bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sonodynamic and photodynamic therapy in advanced refractory breast cancer.
Authors: Wang Xiaohuai , Li Lucy Qing , Zhang Weimin , Luo Yifan , Mitchell Douglas Graham 
Published: February 2017

118 Background: Sonodynamic therapy (SDT), a procedure related with photodynamic therapy, is a promising new modality for treating deep-seated cancer. Two new chlorophyll derived sono-photo-sensitizing agents, along with equipment for systemic SDT, have been developed by EEC Biotech and all approved by regulator for safety on human. Animal studies demonstrate that the sensitizers are specifically absorbed into tumor cells and SDT does inhibit growth of mouse S-180 sarcoma. An in vitro experiment with human breast cancer cell-line showed that SDT was strongly synergetic with chemotherapy. Using sono-photo-dynamic therapy (SPDT) as a supplementary or salvage treatment, we have got some positive results in advanced refractory breast cancers. Methods: Twelve patients were pathologically proven advanced breast carcinoma. Eleven had metastases in viscera including brain, and nine in bones. Ten had chemotherapy before, nine failed at least second lines of conventional chemotherapy. With SPDT, Patients took the sensitizers sublingually on days 1 and 2, red light and multiple ultrasound transducers irradiate tumor area and whole body on days 4 to 6. The treatment was repeated. Nine patients had concurrent chemo with range from moderate to ¼ conventional dosages selected to keep side effects at grade II or better. Results: The twelve patients achieved CR 3(25%), PR 6 (50%), MR 1, SD 2, with an overall response rate of 75%.Median overall survival exceeded 14.5 months. SPDT as sole therapy was effective in three cases. Four treated repeatly with SPDT also achieved positive result after tumor relapsed. One patient with brain metastases showed much reduced. The two SD were TNBC with inflammation-like metastases on the chest surface. The main SPDT side effects were easily reversible mild pain in tumor areas, tiredness and weakness.There was no skin sensitivity.SPDT/dose controlled chemo was well tolerated, even a terminally ill patient was treated safely and effectively. Conclusions: These preliminary data suggest that SPDT has almost no toxicity, and may dramatically enhance chemo efficacy in some refractory advanced breast cancer cases. SPDT has a good trend to be a new systemic, low toxicity tumor therapy and merit for further investigation.
Digital versus screen film mammography: Impact on positive predictive values following transition.
Authors: Roy Elizabeth , Motiuk David , Burrowes Paul , Docktor Bobbie 
Published: February 2017

12 Background: The Calgary Health Region changed from screen film mammography (SFM) to digital mammography (DM) in 2005. This retrospective study was designed to determine the effect of this conversion on positive predictive values (PPV) for cancerous and precancerous breast lesions. Methods: In the Calgary region, biopsies for mammographic calcifications are only done at Foothills Medical Centre (FMC) by a small group of mammographers employing homogeneous techniques. From FMC’s database, we reviewed core biopsy data for mammographic calcifications in the years 2002-2004 (SFM years) and 2008-2010 (DM years). Mammographic masses were excluded. We determined PPVs for each set of years for detection of cancerous lesions (PPV3for calcifications). We further calculated the PPVs of SFM and DM for detection of high-risk lesions, including ADH, ALH, LCIS, and papilloma collectively (precancerous lesions). The detection rates of benign lesions (excluding precancerous lesions) after biopsy were also determined. Statistical analysis was performed using two-tail z-tests. Results: 3,778 biopsies in 3,544 patients were reviewed. The difference in overall detection rate of cancer after biopsy for mammographic calcification between SFM (PPV3 = 24.7%) and DM (PPV3 = 23.8%) was not statistically significant (p = .53). On further analysis, the PPV for precancerous lesions increased (p < .0001) in DM (11.6%) versus SFM (7.8%). No significant difference (p = .065) was found in detection of benign lesions. Conclusions: In comparing DM to SFM, we found no significant change in PPV3 with respect to calcifications. However, with DM, there was a statistically significant increase in detection of lesions considered at risk for future malignancy. Given that the natural history of these premalignant lesions is incompletely understood, the significance of this finding is in question. This potential trend could be further strengthened by determining PPV1for cancerous and precancerous lesions with respect to calcifications. [Table: see text]
TS-1 and docetaxel followed by 5-FU/epirubicin/cyclophosphamide (FEC) as preoperative treatment in women with stage II/III breast cancer: A phase II study.
Authors: Hayashida Tetsu , Jinno Hiromitsu , Takahashi Maiko , Kitagawa Yuko 
Published: February 2017

