bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of endocrine therapy in early-stage breast cancer on time to locoregional recurrence.
Authors: Menjak Ines B. , Maki Ellen , Berman Hal K. , Chung Caroline , McCready David R. , Sridhar Srikala S. 
Published: February 2017

64 Background: Locoregional recurrence (LR) remains a major source of morbidity and mortality in breast cancer. Our primary aim was to evaluate the impact of endocrine therapy (ET) on time to LR. Methods: A retrospective chart review of breast cancer patients (pts) treated with lumpectomy and locoregional radiation from 1999-2005 at the Princess Margaret Cancer Centre was carried out. LR was defined as ipsilateral breast or lymph node recurrence. Kaplan-Meier estimates of survival and univariate analyses were performed for age, menopausal status, tumor and nodal stage, grade, receptor status, adjuvant chemotherapy (AC) and ET. Results: Of 440 pts evaluated, the mean age at primary resection was 56 years (yrs) (range 40-79), and 67% were postmenopausal. The majority had ductal carcinomas (87%) and grade 1-2 (68%) tumors. Tumor distribution was 315 (72%) T1, 120 (27%) T2, 4 (1%) T3; 138 (31%) were node positive. Receptor status was ER/PR+HER2- 206 (47%), ER+PR+HER2unknown 80 (18%), ER-PR-HER2unknown 41 (9%), and triple negative 37 (8%). AC was used in 190 (43%). ET (tamoxifen and/or aromatase inhibitors) was initiated in 294 (84%) eligible pts, and 267/294 (91%) completed a minimum duration of ≥2 yrs. Overall, LR occurred in 24 (5%) pts, and 8/24 (33%) pts with LR also had distant metastases. Average time from surgery to LR was 5.4 yrs (range 8 months-12 yrs). The average duration of ET in pts with LR was 4.3 yrs (range 0-8), and 5.8 yrs (range 0-12) without LR. Of ER/PR+ pts with LR, 3/15 (20%) did not receive ET. At the time of LR, 5 (33%) pts were receiving ET. After stopping ET, 2 (13%) recurred 0-2 yrs, 3 (20%) at 4-5 yrs, and 2 (13%) at 7-8 yrs. Treatment with at least 2 yrs of ET predicted for fewer recurrences: at 2 yrs LR-free rate was 100% vs 90% for <2 yrs ET; at 5 yrs 99.6% vs 84%; and at 8 yrs 98.2% vs 84% (p=0.0092). ER/PR+HER2- pts had lower LR risk (p=0.028), and ER-/PR-/HER+ had higher LR risk (p=0.029). The remaining variables were not associated with risk of LRs. Survival post-LR was 90% (95%CI 64-97%) at 2 yrs and 65% (95%CI 34-84%) at 5 yrs. Conclusions: Pts who completed at least 2 yrs of ET had significantly lower risk of LR. The average time to LR was 5.4 years, and pts with LR had decreased survival at 5 yrs post-recurrence.
Propensity-score matched pair comparison of brachytherapy-based accelerated partial breast irradiation versus whole breast Canadian hypofractionation.
Authors: Chen Peter Y. , Wilkinson John Ben , Shah Chirag , Wobb Jessica , Wallace Michelle , Ye Hong , Marina Ovidiu , Benitez Pamela , Dekhne Nayana , Brabbins Donald S. , Vicini Frank 
Published: February 2017

