bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3-07-41: Sentinel Lymph Node Biopsy Is a Reliable Method for Lymph Node Evaluation in Neoadjuvant Chemotherapy Treated Breast Cancer Patients.
Authors: Kaplan R , Qiu Q , Monni S , Swistel A , Shin S 
Published: June 2012

Abstract
Background: Successful sentinel lymph node mapping in breast cancer patients treated with neoadjuvant chemotherapy has been debated by practicing surgeons due to the potential compromise of the lymphatic drainage system after treatment. Furthermore, whether clinicopathologic variables associated with sentinel lymph node positivity in breast cancer patients differ from similar patients who have been treated with neoadjuvant chemotherapy has not been well-studied.
Materials and Methods: Breast cancer patients who received neoadjuvant chemotherapy were identified in our files. A similar number of breast cancer patients who did not receive such therapy was also selected as a comparison group. Clinicopathologic parameters such as age, type of surgical procedure, number of sentinel lymph nodes removed and/or positive, number of non-sentinel lymph nodes removed and/or positive, tumor size, histologic type/grade, presence of lymphovascular invasion, biomarker expression (ER,PR, HER-2/neu) and multifocality were recorded for each patient in both cohorts. Statistical analysis was performed for each cohort to identify variable(s) that correlated with sentinel lymph node positivity. Additional analysis was performed by computing the odds ratio of sentinel lymph node positivity after adjusting for selected variables. Results: Ninety-seven and ninety-three patients who were and were not treated with neoadjuvant chemotherapy, respectively, were identified. In all patients, successful sentinel lymph node mapping was achieved. When these cohorts were separately analyzed, tumor size, lymphovascular invasion, and non-sentinel lymph node positivity were associated with sentinel lymph node positivity in the cohort that did not receive neoadjuvant chemotherapy. In the cohort that received therapy, lymphovascular invasion and non-sentinel lymph node positivity were associated with sentinel lymph node positivity. In addition, after adjusting for tumor size, lymphovascular invasion and histologic grade, patients treated with neoadjuvant chemotherapy were more likely to have sentinel lymph node positivity than those who did not have this treatment (odds ratio: 5.4, 95% CI 2.4, 12.1).
Conclusions: Successful sentinel lymph node mapping was achieved in all ninety-seven breast cancer patients studied. Regardless of whether neoadjuvant chemotherapy was administered, the presence of lymphovascular invasion and non-sentinel lymph node positivity were found to predict sentinel lymph node positivity. By comparing two cohorts of breast cancer patients differing only in the use of neoadjuvant chemotherapy and adjusting for select variables, those in the treated cohort still remained more likely to have a positive sentinel lymph node.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-41.
P3-08-01: Effects of an Integrated Yoga Program on Mood States, Distress, Quality of Life, Diurnal Cortisol Rhythms and Natural Killer Cell Counts in Metastatic Breast Cancer Survivors.
Authors: Gopinath SK , Rao RM , Sanjeevarao VH , Diwakar RB , Basavalingaiah AS , Patil S , Raghuram N , Ramarao N , Usharani RM 
Published: June 2012

Abstract
Background and objectives: Metastatic breast cancer patients experience tremendous psychological distress due to treatment, disease and uncertainty of their survival. In this study we evaluated the effects of an integrated yoga program versus supportive counseling in advanced breast cancer survivors.
Methods: Ninety one Metastatic breast cancer survivors (group mean age 50.54 yrs ± 8.53 yrs) registered in hospital based cancer registry were recruited if they satisfied selection criteria and gave written consent for participation in the study. The study was approved by the institutional review board. Subjects were randomized to either receive yoga intervention (n=45) or supportive therapy (n=46) counseling as a standard of care for 3 months of intervention period. Subjects were assessed at baseline and after intervention for mood states using hospital anxiety and depression scale, sleep quality using Pittsburg Insomnia rating scale, quality of life using EORTC Qol C30 for breast and perceived stress using perceived stress scale. Saliva samples were collected for three consecutive days at 0600hrs, 0900hrs and 2100hrs before and after intervention for cortisol rhythms using Enzyme Immune Assay kits from Salimetrics and blood samples were collected between 0800hrs to 01000hrs for NK cell enumeration using flow cytometry. 35 subjects in yoga and 31 subjects in controls completed the post measures. Data were analyzed using both parametric (ANCOVA with respective baseline measure as a covariate) and non parametric tests (Mann whitney U test) to evaluate effects of intervention on the above outcome measures. Data for salivary cortisol data was log transformed, area under the curve and cortisol slope computed using linear mixed effects model.
Results: There was a significant decrease in anxiety (p &lt; 0.001), depression (p &lt; 0.001), perceived stress (p = 0.01), fatigue severity (p &lt; 0.001) and interference (p &lt; 0.001) in yoga group compared to controls post intervention. There was a significant improvement in emotional function (p &lt; 0.001), role function (p = 0.03) and cognitive function (p &lt; 0.001) and global quality of life (p &lt; 0.001) in yoga group compared to controls. There was significant decrease in 0600 hrs cortisol within the yoga group (p =0.03) alone. There was a significant increase in Natural killer cell percent in yoga group (p =0.03) compared to controls after intervention. Conclusion: The results suggest biobehavioral effects of yoga intervention could possibly improve quality of life, reduce psychological distress and modulate abnormal cortisol profiles and immune responses in metastatic breast cancer patients.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-08-01.
P3-09-02: Intermittent Dietary Carbohydrate Restriction Enables Weight Loss and Reduces Breast Cancer Risk Biomarkers.
Authors: Harvie M , Wright C , Pegington M , Mitchell E , Evans DG , Jebb S , Clarke R , Goodacre R , Dunn W , Mattson M , Howell A 
Published: June 2012