124 Background: The sequential combination of anthracycline and docetaxel (TXT) is one of the standard regimen in the preoperative setting, however, the adverse events of TXT such as febrile neutropenia, fatigue, edema is not low at all. Several reports showed a synergistic effect of combination chemotherapy with 5-FU and TXT through down-regulation of dihydropyrimidine dehydrogenase (DPD) and thymidine synthetase (TS). (Suto et al., Oncol Rep 2006) Okazaki et al. reported the trial of pre-operative combination chemotherapy of TS-1 (80mg/m2) and TXT (40mg/m2) with 13% of pCR rates (HER2-negative), and less adverse events. This study's purpose was to determine the efficacy of TS-1 and TXT followed by FEC in preoperative setting. Methods: This was a single-arm, clinical study evaluating the patients with stage II/III and HER2 negative breast cancer received 4 cycles of TS-1 (TS-1 80 mg/m2 on days 1-14 and docetaxel 40 mg/m2 on day 1 every 3 weeks), followed by 4 cycles of FEC (fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2on day 1 every 3 weeks). The primary end point was the pCR rate. The secondary end points were the clinical response rate, adverse drug reactions. The sample size of this study (55 patients) was calculated based on pCR rate obtained in previous studies of the sequential combination of anthracycline and TXT in preoperative setting (HER2-negative). Results: From November 2009 to April 2010, 55 patients were enrolled and 50 patients were assessable for clinical and pathologic responses. The overall response rate (caliper) was 82.0%. The pCR rate was 12.0% (6/50). The breast-conserving rate in patients whose tumor size was larger than 3 cm was 53.3%. PgR status was significantly correlated with pCR. (p=0.024) Grade 4 neutropenia was observed in one patient (2.0%) at the first cycle. The most common grade 3/4 non-hematologic adverse event was hand-foot syndrome, observed in 12 patients (24.5%). One patient (2.0%) showed grade 4 diarrhea. Conclusions: These results indicate that the sequential combination of TS-1 and docetaxel followed by FEC is a well-tolerated, effective neoadjuvant treatment for stage II/III breast cancer.
Factors associated with local control in inflammatory breast cancer.
Authors: Brown Lindsay C. , Blanchard Miran J. , Laack Nadia N. 
Published: February 2017

126 Background: Inflammatory breast cancer (IBC) is an aggressive breast cancer variant, with 5-yr overall survival (OS) typically reported at 40-45%. We recently presented our results with once-daily radiotherapy (RT) as a component of trimodality therapy, with 5-yr OS of 64%. Herein we report patient and treatment factors associated with locoregional control (LRC). Methods: With permission of the IRB, review of medical records at the Mayo Clinic in Rochester, MN was performed to identify patients treated with RT for IBC from 2000-2010. Patients with non-metastatic, clinically diagnosed IBC were included. OS, LRC and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. First recurrence in the chest wall or regional lymph nodes was defined as a locoregional recurrence (LRR). Results: 52 women were included in the analysis. Median age at diagnosis was 54 years (range 23-83). Median follow-up for the population was 3.6 years (range 0.7 – 11.9). All patients were treated with adjuvant RT to the chest wall and draining nodal basins in once-daily fractions of 1.8-2.25 Gy (median 2 Gy), to a median of 50 Gy (range 46-60 Gy). Actuarial 5-yr LRC was 85%. LRR was associated with poorer DMFS and OS (p < 0.01). Factors significantly associated with improved LRC included lack of extracapsular extension (ECE) and use of adjuvant chemotherapy (p < 0.05). Factors associated with a trend towards LRC included use of bolus, absence of boost, node negativity at time of surgery and pathologic complete response (pCR). Daily bolus was employed in 90% of patients and was most commonly (68%) 1 cm in thickness. There was a trend towards improved 5-yr LRC when bolus ≥ 1 cm was employed daily (93% v. 67%, p = 0.06). Patients who received a boost to the mastectomy scar (62% of the population, median of 10 Gy, range 10-16 Gy) had poorer LRC (78% v. 100%, p = 0.08), but superior 5-yr DMFS (78% v. 34%, p = 0.035) and OS (77% v. 34%, p = 0.04). Conclusions: LRC is associated with improved OS in IBC. Lack of ECE and use of adjuvant chemotherapy are associated with improved LRC in women with IBC. Node negativity, pCR and use of daily bolus ≥1 cm in thickness are associated with a trend towards improved LRC. The impact of boost requires further analysis.
Trastuzumab-related cardiotoxicity among older breast cancer patients.
Authors: Chavez-Mac Gregor Mariana , Zhang Ning , Niu Jiangong , Zhang Yufeng , Buchholz Thomas A. , Elting Linda S. , Hortobagyi Gabriel N. , Giordano Sharon Hermes 
Published: February 2017

