bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P4-14-08: Intraoperative ultrasound guidance for excision of non-palpable breast cancer
Authors: Barentsz MW , van Dalen T , Gobardhan PD , Bongers V , Perre CI , Pijnappel RM , van den Bosch MA , Verkooijen HM 
Published: August 2014

Abstract
Background: The effectiveness of intraoperative ultrasound (IOUS) for preoperative localization of non-palpable breast cancers within the operation theatre has not been studied extensively. In this prospective cohort study, we compared margin status, re-excision rate and excised volume of IOUS to guidewire localization (GWL).
Methods: A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999–2010. GWL was performed in 138 (54%) and IOUS in 120 (46%) patients. Tumour dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. Calculated resection ratios, i.e. indicating the amount of excess tissue resection, were calculated by dividing the total resection volume by the optimal resection volume (the tumor diameter plus a 1.0 cm margin) and compared between the groups.
Results: The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm), while lesions in the GWL group consisted more often of microcalcifications only (19% vs. 3%). Tumour free resection margins were obtained in more than 93% of patients (93.5% with GWL vs. 93.3% with IOUS, P = .958) and re-excision was performed in 11.0% of patients undergoing GWL and 12.5% of patients undergoing IOUS (P = .684). In both groups, resection volumes were similar, but IOUS led to more optimal tissue resection (calculated resection ratio 4.33 vs 3.30, P = .018). After adjustment for tumor diameter, radiological findings and presence of DCIS, the difference in calculated resection volumes was no longer significant.
Conclusion: For localization of non-palpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumour removal, re-excision rate and excised volume.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-08.
Abstract P4-14-10: Atypical Ductal Hyperplasia diagnosed on directional vacuum-assisted biopsy: is surgical excision mandatory?
Authors: Chauvet M-P , Rivaux G , Farre I , Houpeau J-L , Giard S , Ceugnart L 
Published: August 2014

Abstract
Background: The incidence of atypical ductal hyperplasia (ADH) is increasing due to mass screening. Because of the underestimation risk of malignancy, the management remains controversial. Our goal was to analyze clinicopathologic features of patients with ADH diagnosed on directional vacuum-assisted biopsy (DVAB). The objectives of this continuous retrospective study were to evaluate the underestimation rate of malignancy and to identify predictors of upgrade to carcinoma.
Methods: Between 2003 and 2010, 3159 patients underwent stereotactic DVAB in our institute. We retrospectively evaluate clinical, mammographic and pathological features of 298 cases of ADH who underwent surgical excision in our center (93.1%). Patients with concurrent history of breast cancer, intraductal carcinoma (DCIS) associated, or with no follow-up or surgical excision on place were excluded. Histological scar of macrobiopsy was systematically searched in surgical specimens. A pathologic upgrade was defined by presence of invasive cancer or DCIS on surgical specimen. Statistical tests used were the chi-square or Fisher's exact test.
Results: Among the 298 studied DVAB, 224 ADH were isolated (75.2%), 46 associated to flat epithelial atypia (15.4%) and 28 to lobular neoplasia (9.4%). 98.4% patients presented microcalcifications at diagnosis. In 52 cases, lesions were upgraded to DCIS (n = 38) or invasive cancer (n = 14). The underestimated rate was 17.5%. In 67.3% cases, upgrade lesions were low or intermediate grade DCIS. Only the history of contralateral breast cancer was significantly correlated with the underestimated rate (p = 0.04). There was no statistical difference between these 52 cases and the 246 others for: family history, size of calcification, sampling number, histological lesion, and quality of calcifications removal.
Conclusions: In this study, DVAB may not be considered a therapeutic procedure in case of ADH, even in the case of complete removal of microcalcifications. It is still challenging to identify a subgroup of ADH cases with a low upgrade rate.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-10.
Abstract P4-15-02: Timing of infectious complications following breast conserving therapy with catheter-based accelerated partial breast irradiation
Authors: Haynes AB , Bloom ES , Bedrosian I , Kuerer HM , Hwang RF , Caudle AS , Hunt KK , Graviss L , Chemaly RF , Tereffe W , Shaitelman SF , Babiera GV 
Published: August 2014