Abstract
Background: Energy restriction is a potential strategy for breast cancer prevention but is difficult to achieve and maintain. We found that intermittent energy restriction (2 days strict dieting week) is comparable to the standard approach of moderate daily restriction for weight loss and marginally better for improving insulin sensitivity, but no easier to follow1. In this follow on study we wished to test whether 2 novel intermittent low carbohydrate/low energy diets were feasible and easier to follow than a standard daily energy restriction. Design: Randomised comparison of 3 dietary types over 4 months in 115 overweight or obese (mean body mass index 31.0 [±5.3 SD] kg/m2) women at increased risk of breast cancer (lifetime risk &gt; 1 in 6).
Diets:
1. A restricted low carbohydrate diet (RLCD): 650 kcal and &lt;50g carbohydrate / day for 2 days per week
2. Ad lib low carbohydrate diet (ALCD): &lt;50g / day for 2 days per week with other food types (e.g. protein) ad lib
3. A standard daily restricted Mediterranean diet (DRMD): ∼ 1500kcal/day for 7 days per week
Methods: Weight, anthropometrics, blood markers for breast cancer; insulin resistance, oxidative stress markers, leptin, adiponectin, lipids, inflammatory markers IGF-1 were assessed at baseline, 1, 3 and 4 months.
Results: 88/114 completed the study (77%, drop outs 6 RLCD, 8 ALCD 12 DRMD). Last observation carried forward analyses show both intermittent low carbohydrate diets were superior to standard daily restriction for reducing weight and body fat: mean (95% confidence interval [CI]) change in body fat for RLCD was −4.3 (−5.6 to −3.0) kg, for ALCD −4.1 (−5.2 to −3.1) kg vs. −2.4 (−3.4 to −1.2) kg for DRMD (P value for difference between groups = 0.02). The intermittent groups had greater improvement in insulin resistance: mean (95% CI) change for RLCD was −22 (−35 to −11) %, ALCD −14 (−27 to −5%) % vs. −4 (−16 to 9) % for DRMD (P = 0.02). Other biomarkers are being assayed currently.
Conclusion: Greater weight loss, fewer drop outs and greater reductions in insulin resistance with the novel intermittent low carbohydrate diets indicate that these are alternative approaches for energy restriction for potentially reducing risk of breast cancer and other diseases.
Reference:
1Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int.J Obes (Lond) 35; 714–27, 2011. This study is funded by the Genesis Breast Cancer Prevention Appeal: www.genesisuk.org
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-09-02.
P3-11-06: A Pilot Study of RPFNA in Overweight and Obese Postmenopausal Women.
Authors: Korde LA , Grieco VS , Imayama I , Kumai C , Mason C , Duggan CR , Wang C-Y , McTiernan A 
Published: June 2012

