bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age, hormone receptor status, ethnicity, and adjuvant radiation therapy as predictive factors for cancer-related death in patients age 70 and older with early-stage pT1a,b N0 breast cancer: An NCI-SEER database analysis.
Authors: Ravi Akkamma , Christos Paul J. , Nori Dattatreyudu , Chao Clifford , Yan Weisi 
Published: February 2017

155 Background: Studies have shown that older women are undertreated for breast cancer. Few data are available on 1) cancer-related death in elderly women age 70 and older with pathologic stage T1a, bN0 breast cancer and 2) on the impact of prognostic factors such as increasing age, hormone receptor status (ER), adjuvant radiation therapy (EBRT), chemotherapy, and ethnicity on cancer-related death. Methods: Patient data from SEER database were extracted. Inclusion criteria: females, age 70 and older, pT1a, bN0 invasive breast cancer, ER positive or negative, adjuvant EBRT or no radiation. Cause-specific survival time recorded for all eligible patients. Log-rank test and multivariate Cox regression analysis used for statistical analysis. Hazard ratios (HR) are presented for cancer-related death. Results: ER negative patients had a greater risk of breast cancer death compared to ER positive patients (adjusted HR = 2.34; p < 0.0001). Stage IB patients had a greater risk of breast cancer death compared to stage IA patients (adjusted HR = 1.26; p = 0.09; trend). Patients with no radiation therapy had a greater risk of breast cancer death compared to patients with radiation therapy (adjusted HR = 1.40; p = 0.003). Older age groups had greater risk of breast cancer death compared to patients age 70-74 (referent category) (adjusted HR’s = 1.41, 1.72, and 3.18 for 75-79, 80-84, and 85+ age groups, respectively) (Table). Race had no effect on survival. Conclusions: Patients age 75 and older with T1a, b N0, ER-negative, breast cancer had increased risk of breast cancer-related death. Adjuvant EBRT showed survival benefit in this elderly patient population. Future randomized studies should focus on adjuvant treatments that will improve cancer-related death in this age group. [Table: see text]
Comparison of long-term results of endoscopic video-assisted breast surgery (VABS) between trans-axillary retro-mammary appcoach (TARM) and periareolar approach.
Authors: Yamashita Koji , Shimizu Kazuo , Haga Shunsuke 
Published: February 2017

167 Background: The breast conserving surgery (BCS) and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor of the breast without making any injuries on the breast skin. We evaluated the aesthetic results and the curability of this surgical method. Methods: We have performed VABS on 300 patients since December 2001. The newly devised TARM was performed on 120 patients of early breast cancer, stage I and II. After endoscopic SN biopsy, we elongated the axillary skin incision to 2.5 cm. We dissected major pectoral muscle fascia to detach retromammary tissue behind the tumor. We cut the mammary gland with clear surgical margin, and removed it through the axillary port. The breast reconstruction was made by filling absorbable oxydized cellulose. The postoperative aesthetic results were evaluated by ABNSW. Results: BCS was performed on 286 patients (26 after preoperative chemotherapy) and skin-sparing mastectomy on 14. There was no serious complication after surgery. Surgical margin was minimally positive in 2. The original shapes of the breast were preserved well. The follow-up is 126 months at maximum and 74 months on average. There is 3 locoregional recurrences and 14 distant metastases. 5-year survival rate is 97.3%. With regard to TARM, The skin incision only in the axilla made better looks and shapes of the breast. It could be applied for tumors in any area of the breast without tumor nipple extension. The reconstruction with oxidized cellulose needs no excessive detachment of the skin beyond the surgical margin. The postoperative esthetic results were excellent and better. The sensory disturbance was minimal. All patients expressed great satisfaction. Conclusions: VABS can be considered as a good surgical procedure concerning locoregional control and esthetics. TARM is better on the patients without tumor nipple extension.
Hypofractionated breast irradiation in elderly cancer parients: A Brazilian pilot study.
Authors: Campos Conceicao Souza 
Published: February 2017

