bluuebunny/crossref_metadata_2025_split huggingface dataset:
Active targeting nanoparticle for breast cancer diagnosis and treatment.
Authors: Iwakuma Nobutaka , Toh Uhi , Grobmyer Stephen R. , Koura Keiko , Takenaka Miki , Otsuka Hiroko , Takahashi Ryuji , Shirouzu Kazuo 
Published: February 2017

163 Background: Breast cancer remains a major ongoing public health problem among women. Nanotechnology is the exciting field focused on man-made materials in the size range of 1-100 nanometers (nm). Nanoparticles (NPs) are on the scale of many cellular-level processes and hence are attractive for targeting breast cancer. Emerging nanotechnologies promise new approaches to early detection and treatment of breast cancer. Our group has reported Gold Speckled Silica NPs (GSS) as multimodal contrast agents for fluorescence, magnetic resonance and photoacoustic tomographic (PAT) imaging. The near infrared (NIR) optical absorption property of these particles makes them potentially useful for therapeutic applications such as thermal ablation of tumors. Fulfilling the promise of nanotechnologies for patients with metastatic breast cancer, necessitates delivery of nanomaterials to sites of breast cancer. Now we have focused on the cancer metabolism, we have recently developed active targeting NPs with surface functionalizing agent such as glucose conjugated NPs. We hypothesize that active targeting NPs is more incorporated into cancer cells compared to normal NPs. Methods: Human breast cancer cells, BT474, were incubated with active targeting NPs or normal NPs (as control). The tumor cell uptake was assessed using flow cytometry and fluorescence microscopy experiments. Results: Uptake of active targeting NPs was significantly higher than uptake of normal NPs. Conclusions: Active targeting NPs can be used as suitable targeting NPs for development of imaging agents for early diagnosis of breast cancer. Evolving bio-nanotechnologies such as active targeting NPs promise to enhance the early detection and non-invasive treatment of breast cancer.
Prediction of preclinical myocardial damage utilizing cardiac biomarkers and ultrasound myocardial tissue characterization by integrated backscatter in patients with breast cancer treated with postoperative adjuvant radiotherapy.
Authors: Zhang Yong 
Published: February 2017

169 Background: To evaluate whether cardiac biomarkers, ultrasonic integrated backscatter (IBS) can predict early myocardial damage in breast cancer patients treated with postoperative adjuvant radiotherapy. Methods: Forty-eight left-sided breast cancer patients treated with modified radical mastectomy and non-anthracycline containing chemotherapy regimen were examined. Baseline blood samples were drawn for cardiac markers analysis, including Troponin T (TnT), C-reactive protein (CRP), and brain natriuretic peptide (BNP). Calibrated myocardial IBS (CMIBS, assessed by comparison of the anterior wall (AW), inferior wall (IW), anteroseptum (AS) and posterior wall (PW) with pericardial IBS intensity), cyclic variation of IBS (CVIBS) and conventional echocardiography parameters (LVIDd: the left ventricular internal diameter at end-diastole; IVSTd: the intraventricular septal thickness at end-diastole; PWTd: the posterior wall thickness at end-diastole; LVDs: the left ventricular end-systolic dimension; EF: the left ventricular ejection fraction; FS: the left ventricular fractional shortening. The peak velocity of early (E) and late ventricular filling (A) were also determined for calculating the ratio E/A) were investigated before the initiation of radiotherapy (group A), during (group B, 3 weeks after the initiation, the cumulative dose was about 30Gy) and after radiotherapy (group C, 5 weeks, the cumulative dose was about 50Gy). At each time point, blood was drawn to measure TnT, CRP, and BNP. Results: TnT, CRP, and BNP did not change over time. CMIBS of AW and AS were significantly increased after radiotherapy both during (group B, p<0.05) and at the end of treatment (group C, p<0.01) and meanwhile CVIBS and E/A were decreased significantly throughout the treatment period (group B, p<0.05 for both; group C, p<0.01 for both) compared with the beginning (group A). Conclusions: Myocardial IBS offers a promising approach for early clinical detection and characterization of evolution of cardiomyopathy induced by radiotherapy in breast cancer patients.
Short-term outcomes of immediate breast reconstruction using implant or tissue expander after mastectomy in breast cancer patients.
Authors: Lee Haekyung , Kim Se Won , Kang Tae Ho , Yoon Chan Seok , Ko Seung Sang , Hur Min Hee , Kang Sung Soo , Seul Chul Hwan 
Published: February 2017

