bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do women younger than 40 treated in the hormone-therapy era benefit from a radiotherapy boost as a part of adjuvant breast radiotherapy?
Authors: Tyldesley Scott , Chan Elisa K. , Speers Caroline , Nichol Alan 
Published: February 2017

72 Background: The EORTC 22881 trial showed a 10% reduction in local relapse with a radiotherapy boost (RTB) after breast conserving therapy (BCT) among women ≤40 years old. However no premenopausal patients received hormone therapy (HT) in this study. A policy change in December 1998 recommended the use of HT after chemotherapy for premenopausal ER positive women. A second policy change in December 2001 recommended an RTB after BCT for women ≤40 years old. The purpose of our study was to describe: 1)how the use of HT and RTB after BCT changed after practice guidelines were implemented in a population-based cancer care program; and 2) how local relapse rates (LRR) changed after these policy changes. Methods: A provincial database was used to analyse all women ≤ 40 years old referred for consideration of radiotherapy with margin negative stage 1 and 2 (≤3 nodes positive) breast cancer, treated with lumpectomy and whole breast radiotherapy. Cases were grouped into three eras according to policy transition with 3 month gaps: 1) Jan 1996-Sep 1998, 2) Jan 1999-Sep 2001, 3) Jan 2002 to Sep 2004. Changes in the use of HT and RTB over these eras were assessed. Eight year LR-free survival was calculated using the Kaplan-Meier method and the three eras compared using log rank tests. Multivariable analysis (MVA) was performed including era, size of tumour, nodal status (0 vs 1-3), grade, lymphovascular space invasion (LVI), and use of chemotherapy. Results: There were 130 eligible patients from Era 1, 145 patients from Era 2, and 140 patients from Era 3. ER status did not differ across eras. HT was used for ER positive patients in 13% of Era 1, 68% of Era 2, and 83% of Era 3 cases (p<0.001). RTB was used in 40% of Era 1, 28% of Era 2, and 77% of Era 3 patients (p<0.001). LRR at 8 years were 87.3% Era 1, 94.8 % Era 2, and 94.5% Era 3 (p=0.03). Era (used as surrogate for transitions in the use of HT and RTB) remained significant on MVA (0=0.008). Conclusions: Patterns of use of HT and RTB changed after policy changes. The benefit of adding a boost in women ≤40 years old shown by the EORTC was not observed after the introduction of routine HT at a population level.
Effect of tumor subtype on overall survival in brain metastatic breast cancer patients treated with cranial irradiation.
Authors: Villgran Vipin Das , Mathew Aju , Rosenzweig Margaret Quinn , Abberbock Shira , Naik Rohan Dilipbhai , Jacob Mini , Jankowitz Rachel Catherine , Puhalla Shannon , Lembersky Barry C. , Brufsky Adam 
Published: February 2017

74 Background: Brain metastatic breast cancer (BMBC) is often treated with whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS) or both. Breast cancer tumor subtypes defined by hormone receptor (HR) and HER2 status have an important prognostic role in metastatic disease. It is unclear if tumor subtypes have a prognostic role in patients receiving WBRT or SRS. We aimed to investigate the association between breast cancer subtype and overall survival (OS) among BMBC patients treated with WBRT and SRS. Methods: In a single-institution cohort study, BMBC patients treated with WBRT/SRS during 1997-2013 were identified. Clinico-pathological characteristics and survival information were prospectively collected. Tumor subtype category were defined as HR+/HER2-, HER2+/HR+, HER2+/HR- and triple negative (TN). WBRT category patients received that modality and SRS category patients, only SRS for treatment of brain metastases. OS is defined as time from diagnosis of brain metastasis to death or last follow-up. We conducted univariate analyses using the Kaplan-Meier method and log-rank tests and multivariate analysis using Cox proportional hazards models. Results: Among 193 BMBC patients who received WBRT or SRS, 62 received just SRS, and among them, 45% was HR+/HER2-. The distribution of subtypes was similar in WBRT patients. The median OS in SRS group was 15 months (95% CI 11-18) compared to WBRT with 10 months (95% CI 7-14) (p=0.03). Among patients receiving WBRT, median OS in HER2+/HR- tumor was 30 months (95% CI 13-37), HER2+/HR+ tumor - 14 months (95% CI 5-24), HER2-/HR+ tumor - 8 months (95% CI 4-11) and TN - 5 months (95% CI 3-9) (P=0.0003). There was no significant difference in OS between the breast cancer subtypes among SRS patients: median OS among patients with HER2+/HR- tumor was 11 months (95% CI 5–27), HER2+/HR+ tumor - 25 months (95% CI 7-32), HER2-/HR+ tumor - 18 months (95% CI 14-32), and TN - 12 months (95% CI 3-24) (p=0.07). Conclusions: Among patients with BMBC,tumor subtype is a prognostic factor for survival in those who received WBRT. Tumor subtype provided no prognostic information for those who were treated with only SRS.
Dosimetric predictors of toxicity and cosmesis in women treated with hypofractionated whole-breast irradiation.
Authors: Dilworth Joshua T. , Hymas Richard Val , Jawad Maha Saada , Mangona Victor S. , Zamdborg Leonid , Wobb Jessica , Pietron Arielle , Wallace Michelle , Chen Peter Y. , Grills Inga S. , Brabbins Donald S. 
Published: February 2017