135 Background: The use of trastuzumab in the adjuvant setting is associated with reduction in mortality and recurrence. Trastuzumab is extremely well tolerated, but its use is associated with congestive heart failure (CHF). The incidence of this complication in the general population remains largely unknown, especially in older patients. In this study we evaluated the rates and risk factors associated with trastuzumab-related CHF in a large cohort of older breast cancer patients. Methods: Breast cancer patients > 66 years with full Medicare coverage, diagnosed with stage I-III breast cancer between 2005-2007, and treated with chemotherapy were identified in the SEER-Medicare database. Chemotherapy and trastuzumab use, comorbidities and CHF were identified using ICD-9 and HCPCS codes. Analyses included descriptive statistics and Cox proportional hazard model using trastuzumab as a time-dependent variable and logistic regression. Results: From 3,983 patients included, 847 (21.7%) received trastuzumab. Median age of the entire cohort was 71 years old. Among trastuzumab users the rate of CHF was 28.6% compared to 18.1% in non-trastuzumab users (p<.0001). After adjusting for demographic and clinical characteristics, comorbidities, and type of chemotherapy used, trastuzumab users were more likely to develop CHF than non-trastuzumab users (HR 1.74; 95% CI 1.47-2.06). Among trastuzumab users, older age did not further increase the risk, however history of coronary artery disease (OR 2.23; 95%CI 1.56-3.19), heart valve disease (OR 1.41; 95%CI 1.41-2.88) and emphysema -as a proxy for smoking- (OR 2.03; 95% CI 1.13-3.63) significantly increased the risk of CHF. There was a trend for increased risk of CHF associated with anthracycline use (OR 1.36; 95% CI 0.93-2.00). Conclusions: In this large cohort of older breast cancer patients, the risk of CHF among trastuzumab users was 1.74 times higher than non-trastuzumab users, which is higher than what has been reported in younger clinical trial participants. Among older breast cancer patients treated with trastuzumab, cardiac comorbidities, and emphysema may identify high-risk patients.
Outcomes of an organized breast cancer screening program over the past 15 years.
Authors: Rajapakshe Rasika , Parker Brent , Araujo Cynthia , Chu Christina , Wilson Christine , Sam Janette 
Published: February 2017

14 Background: Founded in 1988, The Screening Mammography Program of British Columbia (SMPBC) is a large, and stable screening program and a formal review of its effectiveness provides suggestions for further improvements. The purpose of this study is to quantify and report trends of the SMPBC and to assess if there have been any major changes in outcomes over the past fifteen years as this program has matured. Methods: A retrospective review of the SMPBC was performed by extracting data from the past 15 years from the SMPBC Annual Reports. The changes and trends in percentage of eligible population screened/participation rate, number of screening exams and number of first screens performed, overall cancer detection rate, and DCIS detection rate was extracted and reported. Furthermore, cost analysis data was extracted, and adjusted to compensate for inflation using The Bank of Canada Inflation Calculator, which bases its calculations from the Canadian Consumer Price Index (CPI) from Statistics Canada. Results: Over the past 15 years, the total number of exams provided per year has almost doubled from 166,746 in 1996 to 303,157 in 2010, and this increase accommodates the overall and aging growth of the BC population. An increasing participation rate is seen from 1999-2009 for women from rural sites and traditionally underserved areas of British Columbia, while the overall participation rate over this time period remains stable (range 48%-51%). The cancer detection rate also remains stable (range: 3.4-4.5 cases per 1000 screens). After adjusting for inflation, a 12.6% increase in the cost per screen from 1995-2009 is observed. This increase is multifactorial and includes an increase in operating costs central services and physician reading fees. Conclusions: The province of British Columbia has consistently had the lowest rates of breast cancer related mortality in Canada, and this may be, in part, because of the long term stability of the BC Screening Mammography Program. Our report suggests that the SMPBC has been effective in accommodating the growing aging population, although there is still room for improvement, as a target participation of 70% is considered the standard to effectively reduce mortality through screening.
Chemotherapy treatment patterns for early-stage breast cancer (ESBC): Decreasing use of anthracycline-based regimens.
Authors: Serrurier Katherine M. , Hwang Jimmy , McGuire Joseph P. , Griffin Ann C. , Melisko Michelle E. , Rugo Hope S. 
Published: February 2017