178 Background: In 2025, Brazil will be the 6th country in the world with the most aged population represented by elderly (15% above 60 years). Nowadays, life expectance is around 65 years old and there is not sufficient data about cancer management in the elderly. Breast cancer is generally detected in more advanced stages and not well treated due to the other medical conditions. The hypofractionation garantees the same local control with mild acute reactions and no functional late complications in a shorter treatment time. Methods: The pilot study addressed the acute local morbidid and the local control of fourteen patients (stages I to III), median age 78 years that received one single 6.5 Gy weekly dose in 5-7 fractions with 6MV photons or 6MéV electrons to the breast or thoracic grid using tangential fields or direct field, accordingly to the patients anatomy (from August 2006 to April 2008). The total dose ranged from 32.5 Gy to 45.5 Gy. The supraclavicular nodes were treated if >= 4 axillary nodes were positive (3/14). Modified mastectomy was the most frequent surgical procedure (9/14). Node negative disease was discovered in seven patients, T2 lesions in eight, invasive ductal carcinoma in nine and positive estrogen receptor in ten. Ten patients had comorbid diseases, the most frequent was high blood pressure. The patients had weekly skin evaluation and were scored accordingly to the RTOG score. The patients were followed in consultation until April 2012. Results: Two cases of erithema were observed after the completion of the treatment. These patients received seven fractions due to boost at surgical bed. The other patients didn't show any acute reactions. To date we observed an early infraclavicular failure after the completion of the radiotherapy. There were two cases of fat necrosis and two fibrosis. There was only one local failure and a second primary in the contralateral breast. Conclusions: The hypofractionated scheme showed good skin tolerance. A longer follow-up is needed for evaluation of local recurrence. We have to consider irradiation of the supraclavicular area in the case of any positive axillary node. The hypofractionation irradiation is a good treatment option for elderly breast cancer patients (> 70 years).
The CXCL7/CXCR2 axis and the migration of breast cells toward the malignant phenotype.
Authors: Kosr Mary Ann , Ju Donghong 
Published: February 2017

181 Background: A component of the epithelial to mesenchymal transition (EMT) is degradation of extracellular matrix and acquisition of migration, both of which support invasiveness. The expression of CXCL7 is associated with the invasive phenotype through interaction with the CXCL7/CXCR2 axis and heparan sulfate. The purpose of this study is to quantify the expression of genes associated with EMT by CXCL7-expressing cells with the migration/invasive phenotype. Methods: Total RNA from CXCL7-transfected breast cells (MCF10AT) was tested for relative gene expression using RT2 Profiler PCR array for EMT (SABiosciences). Vector transfected cells were compared. Each result was verified by real time PCR assay. In parallel, migration assays were performed quantitatively using transwell membranes and qualitatively with the scratch test and photodocumented. Results: The expression of GNG11 and TCF4 was upregulated and SPP1 downregulated as expected for the EMT profile. Specifically, GNG11 (Guanine nucleotide binding protein (G protein), gamma 11) expression was increased 2.94 fold and TCF4 (Transcription factor 4) increased 1.89 fold. The expression of SPP1 (Secreted phosphoprotein 1) was decreased by 6.8 fold. The expression of ZEB2 (Zinc finger E-box binding homeobox 2) was decreased by 1.96 as a transcription factor. Migration of CXCL7-transfectants was significantly increased over vector controls and comparable to invasive isogenic breast cancer cells. Conclusions: The CXCL7-transfected cells with invasive phenotype express genes associated with the EMT expression profile including G-protein signaling pathway.
Cost comparison of radiation treatment options after lumpectomy for breast cancer: Intraoperative radiotherapy versus alternatives.
Authors: Holmes Dennis R. , Pulicharamveettil Juvairiya , Sutter Gary Lee , Rivera Ronald J. 
Published: February 2017