Abstract
Background: Accelerated partial breast irradiation (APBI) has been introduced as an alternative to whole breast irradiation as part of breast conserving therapy for selected patients. The long-term outcomes remain under investigation. Previous publications have emphasized early postoperative infections with APBI with less focus on delayed infection. In the current study, we evaluated patients enrolled on a prospective registry trial for infectious complications after treatment with catheter-based APBI.
Methods: Patients who underwent single-entry catheter-based APBI were identified from a single-institution prospective registry from 2009 to 2011. Data regarding treatment, patient comorbidities, complications, and outcomes were obtained from registry and retrospective chart review. Infectious complications were assessed from the date of APBI catheter insertion and were classified as early (≤30 days) or delayed (&gt;30 days). All patients were maintained on oral antibiotics while the catheter was in place.
Results: A total of 91 patients with 92 cases of primary breast cancer were enrolled on a prospective registry at a comprehensive cancer center between 2009 and 2011 and treated with single-entry catheter-based APBI. The median follow-up time was 76.2 weeks. A temporary catheter was placed at the time of initial operation in 40 cases (43.5%) and left in place a median of 6 days prior to definitive catheter insertion. There were 20 patients (21.7%) who required re-excision. Overall, breast infection occurred in 13 (14.1%) patients. Three (3.3%) patients had infection within 30 days of catheter placement and 10 (10.9%) occurred more than 30 days after catheter insertion (median 112.5 days, interquartile range 51–154). Eight patients were managed with oral antibiotics alone on an outpatient basis. The remainder required a combination of admission, intravenous antibiotics, and aspiration of abscess. One patient underwent operative drainage.
Conclusion: We found an overall infection rate of 14.1% in patients treated with catheter-based APBI. This is consistent with other reports; however, we found that the majority of infections occurred more than 30 days after definitive catheter placement. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. Most infections following APBI can be managed on an outpatient basis without operative intervention.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-15-02.
Abstract P4-15-05: Long-term outcome of breast cancer patients treated with radiofrequency ablation
Authors: Earashi M , Noguchi M , Motoyoshi A , Komiya H , Fujii H 
Published: August 2014

Abstract
Background: Radiofrequency ablation (RFA) is considered to be the most promising non-surgical ablation technique for the treatment of small breast cancer. In feasibility studies, the ablated tumor was surgically removed after RFA, and the tumor cell viability were assessed by histological and/or immunohistological examinations. However, these assessments of tumor viability do not take the place of long-term follow-up in patients treated with RFA alone, because they do not allow for them to be followed up for recurrence after RFA, or to determine if there were any undesirable complications of this procedure. At present, few data are available regarding long-term follow-up of patients treated with this modality.
Methods: Since 2005, we have performed RFA and sentinel lymph node (SLN) biopsy in 19 cases with invasive breast cancer less than 2.0 cm in greatest diameter. After SLN biopsy, a primary electrode (seven-array model 70 Starburst needle electrode; RITA Medical Systems, Mountain View, CA) was inserted into the tumor under real-time US guidance. Then, the prongs of the needle electrode were deployed over a distance of 3 cm in all cases, and the RF generator (RITA model 1500) was activated and set to automatic, with power at 20 W, temperature of 95°C, and an ablation time of 15 min. Axillary lymph node dissection (ALND) was performed in patients with positive SLNs. Several months after RFA therapy, the ablated tumor tissue was excised by multiple mammotome biopsy and examined histologically or immunohistochemically with H&E staining, nicotinamide adenine dinucleotide (NADH)-diaphorase staining, and single-stranded (ss) DNA staining. All cases were followed-up after breast radiation and systemic therapies.
Results: The mean tumor size based on the ultrasonographic maximum dimension was 1.3 cm (range: 0.5–2.0 cm). Although complete response was histologically confirmed in only 8 cases, NADH-diaphorase and ssDNA staining did not demonstrate any viable tumor cells in any of the ablated lesions. At a mean follow-up of 60 months (follow-up range, 37–82 months), there were no cases of in-breast recurrence, although one patient died due to hepatic metastases. Cosmesis of the conserved breast was excellent or good in all of the cases, but a hard lump was persistent after RFA in half of the cases.
Conclusions: The long-term outcome of patients treated with RFA is encouraging with regard to cosmesis and local control. However, a persisted lump can cause patient discomfort, anxiety and fear. Therefore, further studies are needed to establish the optimal technique. Moreover, a prospective study will be required to determine the equivalency in local recurrence rates between the RFA therapy and conventional breast-conserving treatment.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-15-05.
Abstract P4-16-02: A survival benefit from locoregional radiotherapy for node-positive and CMF treated breast cancer is most significant in Luminal A tumors
Authors: Voduc D , Cheang MCU , Tyldesley S , Chia S , Gelmon K , Speers C , Nielsen TO 
Published: August 2014

