bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Oncotype DX recurrence score correlate with survival benefit in “good prognosis” patients as estimated by AdjuvantOnline!?
Authors: Connell L. C. , Teo M. , O'Reilly S. , Beamish R. , Moylan E. J. 
Published: February 2017

38 Background: An important question for ER positive, node negative breast cancer is the benefit of chemotherapy over hormonal therapy. We sought to explore if a low estimate of chemotherapy benefit, based on AdjuvantOnline, correlated with low risk Oncotype DX score , identifying patients (pts) for whom the “hormone therapy alone” treatment decision would not change. Methods: Our institutional database was reviewed to identify pts with ER positive, HER2 negative, node negative breast cancer submitted for oncotype DX testing. Clinicopathologic data and Oncotype Recurrence Score (RS) were extracted and entered into ‘Adjuvantonline’ to obtain estimated survival benefit gained at 10 years (yrs) (SBG@10). Two datasets were obtained; survival benefit gained at 10 yrs from chemotherapy only (SBG@10+C) and net survival benefit gained at 10 yrs: the absolute difference between combined therapy and hormone therapy (SBG@10 net). Pts were distributed into subgroups SBG@10 ≤3% and >3%. i.e. RS ≤18 versus >18.Correlation between SBG and RS were calculated with Spearman’s Rank method. Distribution of RS were compared with Mann-Whitney and Χ2 tests. Results: We identified 77 pts. For SBG@10+C ≤3% (n=28) and >3% (n=49) subgroups, 16 (57.1%) and 23 (46.7%) had low RS, respectively (p=0.53). Three (10.7%) and 10 (20.4%) in each subgroup had high RS (p=0.48). Distribution of RS between both subgroups was not significantly different, p=0.38. Correlation between RS and SBG@10 in the ≤3% subgroup was weak (rs=0.37, p=0.05). For SBG@10 net ≤3% (n=45) and >3% (n=32) subgroups, 25 (55.6%) and 14 (43.8%) had low RS, respectively (p=0.43). Five (11.1%) and 8 (25%) in each subgroup had high RS (p=0.20). Distribution of RS between both subgroups was not significantly different, p=0.19. Correlation between RS and SGB@10 in the ≤3% subgroup was weak (rs=0.21, p=0.15). Conclusions: Although the decision for additional chemotherapy changed for ≈10% with Oncotype DX, we could not identify a cohort of good prognosis pts for whom Oncotype DX would not significantly alter treatment recommendations. There are no subsets of node negative, ER positive, breast cancer for whom Oncotype DX does not provide independently significant prognostic and predictive information.
Automatic breast CAD results for seven categories of abnormalities.
Authors: Brockway J. P. , Carruthers W. B. , Zapata M. , Reiling R. B. 
Published: February 2017

5 Background: This prospective study was conducted to determine efficacy of preclinical use of automatic computer-aided cancer detection (CAD) system. Patients were women of high risk referred for MRI of breast with goals of assessing sensitivity/specificity of an automatic CAD platform which used kinetic and morphological (spiculation, volume, solidity, surface area, elongation, maximum extent) tools. We assessed classification of abnormality using histopathology as our gold standard. Methods: 1,976 patients with 2,149 abnormalities included were scanned from 2007 to 2010. Patient inclusion criteria were women: with dense breasts; BRCA1 or BRCA2 genes; family history of cancer; suspected of having recurrent cancer; anomalous mammogram/ultrasound; pain; or clinical suspicion. All patients included gave institutionally IRB approved HIPAA compliant informed consent. CAD software post-processing was automatically applied to dynamic contrast-enhanced MRI (DCE-MRI). One pre- and 4 post-scan series were used to calculate wash-in/out parameters. System's automatic detection was applied to entire breast(s) volume. No manually placed regions of interest were used. Results: Of 1,976 women scanned, 361 had mastectomies, 17 had bilateral mastectomies, 488 had lumpectomies/excisional biopsies, 623 had core biopsies, 166 had non-surgical approaches; radiation or chemotherapy. Mean tumor resected was 2.95 cm; SD=2.88 cm, while CAD detected breast tumor calculated size was 3.20 cm; SD=2.66 cm. Conclusions: Automatic CAD applied to breast DCE-MRI demonstrated high sensitivity, reasonable specificity, and accurate estimates for location within breast, and volume of malignancy. Automatic 3D CAD translucent display will aid oncology planners in tumor localization, volume and extent estimations. [Table: see text]
Trastuzumab use and survival in HER2 (+) nonmetastatic breast cancer among Turkish women.
Authors: Kayahan M. , Kadioglu H. , Muslumanoglu M. , Igci A. , Ozmen V. , Idiz O. , Eralp Y. , Tuzlali S. 
Published: February 2017

