bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying women at high risk for invasive breast cancer at the time of screening mammography.
Authors: Lopresti Mary Lorraine , Edmiston Kathryn L. , Sood Rahul , Khanna Shrinkala 
Published: February 2017

6 Background: Most mammography centers collect reproductive, family, and environmental data on patients presenting for screening mammograms. These data, if entered into a Gail Model Risk Assessment Tool, can help identify those patients at increased risk. These patients can then be referred to high-risk centers that will focus on risk-reduction strategies. Methods: This study is an observational prospective cohort of 1,000 women presenting for mammographic screening or diagnostic evaluation at mammography clinics affiliated with a single institution. Women at the time of their mammogram were asked to fill out a standard intake sheet by the institutional clinic. These data sheets were gathered and Gail model risk scores were calculated. Women with a 5-year risk of invasive breast cancer of 1.7% or greater were identified. Patients with a history of breast cancer or who underwent diagnostic mammography were excluded. A high risk subgroup was identified and risk factors were analyzed. Women at particularly high risk ( ≥ 3.4% or double the 5-year risk) were analyzed separately. Results: Of 1,000 women screened, 366 had ≥ 1.7% 5-year risk of invasive breast cancer. 26% (96) of these women were under 60 years old while 74% (270) were ≥ 60 years old. Among the latter group, 19.6% (53) were found to have ≥ 3.4% of developing invasive cancer. In these women with double the 5-year risk, 96.2% had a family history of breast cancer and 92.4% had a prior biopsy. Similarly, in women under 60, greater than half were high risk secondary to a prior biopsy or family history. Conclusions: 1/3 of patients who receive annual screening are at high risk for breast cancer. These patients can be identified from data routinely obtained at the time of screening mammography. Many were found to be at increased risk due to a strong family history or prior biopsy. Mammography centers may be the ideal setting in which to alert these patients of their risk and refer them to high risk centers for genetic counseling and consideration of chemoprevention.
A pilot study of preoperative (Pre-op), single-dose ipilimumab (Ipi) and/or cryoablation (Cryo) in women (pts) with early-stage/resectable breast cancer (ESBC).
Authors: Diab Adi , Solomon Stephen Barnett , Comstock Christopher , Maybody Majid , Sacchini Virgilio , Durack Jeremy C. , Blum Brian , Yuan Jianda , Patil Sujata , Neville Deirdre A. , Sung Janice S. , Kotin Alan , Morris Elizabeth Ann , Brogi Edi , Morrow Monica , Wolchok Jedd D. , Allison James , Hudis Clifford , Norton Larry , McArthur Heather L. 
Published: February 2017

67 Background: Intratumoral cryo combined with immune modulation generates a potent systemic anti-tumor immune response that might improve recurrence free survival in ESBC. In this study, we evaluate the safety of pre-op cryo and/or ipi (10mg/kg) in pts with ESBC. Radiographic correlates and intratumoral/serologic immune responses are also explored. Methods: Eligible pts are ≥18y of age with operable ≥1.5 cm invasive ESBC, no history of autoimmune disease and planned mastectomy. Pts are sequentially assigned to receive pre-op: cryo alone (Group-A), ipi alone (B), or ipi with cryo (C). Cryo is administered 7-10d prior to surgery. Ipi is administered 8-15d prior to surgery (1-5d prior to cryo). If at least 5/6 pts in each group proceed with surgery without delay, the regimen will be considered safe/tolerable. Toxicity evaluation continues for 12 wks after ipi administration for Groups B and C. Results: As of May 1, 2013, 7/7 pts were enrolled to Group-A (expanded after a possible technical failure in 1 pt) and 6/6 pts were enrolled to Group-B. The median age was 45y (range 39-69y). All 13 pts in Groups A and B underwent mastectomy without delay. Group C is now accruing with 1/6 patients enrolled and awaiting surgery. 6/7 pts in Group-A and none in Group-B had ischemic tumor necrosis/infarction in the mastectomy tissue. Overall, pre-op cryo or ipi alone have been well tolerated with no study related grade 3/4 adverse events (AE) reported (Table). Conclusions: To date, pre-op cryo or ipi is safe and tolerable in pts with ESBC. A Phase II study of pre-op ipi and cryo in ESBC is planned. Clinical trial information: NCT01502592. [Table: see text]
Do locoregional recurrence and survival outcomes differ in women with node-negative, HER2-positive breast cancer treated with breast-conserving therapy versus mastectomy?
Authors: Peterson David John , Truong Pauline , Sadek Betro , Shenouda Mina , Taghian Alphonse , Alexander Cheryl 
Published: February 2017