187 Background: Increasing constraints on health care resources call for implementation of breast cancer treatment strategies that preserve treatment efficacy while reducing healthcare cost. In this investigation, we model potential cost savings associated with the use of single-fraction intraoperative radiotherapy (IORT) compared to two commonly used alternative radiotherapy approaches. Methods: A database survey was performed of female subjects undergoing breast conserving surgery (BCS) with or without sentinel lymphadenectomy at HealthCare Partners, a major IPA in metropolitan Los Angeles, CA. Subjects were identified by cross-referencing ICD-9 codes (174.0-174.9) for invasive breast cancer, CPT codes for BCS (19120, 19125, or 19301), and CPT codes for sentinel node biopsy without ALND (38500, 38525, or 38740). Calculations were based on the 2011 U.S. Medicare Fee Schedule. Treatment costs and savings were modeled assuming that patients with node-negative disease who underwent BCS were eligible for accelerated partial breast irradiation based on American Society of Breast Surgeons Guidelines (age ≥45, IDCA, DCIS, size ≤3 cm, node and margin negative). Results: A sample of 1,478 women meeting criteria was evaluated to determine the average per-patient cost of breast radiotherapy comparing three modalities: single-fraction IORT ($4,402), 5-day multi-lumen balloon brachytherapy (MLBB) (e.g., MammoSite) ($12,021), and standard 6-week whole breast external beam radiotherapy followed by a tumor bed boost (WBRT) ($8,988). IORT was approximately 49% the cost of standard 6-week WBRT and 37% the cost of MLBB. Conclusions: When eligible breast cancer patients are offered IORT as an alternative to WBRT, the expenditures from this sample may be reduced from $13.3M to $6.5M, a savings of $6.8M. Compared to MLBB, IORT may reduce radiotherapy expenditures from $17.8M to $6.5M, a savings of $11.3M. [Table: see text]
The development of the DCIS score: Scaling and normalization in the Marin General Hospital cohort.
Authors: Baehner Frederick L. , Butler Steven M , Yoshizawa Carl N. , Prasad Che , Cherbavaz Diana B. , Jamshidian Farid , Shak Steven 
Published: February 2017

190 Background: In selected low-risk patients with DCIS treated with wide local excision without radiation, the DCIS score was validated as a predictor of 10 year risk of an ipsilateral breast event (IBE - recurrence of in situ or invasive carcinoma) (p = 0.02) (Solin; SABCS 2011). As part of the development of the DCIS score, scaling from 0 to 100 and determination of risk group cutoff values was done using 100 patient DCIS samples from Marin General Hospital (MGH) selected to have a wide range of tumor characteristics. Methods: 100 patient specimens diagnosed with DCIS were provided by MGH. The Oncotype DX assay was performed, normalized expression levels for the 16 cancer related genes were determined, the DCIS Score and Recurrence Score (RS) were calculated. Distributions of the DCIS score, RS, and individual gene expression levels were described overall and by tumor characteristics. Treatment and pt outcome data were not available. Results: Samples for 96 pts had sufficient tumor and were evaluable; 47% had high nuclear grade, 52% comedo necrosis, 32% tumor size >10 mm, and 9% were ER-negative by IHC. After scaling and risk group cutoff determination, the DCIS score was low risk (0-38) for 49%, intermediate risk (39-54) for 27%, and high risk (≥55) for 24% of pts (Table). The DCIS score was widely distributed within subgroups defined by each of the clinical and pathology characteristics. Proliferation gene expression levels were low in DCIS, on average, relative to prior studies in invasive breast cancer. 92% had a proliferation gene group score <6.5, the threshold used when the RS is calculated; no threshold is used in calculating the DCIS score. Conclusions: Optimal scaling and risk cutoff determination for a wide range of all clinicopathologic characteristics provides for a wide distribution for the DCIS Score. [Table: see text]
Metronomic chemotherapy (MC) in the neoadjuvant setting: Results of two parallel feasibility trials in patients (pts) with HER2 positive (HER2+) and negative (HER2-) locally advanced breast cancer (LABC) (Traq-Me and TAME).
Authors: Petry Vanessa , Leal Alessandro , Arai Roberto J. , Marinho Simone , Paiva Marcelo , Piato Jose R. , Rosa Marcio , Hoff Paulo M. , Mano Max S. 
Published: February 2017