77 Background: Large breast volume (BV) and distance of separation (DoS) have historically served as exclusionary criteria for hypofractionated whole breast irradiation (H-WBI). We investigate dosimetric parameters impacting toxicity and cosmesis. Methods: 299 consecutive patients with T0-2,N0-1,M0 breast cancer were treated with H-WBI at a single institution from 2007-2013. 4,256 cGy were delivered in 16 fractions via tangent photon beams utilizing inverse planning, with objectives to limit the V105 to 15%, the V110 to 2%, and the V115% to <0.1%. 227 patients with available treatment planning information and at least 6 months of follow-up (FU) were analyzed. Dosimetric parameters were correlated with acute (≤6 months post-treatment) and chronic toxicity and overall cosmesis. Proportions of toxicity grade and cosmesis score were compared with chi-square or Fisher exact tests. Results: With a median FU of 2.7 years (range 0.4-6.6 years), there were no local or regional recurrences, 1 distant failure, and one in-field angiosarcoma. Rates of any acute and chronic grade 1/2/3 toxicity were 47%/32%/9% and 53%/22%/7%. Cosmesis (beyond 6 months) was reported as excellent, good, and fair in 45%, 55%, and <1% of patients. The V105 was the best predictor for cosmesis and chronic toxicity, with a V105≤10% being associated with better cosmesis (excellent vs fair/poor) and lower toxicity (grade 0 vs grade 1 vs grade 2/3) compared to a V105>10% (p=0.09 and 0.03, respectively). The mean DoS was 22 cm, with 22% and 3% of patients having a DoS greater than 25 cm and 28 cm. The mean BV was 1523 cc, with 19% and 5% having a BV greater than 2000 cc and 2500 cc. Neither a larger DoS nor a larger BV correlated with an inability to achieve a V105≤10% (p= 0.37 and p=0.13, respectively). Neither DoS nor BV predicted for worse acute toxicity, chronic toxicity, or cosmesis. Conclusions: Minimizing the V110 and V115 and limiting the V105 to ≤10% are useful dosimetric objectives to achieve excellent or good cosmesis following H-WBI. Acceptable toxicity and excellent cosmesis are achievable in women with large DoS or BV, provided techniques to maximize dose homogeneity are employed.
Combined experience at three breast centers with routine use of an intraoperative margin assessment device including comparison to historical re-excision rates.
Authors: Sebastian Mary L. , Police Alice Marie , Akbari Stephanie , Anglin Beth 
Published: February 2017

79 Background: Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. This study is the first compellation of data among three breast centers to assess the impact of an intraoperative margin assessment tool (MarginProbe) on re-excision rates. This device has been approved for clinical use in the United States since 2013. We present groups of consecutive patients in each of these breast centers – before and after the implementation of routine intraoperative use of the margin assessment device during lumpectomy procedures. Methods: Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. We established the historical re-excision rates of each surgeon on a consecutive set of patients in a corresponding period just before we began using the device. Results: In total, 165 patients were treated in three institutions up until April 2014. Sixteen patients (9.7%, 16/165) required re-excision. Historical re-excision rates corresponding to periods of use before the intraoperative margin assessment device was put into use were 25.8% (48/186). The re-excision rate was reduced by 62% (P<0.0001). Six re-excisions were due to a positive shaving which was not measured by the device. Conclusions: Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.
Discrepancies in three commercial prognostic breast cancer assays used in adjuvant chemotherapy decisions.
Authors: Bayewitz Ashrei Y , Schneider Jeffrey Gary , Ogden Lorna , Turi George 
Published: February 2017

