bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implantable marker to facilitate use of hypofractionated radiation in early breast cancer.
Authors: Cross Michael , Ross Joe , Jones Scott , Smith Arnold , Beck Thadeus 
Published: February 2017

38 Background: Shorter courses of radiation therapy have advantages for patients and could result in significant cost savings for the healthcare system. The British and Canadian experience with hypo-fractionated regimens have shown that survival rates in appropriately selected patients is equivalent to other methods. However, adoption of these techniques has been hindered by fear of potential complications such as poor cosmetic outcomes. By improving targeting of the surgical tumor bed, an increased use of "field in field" planning helps to decrease "hot spots" commonly related to toxicities. This could potentially assist with increased use of hypo-fractionated regimens in a reliable, safe and cost-effective manner. To determine the ability of a new surgical implant marker to facilitate use of hypofractionated radiation delivery, we prospectively studied the radiation regimens delivered to 100 patients implanted with the device in our community-based practice. Methods: Over a 36 month period, 110 volumetric tissue markers were surgically implanted at the tumor bed excision site in 109 patients during partial mastectomy (PM). Routine CT imaging of the breast was performed for treatment planning and the marker was rated for visibility and its utility in delineating the target region. Radiation treatment regimens were recorded and reported. A cost analysis was also performed. Results: In all patients, the marker was easily visible and in 95.7% of cases, it was found to be useful during radiation treatment planning for RT target delineation. 36.8% of patients received conventional full-course whole breast irradiation plus boost, 56.6% received hypo-fractionation plus boost, and 4.3% received accelerated partial breast irradiation. With routine use of the implant, there was a marked increase in the use of hypo-fractionated regimens, resulting in a 25% cost savings per patient. Conclusions: This 3-dimensional implant was easily visible and particularly useful in targeting the tumor bed when implanted during PM. With routine use of the device we observed an unanticipated increased use of accelerated radiation protocols, a net cost savings in patients' treatment and a significant improvement in cosmetic outcomes.
Impact of margin status and re-excision on local control in patients undergoing breast-conservation therapy for ductal carcinoma in situ.
Authors: Shaikh Talha , Li Tianyu , Sheikh Fatima , Murphy Colin T. , Zaorsky Nicholas , Bleicher Richard J. , Sigurdson Elin R. , Goldstein Lori J. , Hayes Shelly B , Anderson Penny R 
Published: February 2017

57 Background: The purpose of this study was to identify the impact of final surgical margin (SM) status, SM width, and re-excision on outcomes in patients with ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Methods: The study population consisted of women diagnosed with DCIS undergoing BCT between 1989-2014. All women received adjuvant whole breast radiation plus a boost. The primary endpoint was local control (LC) defined as an ipsilateral breast failure. A negative SM was defined as > 2 mm, close SM was defined as > 0 to < 2 mm, and a positive SM was defined as tumor at the inked SM. Cox proportional hazards model was used to determine predictors of outcomes on multivariate analysis (MVA). Actuarial incidence of LC was estimated using the Kaplan-Meier method. Results: A total of 498 patients were included. The median age was 58 (range 30-91) and the median follow-up was 8.3 years (3 months-27 years). A total of 400 patients had a final negative SM, 87 had a close SM, and 11 had a positive SM. A total of 172 patients received adjuvant hormonal therapy, 265 patients required at least one re-excision. Patients with positive or close SMs were more likely to receive a radiation dose > 60 Gy (p < 0.001) and undergo re-excision (p < 0.01). The 10-year LC rates were not significantly different between patients with a negative (93.5%), close (91.8%), or positive (100%) SM (p = 0.57). There was no difference in 10-year LC rates according to a SM width of 0-1 mm (100%), > 1 to 2 mm (88.5%), or > 2 mm (93.5%) (p = 0.85). On univariate analysis, there was no significant difference in LC when comparing negative versus close or positive (p = 1.0) SMs. There was no difference in LC in patients undergoing re-excision for initial close or positive SMs (p = 0.55). On MVA, after controlling for age, dose, hormonal therapy, comedo subtype, and grade, there were no factors associated with LC. Conclusions: This large single-institution experience demonstrates that risks of local failure remain poorly characterized. Re-excision and whole breast radiation plus boost resulted in excellent LC for women with DCIS. Our data suggests that trials aimed at personalized de-intensified local therapy are warranted.
Rapid intraoperative digital specimen tomosynthesis.
Authors: Kaufman Cary Steven , Behrndt Valerie , Hill Laurie , Caro Rebecca , Nix Sid , Zacharias Karen , Evans Erik , Mahon Carol , Ness Karen , Schnell Nancy 
Published: February 2017

