcinoma in situ. Histologically, it resembles ductal carcinoma in situ (DCIS), leading to controversy over proper management. Yet, the natural history of PLCIS is unknown. Here we describe our experience with PLCIS. Methods: Review of pathology reports (1995–2012) identified 233 cases of LCIS variants. Patients with synchronous ipsilateral DCIS or invasive cancer (IC) were excluded leaving 25 cases for review. Consensus review by 3 pathologists further excluded 7; leaving 18 cases, 12 of which were classified as PLCIS and 6 as LCIS with pleomorphic features (LCIS-PF). (Table) PLCIS was defined by cellular dyshesion, nuclear pleomorphism with a 2-3 fold size variation, conspicuous nucleoli, mitoses and abundant cytoplasm; lesions not meeting all parameters were classified as LCIS-PF. Loss of e-cadherin was confirmed; clinical data were obtained from medical records. Results: Mean patient age at diagnosis of PLCIS/LCIS-PF was 57 yrs (42-67 yrs). All cases presented with imaging abnormalities. A previous history of breast cancer was present in 7/18 (39%) pts (3/7, ipsilateral; 4/7, contralateral). Following PLCIS/LCIS-PF diagnosis, 6/18 (33%) pts underwent mastectomy and 12/18 had excision alone, with (n=3) or without chemoprevention (n=9). Margin status was negative in 4/12 pts; close in 3/12 pts and positive in 5/12 pts undergoing excision. At a median follow-up of 27 mos (2-148 mos), 2/12 pts treated with excision developed ipsilateral breast cancer (1 DCIS; 1 IC). Both had close margins at initial excision; median time to cancer, 54 mos. Conclusions: Pure PLCIS is an uncommon lesion. Synchronous malignancy or prior history of breast cancer are often present in patients with PLCIS, contributing to the difficulty in determining the actual risk conferred by this lesion and appropriate management. Efforts to systematically characterize LCIS variants and prospective documentation of outcomes are needed to clarify the significance of these lesions. [Table: see text]
Intraoperative radiotherapy in previously augmented patients with early-stage breast cancer.
Authors: Holmes Dennis R. , Lewinsky Bernard S. , Rashtian Afshin , Robertello William J. , Rivera Ronald J. , Feiler Karen 
Published: February 2017

186 Background: Breast conservation therapy (BCT) is the preferred treatment for early stage breast cancer (ESBC), providing equivalent survival to mastectomy with improved quality of life (QOL). Nevertheless, previously augmented women (PAW) with ESBC are often denied access to BCT due to potential complications arising from capsular contracture from exposure to whole breast radiation therapy (WBRT). Instead of BCT, PAW are commonly advised to undergo total, skin-sparing, or nipple-sparing mastectomy with or without breast reconstruction to eliminate the need for WBRT. These more extensive procedures alter the form and function of the breast, increase the risk of perioperative morbidity, prolong postoperative recovery, and add incremental costs. Intraoperative radiotherapy (IORT) emerged as a strategy for delivering breast radiotherapy that preserves the option of BCT in PAW with ESBC. IORT confines the effects of radiotherapy to the quadrant of the breast and to the portion of the prosthesis in proximity to the cancer. Since IORT is administered at the time of BCT, it permits insertion of a radiation barrier to further shield the prosthesis from effects of radiotherapy. Methods: We present several examples of PAW who underwent BCT combined with IORT for the treatment of ESBC. Results: Four women with an average age of 51.8 years (range: 47-57) were treated with BCT and IORT for ESBC using the Intrabeam System (Carl Zeiss-Meditec, Inc., Oberkochen, GE). All women had either saline (SA), silicone (SI), or combination retropectoral implants (RP). All pathological margins were clear and IORT was administered without complications. Average follow-up was 26 months (range: 1-72 months). None experienced a recurrence and breast cosmesis was acceptable in all women. Conclusions: IORT preserves the option of BCT in PAW by reducing the impact of radiotherapy on the breast. This radiotherapy approach eliminates the physical burden, impact on QOL, and cost of more extensive breast procedures. Consequently, IORT should be considered a preferred treatment for PAW facing a diagnosis of ESBC. [Table: see text]
Experience and outcomes of nipple-sparing mastectomy following reduction mammoplasty.
Authors: Alperovich Michael , Blechman Keith M. , Samra Fares , Shapiro Richard , Axelrod Deborah M. , Choi Mihye , Karp Nolan S. , Guth Amber Azniv 
Published: February 2017