84 Background: OT (Oncotype DX), MS (Mammostrat) and MP (Mammaprint) are three prognostic measures of breast cancer recurrence risk. All three were retrospectively validated in large patient cohorts and are now used when deciding on risk-reducing adjuvant chemotherapy. Our objective was to directly compare these three assays and their potential for differential effects on adjuvant chemotherapy decision making. Methods: We have previously reported that OT reduces adjuvant chemotherapy utilization, whereas MS did not exhibit this same net tendency in identical patients. In this study, we performed MP assays in 31 ER+ N0 breast cancer patients for which we already had OT and MS results. Decision analysis was applied to determine changes in management that would be most likely depending on which assay was used to guide decision making. Results: Our decision analysis demonstrated that in a substantial proportion of breast cancer patients, each of the three assays led to changes in adjuvant treatment decisions compared with what would have been chosen based upon conventional criteria alone. OT changed the decision in 55% of patients, and MS and MP would have changed those decisions in 45% and 65% of patients, respectively. In two-by-two paired analyses, treatment decisions would have differed in 61% of cases for OT versus MS; 29% for OT versus MP and 38% for MS versus MP. OT had the greatest tendency to eliminate adjuvant chemotherapy use (in 55% of patients versus MS and in 22% of patients versus MP), whereas MS had the greatest tendency to increase chemotherapy use (in 55% of patients versus OT and 35% versus MP). Conclusions: In this study of 31ER+ N0 breast cancer patients, three commercially available prognostic assays (OT, MS and MP) often yielded discordant risk category results. Our decision analysis suggests that these discordant results may frequently lead to different chemotherapy choices based upon which assay had been selected to guide decision making.
Mean radiation dose to the heart in patients with left breast cancer with and without breath-hold technique.
Authors: Jacobson Geraldine M. , Watson Christopher Nicholas , Zhang Jianjun , Wen Sijin , Bunda-Randall Nicole Helen 
Published: February 2017

85 Background: Mean heart dose (MHD) from breast irradiation has been correlated with late risk of ischemic heart disease. We previously reported using 3-D conformal radiation with field-in-field forward planning and heart blocking; MHD is substantially lower than described for patients treated before 2001. To further reduce MHD, we treated eligible patients with left breast cancer with breath hold technique. We compared the MHD with and without breath hold technique. Methods: We reviewed 45 radiation treatment plans of patients treated to the left breast from 5/2013-5/2014. All patients were evaluated for breath hold technique. Criteria were ability to hold the breath for 20 seconds and a stable chest position. 18 patients were treated with breath hold (BH), 27 patients with non-breath hold (NBH). All treatment plans were CT-based, 3-D conformal with field-in- field forward planning and heart blocking. Two treatment regimens were used: hypofractionation (HF) (16 x 2.66 Gy, no boost) or standard fractionation (SF) (46.8-50.4 Gy, +/- 10 Gy boost). Fisher's exact test and t-test were used to assess the data between MHD with breath hold (BH) and without (NBH). Results: Average MHD was 1.03 Gy (0.59-1.7) in BH patients, in comparison to 1.57 Gy (0.89-2.50) in NBH patients p<0.0001). MHD was associated with total breast dose (p=0.01) and BH patients were younger, average age 55.78 years (21.41-48.37) vs NBH, average 62.78 years (38-82). There was no association between breath hold and BMI. BH BMI average 34.12 (21.41-48.37), NBH average BMI 32.6 (20.58-44.71) p=0.46. Conclusions: Patients treated with radiation to the left breast with breath hold technique had significantly lower MHD than those treated with non-breath hold. (p=0.0001) Breath hold eligible patients tended to be younger; there was no relation between breath hold eligibility and BMI.
Outcomes of patients with triple-negative breast cancer treated with radiation therapy.
Authors: Yadav Siddhartha , Jawad Maha Saada , Wobb Jessica , Wilkinson J. Ben , Yadav Dhiraj , Wallace Michelle , Barnes Michael A , Grills Inga S. 
Published: February 2017