59 Background: About 75% of newly diagnosed breast cancers are not palpable and require image localization to remove the target lesion. Digital specimen mammography devices were developed to identify lumpectomy targets in the operating room. Despite the availability of two-dimensional digital specimen mammography (2D), the re-excision rate for lumpectomy remains significant. Specimen tomosynthesis (3D) may provide a more detailed image than standard 2D with consecutive image slices of the lumpectomy specimens for immediate review. Methods: A consecutive series of 28 breast cancer patients underwent intraoperative specimen imaging with both 2D and 3D imaging. Data recorded for each specimen on each device included 1) accuracy of identification of target lesion, 2) time required to produce comparable images, 3) ease of forwarding images via PACS to radiology, 4) predicted closest margin according to each specimen imaging device compared with final pathologic measured margin, and 5) ease of use by the surgeon and/or nurse. Results: The central focus of all 28 lesions were accurately identified with both 2D and 3D. After a short learning curve, details on the tomosynthesis images were seen not clearly shown on the 2D unit including some spiculated masses and architectural distortions. The location of closest margin was more specific with the 3D device due to “Z-axis” measurements which obtain the vertical distance of the target within the specimen. The spatial relationship of marginal calcifications or marking clips at the edge of the specimen provided by the 3D “Z-axis” was superior to the 2D orthogonal views. Although the time taken to obtain the 3D image was 74 seconds longer than a single image with the 2D device (106 vs. 32 seconds), this was equal to the time taken to obtain the two orthogonal images using the 2D device. Ease of use was equal for both 2D and 3D. Too few patients with positive margins were found to assess a difference in intraoperative positive margin prediction. Conclusions: Our initial experience with 3D tomosynthesis of lumpectomy specimens demonstrate clear images and increased information available for the breast surgeon. Research is planned to further examine the added value of high resolution tomosynthesis in breast surgery.
Two-year outcomes of a prospective study of proton therapy for breast cancer regional nodal irradiation.
Authors: Bradley Julie Ann , Dagan Roi , Ho Meng Wei , Rutenberg Michael Scott , Li Zuofeng , Mendenhall Nancy P. 
Published: February 2017

65 Background: Through improved nodal coverage and decreased dose to the heart and lung, proton therapy (PT) may improve the therapeutic ratio for treatment of breast cancer requiring regional nodal irradiation (RNI). The purpose of this study is to report 2-year disease control and toxicity. Methods: From May 2012 to February 2014, 18 women (stage IIA-IIIB) were prospectively enrolled on a pilot study. Median age was 51.8 yrs (range, 42-73), with equal division between breast-conserving therapy (BCT) and mastectomy and right- and left-sided cancers. Median number of positive nodes among the 16 node-positive patients was 2 (range, 1-14). Five patients had ≥ 10 nodes positive on axillary dissection (N3a). Treatment targets (clinical target volumes for breast/chest wall, supraclavicular, axillary, internal mammary nodes) and organs at risk were delineated on CT scans. PT alone was used for 10 patients (9 postmastectomy; 1 postBCT) and combined proton-photon in 8 (all BCT). Toxicity was prospectively recorded using CTCAE v4.0. Results: Median follow-up was 1.9 yrs (range, 0.3 – 1.7). Two-year overall survival was 94% and locoregional control was 100%. Two-year distant metastases-free survival was 76%. No grade 4+ toxicity developed. Two patients developed grade 3 cellulitis. One patient had a reconstructive failure associated with postsurgical cellulitis. A right-sided patient was diagnosed with congestive heart failure 2 months after completing PT after diagnosis of a pulmonary embolus 1 month prior. She had elevated B-type natriuretic peptide before PT after adriamycin-based chemotherapy. Mean heart dose was 0 Gy and cardiac V5 0%. Grade 2 toxicities included pneumonitis in 1 patient who received concurrent chemotherapy, fatigue (n = 1), breast atrophy after removal of a 10x6x3cm lumpectomy cavity (n = 1), and lymphedema in 1 patient with > 20 nodes surgically excised. One patient with a history of rib fractures developed an ipsilateral rib fracture 7 months after PT. Conclusions: For women with locally advanced breast cancer, PT for RNI has proven feasible after either mastectomy or BCT. PT allows for highly conformal radiation delivery without compromise of target coverage or excess exposure of normal tissue. Clinical trial information: NCT01365845.
Impact of primary care providers on patient screening mammography and initial presentation in an underserved clinical setting.
Authors: Keshinro Ajaratu , Hatzaras Ioannis , Dhage Shubhada , Rifkind Kenneth , Joseph Kathie-Ann P. 
Published: February 2017