65 Background: Given the initial report of the RAPID trial with greater morbidity for 3-D conformal external beam APBI [3D-APBI] vs. Canadian Hypofractionation [CHfx], a propensity-score matched-pair analysis of brachytherapy-based APBI [B-APBI] vs. CHfx was performed to assess efficacy, toxicities, and cosmesis. Methods: Early-stage breast cancer patients treated with B-APBI or CHfx were reviewed. With ≥ 1y follow-up [FU], B-APBI (n=108) pts were matched 1:1 to CHfx (n=108) by age, T-stage, nodal/ER status, endocrine or chemotherapy and laterality. Ipsilateral breast tumor recurrence (IBTR), regional recurrence (RR), distant metastasis (DM), contralateral breast cancer (CLBC), cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) were compared by Kaplan-Meier (log-rank test). Toxicities were graded per CTCAE v3 and comesis per Harvard criteria. Results: Median FU was 5.7 y (1.0-17.8) for B-APBI and 2.1 y (1.0-5.7) for CHfx [p < 0.001]. Patients did not differ by match criteria. In comparing B-APBI to CHfx, median age was 69.0 vs. 70.0 [p = 0.72]; for laterality, T-stage, nodal/ER status, endocrine or chemotherapy, no significance [NS] was noted between the 2 groups [p = 0.79, 1.0, 0.60, 0.09, 0.15, and 0.16 respectively]. Comparing B-APBI to CHfx, NS was seen in 5-y actuarial rates of IBTR [1% vs. 0% p = 0.35], RR [0% both], DM [3.4% vs. 0% p = 0.25], CLBC [2.3% vs. 2% p = 0.63], CSS [94.3% vs. 100% p = 0.47], OS [87.7% vs. 88.3% p = 0.71] & DFS [97.5% vs. 100% p = 0.52]. The majority of maximal late toxicities were Gr 1-2. Of toxicities analyzed, including pigmentary changes, edema, pain, induration, volume reduction, telangiectasia, fat necrosis and seroma, only Gr 2-3 hyperpigmentation was significantly higher in the CHfx [8% B-APBI vs. 22% CHfx p = 0.017]. Good/excellent cosmesis was seen in > 93% in both groups. Conclusions: With FU of >5 yrs, B-APBI has similar efficacy and cosmesis but less morbidity vs. CHfx; the lesser toxicity of B-APBI vs. CHfx is in contradistinction to the RAPID results comparing 3D-APBI vs. CHfx. Further FU and more patients are needed to substantiate these findings.
Does anesthesia type influence breast cancer outcomes?
Authors: Tsigonis Abraham , Landercasper Jeffrey , Al-Hamadani Mohammed , Linebarger Jared , Vang Choua , Marchese Edward , Krause Forest , Johnson Jeanne , Marcou Kristen , Hudak Jane 
Published: February 2017

66 Background: Surgery maintains a central role in the local treatment of Stage 0-III breast cancer. Recent studies suggest patient immunity is altered by general anesthesia (GA), potentially worsening cancer outcomes. A single retrospective case review has concluded that breast cancer patients receiving regional anesthesia with paravertebral block (PVB) anesthesia had better cancer outcomes compared to patients receiving GA, but these conclusions have not been validated. We hypothesized that local regional anesthesia (LRA) would be associated with better cancer outcomes compared to GA. Methods: We performed a retrospective review of Stage 0-III breast cancer patients undergoing surgery in a single center during a nine year period ending 1/1/2010. Patients undergoing neoadjuvant therapy or major flap reconstruction were excluded. Data regarding patient, tumor and treatment factors known to influence cancer outcomes were collected. Overall survival (OS), disease free survival (DFS), local regional recurrence (LRR), and ipsilateral breast tumor recurrence (IBTR) were calculated by Kaplan-Meier method with Log-Rank comparison. Results: We analyzed 1,107 patients. Median age was 64 years (range 24-97). Median and longest follow-up were 5.5 and 12.5 years. GA was utilized for 461 (42%) patients, and 646 (58%) received LRA. Initial operation was breast conserving in 796 (72%) and mastectomy in 311 (28%). Forty two patients died from breast cancer (crude mortality 3.8%). LRR occurred in 34 patients (3%). LRA was used more than GA in patients with lower grade and stage, smaller tumors, positive hormone receptor status, and negative nodal status (p<0.001). We identified no differences in OS, DFS, LRR or IBTR in comparison of GA to LRA. Conclusions: Type of anesthesia for breast cancer surgery did not affect cancer outcomes in our institution. This result differs from the only prior published clinical report on this topic.
A questionnaire study to document surgical and oncologic management of axillary micrometastases and isolated tumor cells in early-stage breast cancer across the United Kingdom.
Authors: Tanna Nikhil , Cleator Susan Jane , Hadjaminas Dmitri , Palmieri Carlo 
Published: February 2017