176 Background: Mastectomy is a life-saving management but can cause significant adverse reactions. So, breast reconstruction is a concern in recovery after mastectomy. We report our experience with immediate breast reconstruction using implant or tissue expander, which confirmed the oncologic safety and high patients’ satisfaction. Methods: This study is a retrospective review of all patients who underwent reconstruction with implant or tissue expander immediately after mastectomy. Seventy-seven patients underwent breast reconstruction at a general hospital breast cancer center from January of 2008 to December of 2010 and 14 patients were excluded because of follow-up loss. Therefore 63 patients were included. To access patient’s satisfaction, questionnaire was sent to all patients. Results: Mean age of the patients is 44.1 years. ( range: 29-64) After median follow-up periods of 22.4 months, there was 1 case of locoregional recurrence, 1 case of distant metastasis and overall breast cancer specific survival was 100%. Overall major complication rate was 11.1% (7 patients), such as nipple areolar complex (NAC) necrosis and implant removal. Among 10 patients who had NAC necrosis, 6 patients improved after observation, and 4 patients performed NAC excision. Three patients were removed their implant due to severe infection, leakage or dissatisfaction. There were 32 cases of total mastectomy, 12 cases of skin sparing mastectomy (SSM), 19 cases of NAC sparing mastectomy (NSM). According to the result of questionnaire, 84.1% was satisfied with generalized operational result, 77.8% with cosmetic result. Among 19 patients who had performed NSM, 89.5% was satisfied with general result, 84.2% with cosmetic result. Conclusions: Immediate breast reconstruction using implant after mastectomy is technically feasible and oncologically safe as well as relatively good patient’s satisfaction. But we need more long-term experience.
Radiation therapy for malignant phyllodes tumors: An analysis of over 3,100 patients from 1998 to 2009.
Authors: Williams Richelle T. , Gnerlich Jennifer Lynn , Yao Katharine , Jaskowiak Nora T. , Kulkarni Swati 
Published: February 2017

183 Background: Malignant phyllodes tumors of the breast are uncommon. Currently, there are no standard treatment guidelines for adjuvant therapy. We hypothesized that there has been a trend towards increased use of radiation despite its uncertain effect on outcomes. Methods: Using the National Cancer Data Base, treatment trends and predictors of radiation utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan-Meier and Cox regression were used to determine the effect of radiation on local recurrence (LR), disease-free survival (DFS), and overall survival (OS). Results: Of 3,153 patients, 57.4% underwent lumpectomy and 42.6% underwent mastectomy. Overall, 14.2% received radiation, with utilization doubling over the study period (9.2% in 1998 vs. 19.8% in 2009, p<0.001). Women were significantly more likely to receive radiation if they were diagnosed later in the study (OR 2.25, 95% CI 1.26-4.03), were age 50-59 (OR 1.64, 95% CI 1.13-2.39), had tumors >10cm (OR 2.28, 95% CI 1.55-3.35), or had nodes removed (OR 2.04, 95% CI 1.56-2.69). Race/ethnicity, socioeconomic factors, hospital characteristics, type of surgery, and margin status were not independent predictors of radiation. Of 1,758 patients with known recurrence status, overall recurrence was 13.8% and LR was 5.9%. With 50 months median follow-up and controlling for potential confounders, radiation reduced LR (aHR 0.41, 95% CI 0.18-0.92) but had no impact on DFS or OS. Conclusions: Use of adjuvant radiation for malignant phyllodes doubled from 1998 to 2009. Tumor factors and time were the main determinants of utilization. Radiation decreased LR but had no effect on DFS or OS.
Extent of lymph node involvement in breast cancer patients with sentinel lymph node metastasis.
Authors: Murata Takeshi , Takahashi Maiko , Hayashida Tetsu , Hirose Shigemichi , Jinno Hiromitsu , Mukai Makio , Kitagawa Yuko 
Published: February 2017