8 Background: Screening mammography (SM) is a routinely used modality for earlier detection of breast cancer and is effective in reducing breast cancer-related morbidity and mortality. A better understanding of the impact of access to primary care physician (PCP), on the screening protocols and stage presentation, is needed to address the issue of breast cancer stage disparity amongst underserved women. Methods: A retrospective chart review of the electronic medical record, for breast cancer patients newly diagnosed from 2012-2013, was performed using the tumor registry at Bellevue Hospital Center, the largest public hospital in New York City. Patients with recurrent breast cancer, stage IV breast cancer, and those that weren’t managed surgically at our institution, were excluded from the study. Data including patient demographics, established relationship with PCP, and screening mammogram and palpable mass at presentation, were obtained and analyzed using SPSS Statistics Software. Results: 173 patients were included in the study of which 5 presented with bilateral breast cancer (n = 178). The majority of the patients seen at our institution were from minority groups, primarily Hispanic (34%) and Chinese (23%). 129 patients (72%) had a PCP at the time of diagnosis versus 49 patients (28%) without a PCP. Patients without a PCP were more likely to have a palpable breast mass at presentation, compared to patients with a PCP (73% vs. 42% respectively, p < 0.05). Furthermore, only 32 % of patients without a PCP had a SM at time of presentation, compared to 61% of patients with a PCP (p = 0.003). Overall, in the group of patients with a PCP, the majority presented with stage I breast cancer (43%), followed by 29% with stage 0. In comparison, the majority of patient without a PCP presented with stage II (41%), followed by 29% with stage I (p = 0.019). Conclusions: There is a benefit for patients with access to a PCP, as it leads to a higher likelihood of breast cancer detection via SM, as opposed to a symptomatic presentation, such as a palpable mass. Therefore, these patients are more likely to be diagnosed with an earlier stage of breast cancer, which improves their mortality.
Impact of comorbidities on surgical outcomes following mastectomy in elderly breast cancer patients: An analysis of the NSQIP database.
Authors: Mays Simone , Moo Tracy-Ann , Simmons Rache M. 
Published: February 2017

88 Background: Approximately 4% of women age 70 will develop breast cancer during the next ten years. There is limited data on surgical outcomes in elderly patients undergoing treatment for breast cancer. This study examines complications following mastectomy in elderly patients and determines how comorbidities impact those outcomes. Methods: The American College of Surgeons National Surgery Quality Improvement Program database was used to examine complications and comorbidities in breast cancer patients 70 or older undergoing mastectomy from 2007-2012. The relationship between complication and comorbidity was characterized using descriptive statistics and Wilcoxon rank-sum test. Variable frequencies were compared using Chi-square or Fisher’s exact test with a statistically significant two-sided p-value set at 0.05. Results: We identified 12,026 patients 70 or older who underwent mastectomy. The 30-day overall morbidity rate was 4.22%. Myocardial infarction (MI) was associated with history of bleeding disorder and cerebral vascular accident (CVA) (P < 0.05). Prior CVA, transient ischemic attack and MI were associated with post-operative CVA (p < 0.05). Chronic obstructive pulmonary disease and steroid use impacted post-operative pneumonia (p < 0.05). Bleeding disorder, hypertension, and steroid use impacted urinary tract infection occurrence (p < 0.05). Diabetes increased the rate of wound dehiscence (p = 0.001). Conclusions: The 30-day morbidity rate of elderly breast cancer patients undergoing mastectomy is low. Although the complication rate is low, certain comorbidities increase the risk of specific complications. Appropriate measures should be taken to optimize comorbidities in elderly patients to further minimize adverse outcomes.
A new method for partial breast reconstruction: 3-year New Zealand experience.
Authors: Govender Stan , Harman John , Lebovic Gail , Simpson John , Benjamin Benji 
Published: February 2017