193 Background: Breast cancer resection strives for less radical approaches that offer superior aesthetic results without compromising oncologic safety. Nipple-sparing mastectomy (NSM) has gained popularity, but usually has been offered to smaller breasted and minimally ptotic women without history of extensive breast surgery. We present a series of nine nipple-sparing mastectomies following reduction mammoplasty. Methods: Charts of patients who underwent NSM following reduction mammoplasty at the NYU Medical Center from 2006 through 2011 were reviewed. Outcomes measured include post-operative complications, breast cancer recurrence, presence of cancer in the nipple-areolar complex, and nipple-areolar complex viability. Results: In total, the records of 235 (145 prophylactic, 90 therapeutic) NSM patients at NYU Medical Center were reviewed. Six patients for a total of 9 breasts had NSM following reduction mammoplasty. This subset of patients had a mean age of 46.2, mean BMI of 25.1, no history of diabetes and 1 smoker. Seven of 9 breasts were therapeutic resections and 2 of 9 were prophylactic. Time elapsed between reduction mammoplasty and NSM ranged from 33 days to 11 years. The majority of resections were in Stage 0 patients (6/9) with 1/9 in Stage I and 2/9 in Stage IIA. In all cases, prior reduction mammoplasty incisions were utilized for NSM. Eight patients were reconstructed immediately with tissue expanders, and 1 patient had a latissimus dorsi flap with immediate implant. Complications included 1 hematoma requiring evacuation and 1 displaced implant requiring revision. There were no positive subareolar biopsies and 100% nipple viability. Mean follow-up time was 9.4 months. Conclusions: Our experience demonstrates that NSM can be offered following reduction mammoplasty with comparable reconstructive outcomes to NSM alone. Reduction mammoplasty followed by NSM has potential as a reconstructive tool in prophylactic cases unsuited for primary NSM.
Early diagnostic value of survivin and its alternative splice variants in breast cancers.
Authors: Khan Salma , Yuan Yuan , Valenzuela Malyn May , Turay David , Ferguson Heather , Wong Siu-Fun , Perez Mia , Mirshahidi Saied , Wall Nathan R 
Published: February 2017

35 Background: The inhibitor of apoptosis (IAP) protein Survivin and its splice variants are differentially expressed in breast cancer tissues and have recently been shown to be released from tumor cells via small membrane-bound vesicles called exosomes. Tumor-derived exosomes play multiple roles in tumor growth and metastasis and may produce these functions by impacting immune escape, tumor invasion and angiogenesis. We, therefore, hypothesize that analysis of exosomal Survivin and its splice variants may provide a novel biomarker for early diagnosis of breast cancer in addition to current recommended methods. Methods: Twenty paired breast cancer patient’s sera and tumor tissue, and ten normal control sera were used for analysis. ELISA was performed to quantitate serum levels of Survivin. Exosomes were isolated from the sera using Exoquick. RT-PCR, western blots with densitometry, and immunohistochemistry followed by confocal microscopy were then performed. Results: For each breast cancer patient serum, Survivin levels were significantly higher compared to control (p<0.05). While Survivin and the DEx3 splice variant expression and localization were similar, differential expression of Survivin and the 2B splice variant protein and mRNA existed in the exosomes and tissue samples. Survivin and -DEx3 proteins were the predominant forms detected in 100% (20/20) of the breast cancer tissues evaluated, whereas a more variable expression of Survivin-2B, with enhanced levels found in areas of necrosis. We also for the first time here show the exosomal localization of Survivin and its splice variants DEx3 and 2B in sera from breast cancer patients. Conclusions: The result of the proposed project supports our hypothesis that differential expression of exosomal-Survivin and its alternative splice variants may serve as a diagnostic marker in breast cancer patients. For future direction, we plan to study the prognostic value of exosomal-Survivin and its splice variants on a large panel of primary breast cancers within a setting of well-followed clinical outcomes.
Metastatic breast cancer and the elderly: A single institution, retrospective review.
Authors: Kidd Michael , Karlin Nina J. , Dueck Amylou C. 
Published: February 2017