88 Background: This study compares outcomes between different types of loco-regional treatment modalities used in patients with triple negative breast cancers. Methods: 299 patients with triple negative breast cancer diagnosed between April 2004 and August 2011 at a single institution and who were treated with radiation therapy were included in an IRB-approved retrospective review. Electronic charts were reviewed for demographic and pathologic data as well as outcome data including locoregional and distant recurrence. The median follow up period was 3 years. 200 (70%) patients underwent lumpectomy with whole breast irradiation (WBI). 68 (22.7%) patients received mastectomy and radiation while 31(10.4%) patients were treated with lumpectomy with accelerated partial breast irradiation (APBI). Results: Forty-nine patients (16.4%) experienced recurrence (10 local; 6 contralateral; 3 regional; 36 distant). There was a significant (p<0.0001) difference in the proportion of patients that experienced a recurrence in each treatment group: 34% (n=23) in mastectomy with radiation group; 12% (n=23) in lumpectomy with WBI group; 10% (n=3) in lumpectomy with APBI group. On univariate analysis, tumor size, tumor stage, nodal stage, overall stage, total number of positive nodes, total number of nodes removed, and whether or not the patients had an axillary lymph node dissection were significantly associated with recurrence (p<0.05). When these predictor variables, including treatment type, were examined using a stepwise cox proportional hazards regression model for recurrence, the only variables that remained significant were tumor stage (p= 0.0003) and the number of positive nodes (p= 0.0008). Survival curves were significantly different (p = 0.016) between the lumpectomy with WBI group and the mastectomy with radiation group. Over all follow-up times, the probability of survival was smallest for the mastectomy with radiation group. Conclusions: The recurrence pattern for triple negative breast cancers treated with radiation therapy was primarily distant for all treatment modalities. In our patient population, tumor stage and number of positive lymph nodes predicted for recurrence while radiotherapy technique did not.
Ideal breast volume resection during wide local excision: Is it ∏ in the sky?
Authors: Hillick Dearbhla , Shanley Eoghan , Mohd Noor Aslam , Johnston Alison , Sugrue Michael 
Published: February 2017

91 Background: Despite advances in imaging and pre-operative work-up, there is significant variability in breast volume excision, margin positivity and re-excision rates in wide local excision (WLE) surgery. Suggested ideal resection volumes and benchmarks for maximal % breast volume excision have been suggested (Krekel N, Zonderhuis B, Muller S et al (2011). Excessive Resections in Breast Conserving Surgery A Retrospective Multicentre Study. The Breast Journal 17 (6): 602-609). This study assessed whether there was much difference between actual and expected breast specimen volumes, allowing for tumour size variation. Methods: A retrospective review was undertaken of symptomatic patients undergoing WLE in a single breast surgeon’s practice between May 2011 and May 2013 at a designated breast cancer centre. Patients with DCIS were not included. Modified Krekel optimal resection volumes (ORV) [4/3 π (r+1.0cm)3] were estimated to include 1.0cm, 1.5cm and 2.0cm macroscopic margins. Breast volume was calculated using Katariya and Kalbhen mammographic formulae. Excess resection was defined as the difference between total specimen and optimal specimen volume. Results: 50 consecutive patients, mean age 63 years (range 38-88), mean BMI 28.1 ±4.8, mean tumour size 24.0 ±11.5cm3 were studied. Of the 50 patients 44/50 (88%) had a palpable tumour. 52% had T2 tumours, 68% had associated DCIS and 32% were node positive. Mean specimen weight was 78.6g ±1. Mean optimal and actual breast resection volumes were 42.6 ±37.3 cm3and 160 ±102.4 cm3; 6/50 had positive margins leading to re-excision in 4. The mean breast and specimen resection volumes were 815 ±327.4cm3 and 225 ±153.8 cm3 resulting in a mean percentage breast volume excision of 19.3 ±99%. Potential excess resection in 48/50 patients with a mean excess resection volume of 182.7 ±145 cm3. Conclusions: This study identified the opportunity to improve consistency in the volume of breast resected. Determining ideal volume resection should be part of patient surgical oncological planning.
Diagnostic delay in young women with breast cancer: A population-based analysis.
Authors: Quan May Lynn , Austin Janice , Lam Nadine , Quinn Rob 
Published: February 2017