Abstract
Background: Between 1978–1986, 318 premenopausal women treated with mastectomy for lymph node positive breast cancer, were randomized to CMF chemotherapy alone vs. CMF chemotherapy and adjuvant radiotherapy (RT) to the chest wall and regional lymph nodes. After 15 years of follow-up, post-mastectomy RT was associated with a statistically significant 29% relative risk reduction in mortality. Recent evidence suggests that Luminal A tumors, identified using hormone receptors and Ki67, have a particularly favorable prognosis. We retrospectively identified the Luminal A tumors from this clinical trial cohort to determine if the response to postmastectomy RT differed among Luminal A and non-Luminal A tumors.
Methods: 203 archival breast tumor samples from this study were used to construct a tissue microarray. Luminal A tumors were identified using an immunopanel consisting of: estrogen receptor, progestorone receptor, Her2, and Ki67. Luminal A tumors were defined as either ER or PR positive, Her2 negative, and Ki67 &lt; 14%. Kaplan-Meier estimates and the log-rank test were used to test the differences in locoregional relapse free survival (LRFS) and breast cancer specific survival (BCSS). Interaction between treatment and Luminal A/Non-luminal A were tested using Cox regression analysis.
Results: The intrinsic subtype was successfully determined in 144 breast tumors, and 49 were classified as Luminal A (34%). Survival outcomes at 10 years are summarized in Table 1:

Conclusion: Our study examines the outcome of Luminal A tumors in patients with higher risk (premenopausal and lymph node positive) breast cancer treated with CMF chemotherapy. We observed that both subjects with Luminal A tumors and non-Luminal A tumors appear to demonstrate improved locoregional control with post-mastectomy RT, although this was only significant for Luminal A tumors. The non-significant interaction test suggests that there is no observable difference in radiosensitivity in this limited study population. However, the improvement in BCSS with post-mastectomy RT was only significant in the subjects with Luminal A tumors, and the interaction test was statistically significant.
Our results raise the possibility that patients with non-Luminal A breast tumors are at higher risk of occult metastatic disease at presentation, and may not derive a survival benefit with improved locoregional control in the setting of CMF chemotherapy. In contrast, locoregional control has a significant effect on survival with Luminal A tumors. Our study suggests that a favorable Luminal A diagnosis should not be a reason to omit regional radiotherapy in node positive patients, as it is this subgroup that may derive the greatest benefit.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-02.
Abstract P4-16-04: Outcome of stage II/III breast cancer treated with neoadjuvant versus adjuvant radiotherapy in British Columbia.
Authors: Lohmann AE , Voduc D , Speers C , Chia S 
Published: August 2014