141 Background: Anthracyclines (A), given in sequence or combination with other agents, have been the mainstay of adjuvant chemotherapy (CTX) for ESBC for more than two decades. Recent molecular studies have questioned the value of A for lower risk disease. A single prospective trial presented in 2005 and published in 2006 (Jones et al) compared docetaxel and cyclophosphamide (TC) to doxorubicin and cyclophosphamide and reported improved disease free survival (2006) and overall survival (2009) with TC. We sought to understand the impact of this study on the type of CTX regimens used to treat ESBC. Methods: Using the UCSF Cancer Registry database and including patients who received at least one cycle of CTX at UCSF, we recorded use of A or non-anthracycline (NA) based CTX regimens in women with ESBC and correlated type of CTX with tumor stage, receptor status, and age. Based on the publication date of TC we looked at the use of A versus NA based CTX during two time periods, 2000-2005 and 2006-2010. Results: 1,116 patients met criteria for inclusion; 17 were excluded due to inadequate information. Patient characteristics were: median age 49 (range 21-78), stage I (24%), stage II (56%), and stage III (20%), 50% hormone receptor (HR) +, 25% HER2 +, 17% HR-/HER2-. From 2000-2010, 80% received A CTX. Overall use of A decreased from 95% to 65%, while use of NA based CTX increased from 5% to 35%. The table compares use of NA CTX during the two time periods by clinical variables. Conclusions: Use of NA CTX increased significantly over the 2nd half of the last decade in all cases except those patients with stage III disease. The timing of this marked change correlates with publication of TC, and emphasizes the impact of positive phase III trials on treatment practice. This study was supported by the UCSF Cancer Registry. [Table: see text]
Intraoperative electron radiotherapy in early-stage breast cancer: A report on 226 patients.
Authors: dall'Oglio Stefano , Maluta Sergio , Marciai Nadia , Gabbani Milena 
Published: February 2017

143 Background: We report the results of a single-institution phase II trial of accelerated partial breast irradiation (APBI) using a single dose of intraoperative electron radiotherapy (IOERT) in patients with low-risk early-stage breast cancer. Methods: From July 2006 to December 2009, 226 patients suitable for BCT were enrolled in a phase II trial with IOERT as radical treatment immediately after surgical resection. All patients had biopsy-proven cancer. After the surgeon temporarily re-approximated the excision cavity, a dose of 21 Gy using IOERT was delivered to the tumor bed with a margin of 2 cm laterally. Results: No acute reactions were reported after irradiation. Three patients experienced a transient edema. In 7 others a haematoma was observed. No cases of liponecrosis were observed. With a mean follow-up of 49 months (range 31-66 months), only one case of local recurrence has been reported. The observed toxicity was considered acceptable. As to cosmetic results, at 6 months after the end of IORT, 71/226 patients (31.4.%) had a score of 2 for symmetry and contour (asymmetry exhibited by 1/3 or less of volume breast), while 19/226 (8.4%) had a score 3 (asymmetry greater than 1/3 of breast volume). These findings remained unchanged at the following examinations. No breast oedema, discoloration at site or scar prominence were observed. Conclusions: IOERT offers the advantage of an excellent delineation of the tumor bed under visual control and high sparing of normal tissue, including the skin. IOERT delivers a very high biologically dose at the time of the surgery, when residual tumor cells are more rapidly proliferating. IOERT is insensitive to chemotherapy sequencing since all of the radiation is given during the surgery. The absolute recurrence rate of 0.4% and the recurrence rate per year of 0.2% of the present study are very encouraging. APBI using a single dose of IOERT can be delivered safely in women with early, low-risk breast cancer. A longer follow-up is needed to ascertain its efficacy compared to that of the current standard treatment of whole breast irradiation.
Primary and secondary prophylactic nipple-sparing subcutaneous mastectomy (NSSM): A retrospective single-center analysis.
Authors: Paepke Stefan , Allhorn Svenja , Kiechle Marion 
Published: February 2017