197 Background: In a previous randomized trial (SWOG 0012), MC seemed to improve pCR rates compared to standard anthracycline/taxane neoadjuvant chemotherapy (NC). We aimed to evaluate the feasibility of MC with a taxane→anthracycline schedule, which has also been shown potentially superior to the reverse sequence [J Clin Oncol 28:15s, 2010 (suppl; abstr 548)]. We also aimed to establish the feasibility of MC in combination with trastuzumab. Methods: The original accrual goal was 25 HER2+ pts and 40 HER2- pts. HER2- pts received MC consisting of paclitaxel (100mg/m2) x8 weeks followed by doxorubicin (24mg/m2) x9 weeks combined with oral cyclophosphamide (100mg/day), without G-CSF. HER2+ pts also received trastuzumab (4 mg/kg followed by 2mg/kg) concurrently with the entire CT. Objectives: Primary: To evaluate the feasibility of these schedules (defined as a febrile neutropenia [FN] rate no higher than 10%). Secondary: cardiac safety and general tolerability; efficacy as measured by objective clinical, radiological and pathologic complete response (pCR). Results: Almost all pts were staged as III (TraQme 8/9 88% and MeTo 4/11 36%). The HER2+ cohort was prematurely closed after 2 (22%) pts developed G3 pneumonitis (during the metromonic phase). Both responded to medical treatment and recovered. One pt had G2 hand-foot skin reaction (HFS) and another had G2 mucositis. The HER2- cohort was also prematurely closed with only 11 pts because of high rates of mucocutaneous toxicity (G3 HFS in 36%, G3 rash in 9%) and also due to the recent SWOG0221 negative results. There were 2 (18%) cases of FN and 3 (27%) of G4 neutropenia in this cohort, but no cases of pneumonitis. 1/11(9%) HER2- and 5/9HER2+(55%) pts had a pCR. VEGF pathway-related biomarkers were collected and will be presented at a later date. Conclusions: The proposed MC schedules proved too toxic to be considered for further clinical development. In addition, MC resulted in unexpectedly high rates of severe pulmonary toxicity when given in combination with trastuzumab. HER2+ but not HER2- pts had an impressively high pCR rate.
The dosimetric impact of supraclavicular nodal irradiation on the thyroid in patients receiving radiotherapy for breast cancer.
Authors: Ung Kim Ann , Moran Brigid , Portillo Maria , Kron Tomas , Sawyer Brooke , Herschtal Alan , Chua Boon H 
Published: February 2017

198 Background: The thyroid is not routinely considered an organ at risk in supraclavicular (SC) nodal radiotherapy (RT) for breast cancer. We aim to compare the dosimetric impact of two RT planning techniques on the thyroid: (1) conventional single anterior field to encompass the SC nodal volume defined using clinical and radiological landmarks; and (2) 3-dimensional (3D)-conformal planning to encompass the SC nodal volume contoured on planning computed tomography (CT) scans. Methods: The thyroid and SC nodal volumes were contoured on the planning CT datasets of 20 patients who had RT to the breast/chest wall and SC nodes to a dose of 50 Gy in 2-Gy daily fractions. Comparison of the following dosimetric parameters between the techniques was performed: mean and maximum thyroid dose; V5, V30, and V50 (percentage of thyroid receiving ≥5, ≥30, and ≥50 Gy respectively); percentage of SC nodal volume receiving 95-107% of the prescribed dose (homogeneity index, HI); and maximum spinal cord dose. Anatomical characteristics that influenced the dose distribution were investigated. Results: The 3D-conformal planning technique significantly increased all dosimetric parameters for the thyroid (p<0.001) (Table). It improved the mean HI of the SC nodal volume (16% vs. 93.2%; p<0.001) but resulted in a higher spinal cord dose (mean maximum dose 6.1 Gy vs. 30 Gy). The thyroid volume and depth of SC nodes did not influence the differences in the thyroid doses between the two techniques. The depth of SC nodes was significantly associated with the difference seen in the HI of SC nodal volumes between the techniques (p=0.004). Conclusions: The 3D-conformal planning technique improved the dosimetric coverage of the SC nodal volume but increased radiation doses to the thyroid compared to the single field technique. The longer term clinical consequences of radiation to thyroid should be considered in SC nodal irradiation for patients with breast cancer. [Table: see text]
Are ulcerated breast cancers biologically more aggressive compared to their non-ulcerated counterparts?
Authors: Tea Muy-Kheng Maria , Pohlodek Kamil , Staudigl Christine , Fritzer Nadja , Bartova Michaela , Singer Christian F. 
Published: February 2017