199 Background: Axillary lymph node dissection (ALND) is a standard procedure in patients with positive sentinel lymph node (SLN). However, the appropriate level of ALND remains to be elucidated. The aim of this study is to determine the extent of lymph node involvement and predictors to assess non-SLN status in patients with metastatic SLNs. Methods: A prospective database of 235 breast cancer patients with metastases in SLNs who underwent ALND at Keio University Hospital from January 2001 to December 2011 was reviewed. Results: The median age of the patients was 54 years (range 28-86 years) and the mean tumor size was 2.08±0.74 cm. The mean total number of sentinel, level I, and level II lymph nodes removed was 2.72, 18.2, and 2.47, respectively. Other tumor factors include 66.5 % lymphatic invasion positive, 23.7% being nuclear grade 3, 89.4% estrogen receptor positive, and 83.2% progesterone receptor positive. Among 235 patients with SLN involvement, non-SLN metastases were identified in 72 (30.7%) patients and 13 (5.5%) patients had metastases at level II nodes.A univariate analysis showed a significant correlation between non-SLN involvement and number of tumor-involved SLNs. The mean number of tumor-involved SLNs in patients with positive non-SLNs was 1.86 compared with 1.33 in patients with negative non-SLNs (p=0.001). Patients with 2 or more positive SLNs showed a significantly higher rate of non-SLN metastases compared with patients with 1 positive SLNs (47.4% (37/78) vs. 22.3% (35/157), p<0.001).The mean number of tumor-involved SLNs in patients with positive lymph nodes in level II was 2.08 compared with 1.46 in patients with negative lymph nodes in level II (p=0.016). Patients with 2 or more positive SLNs showed a significantly higher rate of metastases at level II nodes compared with patients with 1 positive SLNs (10.3% (8/78) vs. 3.2% (5/157), p=0.0026). Conclusions: Among 235 patients with SLN involvement, the positive rate of non-SLN metastases was 30.7%, whereas that of level II lymph nodes was 5.5%. The number of tumor-involved SLNs was a significant predictor of non-SLN involvement and level II lymph node metastases.
Axillary lymph node coverage of tangent radiotherapy: Comparison of supine versus prone positioning.
Authors: Thompson Gregory M. , Lavigne Ruth F. , Dimascio Mark , Bohorquez Carlos , Lamba Michael A. S. 
Published: February 2017

200 Background: Recent randomized evidence has demonstrated low rates of axillary nodal failure in patients with one to two positive lymph nodes who receive local therapy with sentinel lymph node biopsy and simple tangential radiotherapy alone. Decreasing utilization of complete axillary nodal dissections has potential implications for radiotherapy treatment delivery design. We sought to compare the inadvertent coverage of the axillary lymph nodal regions between supine versus prone position for whole breast radiotherapy using simple tangent fields. Methods: Twenty patients with breast cancer who had previously received whole breast radiotherapy with simple tangent fields were randomly selected. Patients were selected such that 10 patients had received treatment in the supine position and 10 patients in the prone position. Axillary lymph node levels I-III were contoured by a single physician according to the RTOG breast contouring atlas. The previously generated radiotherapy plans, each to deliver a prescribed dose between 42.56 and 50Gy, were dosimetrically compared to assess differences in coverage of the nodal volumes. Results: In both positions, dose to each of the axillary nodal regions was low. For level I, the volume receiving 95% of the prescribed dose (V95) was 34.7% for supine positioning and 1.6% for prone positioning. All other analyzed volumes, specifically V25 (71.5% vs 32.6%), V50 (63.3% vs 28.2%), and V75 (57.6% vs 24.1%), were 50% greater for supine compared to prone positioning. Level II coverage was less with V95 of 6% and 0.1% respectively. Similarly V25 (32.8% vs 5.7%), V50 (25.7% vs 3.8%), and V75 (20.3% vs 2.1%) were less compared to level one and greater in the supine position. Level III coverage was less than 10% for both positions at all measured volumes of V95, V75, V50, and V25. Conclusions: Delivery of radiotherapy using simple tangents inadequately covers all axillary nodal levels. Coverage is greater in the supine position with very little inadvertent coverage in the prone position. The risk of nodal recurrence should be carefully considered when deciding to use a simple tangential field design. Additional factors such as dose to the lung and heart should also be considered for positioning.
Feasibility of concurrent weekly paclitaxel and radiotherapy in node-positive breast cancer: An experience from India.
Authors: Kumar Mohan , Subramanian Murali , AG Rajeev , Ponni Arul , S Nirmala , Kilara Nalini , MG Janaki 
Published: February 2017