56 Background: HER2 overexpression observed in 10-25% of breast cancers is associated with rapid proliferation. HER2-targeted trastuzumab has been used in metastatic breast cancer, and since 2004 in early breast cancer. However, trastuzumab therapy is expensive and long lasting resulting sometimes in cardiac side effects. In this study we tried to find out whether there was a subgroup of early breast cancer patients trastuzumab could be omitted. Methods: Records of patients treated for HER2-positive breast cancer in Istanbul Medical School between Jan 2000 and Sept 2009 were retrospectively evaluated. Disease-free survival (DFS) and overall survival (OS) were calculated either from follow-ups, or by calling. Kaplan meier and LogRank tests have been used for comparison (P<0.05, 95% CI). Results: Follow up period was 32.2±14.9mo for trastuzumab group (TG, n:87) compared to 47.4±20.8mo for non-trastuzumab group (NTG, n:63) (P=0.0001). Groups were similar for age, menopausal status, size (T), histological grade and type, location, hormone responsiveness, presence of lymphovascular invasion, surgery, and use of local/systemic/hormonal therapy. NTG had more N0 cases (44.4% vs. 12.6%, P=0.0001), breast related deaths (15.9% vs. 5.7%, P=.042) and systemic metastases (27% vs. 13.8%, P=.043). Number of local recurrences was similar. Mean DFS and OS were significantly less in TG (P<0.0001). However differences between DFS and OS of groups were not significant despite a considerable increase for both in TG at fifth year (P=0.147, P=0.450). No difference in DFS and OS between TG and NTG was observed when patients who had chemotherapy and/or radiotherapy and/or hormonotherapy were compared to those who did not. OS was not different between TG and NTG for T1, T2, and T3 tumors and for patients ≤35y. But in N2 and N3 tumors, use of trastuzumab increased OS significantly (P=0.007). Conclusions: Both number of events and systemic relapses were less in TG but we could not find a significant difference in DFS and OS between TG and NTG in Turkish nonmetastatic cancers. Prolonged follow up might be necessary to search for the subgroup who would not benefit, if any, as an incremental benefit in both DFS and OS was observed with trastuzumab use at fifth year.
Results of Oncotype DX in early-stage invasive lobular carcinoma.
Authors: Deneve J. L. , Joh J. E. , Acs G. , Soliman H. H. , Khakpour N. , Laronga C. , Lee M. C. , Kiluk J. 
Published: February 2017

59 Background: The Oncotype DX (ODX) genomic assay has been used since 2004 to estimate prognosis and guide adjuvant treatment in patients with estrogen receptor-positive, node-negative invasive breast tumors. However, the impact of ODX assay testing in patients with invasive lobular carcinoma (ILC) has not been specifically reported. We describe our experience in patients with ILC who underwent ODX assay testing and how this affected adjuvant treatment. Methods: An IRB approved retrospective review was performed on all patients undergoing treatment for early stage, node-negative ILC from 2006-2011. All cases were reviewed by a single pathologist (GA) for verification of histology and subtype. The impact of ODX assay testing on treatment management was evaluated. Results: Thirty-nine patients underwent ODX genomic assay testing of early stage, node-negative ILC with a median age of 62 years. ILC tumor classification included classic (67%), pleomorphic (23%) and mixed (10%) subtypes with a median tumor size of 2.0 cm (0.6-6.0). Ninety-seven percent of tumors were estrogen receptor-positive, 74% progesterone receptor-positive. Median ODX recurrence score was 15 (0-34) with an ODX 10-yr risk of 10% (3-23). ODX risk classification was: Low (N=26), Intermediate (N=12), and High (N=1). There was no difference in ODX recurrence score or risk classification between ILC subtypes (p=0.52 and p=0.35, respectively). Adjuvant chemotherapy was used in 26% (TC N=8, AC N=1, FEC 100 N=1). Tumor size or ILC tumor subtype were not significant for adjuvant chemotherapy use while tumor grade (p=0.046), ODX recurrence score (22.8 vs 13.6, p<0.0001), ODX risk classification (p=0.009) and ODX 10 year risk (15.9 vs 9.0, p<0.0001) were significant. With a median follow up of 16.5 months, there were no recurrences or tumor-related deaths. Conclusions: ODX testing on early stage node-negative ILC may serve as a useful adjunct when counseling patients on the decision for adjuvant therapy. The long-term impact on recurrence or survival in patients with ILC who receive adjuvant chemotherapy based on ODX recurrence score remains undetermined and warrants further testing.
Characteristics of multifocal and multicentric breast cancers detetected by preoperative MRI.
Authors: Killelea B. K. , Grube B. J. , Philpotts L. , Sowden M. , Horowitz N. , Lannin D. R. 
Published: February 2017