68 Background: A questionnaire study to document Surgical and Oncological management of Axillary Micrometastases and Isolated Tumour Cells in early-stage breast cancer across the U.K. Methods: A web-based 10-question survey examining management of axillary micrometastases (Mi) and Isolated Tumour Cells (ITCs) in early stage breast cancer was distributed to the membership of the UK Intergroup, a group of 130 breast cancer surgeons and 223 oncologists engaged in clinical breast research. Results: Responses were obtained from 58 breast cancer teams (‘multidisciplinary teams, MDTs’ or ‘tumour boards’), including academic and community-based. Of the 79 responses, 23 (29%) were from surgeons and 56 (71%) from oncologists. 15 centres provided responses from more than one member. For a given question, MDTs for which members gave inconsistent answers were excluded from the analysis. 17 centres (29.3%) reported performing intra-operative assessment of sentinel node biopsies (SNB); 23% Imprint Cytology; 31% PCR and 46% reported using frozen section. Regarding management of Mi, 8 centres (16%) reported performing axillary node clearance (ANC) to level 2 always; 8 centres (16%) clearance to level 3 always, 10 centres (20%) never ANC for Mi and 24 (48%) centres reported sometimes performing ANC. On asking whether centres would consider performing neither ANC nor delivering axillary Radiotherapy (RT) for macrometastases discovered at SNB, 1 centre (2%) reported always, 22 centres (42%) reported never and 29 centres (56%) reported sometimes. Regarding management of ITC’s, 2 centres (3.5%) reported performing ANC, 3 centres (5.3%) delivering RT only and 52 centres (91%) performed neither. The question associated with most inconsistency within an MDT was that which explored giving chemotherapy for patients with Mi or ITCs (80%). Conclusions: In a survey of U.K. breast cancer MDTs, significant variation in management of low volume disease in the axilla was seen. Given the challenge of performing phase 3 trials in this setting, clinicians should be supported to audit treatment and outcomes so the impact of differing protocols on outcomes may be established.
Evaluation of a cancer gene sequencing panel in a hereditary risk assessment clinic.
Authors: Kurian Allison W. , Hare Emily E. , Mills Meredith , McPherson Lisa , Kingham Kerry , Whittemore Alice S. , McGuire Valerie , Gong Gail , Ladabaum Uri , Cargill Michele , Ford James M. 
Published: February 2017

7 Background: Multiple-gene sequencing panels are entering clinical practice. We report on research testing with a custom sequencing panel comprising 43 genes and 32 cancer-associated variants among patients referred for assessment of hereditary breast and ovarian cancer risk. Methods: Patients referred to the Stanford Cancer Genetics Program for clinical BRCA1 and BRCA2 (BRCA1/2) mutation testing from 2002-2012 were invited to donate a blood sample for research on an Institutional Review Board-approved protocol. Blood samples were frozen at -80 degrees, and DNA extracted after <1-10 years. The entire coding region, exon-intron boundaries (+/- 10bp) and all known pathogenic variants in other regions were sequenced for 43 genes that have published associations with risk of breast, ovarian and other cancers. An additional 32 cancer-associated variants were also sequenced. Clinically significant results were disclosed to patients. Results: Germline DNA samples were sequenced from 199 women: 141 had breast cancer, and 57 carried known BRCA1/2 mutations. Analytic results for BRCA1/2 sequencing and pathogenicity interpretations were concordant with prior clinical testing for all patients. Twenty variants designated as pathogenic, either based on published literature or due to a novel truncating or splice donor/acceptor effect, were observed in genes other than BRCA1/2, including ATM, BLM, CDH1, CDKN2A, MUTYH, MLH1, NBN, PRSS1, and SLX4. Thirteen patients had pathogenic variants warranting a change in cancer screening or risk reduction based on practice guidelines; they were invited for confirmatory clinical testing and counseling. One 53-year old patient with a personal history of breast and endometrial cancers was found to carry a pathogenic MLH1 mutation; she underwent risk-reducing salpingo-oophorectomy and colonoscopy, with removal of a tubular adenoma. Conclusions: Among patients referred for BRCA1/2 mutation testing, a comprehensive sequencing assay identified 20 [10.1%, 95% confidence interval (CI) 6.5%-15.1%] pathogenic mutations in other genes, of which 13 (6.5%, CI 3.8%-11%) prompted a change in care. Disclosure of research results to participants was feasible and well-tolerated.
Outcomes of triple-negative versus non-triple-negative breast cancers managed with breast-conservative therapy.
Authors: Bhatti Abu Bakar Hafeez , Khan Amina Iqbal , Siddiqui Neelam , Muzaffar Narjis , Shah Mazhar Ali 
Published: February 2017