201 Background: Breast cancer patients with positive node and extra nodal spread are at a higher risk for distant metastases and they require immediate adjuvant chemotherapy. Similarly patients after breast conservative surgery or with patholgical T3, T4 disease require adjuvant radiation as early as possible. Taxanes have shown good response in node positive patients and are combined in many adjuvant chemotherapy regimens. Hence the current study was taken to assess the feasibility of concurrent weekly paclitaxel and radiotherapy. Methods: A prospective study was conducted on 22 female breast cancer patients after modified radical mastectomy or breast conservative surgery with pathologically positive node. Chest wall or whole breast radiotherapy was given on Tele Cobalt or Linac for a dose of 50 – 50.4Gy in conventional fractionation. Boost of 16 Gy was given to tumor cavity for those undergone breast conservative surgery. All patients received Inj. paclitaxel 60 mg/m2 once a week for 5 weeks. After completion of RT, paclitaxel dose was increased to 80mg/m2 for remaining 7 cycles. This was followed by anthracycline-based treatment sequentially as per standard adjuvant guidelines. Patients assessed weekly and toxicities graded based on CTC version 03. The minimum follow up was 2 months after completion of chemoradiation. Chi-Square test and Fisher exact test were used to interpret the results with literature. Results: See table. Skin reaction was more frequent and severe of all toxicities (p=0.003). With available literatures on adjuvant radiation alone the grade III and higher skin reactions are 3% but in our study it is 28% because of which 5/22 (22%) patients had interruption of both chemotherapy and radiation. Conclusions: Concurrent chemoradiation with weekly paclitaxel in adjuvant treatment of ca breast is associated with more Skin reactions which may result in significant treatment interruptions. It should be practiced cautiously which requires further randomized control studies to assess the toxicities in detail. [Table: see text]
Single-duct nipple discharge: How concerned should we be?
Authors: Allan Michelle E. , Thomson Simon , Baldota Sanjay Zumberlal 
Published: February 2017

58 Background: Nipple discharge has a known association with breast cancer, but determining which cases to identify as being at high risk is a complex and controversial task for the clinician. The current policy at West Hertfordshire Hospitals Trust is to offer microdochectomies to all women who present with unilateral single duct discharge, dominant duct discharge or persistent duct discharge and negative cytology and pre-operative imaging. The aim of this study is to determine if a more discriminative approach might be applied to women who present with nipple discharge. Methods: All patients who underwent a microdochectomy over a 4-year period (2006-2011) were assessed. Patient demographics, characteristics, presenting complaint, pre-operative imaging, and pathology results were analysed. Results: Of the 122 patients analysed in this study, only 7 (5.74%) were diagnosed with malignant carcinoma: 4 patients had DCIS; 3 patients had DCIS and IDC. Of these, 2 had bloodstained nipple discharge. Another two women were diagnosed with papillary carcinoma; only one of them presented with bloodstained nipple discharge, although both had single duct discharge only. 42 cases of mammary duct ectasia (34.43%) and 52 cases of papilloma (42.62%) were found. All women with malignant diagnoses were over the age of 55. Although 47 women (38.52%) presented with a history of blood-stained discharge, only 17 of this cohort (36.17%) had positive cytology – one of whom was diagnosed with multifocal intermediate-grade DCIS. The other 16 women were diagnosed with papillomas, duct ectasia, and benign breast disease. Of those 30 women who presented with a history of bloodstained discharge and had negative cytology, only two were diagnosed with carcinoma (DCIS + IDC and papillary Ca); of those 17 with no recorded bloodstained discharge but positive cytology there were no malignant diagnoses. Conclusions: Microdochectomy performed for nipple discharge results in a low rate of malignancy on excision. Our results from this study correspond with other microdochectomy series. It would appear that a cytological diagnosis is an equivocal discriminator for cancer at best. Further work on a prospective study will help to differentiate patient groups who would most benefit from surgical intervention.
Perceived sexual dysfunction in breast cancer survivors.
Authors: Block Elizabeth Anne , Zomerlei Terri Ann , Keto Jessica , Caughran Jamie 
Published: February 2017