89 Background: Most women in New Zealand undergo partial mastectomy (PM) and 6 weeks of whole breast irradiation for early breast cancer. Oncoplastic surgery (OPS) is common, however, reconstruction of the breast during partial mastectomy presents challenges for radiation targeting since tissues have been extensively rearranged. Further complicating matters, the seroma cavity is often absent, and many patients travel to different cities for radiation without much communication between the surgeon and radiation oncologist prior to treatment. Throughout the country there is interest in promoting hypofractionated or accelerated radiotherapy, however, these techniques cannot be popularized without accurate targeting to minimize complications. In this series of patients we studied a new method of breast reconstruction using a bioabsorbable implant that serves as a surgical site marker as well. Methods: Following informed consent, 15 women were studied in a prospective manner. The bioabsorbable implant was sutured into the tumor resection site, and tissue flaps were directly attached. Radiation treatment protocols followed ASTRO guidelines. Results: The implant provided volume replacement and acted as a scaffolding for the breast tissue flaps providing local reconstruction. Cosmetic outcomes were excellent in all patients, no device related or radiation complications occurred. One patient had a post-operative hematoma that resolved without intervention, there were no post-operative infections. 3 year follow up shows no tumor recurrences, and no untoward effects. When compared to conventional radiation targeting, use of the implant showed a > 50% reduction in treatment volume is possible. 3 year mammograms show normal regrowth of tissue without artifact and with minimal fibrosis. Conclusions: Three year follow-up shows this "mini" breast implant assists with oncoplastic breast reconstruction, while at the same time clearly marks the surgical site of tumor excision. Patients tolerated it well, and radiotherapy planning, positioning and treatment were all facilitated by the implant. Excellent patient outcomes in this pilot study have resulted in a national evaluation of this method in the public healthcare sector.
Health-related quality of life of of women with breast cancer undergoing chemotherapy in the northern region of Brazil.
Authors: Sawada Namie Okino , Santana Mary Elizabeth de , Sonobe Helena Megumi 
Published: February 2017

92 Background: In Brazil, the estimate for the year 2015 is approximately 576,000 new cases of cancer. Breast cancer is the most common in Brazilian women and the state of Pará is the first with the highest incidence of breast cancer in northern Brazil. The high incidence and changes caused by treatment and own illness as the disturbances in body image, functional, emotional and social changes cause fear in women, as well as disrupting daily activities and impact the health-Related Quality of Life (HRQOL). Improving HRQOL is an important goal so the evaluation of HRQoL of these patients is of interest to health professionals, as they provide information that help in planning treatment and rehabilitation. The objective is to evaluate the HRQoL of patients with breast cancer in chemotherapy treatment. Methods: It is a cross-sectional study with quantitative exploratory design. This place was a public hospital in the city of Belém do Pará, Women were included with breast cancer, over eighteen years old and excluded those with cognitive problems and metastases. The European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ C 30) and Questionnaire Breast Cancer Module (QLQ BR23) have been administrated. The project was approved by the Ethics Committee and were respected the resolution 466/2012 CNS / MS. Results: The sample consisted of 89 women with breast cancer undergoing chemotherapy, most in the age group over 40, mulatto, married, fundamental level of education, domestic load, Catholic religion, live in rural areas with incomes of one to two minimum salaries. The EORTC QLQ C 30 showed that the average QOL was 75.56, and the most impaired functions were physical (M = 65.62) and role performance (M = 58.61) and the most frequent symptoms were diarrhea, constipation, dyspnea, nausea and vomiting, fatigue, pain and loss of appetite. EORTC BR23 demonstrated functional scale (M = 49.95) and symptoms scale (M = 33.00). Conclusions: The results show that the side effects of chemotherapy affect the physical and functional function and consequently HRQoL of these patients.
Factors influencing fatigue in breast cancer patients undergoing breast irradiation.
Authors: Perry Edward Belk , Mulay Sudhanshu Bharat , Kamath Jayesh , Dowsett Robert J. , Neuwirth Jacob , Grady James , Gold Courtney , Liang Bruce , Tannenbaum Susan 
Published: February 2017