69 Background: Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer subtype is an adverse prognostic factor, it is unclear whether there are differences in outcomes according to the type of locoregional treatment used in this population. This study compared locoregional recurrence and survival outcomes in women with node-negative, HER2-positive breast cancer treated with Breast Conserving Therapy (BCT) versus Modified Radical Mastectomy (MRM). Methods: Independent datasets from the BC Cancer Agency (BCCA) and the Massachusetts General Hospital (MGH) were pooled and analyzed. Study subjects included 748 patients between 2003-2009 with pT1-2, N0, M0 Her2+ breast cancer, treated with BCT or MRM. Standard clinico-pathologic factors were analyzed. Kaplan-Meier locoregional recurrence (LRR), breast cancer specific survival (BCSS) and overall survival (OS) were compared between cohorts treated with BCT vs. MRM. Multivariable analysis (MVA) with Cox regression modeling was performed to evaluate the prognostic significance of type of locoregional treatment on outcomes. Results: Median follow-up time was 4.2 years for BCCA and 6.0 years for MGH. Comparison of clinico-pathologic factors according to type of locoregional treatment found that patients treated with MRM had higher proportions of grade 3 histology (69% vs. 60%, p = 0.004) and PR-negative disease (56% vs. 44%, p = 0.008) and lower rates of endocrine therapy (51% vs. 64%, p <0.001) and herceptin therapy (50% vs. 57%, p = 0.04). There were no significant differences between BCT and MRM groups in 5-year Kaplan-Meier LRR (2.0% vs. 1.7%, p=0.88), BCSS (97.2% vs. 96.1%, p=0.70), and OS (95.5% vs. 93.4%, p=0.19). On MVA, BCT and MRM were associated with similar LRR, BCSS, and OS. The only factor associated with reduced OS was T2 disease (HR 3.1, p=0.01). Conclusions: In this multi-institutional study, no significant outcome differences were found among women with T1-2 N0, HER2-positive breast cancer treated with BCT or MRM. Breast conserving therapy is safe in this population, providing high rates of locoregional control and survival equivalent to mastectomy.
Radiation-induced lung and heart toxicity in patients with early-stage breast cancer treated with hypofractionated radiotherapy following breast-conservative surgery.
Authors: Fragkandrea-Nixon Ioanna 
Published: February 2017

73 Background: Hypofractionated RT for breast cancer (BC), although reducing cost and time, could have negative impact on normal underlying lung and heart. We studied and compared lung function and the post –RT radiological changes using High–Resolution CT (HRCT) in early BC patients, treated with 3-D conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime. Additionaly, in patients with right-sided breast cancer, we monitored changes in LVEF performing MUGA scans. Methods: Between 2008 and 2009, 61 early BC patients (TI-2N0M0) were randomised into Group A (n=31) and Group B (n=30) receiving standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed or 43.2Gy/16f/22d plus same boost dose respectively. All patients were subjected to dynamic lung testing, on D0 (before RT), during and after RT at 3 and 6 months. HRCT scans were performed at baseline, and 3, 6, 12 months after RT. Dosimetric factors (CLD, V20, D25, MLD) were calculated. MUGA was performed in patients with right sided BC prior and 6 and 12 months post RT. Results: At 3 months after RT, pulmonary changes were classified at HRCT as follows: 91.8% were Grade 0, 8.19% Grade 1, and 0% Grade 2. At 6 months, 86.98% were Grade 0, 11.47 % Grade 1, and 1.6% Grade 2. At 12 months, 88.52% were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and age, smoking, chemotherapy, hormonotherapy, V20. No changes were found in LVEF prior and 6 and 12 months post radiotherapy. Conclusions: Lung toxicity as assessed with HRCT and PFTs was minimal in both treatment arms and our results are in consistency with other published data. In our series, no significant changes were found in LVEF in both treatment arms.
Identifying the surgical cavity following oncoplastic surgery: Utility of a novel tissue marker.
Authors: Harman John , Govender Stan , Benjamin Benji , Simpson John 
Published: February 2017