67 Background: Many newly diagnosed breast cancer patients undergo preoperative MRI to define the extent of their disease, as well as to evaluate the contralateral breast. The purpose of this study was to determine the number of patients who were diagnosed with a second malignancy detected solely on MRI at our institution, to compare them to a control group of patients who had an MRI not leading to a diagnosis of cancer, and to compare tumor characteristics of the primary and secondary tumors. Methods: A breast center database was searched for all newly diagnosed breast cancer patients who underwent preoperative MRI from January 2005 to March 2010. Among those who were diagnosed with a biopsy-proven second malignancy based on suspicious MRI findings, pathology and imaging reports were reviewed and data regarding patients and tumors was collected. Results: Out of 624 patients with newly diagnosed breast cancer who had a preoperative MRI, 53 (8.5%) had a second tumor identified solely by MRI. Of these, 40 were ipsilateral, 12 were contralateral, and 1 bilateral. Thirty seven percent were multifocal and 56% were multicentric. Patients who had an MRI were younger than those who didn’t, but there was no difference by age or race for those who had a second tumor found compared to those who didn’t. Tumor size, nodal status, PR status, and Her2 status were significantly associated with the group who had a second tumor. Among the group with additional tumors found on MRI, histology, ER/PR status and grade were strongly correlated between the primary and the secondary lesion. Conclusions: Tumors that were larger, node positive, lobular histology, hormone receptor positive, or HER2-negative had a higher chance of having a second tumor on preoperative MRI. [Table: see text]
Use of patient navigation to improve diagnostic and treatment delays among patients with abnormal mammography results from a mobile unit.
Authors: Lee J. Y. , Henry-Tillman R. S. , Klimberg V. S. , Fincher R. , Enoch K. , Preston M. , Jackson S. , Kenney P. 
Published: February 2017

73 Background: Screening mammography is frequently the initial step to breast cancer diagnosis. Upon detection of an abnormality on a mammogram, the patient must undergo follow-up procedures for diagnosis and treatment. The objective of this study was to examine the diagnostic and treatment delays after detection of an abnormality on a mammogram performed at a mobile unit. Methods: During one-year beginning in February 2010, the mobile mammography unit of the University of Arkansas for Medical Sciences (UAMS) performed 1,547 mammograms in women who resided in counties that lacked a stationary mammography unit. Most of these counties are in rural areas with high poverty rates. The women were predominantly non-Hispanic white (62%) or African-American (36%) and 41% lacked health insurance. A patient navigator was available to assist patients through scheduling follow-up appointments, when needed. Diagnostic delay was defined as time from abnormal mammogram to biopsy that exceeded 60 days. Treatment delay was defined as time from abnormal mammogram to treatment initiation that exceeded 90 days. Results: A total of 14 cancer cases were detected among the 1,547 women screened. The median age of these patients was 56 years of age and ranged from 46-79 years. The median time from screening mammography to biopsy was 31.5 days and ranged from 9-92 days, and diagnostic delay occurred in 2 (14%) patients. The median time from screening mammography to treatment was 78 days and ranged from 37-199 days, and treatment delay occurred in 5 (36%) patients. Three of these patients were managed outside the UAMS health care system, one patient required bilateral mastectomies and one patient refused the initial treatment recommendation. Conclusions: Responsive health systems require vehicles to strengthen the continuum of breast care. With the use of a patient navigator, the proportion of patients with breast cancer who experienced diagnostic delays is comparable to that of other studies, but the proportion with treatment delays is higher than in other reports. Patient navigation provides a promising model to decrease diagnostic delays and improve access for the medically underserved.
Impact of internal mammary node inclusion in the radiation treatment volume on the outcomes of patients with breast cancer treated with locoregional radiation after six years of follow-up.
Authors: Olson R. A. , Woods R. , Lau J. , Speers C. , Lo A. , Tyldesley S. , Weir L. 
Published: February 2017