Abstract
Backgroud: Neoadjuvant radiotherapy (NRT) is generally recommended after systemic therapy for inoperable stage III breast cancer. At the BCCA, neoadjuvant radiation is also frequently offered for patients with operable node positive disease after neoadjuvant chemotherapy. There is a lack of randomised trial data comparing outcomes in stage II/III breast cancer when radiation therapy is delivered neoadjuvantly versus adjuvantly.
Aim: The primary objective of this study is to assess the clinical outcomes, as measured by relapse-free survival (RFS), overall survival (OS), and breast cancer-specific survival (BCSS), of women with stage II/III breast cancer treated with neoadjuvant chemotherapy and either neoadjuvant or adjuvant radiotherapy.
Methods: Patients were identified by linking the Breast Cancer Outcomes Unit (BCOU) with the British Columbia Cancer Agency Pharmacy data repository. Inclusion criteria included: Female, referred to BCCA with newly diagnosed disease, clinical stage II or III breast cancer, neoadjuvant chemotherapy, breast surgery performed as part of the initial treatment plan, RT (given adjuvantly or neo-adjuvantly to the breast/chest wall +/− regional nodes). Patients were excluded if they had a previous or synchronous in situ or invasive breast cancer. Demographic data, treatment characteristics, ER, PR and HER-2 status (when available) were extracted. Data was analyzed using descriptive statistics and Kaplan Méier curves survival analyses were produced using SPSS, V. 14.
Results: Between Jan 1, 1995 and Dec 31, 2008, 687 patients with stage II/III disease were identified. 394 patients received neo-adjuvant and 293 patients received adjuvant radiation. Patients treated with neoadjuvant vs. adjuvant RT differed in age (median: 51yrs vs. 49yrs, p &lt; 0.001), margin status (86.5% negative/5.1% positive/ 8.4% unknown vs. 94.2% negative/1.7% positive/4.1% unknown, p = 0.02), surgery (94.2% vs. 87.7% mastectomy, p = 0.003), and type of chemotherapy (50.3% vs. 24.6% anthracycline only, p &lt; 0.001) respectively. No differences in 5-year RFS (60.0 vs. 64.8 %, respectively, p = 0.07), 5 year BCSS (67.9 vs. 73.1 %, respectively p = 0.17) and 5-year OS (66.2 vs. 72.5 %, respectively, p = 0.06) were seen in the neoadjuvant vs. adjuvant population.

Conclusion: Within the limitations of this retrospective study, the sequence of use of radiation pre-operative compared to post-operative following neoadjuvant chemotherapy appears to have similar clinical outcomes.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-04.
Abstract P4-16-06: Radiotherapy to the Primary Tumor Is Associated with Improved Survival in Stage IV Breast Cancer
Authors: Morgan SC , Caudrelier J-M , Clemons MJ 
Published: August 2014