96 Background: We are conducting an exploratory, prospective study to investigate factors associated with radiation-induced fatigue in women with early breast cancer undergoing radiation therapy (RT) for breast conservation. Our hypothesis is that fatigue associated with adjuvant RT is related to tissue damage by apoptosis and inflammation, and to baseline psychological profiles. Methods: All subjects were assessed immediately before RT (T1), mid-point of RT (T2), end of RT (T3), 6 months (T4) and 1 year (T5) after completing RT. Clinical evaluations of skin toxicity, laboratory measures, fatigue, distress, depression, anxiety, sleep, energy and pain were assessed using validated measures. Results: Thirty-one subjects (target 50) have been enrolled to date; 23 have completed T3 and are presented here. 35% had a history of depression and 17% are currently depressed; 22% had past and current anxiety. BCTOS breast pain, tenderness and sensitivity increased during RT and were consistent with functional pain scores. No clinically relevant changes in energy or distress were seen. Despite a notable prevalence of depression and anxiety at baseline, there were no relevant changes in depression or anxiety. Most IL-1β, IL-4, IL-6 and IL-10 levels were undetectable. 39% of subjects showed increases in fatigue and were 14 years younger than non-fatigued subjects. Fatigued subjects had more frequent past (44%) and current (33%) depression than non-fatigued subjects (29% and 7%, respectively), and woke up tired more frequently (44% versus 0%). Current depression, but not fatigue, was associated with decreased a.m. cortisol levels during RT. 56% of fatigued subjects had an RTOG Acute Skin Toxicity score > 1 and 78% had BCTOS breast-specific pain subscales scores ≥ 3 during RT vs. 21% and 14% of non-fatigued subjects, respectively. Serum caspase-1 (inflammation) and caspase-3 (apoptosis), hs-CRP and TNF-α were increased but not associated with fatigue. Conclusions: Our preliminary findings suggest that radiation-associated fatigue is complex and, as hypothesized, is dependent on a patient’s psychological profile in the setting of skin toxicity and insomnia. If this data holds at study completion, it may guide clinical interventions.
Intended and unintended consequences: Ethics, communication, and prognostic disclosure in pediatric oncology.
Authors: Marron Jonathan Michael , Kang Tammy I , Cronin Angel , Mack Jennifer W. 
Published: February 2017

10 Background: Most patients wish for all available information about their prognosis, but physicians can be hesitant to discuss prognostic information with patients, particularly those with poor prognoses. For some, concerns that this will cause anxiety, depression, or decreased hope outweigh the ethical obligation to provide such information. Methods: We surveyed 353 parents of children with newly diagnosed cancer at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and the Children’s Hospital of Philadelphia. We used multivariable logistic regression to assess associations between parental report of elements of discussions of prognosis with the child’s oncologist (quality of information, quality of communication, prognostic disclosure) and the intended/unintended outcomes of these discussions (trust, hope, peace of mind, depression, anxiety). Analyses were stratified by the child’s prognosis: favorable ( ≥ 75% likelihood of cure) or less favorable ( < 75% likelihood) as reported by the oncologist. Results: Among parents of children with less favorable prognoses (n = 140), those who reported receiving high quality information from the oncologist expressed greater peace of mind (odds ratio [OR] 4.44, 95% confidence interval [1.53, 12.90], p < 0.01), and those who reported their oncologist to have provided high quality communication endorsed greater trust in the oncologist (OR 3.25 [1.22, 8.70], p = 0.02) and feelings of hope (OR 2.96 [1.24, 7.03], p = 0.01). Parents who received more information about prognosis were not significantly more anxious (p = 0.82), depressed (p = 0.55) or less hopeful (p = 0.86) than those who received less prognostic information. Similar findings were seen in the more favorable prognosis subset and the overall cohort. Conclusions: We find no evidence that greater prognostic disclosure leads to the unintended consequences of increased anxiety, depression, or decreased hope, even in parents of children with less favorable prognoses. Rather, communication processes may increase the intended consequences of peace of mind, trust, and hope, supporting the discussion of prognosis with all parents, even those of children with a lower likelihood of cure.