81 Background: There is ongoing controversy about radiotherapy (RT) to internal mammary nodes (IMNs). Proponents of IMN RT cite the survival benefit seen in postmastectomy RT trials that included IMNs. However, others point out that benefit cannot be definitively attributed to IMN inclusion, as other lymph node regions were included in the RT arms. The issue is important, as IMN RT potentially increases cardiac and respiratory morbidity. Methods: 2,413 women referred to a provincial RT program with newly diagnosed node positive, or T3/4N0 non-M1 invasive breast cancer, treated with a complete course of locoregional RT from 2001 to 2006, were retrospectively identified in a provincial database. IMN RT inclusion versus exclusion was determined through review of patient charts and RT treatment plans. Breast cancer-specific survival (BCSS), relapse-free survival (RFS), and overall survival (OS) were compared between the two groups using univariate and multivariable analyses. Results: Analyses were performed at a median follow-up of 6.2 years. 41.4% of the subjects received IMN RT. The 5-year BCSS for the IMN inclusion and exclusion group was 84.8% versus 82.9%, respectively (HR 0.93 [95% CI 0.76, 1.14]; p=.51); the 5-year RFS was 87.4% versus 86.9% (HR 0.993 [0.83, 1.19]; p=0.94); and the 5-year OS was 84.8% versus 82.9% (HR 0.84 [0.70, 1.01]; p=0.06). After controlling for potentially confounding variables, there was no significant difference in BCSS (HR 0.96 [0.78, 1.18], p=0.88), RFS (HR 1.02 [0.84, 1.22], p=0.87), or OS (HR 0.91 [0.76, 1.10]; p=0.35). Conclusions: After a median follow-up of 6.2 years, this population-based study shows no benefit from including IMNs in the locoregional RT volume after adjusting for other prognostic and treatment variables.
Intraoperative ultrasound for improvement of re-excision rates in breast-conserving surgery.
Authors: Knauer M. , Tschann P. , Koeberle-Wuehrer R. , Obwegeser U. , Jasarevic Z. , Stockinger R. , Hefel C. , Schuster A. , Wenzl E. , Haid A. 
Published: February 2017

91 Background: Due to improved screening for early breast cancer, the percentages of small and nonpalpable breast tumors have significantly increased during the last decades. After lumpectomy, re-excision rates of 32%-63% have been reported and the routine placement of localization needles is painful, time-consuming, and costly. In this study we investigated the value of intraoperative ultrasound (IOUS) in the hand of the breast surgeon as a fast and cheap method for potentially improving unacceptable re-excision rates. Methods: Between July 2001 and December 2010, in 773 of 1,195 breast cancer patients a breast-conserving treatment has been performed at the certified breast care center Vorarlberg (breast-conservation rate 64.7%). In 74.9% (579/773) of the tumors IOUS was performed, of which 44% were nonpalpable and 56% were insufficiently palpable, respectively. 7.5-10 MHz linear ultrasound probes were used by four breast surgeons in combination with intraoperative macroscopic resection margin assessment by the pathologist for prospective evaluation of definitive resection margin status over time. Furthermore, local recurrence rates were assessed. Results: During the study period, 579 of the included primary tumors were detected by IOUS. The metachronous re-excision rate was halved from 22% (30/135) in the period 2001-2003 to 11% (13/121) between 2008 and 2010. Between 2001 and 2010 we achieved a total re-excision rate of 13% (74/579). In 53% of re-excision specimens, no residual tumor was present, in 23% DCIS and in 24% invasive tumor was found, respectively. At a median follow-up of 56.4 months, a local recurrence rate of 1.7% was observed using our approach of IOUS combined with intraoperative margin assessment. Conclusions: IOUS in the hand of the breast surgeon proved to be a valuable, fast, and cheap method to improve metachronous re-excision rates in breast-conserving surgery. Patients can be spared the painful, costly, and time-consuming placement of a localization needle. Furthermore, tissue-sparing operations can be performed more easily and intraoperative specimen radiography can be avoided. The actual pathologic tumor size, however, is often being underestimated, especially regarding in situ cancers.
Nipple-sparing mastectomy: Evaluation of oncologic safety and aesthetic outcomes in 94 patients.
Authors: Millen E. C. , Pinto R. R. , Menezes L. , Almeida F. C. O. , Novita G. , Frasson A. L. , Paula B. h. , Cruz M. R. D. S. 
Published: February 2017