76 Background: Oncoplastic surgery has helped improve outcomes following partial mastectomy. However, in most cases, patients still require post-operative radiotherapy, which can cause significant complications. While recent advances have made it feasible to perform external beam radiation in a more targeted and accelerated fashion, these methods are not commonly used in the treatment of breast cancer. This is due to the difficulty in identifying the margins of the surgical site, and can be particularly challenging with oncoplastic surgery (OPS). In this pilot study, we evaluated a new method for marking the margins of the surgical cavity when using oncoplastic techniques. Methods: 15 patients were selected to have a 3-D tissue marker implanted at the time of lumpectomy. All patients were candidates for partial mastectomy, sentinel lymph node biopsy and breast reconstruction using OPS. Post-operative treatment plans including radiation and/or adjuvant chemotherapy were completed as recommended. Patients were followed and imaged with standard breast imaging following completion of their treatment. Results: The marker was easily identified and clearly delineated the margins of the lumpectomy cavity. It allowed for 3-D characterization of the borders surrounding the cavity, and it was easily distinguishable from the seroma and other surgical tissue changes. Respiratory motion was easily tracked using the device making it possible to apply advanced radiation treatment methods such as IMRT and accelerated protocols. When compared to conventional methods of determining the target area, use of the marker resulted in treatment volumes that were reduced by >60%. In appropriate patients, the marker also facilitated the use of an accelerated protocol, decreasing total treatment time from 6 weeks to 5 days. No complications were reported. Conclusions: This novel 3-D marker was consistently visualized, was readily incorporated into standard and advanced dose planning methods, and had appreciable benefits when designing optimal treatment plans. Its unique features were also helpful when using oncoplastic techniques, and proved valuable for long-term follow-up using standard methods of breast imaging.
Clinical and pathologic characteristics of patients with PI3K-mutant breast cancers.
Authors: Lloyd M. Cooper , Sanders Melinda , Kuba Maria Gabriela , Farley Jaime , Lai Darson , Su Zengliu , Mayer Ingrid A. , Means-Powell Julie Ann , Vnenzak-Jones Cindy , Levy Mia Alyce , Pao William , Arteaga Carlos L. , Abramson Vandana Gupta 
Published: February 2017

8 Background: Mutations in PIK3CA are the most common somatic alterations in breast cancer and represent a potentially useful therapeutic target. As more PI3K pathway inhibitors enter the clinical arena, it is important to understand the characteristics of patients harboring mutations. This study seeks to identify the clinico/pathological characteristics of PI3K mutant breast cancers in patients evaluated at Vanderbilt University Medical Center. Methods: Molecular profiling (SNaPShot) was used to detect mutations in three genes in the PI3K pathway (PIK3CA, PTEN, AKT1). Electronic medical records of breast cancer patients whose tumors underwent testing from June 2010 to January 2013 were reviewed. PI3K mutation rates, histological tumor grade, receptor status (ER/PR/HER2), and recurrence-free survival were tabulated. Results: Three hundred evaluable tests were identified, with PI3K mutations detected in 83/300 (28%). Patients with PI3K mutations were more likely to be ER/PR positive (73% vs. 48%; p<0.001) and less likely to be HER2 positive (6.0% vs. 20.7%, p=0.0022). Only 6/83 patients (7.2%) with triple negative cancers harbored PI3K mutations. 32% of patients with PI3K mutations participated in clinical trials, versus 25% without. Conclusions: Tumors with PI3K mutations were more likely to be ER/PR positive, of intermediate grade, and associated with longer recurrence-free survival. Patients with PI3K mutations were more likely to participate in clinical trials. These data and the potential eligibility of patients harboring mutations for clinical trials support the prognostic and clinical utility of SNaPShot testing for all breast cancer patients at a tertiary care center. [Table: see text]
Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery.
Authors: Ozaki Shinji , Ohara Masahiro , Shigematsu Hideo , Kadoya Takayuki , Kataoka Tsuyoshi , Okada Morihito 
Published: February 2017