21 Background: Ulcerated breast carcinomas belong to the group of locally advanced breast cancers. In this study, the authors analyzed the biological presentation of ulcerated breast cancers (ULBC), examined their histo-pathological characteristics, and addressed the question whether T4b carcinomas have more aggressive phenotypes compared to their non-ulcerated counterparts (NULBC). Methods: In this case-control study the histo-pathologies of 66 patients with ulcerated locally advanced breast cancer were evaluated and compared with 132 consecutive non-ulcerated age-matched breast malignancies at the Medical University of Vienna and Comenius University School of Medicine of Bratislava. Results: The mean age in the ULBC and NULBC group was 64,86 (SD +/- 15,54) and 64,70 (SD +/- 14,11), respectively. The average tumor size at diagnosis in the ULBC group was 54.12 mm, 55% larger than in the NULBC group (p=<0.001). Furthermore, we detected statistical significantly more poorly differentiated (G3) tumors in the ULBC collection (p=0.003) and more Her-2-neu positive (p=0.035) breast cancers. In contrast, more hormone receptor positive (ER +/- PR positive) breast cancers were detected in the NULBC group (p=0.04). In addition, a total of 37.3% (n=25) patients with ULBC were diagnosed with primary metastasis. Conclusions: To our knowledge this is the first direct comparison between ULBC and NULBC.We could demonstrate that ulcerated breast cancers are characterized by more aggressive phenotypes. The observed differences of more unfavorable prognostic factors might contribute to the generally known poor prognosis of ULBC.
Can excisional biopsy be avoided for papillary breast lesions with typical benign sonographic features and concordant core needle biopsy (CNB)?
Authors: Fu Winnie , Motiuk David , Elliot Tracy , Docktor Bobbie 
Published: February 2017

26 Background: The role of surgical excision in the management of papillary lesions remains controversial. Some studies have documented upgrade rates to malignancy or atypia as high as 17%. However, due to the inclusion of atypia or malignancy at percutaneous and other differences in methodology, these rates may have been over-estimated. This study was designed to determine sonographic features that can help to decide if a lesion warrants excision or standard follow-up. Methods: With institutional review board approval, we retrospectively reviewed 113 benign papillomas without atypia that were diagnosed at US-guided CNB at Foothills Medical Centre from 2005 to 2010. Surgical pathology for 62 of these lesions were assessed. Two radiologists who were blinded to the diagnosis reviewed the sonographic images to determine the likelihood of benignity. Statistical analysis was performed using chi-square and z-score tests. Results: In our study, 5.3% of benign papillomas were upgraded. The sonographic features associated with a higher likelihood of upgrade were intracystic type [LR+ 5.67, 95% CI (1.47,12)], non-periareolar location [LR+ 2.30, 95% CI (1.04,5.06)], complex echogenic pattern [LR+ 3.10, 95% CI (1.00,9.63)], and radiologist’s impression of unlikely benign (final BiRADS) [LR+ 1.48, 95% CI (1.01,1.90)]. Although no feature was statistically significant for greater likelihood of benignity, the sonographic features that may better predict benign pathology at excision include lesions <1cm in size [LR- 0.52], homogeneously solid [LR- 0.63], smooth margin [LR- 0.69] and periareolar location [LR- 0.47]. Conclusions: The management of benign papillomas diagnosed with CNB remains controversial with a lack of agreement among published articles. Our study identifies characteristic sonographic features that are associated with higher likelihood of malignancy, warranting surgical excision. Conversely, it may not be unreasonable to place patients with lesions that are stratified as low risk into standard radiographic follow-up. As the confidence intervals span 1.00 for latter, further study is necessary to confidently recommend follow-up in place of excision.