97 Background: The surgical treatment of breast cancer has evolved from radical mastectomy to breast conservation therapy. Today we have another therapeutic dilemma: how to manage the nipple-areolar complex (NAC) in mastectomy offering patients better aesthetic results with oncologic safety. Methods: We analyzed data on 125 consecutive nipple- or skin-sparing mastectomies (SSM) with immediate reconstruction with tissue expander, prosthesis or autologous tissue performed in 94 patients from 2003 to 2010 in a tertiary referral hospital. Nipple-sparing mastectomy (NSM) was performed for treatment disease (n= 94) and prophylaxis of contralateral breast or symmetrization in selected cases (n= 31). Results: Mean patients age was 46.8 years (range 27 to 69 years) and mean follow-up time was 27.2 months (range 2 weeks to 81 months). Twelve patients were stage 0, 41 stage I, 35 stage II A and B and 7 stage III. There were 125 nipple- or areola-sparing mastectomies (31 bilateral and 94 unilateral), including 112 NSM and 13 SSM. On pathologic review, 12 breasts had carcinoma in situ, 83 invasive carcinoma, and 31 breasts were cancer free. Thirteen nipples (13.8%) were compromised by tumor on subareolar biopsy and were removed. The location and type of incision was variable according to the tumor site and previous patient scar. Periareolar incision with prolongation along the inferior pole of breast was the preferred method. Patients with positive axillary node (27.5%) received adjuvant radiotherapy. There was no nipple necrosis. One patient presented local relapse in the skin-sparing group within 24 months. Conclusions: These data demonstrate that NSM is oncologically safe and can be performed with all types of breast reconstruction.
Utility of esophageal stenting for esophageal cancer patients with dysphagia undergoing neoadjuvant therapy.
Authors: Brown R. E. , St. Hill C. R. , Harkenrider M. M. , Ellis S. , Sharma V. R. , El-Ghamry M. N. , Scoggins C. R. , McMasters K. M. , Abbas A. E. , Martin R. C. 
Published: February 2017

105 Background: For esophageal cancer patients with dysphagia, symptom relief and maintenance of nutrition remain significant barriers to completion of neoadjuvant therapy (NAT). We hypothesized that esophageal stenting would allow for successful delivery of planned NAT, with improvement in quality of life (QOL) and maintenance of nutrition. Methods: A multi-institution prospective phase II clinical trial examined esophageal cancer patients with dysphagia undergoing NAT. All had a self-expanding polymer esophageal stent (ES) placed at initiation of NAT. Individual chemotherapy and RT regimens were determined via multidisciplinary collaboration. Results: 32 patients were enrolled with dysphagia and potentially resectable esophageal cancers. All had ES placement prior to NAT. Two patients had stent migrations that required replacement. There were no ulcerations or perforations. Significant QOL improvements were noted within a week after ES placement, which persisted throughout NAT. NAT with chemo + RT was planned in 17 patients, of which 12 (71%) received planned dosing. NAT with chemotherapy alone was planned in 15 patients, of which 10 (67%) received planned dosing. Chemotherapy was most commonly 5FU/cisplatin based. 3D conformal RT with high dose photons was used most frequently, with a mean of 97% of the planned RT dose delivered. Among all patients, alterations (n=5, 16%) or cessation (n=5, 16%) of planned NAT regimens were required for treatment-related toxicity or disease progression. One patient required a jejunostomy tube for nutritional maintenance. Conclusions: Esophageal stenting is an effective method of improving QOL and relieving symptoms that allows for successful completion of NAT, with maintenance of performance and nutritional status. [Table: see text]