70 Background: Triple-negative breast cancer represents a subgroup of breast cancer associated with aggressive behavior and high risk of local and regional failure. Aggressive surgical intervention is considered optimal for this cancer which has made role of Breast conservative therapy (BCT) debatable in these patients. The objective of this study was to compare outcome of BCT for triple negative versus non-triple–negative breast cancers. Methods: Data of patients who underwent breast conservative therapy between 1997-2009 at Shaukat Khanum Cancer Hospital and had complete receptor status information were extracted. Patients were divided into triple-negative breast cancer (TNBC) and non-TNBC. Patient characteristics, medical treatment modalities and adverse events between two groups were compared. Five year locoregional recurrence free, disease free and overall survival was calculated. Univariate and multivariate analysis was done to identify independent predictors of outcome. Results: A total of 194 patients with TNBC and 443 with non-TNBC were compared. Significant differences was present for age at presentation (p<0.0001), family history (p=0.005), grade (p<0.0001) and use of hormonal therapy (p<0.0001). The actual number of locoregional failures, distant failures, and mortalities were not significantly different. No significant difference was present in 5-year locoregional recurrence free (96% vs. 92%, p=0.3), disease free (75% vs. 74%, p=0.7) and overall survival (78% vs. 83%, p=0.2). Tumor size, nodal involvement and hormonal treatment were independent predictors of survival on multivariate analysis. Conclusions: Breast-conservative therapy has comparable outcomes for triple-negative and non-triple–negative breast cancers.
Endoscopic single port skin-sparing total mastectomy with periareolar incision: Early results.
Authors: Yamashita Koji 
Published: February 2017

77 Background: Early-stage breast cancer, such as DCIS, may force to complete removal of the mammary gland because of its wide spread in the breast. For such cases, skin-sparing mastectomy (SSM) should be recommended. However, the conventional oncoplastic surgery leaves some ugly scars on the breast due to large skin incisions. By applying the endoscopic video-assisted breast surgery (VABS), we can provide more aesthetic surgery with single periareolar port approach, leaving only a small and inconspicuous scar on the breast. Methods: VABS of SSM consists of periareolar skin incision, dissection of whole mammary gland, sentinel node (SN) biopsy, and axillary node (AN) dissection. After SSM, the breast reconstruction was performed by the delayed or simultaneous method. We use the implant for simultaneous reconstruction. SN biopsy was performed endoscopically with only 1 cm incision in the axilla which was marked with 3D-CT lymphography prior to surgery. For SSM, we made a skin incision of 2.5 - 3.5 cm incision at the foot-side edge of the areola, to preserve blood flow around the areola. We cut across the gland near the nipple and quickly checked the transected stump by fast frozen section. Subcutaneous detachment was applied to the entire gland. Back of the gland was peeled just above the pectoralis major muscle fascia. The liberated gland was removed through the port with a plastic bag. Results: We performed VABS on 300 patients since 2001, and SSM on 30 patients. Tumor size is 1.6 cm on average. Age is 57.2 years. 23 nipples were preserved. 17 cases were DCIS. 4 were invasive lobular carcinoma. 9 were invasive ductal carcinoma. 2 cases had SN metastasis. One case had AN metastasis. Between VABS and the conventional surgery, there was no difference in the amount of blood loss and operation time. Postoperative aesthetics was particularly good after simultaneous reconstruction. They had less sensory disturbance and high satisfaction. After 38 months, there have been no distant metastases, no postoperative deaths, and one local recurrence). Conclusions: VABS SSM with periareolar skin incision approach makes better aesthetic results.
Utility of a three-dimensional bioabsorbable tissue marker in delineating the lumpectomy cavity.
Authors: Cross Michael , Ross Joe , Jones Scott , Beck Thad 
Published: February 2017

78 Background: Advanced methods of external beam radiotherapy are not widely used to deliver post-operative treatment for breast cancer due to difficulty in defining the target region surrounding the surgical cavity. Common targeting methods utilize surgical clips and/or seroma based tissue changes. However, these methods can result in over-estimation of treatment volumes resulting in undesirable radiation exposure to adjacent normal tissues. In addition, these techniques fall short of the required precision necessary to utilize newer methods of radiation delivery. In order to assess its ability to assist with identification of the surgical excision site, we evaluated a 3-dimensional tissue marker surgically placed during partial mastectomy. Methods: A total of 30 patients were implanted with a 3-D bioabsorbable tissue marker at the time of partial mastectomy. Post-operative CT simulation and treatment plans were generated and compared. The tissue marker was rated for its utility in defining the target area for treatment planning as well as day to day patient positioning between fractions. Most patients received standard whole breast irradiation with a boost to the tumor bed as treatment, however advanced techniques were used in selected cases. Results: The marker was easy to use with standard surgical techniques. No complications were reported and it was consistently and easily visualized with clinical imaging allowing it to be readily incorporated into standard and advanced planning methods. The marker had appreciable benefits when designing optimal treatment plans, particularly when no seroma fluid remained. In these cases, the marker identified the surgical site that could not have been identified using traditional methods, and target volumes were decreased by >40% in most cases. In addition, the device assisted with image-based tracking of the lumpectomy cavity during respiratory motion (4-D CT) enabling use of IGRT. Conclusions: The Biozorb tissue marker provided a consistent method for identifying the lumpectomy site and was a useful tool for post-operative radiotherapy and clinical followup. In addition, it provided a novel method of marking the lumpectomy cavity when using oncoplastic techniques.
Radiation therapy practice patterns for elderly patients with early-stage breast cancer.
Authors: Healy Erin , Qi Lihong , Vuong Jason , Bold Richard J. , Rash Dominique , Mayadev Jyoti 
Published: February 2017