55 Background: The aim of this retrospective study was to examine the overall survival (OS) of metastatic breast cancer patients over a decade and assess for any differences with respect to age, tumor characteristics, and ECOG status. Methods: Data on metastatic breast cancer cases from 1999-2010 were retrieved from the institutional cancer registry and linked to electronic medical records. Through chart review of 240 metastatic breast cancer cases, we determined hormone receptor (HR), HER2/neu (HER2), ECOG, age at diagnosis of metastatic cancer and mortality data. Kaplan-Meier survival curves for OS were used and compared between HR status, HER2 status, ECOG, and age at diagnosis using log-rank regression and Cox Regression analysis was performed to control for these variables. A 95% confidence interval (CI) was used. Results: The median OS of the sampled cases was 2.2 years (CI: 1.8-2.5 years). Analysis for overall survival by pre-determined age groups demonstrated no significant difference between the age groups (p value 0.46), but did yield a statistical difference based on ECOG status (p value 0.0001). Cox regression analysis showed consistent findings where survival was significantly affected by HR, HER2 status and ECOG but not age (HR: p value <0.0001; HER2: p value 0.0132; ECOG: p value <0.0001; age at diagnosis: p value 0.8462). Analysis for OS based on HR yielded a median survival of 1.4 years (CI: 0.9-1.6 years) for HR negative and 2.5 years (CI: 2.2-3.0 years) for HR positive (p value 0.0018). HER2 yielded a median survival of 1.8 years (CI: 1.4-2.3 years) for no amplification and 3.0 years (CI: 2.5 - 3.4 years) for amplification (p-value 0.0043). HR negative, HER2 non-amplified tumors had the poorest median OS at 0.7 years (CI: 0.5 - 1.1 years) whereas those tumors with HR positive, HER2 amplified had the best median OS at 3.0 years (CI: 2.5 - 4.7 years) with a p value < 0.0001. Conclusions: In this retrospective analysis, there was no significant survival difference with respect to age. Age continued to have no significant effect on survival when adjusting for ECOG, hormone status, and HER2/neu status. Those factors that did act as determinants of survival were ECOG status, hormone status and HER2/neu status of the tumor.
Making it work: Breast cancer survivorship care at Johns Hopkins.
Authors: Bantug Elissa Thorner , Peairs Kimberly S. , Shockney Lillie D. , Zafman Nelli , Riley Carol D. , Reese Jennifer Barsky , Snyder Claire Frances , Stearns Vered , Wolff Antonio C. 
Published: February 2017

61 Background: Breast cancer survivor numbers are increasing due to population aging and improved treatment outcomes but many of their long-term health care needs are unmet. Integrated follow-up care strategies that enhance care coordination, education, and access to survivorship resources are needed to provide patients with evidence-based care that addresses medical and psychosocial needs after cancer treatment. Methods: In 2008, we established the Johns Hopkins Breast Cancer Survivorship Program with representation from the Schools of Nursing, Public Health, and Medicine to address the needs of patients completing initial cancer treatment and transitioning to long-term follow-up. Patient educational resources were created within an interactive website ( http://bit.ly/hZfzFi ) including > 35 patient/provider educational video clips, blogs and social media. Activities including provider educational events, educational folders, and trainee curriculum additions have been ongoing. Starting May 2011, Hopkins patients were offered a one-time transition visit with a nurse practitioner focusing on individualized treatment summary/survivorship care plan activities (e.g., cancer screening/surveillance, medical intervention, psychosocial support, and care coordination with non-cancer providers). Results: Our website is averaging 3,000 hits monthly. We have participated in 22 provider/trainee formal educational presentations. In the pilot phase of these transition visits (n=40), age/race breakdown of participants were representative of our breast cancer population (median age 51, range 34-69; 17% African Americans). Our post-visit survey (n=37), 97% found the survivorship visit beneficial and all reported that this one-time consultation helped with transitioning away from treatment. Conclusions: A multidisciplinary patient-centered approach to breast cancer survivorship allowed us to develop comprehensive clinical and educational service models to benefit patients and their cancer/non-cancer providers. This program aims to enhance education, overcome the fragmentation of the health care system, and improve overall health and wellness of breast cancer survivors as they transition to long-term survivorship.
Risk of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after adjuvant chemotherapy (CT) for early breast cancer (BC) in the community setting.
Authors: Denduluri Neelima , Espirito Janet L. , Turnwald Brian , Wang Yunfei , Asmar Lina , Hoverman J. Russell , Neubauer Marcus A. , Bosserman Linda D. , Busby Leslie T. , Brooks Barry Don , Cartwright Thomas H. , Sitarik Mark A. , Schnadig Ian D. , Winter William E. , Garey Jody S. , Bergstrom Kimberly A. , Beveridge Roy A. , Patt Debra A. ,   on behalf of The US Oncology Network Pathways Task Force
Published: February 2017