80 Background: We developed a new procedure called hybrid endoscopy-assisted breast-conserving surgery (EBCS), which consists of a combination of plastic surgery and endoscopic surgery techniques. The purpose of this study was retrospectively to analyze the clinical outcome of hybrid-EBCS and compare the cosmetic outcomes between hybrid-EBCS and conventional breast-conserving surgery (CBCS). Methods: We reviewed medical records of patients who had undergone hybrid-EBCS (n = 73) or CBCS (n = 90) between May 2005 and April 2011 and had been followed-up in our department until March 2012. The clinical outcomes, and cosmetic outcomes of these 2 groups were compared. The safety of hybrid-EBCS was also analyzed by confirming its complications and pathological surgical margin. Results: In the hybrid-EBCS group, operation time was longer by 30–50 minutes. Blood loss was not significantly different between the 2 groups. The surgical margin of hybrid-EBCS was as follows: 1 patient (1.4%) had a positive margin; 4 patients (5.5%) had a margin of less than 2 mm; in 9 patients (12.3%), the margin was > 2 mm and < 5 mm; and in 59 patients (80.8%), it was more than 5 mm. Seven cases (9.6%) of postoperative complications occurred in 6 hybrid-EBCS patients. To date, no local recurrence has been observed in hybrid-EBCS patients (postoperative observation period: 18.1 ± 5.6 months). Compared with the CBCS group, the hybrid-EBCS group had better cosmetic results, especially with a less noticeable operative scar (p < 0.01). Conclusions: Hybrid-EBCS can provide sufficient free margin, and its surgical curability is acceptable. Additionally, this method is superior to CBCS in terms of cosmetic outcome.
The choice of IMRT for early-stage right breast cancer.
Authors: Edwards-Bennett Sophia , Andrews Stephen , Francke Patrick , Vicini Frank 
Published: February 2017

81 Background: The benefit of Intensity Modulated Radiation Therapy (IMRT) has been established for left breast cancer. However, IMRT is not routinely employed for right breast cancer. The purpose of this study is to (1) compare dosimetric parameters in women with early stage right breast cancer undergoing whole breast radiation therapy using 3-dimensional conformal radiation (3DCRT) versus intensity modulated radiation therapy (IMRT) (2) determine treatment planning and/or anatomical correlates for patients who may benefit from IMRT. Methods: IMRT versus 3DCRT treatment plans were compared for 20 consecutive female patients with early stage (T1-T2 N0M0 ) right breast cancer treated at our center from 1/2012 to 12/2012. The planned target volume (PTV), contoured according to the RTOG atlas guidelines, was prescribed to 46-8-50.4 Gy in 26-28 fractions with PTV coverage goal of ≥ 95 % receiving the prescription dose. Dosimetric and anatomic parameters: % right lung receiving 20 Gy (lung V20), maximum breast dose (Dmax), maximum skin dose (Dmax skin), chest wall separation (CWS) and medial gantry angle (MGA) were determined for each paired treatment plan. Wilcoxon-signed rank test was utilized to compare IMRT and 3DCRT dosimetric parameters. Univariate analysis was used to identify planning or anatomic correlates associated with favorable dosimetric outcomes. Results: The lung V20Gy for IMRT ( 10.86±2.81%) was significantly lower than for 3DCRT (12.92±3.45 %, p < 0.043). IMRT significantly reduced Dmax to 53.79 ± 2.17 Gy from 56.7 ± 2.24 Gy with 3DCRT (p 0.001). 3DCRT yielded significantly higher Dmax skin (33.47±3.21 Gy) than IMRT (24.16 ±2.65 Gy, p< 0.0001). Mean CWS and MGA were 22.4 ± 2.6 cm and 126 ± 5.1° respectively. There was a significant association between CWS and Dmax for 3DCRT (p < 0.026). Conclusions: The most significant impact of IMRT for right breast cancer was the reduction of Dmax and Dmax skin, with a more tempered advantage in the reduction of lung V20. Reduction of maximum breast and skin dose harbors clinical relevance as it relates to acute skin toxicity, long- term fibrosis and adverse cosmetic outcomes. Chest wall separation may be a potential planning surrogate marker to determine which right-sided breast cancer patients may benefit from IMRT.
Evaluation of the anticarcinogenic effect of solanumrastratum dunal (Mexican thistle) on breast cancer cells MDA.
Authors: Valadez Vega Maria Del Carmen , Garcia Velasco Laura , Zuniga Perez Clara , Sanchez Gutierrez Manuel , Morales Gonzales Jose Antonio 
Published: February 2017