82 Background: Controversy exists regarding the benefit of whole breast radiation (RT) after breast conservation surgery (BCS) in elderly early stage breast cancer patients. We investigated the clinical and pathological characteristics that influence referral patterns and consent for RT. Methods: Between 2006 and 2011, 93 women, aged ≥ 70 were treated with BCS at the University of California Davis Medical Center (UCDMC). Electronic medical records were reviewed to identify pathological and clinical tumor characteristics, including stage, nodal involvement, lymphovascular invasion, margin status and molecular subtype. Patient factors including Karnofsky performance status, Charlson comorbidity index, and distance from UCDMC were recorded. Adjuvant therapy recommendations regarding RT, radiation dose and fractionation, hormonal and chemotherapy, and the ultimate treatment plan were noted. Descriptive statistics were used to characterize the referral pattern data. Patient and tumor characteristics were compared between those referred and not referred for RT using chi-square tests for categorical variables and Student’s t tests for continuous variables. Similar comparisons were also conducted for those who consented and declined RT. Results: Of the 93 women eligible for adjuvant whole breast radiation, 79 (85%) were referred to radiation oncology. Sixty five patients had stage I, 16 had stage II, and 4 had stage III breast cancer. Seventy four patients had a luminal A molecular subtype, 11 of whom declined RT. Hormonal therapy was recommended for 78 patients, of which 11 were not referred to RT. The mean age of those referred to RT was significantly less than those not referred, 76 vs. 81 years, P = 0.006. Mean distance to UCDMC was 17.2 miles for those not referred and 34.4 miles for those referred, P = 0.02. There were no significant correlation between stage, molecular subtype, margin status or lymph node involvement and referral to RT. Conclusions: The majority of elderly patients are referred to RT but increased age and comorbidity were associated with non-referral. Patients’ perception of their own comorbidity, previous experience with RT and the decision to pursue hormonal therapy contributed to patients’ decisions to decline RT.
Acute and late side effects for intraoperative electron radiotherapy during breast-conserving surgery of breast cancer.
Authors: Boelke Edwin , Alessandro Marina , Budach Wilfried , Zwiefel Karin , Janni Wolfgang , Matuschek Christiane 
Published: February 2017

94 Background: Intraoperative boost irradiation as part of breast-conserving therapy is a perfect method to adequately capture the high risk tumor relapse area. The most homogeneous dose distribution is achieved with electrons. Intraoperative radiotherapy (IOERT) as a boost for breast cancer releases a high single dose of radiation to the breast tissue; therefore acute toxicity is of particular attention. To date there is only inadequate information available on breast cancer patients treated with IORT using electrons applied as a boost. We therefore analyzed the acute toxicity and late side effects after radiotherapy with 10 Gy as a boost with a minimum follow-up of 3 months. Methods: A total of 385 patients treated with IOERT (10 Gy with 5, 7 and 9 MeV electrons) with a dedicated robotic linac (NOVAC 7, New Radiant Technology, Aprilia, Italy) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT,50- 50.4 Gy; 1.8-2 Gy per fraction) were included in this study. All patients underwent a retrospective follow-up regarding acute and late side effects. Toxicities were documented using the common toxicity criteria (CTC 4.0 of the European Organization for Research and Treatment of Cancer). Results: The IOERT was well tolerated and the cosmetic results were good. As a side effect there were five patients with seroma. Two patients developed a secondary wound healing. Two patients developed chronic pain in the irradiated breast. Ten patients developed a grade 2 fibrosis. The remaining patients did not develop any grade 3 or 4 side effects. The observed toxicity rates were not influenced by age, tubus size, electron energy or systemic therapy. 80 patients had a follow up longer than 5 years. Three of them developed distant metastasis and one patient died. Conclusions: After IOERT of the breast using electrons we did not find any unexpected acute and late toxicity rates.