62 Background: AML and MDS complicate adjuvant CT in BC. Incidence Rates of MDS/AML with pegfilgrastim (PGCSF) use and newer adjuvant regimens in large patient (pt) populations are not widely characterized. Methods: We queried the iKnowMed electronic health record from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 visits and follow up (f/u) through 2/2012 for our retrospective study. We stratified pts by adjuvant CT utilization (yes/no), regimen type, PGCSF use, age, and characterized the incidence of MDS/AML captured as a secondary diagnosis. Fisher’s exact test and student t-test were used for categorical and continuous variables, respectively; Cox proportional hazard model was used to estimate hazard ratios (HR) for risk factors associated with AML/MDS development. Results: We identified 20,900 pts with median f/u of 2.8 years (yrs) (1.2-5.2 yrs). 11,295 pts (54%) received CT, 41% of whom received anthracyclines (A); 9,605 (46%) did not receive CT. Median age of diagnosis in the CT and non-CT arms was 54 and 64 yrs, respectively (p < 0.01). Among the CT-treated group, 12 pts or 0.11% (95% CI, 0.06-0.19) developed AML/MDS with median time to onset of 1.8 yrs and median f/u of 2.7 yrs. Of these 12 pts, 8 received A and 11 PGCSF. In the non-CT group, 18 pts or 0.19% (95% CI, 0.11-0.30) developed AML/MDS with median time to onset of 2.2 yrs and median f/u of 3 yrs (p=NS). Multivariate analysis of pts who received CT revealed pts ≥70 vs. <70 yrs and those that received A-containing vs. alternate regimens were more likely to develop AML/MDS. Conclusions: Adjuvant CT did not increase risk of AML/MDS compared with those that did not receive CT. However, our findings confirm that increased age and A-containing CT regimens are associated with increased risk. The low event rate in our study population may be due to short f/u, younger age in the CT treated arm, and high utilization of non-A CT. Association with PGCSF warrants further evaluation. [Table: see text]
A 5-year review of an educational program focused on meeting the needs of patients with advanced breast cancer.
Authors: Ahmed Ivy A. , Harvey Allison , Amsellem Marni 
Published: February 2017

87 Background: Women living with advanced breast cancer have distinct often unmet needs, even compared to other women with breast cancer. For the past five years, the Cancer Support Community has been committed to delivering Frankly Speaking About Cancer: Advanced Breast Cancer, a comprehensive psychosocial education program created for women with metastatic breast cancer and their families. The program’s clinically facilitated evidence-based education workshops have reached 2,690 attendees since its inception in 2006. The workshop provides valuable information about current treatments, clinical trials, side-effect management, and social and emotional challenges of an advanced breast cancer diagnosis. Workshop outcomes are analyzed annually, informing program content and ensuring the program is meeting the needs of those served. As the program enters its sixth year, data were consolidated across years to investigate how the program has been meeting the needs of these women and their loved ones. Methods: 1,827 workshop attendees since the program’s beginning have completed evaluations (68% response rate) which included assessing levels of pre- and post-workshop knowledge about advanced breast cancer, patient-provider communication, and general workshop feedback. Results: 64.9% of respondents were survivors, 78.5% were Caucasian, and the average age was 56. Most workshop respondents (89.6%) reported gaining a high or very high level of knowledge about advanced breast cancer, with significant increases compared with pre-workshop levels (p <.01). Most reported intent to increase communication with their clinical team following the workshop. A majority reported feeling better equipped to ask questions to their health care team (92.1%), and discuss the possibility of clinical trials with their healthcare team (77.7%). Furthermore, 90% of attendees felt confident that after the workshop they could speak knowledgably about side effects of cancer treatment with their doctor, a key issue in regards to quality of life. Conclusions: Taken together, the data indicate the continued relevance of this program for those affected by advanced breast cancer.