92 Background: Breast cancer in young women is aggressive. Delays in diagnosis and treatment may contribute to the worse outcomes observed in the treatment of breast cancer in young women. The purpose of this study is to determine if there was diagnostic delay for women ≤ 35 with breast cancer in Alberta. Methods: We conducted a population based analysis of all women ≤ 35 treated for breast cancer between 2007 and 2010. Patient demographics, diagnostic modality, and time to treatment (surgery and radiation) were abstracted. “Diagnostic” and “treatment” delay were defined as ≥ 90 days from first imaging to pathologic diagnosis and pathologic diagnosis to surgery. Results: One hundred and one patient charts were identified in the Alberta Cancer Registry and reviewed. Mean age at diagnosis was 31.6 (± 3.3) years. Initial imaging modality was mammogram and ultrasound in 49.5% and 46.5% of women. The median time from imaging to pathologic diagnosis was 6 days (range 0-502). Of these, 11 (10.1%) women experienced diagnostic delay, with a median delay of 131 days (range 95-502). The stage at diagnosis was not significantly different for women with and without diagnostic delay (p = 0.47). For women with diagnostic delay, the initial imaging findings were most often reported as likely benign or recommended only follow up imaging. Mean time from diagnosis to surgery was 25 (± 14) days. Of patients undergoing surgery, 25 (24.8%) had breast conserving surgery. Radiation therapy occurred at a median of 48 (range 25-204) days post operatively or post chemotherapy. Conclusions: Ten percent of women ≤ 35 with breast cancer experienced a diagnostic delay. Diagnostic delay most often occurred due to initial imaging reports of benign or negative findings. Further studies are required to determine the impact of diagnostic delay on patient outcomes.
Does 8-guage stereotactic core needle biopsy improve the accuracy over 11-gauge devices? Evaluation of pure DCIS on stereotactic biopsy and the rate of upstaging.
Authors: Halaharvi Deepa R. , Cripe Mark H. 
Published: February 2017

97 Background: Ductal carcinoma in situ (DCIS) accounts for 25% of newly diagnosed breast cancers. Core needle biopsy (CNB) has replaced open surgical biopsy for mammographic calcifications. We compare our experience with 8-gauge vs. 11-gauge vacuum assisted core needle biopsy in pure DCIS. We hypothesize that the diagnosis of DCIS with use of an 8-gauge vacuum-assisted core needle will lead to a lower rate of upstaging to invasive cancer at definitive surgical excision compared to 11-gauge vacuum-assisted core needle biopsy. Methods: A retrospective study was performed evaluating all patients who underwent a stereotactic core needle biopsy at our institution for DCIS during 2008-2012.We then compared the upstaging rates between patients biopsied using 8 or 11-gauge biopsy devices. Results: A total of 580 patients underwent STCNB during 2008-2012 at our institution, there were 461 patients excluded as they did not meet inclusion criteria and 119 patients were included. The most common mammographic finding was calcifications in 104/119 (87.4%) and a mammographic mass in 15/119 (12.60%). Biopsy with the 11 gauge needle was utilized in 60 patients and 59 patients with 8-G needle. Factors associated with upstaging were using a smaller 11 gauge needle and a mass on imaging, higher grade and more than four cores obtained on biopsy. There was an upstaging rate of 17/60 (28%) in patients who underwent stereotactic biopsy using a11-gauge needle versus upstaging rate of 7/59 (11.8%) in patients who underwent stereotactic biopsy using 8 gauge needle. We obtained a statistically significant p-value of 0.025. Conclusions: This is one of the few studies comparing upstaging rates from pure DCIS on STCNB using 8 and 11-gauge stereotactic vacuum assisted needles. Our results show that there is a statistically significant decrease in upstaging of pure DCIS to invasive malignancy at excision using the larger 8-gauge needle devices. The clinical implication is that SLNB need not be performed secondary to the low upstaging rate. We recommend that all stereotactic core needle biopsies be performed using the 8-gauge needle devices, and that SLNB generally be omitted for DCIS.