84 Background: The use of medicinal plants has been very common since ancient times, used for the treatment of several diseases such as cancer. In many towns in Mexico are used extracts from plants such as Solanum rastratum Dunal (buffalo bur, spiny nightshade, Colorado bur, Kansas thistle, Mexican thistle, and Texas thistle), which has shown to be effective in improving symptoms of some diseases conditions, there are reports indicating its use in the treatment of some types of cancer, such as the breast and cervical cancer. For this reason, in this work the aim was to evaluate the anticarcinogenic effect of extracts of Solanum rastratum Dunal on human breast cancer cells MDA. Methods: The plant was collected, cleaned, separate the different sections, were dried in darkness in special panels at room temperature; subsequently the extracts were prepared from the leaf, stem and flower-fruit using solvents of different polarity (methanol, ethyl acetate and hexane). Extracts were analyzed in cultured MDA cells line and the cytotoxic effect was evaluated by MTT technique. Results: The results showed that the stem and leaf extracts were those which showed higher inhibitory effect on cell viability, with those obtained with ethyl acetate which showed better anti-carcinogenic effect, while the hexane extract of the flower and fruit mixture which was showed higher inhibitory effect on this part of the plant; however generally the ethyl acetate extract obtained from the leaf was the one with greater cytotoxic effect in this cell line. Conclusions: The results of this work lead to the conclusion that is greater cytotoxic effect of ethyl acetate extract of the leaf than the other extracts tested. These results are contrasting with the traditional use of the extract of this plant, since traditionally people employ the aqueous extract of this plant, which would be equivalent to methanolic extract used in this study, which was who presented the lower cytotoxic effect of three solvents studied.
Role of sentinel lymph node biopsy (SLNB) and preoperative MRI in the management of patients with pure high-grade ductal carcinoma in situ (DCIS).
Authors: Sunkara Rajitha , Taneja Charu , Chi Dorcas , Wolfe Gail , Segal Christine , Keel Allison , Olhava Phoebe , Martin Leslie A. 
Published: February 2017

87 Background: The overall incidence of SLN metastases in pure DCIS is < 1% and the results of SLNB do not usually impact treatment or survival but adds significant surgical morbidity. In addition, there is no evidence regarding the role of preoperative MRI in the management of DCIS. The purpose of our study was to identify the efficacy of SLNB and the benefit of preoperative MRI in high-grade DCIS. Methods: We performed retrospective review of 364 patients with DCIS, identified through our cancer registry database, that were seen from 2003 to 2012 at our institution. Of these, 62 patients were diagnosed with high-grade DCIS (Grade 3 or 2 with comedonecrosis) by core needle biopsy, and underwent SLNB. The remaining 302 patients had either low-grade DCIS or did not have a SLNB. Results: Median age was 56 years (range 33-80). Sixty two patients had high-grade DCIS on definitive excision and 2/62 patients were noted to have small invasive focus of disease. 15/62 (24.19%) patients underwent mastectomy and 47/62(78.1%) underwent lumpectomy. No patient had a positive SLN (0/62). 15/62 (24.2%) patients had breast MRI preoperatively and among them, in 5 (33.3%) patients, MRI findings changed the surgical decision to mastectomy. Among these 5 mastectomy patients, four of them (80%) had pathologically confirmed findings consistent with preoperative MRI suspicions. In lumpectomy patients, close margin of less than 1mm was seen in 4/9 (44.4%) patients with staging MRI and in 24/38 (63.15%) patients without MRI (p = 0.45. Fisher’s exact test). However the positive margin leading to re-excision was seen in 2/9 (22.2%) patients who underwent lumpectomy with staging MRI, and 9/38 (23.6%) patients who underwent lumpectomy without staging MRI. Conclusions: In our study, no patient with high grade DCIS had a positive sentinel node suggesting that routine sentinel node biopsy is not necessary in DCIS patients. The use of MRI changed the surgical planning in 33.3% of patients, but did not improve the surgeon's ability to achieve clear margins.