67 Background: Sexual dysfunction after breast cancer treatment has been well documented in the literature. However, the degree of dysfunction and how best to address this issue in survivors is less clear. We sought to determine the prevalence of patient perceived sexual dysfunction in breast cancer patients in our patient population. Methods of addressing dysfunction, influence on satisfaction, and interfering factors were indentified. Methods: An IRB-approved survey study of English speaking female breast cancer patients stage 0-III, ages 20 to 80, from 2008-2011 was performed. A 30 question survey containing components related to demographic, breast cancer treatment, perceived impact on sexual function due to treatment, overall satisfaction with intimate relationship, and factors interfering with intimate relationships was used. Results: Of the 407 women meeting inclusion criteria, 103 returned an informed consent, and 83 completed the survey. A total of 47 (64%) of responders felt that treatment had a negative impact on their sexual function. Of those, only 23% discussed the issue with a care provider while 60% desired a physician initiated conversation. A negative perception was associated with decreased satisfaction with intimate relationships (p<0.001). The prevalence of treatment related interfering factors such as fatigue, hot flashes, scars, dysparunia, and breast tenderness were cited most frequently. Of these, only the presence of scars was significantly associated with a perceived negative impact on intimate relationships (p<0.04). Women treated with breast conservation were less likely to perceive a negative impact than mastectomy patients (p=0.036). Conclusions: Patient perceived sexual dysfunction is a documented consequence of breast cancer treatment. Our data demonstrates that patients do not feel this issue is addressed during routine care. However, the majority of patients want this issue discussed with their physicians. Sexual dysfunction is independent of age, time post surgery, and interfering factors making it difficult to identify high risk populations. Therefore, sexual dysfunction should be identified in breast cancer patients during follow-up with interventions made when appropriate.
Gene expression panel (TheraPrint) analyzed as predictors of response to neoadjuvant chemotherapy (NCT) in patients (pts) with stage II-III and inflammatory breast cancer (BC).
Authors: Somlo George , De Snoo Femke , Peeters Justine , Stork-Sloots Lisette , Simon Iris , Robinson Kim 
Published: February 2017

8 Background: TheraPrint is a microarray-based gene expression panel of 125 genes identified as potential targets for prognosis and therapeutic response. These genes may hold the key to a greater level of personalized prognosis and therapy for BC pts. The aim of the current study was to assess the clinical relevance of the TheraPrint genes for either predictive and/or prognostic value in two patient cohorts treated with NCT. Methods: The 1st patient cohort are 68 Stage II-III BC pts treated with NCT. Expression data from Agilent full genome arrays, containing the MammaPrint, BluePrint and TheraPrint diagnostic profiles/probes (Somlo et al, 2009). Median FU 2.3 years. The 2nd patient cohort are 230 Stage I-III BC pts treated with NCT. Expression data from Affymetrix probe sets was publically available (Iwamoto et al, 2011). Median FU 5.2 years. To identify genes that are differentially expressed between responders (pCR/RCBI) and non-responders, a supervised analysis was performed. The analysis was performed across all pts and also within groups of HER2+ and HER2-. Univariate t-tests were performed, with results filtered by permutation p-value (p<0.05) and fold change of >1.5. Global test was also reported. In addition, survival data analysis was performed across all pts. Results: Overlapping genes between the 2 datasets that were significantly differentially expressed between responders and non-responders include: BCL2 (down-regulated) and CDH3, GRB7, KRT6B, KRT17 (up-regulated). When analysing the HER2- subgroup, 3 genes turned out to be differentially expressed between responders and non-responders in the 2 datasets: FLT1, PIK3R1 (down-regulated) and KRT6B (up-regulated). For the HER2+ subgroup, only one gene overlapped for the 2 datasets: IL2RA (up-regulated). The top canonical pathways for the significant genes have been analyzed, and in addition correlation of the TheraPrint gene expression with survival for these pt groups. Conclusions: This study has identified several genes from a panel of 125 TheraPrint genes with statistically significant correlation between expression and response to NCT.