162 Background: Given a strict indication the NSSM is a oncologically safe surgical procedure and allows breast reconstructive interventions with a good cosmetic result. With regard to prophylactic mastectomy (PM) the (radical) ablatio mammae is so far regarded as the therapy of choice, since a maximal removement of the breast glandular tissue seems ensured. So far, it is unclear if NSSM is a oncologically safe treatment option also in the context of prophylactic surgery. The introduction of new materials for tissue extension in plastic-reconstructive interventions such as porcine acellular dermis (Strattice) or titanized polypropylene meshes (TiLoopBra) permits the reconstruction of the natural breast shape and size and thus the preservation of the body integrity also in prophylactic operations. Methods: This is a retrospective analysis of the PM performed at the Department of OB/GYN of the TU München (Munich, Germany) between 01/2005 and 12/2011 (76 cases). Primary PM were done in 13 cases due to positive family history (n=3), BRCA mutations (n=9) or at the request of the patient (n=1). 63 breast cancer patients were operated (secondary contralateral mastectomies) because of a positive familiy history (n=21), BRCA mutations (n=17) or high need for security (n=25). 19 mastectomies and 57 NSSMs were performed. With all NSSMs an instant reconstruction was done (17x expander, 25x implants, 1x TRAM, 14x DIEP), in 42 patients using a tissue extension (titanized poylpropylene meshes or acellular dermis). 9 patients with ablatio mammae received a breast reconstruction. Results: There was a continuous increase in prophylactic operations and NSSMs over the past five years. In four patients there was a coincidental pathological finding diagnosed in the healthy breast (2x DCIS, 1x Ca, 1x CLIS). In the group of primary prophylactic operated patients there were no (pre-)cancerous lesions found. In the secondary PM patients there were no recurrences, secondary cancers or metastases. Conclusions: In conclusion there was no difference between both surgical techniques with regard to oncologic safety. As far as breast reconstructive possibilities are concerned there are clear advantages in NSSM.
Breast cancer and vitamin D in postmenopausal minorities.
Authors: Gokalp Yasar Demet , Khosla Pam 
Published: February 2017

17 Background: Bone health is a particular concern for breast cancer survivors, because these women have 15% higher fracture risk than women without a history of breast cancer. Many studies have suggested that vitamin D deficiency may be involved in breast cancer initiation, progression, and prognosis. This study examines the prevalence of vitamin D deficiency among postmenopausal breast cancer patients in minority population. Methods: This retrospective study reviewed the electronic records of 200 postmenopausal breast cancer patients from ethnic groups of blacks, Hispanics and Asians. Results: Of the 200 patients, 84 (42%) had their 25-OHD levels checked at least once. Of patients, 42.7% found body mass index (BMI)>30kg/m2. There was significant difference between race and BMI (p<0.05). Black Vitamin D deficiency (level< 20ng/mL) found in 35 (41.7%), vitamin D insufficiency (level range 20-30ng/mL) found in 30 (35.7%) of the patients. The median serum 25-OHD level was 21 (range 4-65ng/ml). The serum 25-OHD levels did not have significant difference among blacks and Hispanics. Tumor stages found negatively correlated with 25-OHD levels r=-0.227 and p=0.04. Conclusions: This study revealed that vitamin D deficiency has a high prevalence among postmenopausal breast cancer minority population. Data from Third National Health and Nutrition Examination survey showed that mean serum 25-OHD levels among white, Hispanic and black women were 76ng/ml, 56.7ng/ml and 45.3ng/ml, respectively. Also, prevalence rate of vitamin D deficiency is reported in the studies among breast cancer patients are approximately 30%. Our data compared with this general population’s numbers is low; our median 25-OHD level was 21ng/ml. Our study found negative correlation with Vitamin D levels and stages of the breast cancer. Information is lacking on direct prognostic effect of vitamin D in breast cancer but this findings including our study support the hypothesis that vitamin D has a role in the pathogenesis of breast cancer. In the setting of breast cancer diagnosis either for bone health, or for breast cancer prognosis in postmenopausal women, we advocate routine 25-OHD levels screening for the vitamin D deficiency especially in minority populations would be beneficial.