Abstract
Background: In patients found to have metastatic disease at the time of breast cancer diagnosis, the role of local therapy is undefined. Numerous retrospective analyses have suggested that surgery and/or external beam radiotherapy (EBRT) directed at the primary tumor may improve overall survival (OS). All these analyses, however, are subject to significant selection bias. The current retrospective analysis of a large registry dataset attempts to limit the effect of this bias.
Methods: The study population consisted of women in the Surveillance, Epidemiology, and End Results (SEER) program database diagnosed with stage IV breast cancer between 1988 and 2009. Only those patients for whom surgery to the primary tumor was recommended but was not undertaken (due to patient refusal or other uncategorized reasons) were included. In this population of patients deemed candidates for surgery, the association between receipt of primary tumor-directed EBRT and overall survival was studied. Descriptive statistics were used to characterize the study population. OS was estimated using the Kaplan-Meier (KM) method. Univariate and multivariate Cox regression were used to identify factors associated with OS.
Results: A total of 3,529 cases were analyzed. EBRT was received in 768 cases. Median age at diagnosis was 68 years (IQR, 56–79 years). Median follow-up by reverse KM estimate was 98 months (range, 0–252 months). On univariate analysis, EBRT was associated with improved OS (hazard ratio 0.80, 95% CI 0.74–0.87, p &lt; 0.001). 1-year, 3-year, and 5-year OS was 56.9%, 24.2%, and 10.7% respectively in those receiving EBRT and 44.3%, 16.6%, and 7.2% respectively in those not receiving EBRT. Median OS in those receiving EBRT was 15 months compared to 7 months in those not receiving EBRT. In a multivariate Cox model taking into account receipt of EBRT, age at diagnosis, year of diagnosis, ethnicity, number of primary cancers, estrogen and progesterone receptor status, histologic grade, and size of primary tumor, EBRT remained significantly associated with improved survival (hazard ratio 0.86, 95% CI 0.76–0.97, p = 0.011).
Conclusions: In a population of women presenting with metastatic breast cancer, all of whom were deemed candidates for surgery to the primary tumor but who did not undergo surgery, receipt of EBRT was associated with improved OS. The observed 8-month absolute difference in median OS is clinically significant. This analysis could not account for performance status, extent of metastatic disease, co-morbidities, use of systemic therapies, and other potentially confounding factors. Only randomized studies, such as the Eastern Cooperative Oncology Group E2108 trial currently underway, will be able to definitively assess the value of local therapy directed at the primary tumor in this setting.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-06.
Abstract P4-16-09: Dosimetric feasibility and acute toxicity in a prospective trial of ultra-short course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device
Authors: Khan AJ , Vicini FA , Brown S , Haffty BG , Kearney T , Dale R , Arthur DW 
Published: August 2014

Abstract
Background: Shorter courses of APBI with novel fractionation schedules are being investigated; a large randomized trial from Europe has recently shown the safety and efficacy of a single-fraction adjuvant approach (with limited follow-up). We designed a prospective trial to identify and address the potential radiobiological and logistical limitations of single-fraction, intraoperative APBI.
Methods: We designed a single-arm, multi-institutional, prospective phase II trial that sequentially treats three cohorts of women (each n=30) with three progressively hypofractionated schedules. Eligible women were age ≥ 50 years with unifocal invasive or in situ tumors ≤ 3.0 cm, excised with negative margins, and with negative lymph nodes and positive hormone-receptors. Using a reference schedule of 60 Gy delivered in 2 Gy fractions, and assuming tumor parameters: a/b = 4 Gy; a = 0.27 Gy-1, and repopulation parameters of: Teff = 26 days; delay time = 0 days, the reference tumor BED is ∼ 86 Gy4. We began with a schedule of 4 fractions of 7 Gy delivered twice-daily using a Contura MLB multi-lumen device. We defined very conservative dosimetric criteria for acceptability: maximum skin and rib dose to not exceed 100% of prescription dose, and V150 and V200 to not exceed 40 cc and 10 cc, respectively. Subsequent schedules are 3 fractions of 8.25 Gy and 2 fractions of 10.25 Gy, both delivered over 2 days. The primary endpoint is to exclude a local failure rate exceeding 10% with the upper limit of a 95% confidence interval.
Results: A total of 30 patients have been enrolled at the 7 Gy × 4 fractions dose-level and followed for a minimum of 6 months. The median skin dose as a percent of prescription dose (PD) was 84% (40–100) and the median rib dose was 71% (16–119). 96% of the PTV_eval received a median of 95% of PD (range 85–103). The V150 (range 14–48cc) and V200 (range 0–29cc) criteria were met in all cases. One breast infection occurred and was treated; 2 cases of symptomatic fat necrosis and 2 cases of symptomatic seromas occurred. No acute toxicities greater than CTCAE grade 2 have been observed.
Conclusion: Short-course APBI is dosimetrically feasible using the Contura MLB and appears to be tolerable in terms of acute toxicities. Our approach is based on well-defined radiobiological parameters and allows for an abbreviated course of treatment that is guided by full pathological review and the ability to objectively achieve and validate acceptable dosimetric criteria in each case. We have opened enrollment to the next schedule of 8.25 Gy for three fractions.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-09.