Abstract
Background: Random periareolar fine-needle aspiration (RPFNA) is a research-based procedure used to obtain breast epithelial cells and fluid. Data suggest that atypia in epithelial cells from RPFNA specimens is associated with an increased risk of breast cancer, and changes in the degree of atypia may be a viable biomarker for response to chemopreventive interventions.
Methods: We performed RPFNA on 37 overweight or obese (body mass index (BMI≥ 25.0 kg/m2) postmenopausal (50-75 y) women enrolled in a randomized clinical trial of Vitamin D vs placebo in combination with a lifestyle (diet + exercise)-based weight loss program. Eligibility criteria included serum vitamin D concentrations 10–32 ng/mL. The procedure was performed by two trained clinicians prior to randomization to assess baseline cell counts and degree of atypia. Two areas in the breast (10:00 and 2:00 positions) were infiltrated with lidocaine, and 8 to 10 aspirations of cellular material were performed using 1.5 inch, 21-gauge needles. The aspirated fluid was placed in 9 cc of Cytolyt Thinprep (Hologic Inc.) with 1 cc of 1% neutral buffered formalin and slides were prepared according to the University of Washington Department of Pathology non-gyn protocol.
Results: Thirty-seven women were included in this analysis. The mean age and BMI of study participants was 59.3 years and 32.5 kg/m2, respectively. The mean 5-year Gail risk score for study participants was 1.96%; 52% of women had a 5-year Gail risk &gt;1.66%. Eight participants (21.6%) had &gt;50 cells present on cytology examination. One additional participant had 10–50 cells, and one had &lt;10 cells. No specimens showed cellular atypia. The remainder of study participants had only blood or fibroadipose tissue on cytology specimens. Women with epithelial cells present were younger (mean age 55.0 vs. 60.2 years, p=0.05). There were no significant differences in BMI or Gail risk score between those with and without epithelial cells.
Conclusions: RPFNA in our sample of overweight/obese postmenopausal women did not yield epithelial cells in a majority of participants. Younger age was associated with a greater cell count. We are planning further studies to determine whether other markers in RPFNA specimens can be used to assess breast tissue changes in response to chemopreventive interventions.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-11-06.
P3-12-02: Intra-Operative Margin Assessment of Diffuse Disease with MarginProbe” as an Adjunct to Standard of Care, Results from a Randomized Prospective Multi Center Study.
Authors: Boolbol SK , Cocilovo C , Tafra L 
Published: June 2012

Abstract
Background
The ability to obtain negative margins with a single surgical procedure remains a challenge, particularly in patients with diffuse disease such as DCIS and lobular pathology. A novel device (MarginProbe, Dune Medical Devices, Inc.) is intended to provide surgeons with real time, intraoperative detection of cancerous tissues at the margins of excised specimens. A study was performed to determine if there was a device-associated improvement in complete surgical resection (CSR) and therefore a decrease in the rate of patients requiring re-excision with these disease types. The current analysis stratified the data based on tumor type with a special focus on DCIS patients, patient with a DCIS component, and lobular patients.
Methods: All 596 patients underwent breast conservation, with image-guided localization, and were randomized in a prospective, international, multicenter (n=21) study. Randomization occurred in the operating room, following standard lumpectomy procedure, including palpation followed by additional cavity resections as indicated. In the device arm, MarginProbe was used on each specimen margin and device positive readings required additional resections of the cavity. Pathologists were blinded to study arm. Re-excision criteria were not dictated by the protocol.
A primary endpoint of this study was CSR, defined as the correct intraoperative identification and resection (if not skin or fascia) of all positive margins on the main lumpectomy specimen. Positive lumpectomy specimens were defined as those having at least one margin having cancer ≤1mm from the surface. Successful CSR results in reduced positive margin rate after lumpectomy.
Results: Results are presented in Table 1. The improvement in CSR was significant for all diagnosis types. The decrease in candidates for re-excision due to failed CSR was significant for all DCIS and mixed tumor types.

Conclusions: Use of the device resulted in significant improvement in CSR and therefore a significant decrease in the need for reexcisions. Further studies should be conducted to evaluate the use of the device for additional patient cohorts, such as patients receiving neoadjuvant treatment and patients who have undergone prior breast surgery.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-12-02.
P3-12-04: Involved Anterior Margins after Breast Conserving Surgery: Is Re-Excision Required?
Authors: Mullen R , Macaskill EJ , Khalil A , Elseedawy E , Brown DC , Lee AC , Purdie C , Jordan L , Thompson AM 
Published: June 2012

Abstract
Background: Complete tumour excision in breast conserving surgery (BCS) is critical for successful treatment; involved circumferential resection margins are associated with increased disease recurrence. However, the importance of an involved anterior margin is less clear. The purpose of this study was to audit an aggressive approach to involved anterior margins and hence assess whether anterior margin re-excision yields clinical benefit.
Material and Methods: A retrospective case note and pathology review was performed for all patients who underwent BCS between 2006 and 2010 through a single cancer centre. An involved margin was defined as &lt;1mm clearance of invasive or in situ breast cancer. Results: 1667 patients underwent BCS for invasive and/or in-situ disease, of whom 114 (6.8%) underwent re-excision, most commonly for mixed invasive and in-situ pathology. The annual re-excision rate rose significantly (p&lt;0.001), with no change in whole tumour diameter, specimen weight or specimen volume. A total of 170 involved margins were identified: most commonly the anterior margin (59 margins, 30.6%) followed by the posterior (39 22.9%) or inferior (31, 18.3%) margin. Patients with anterior margin involvement were more likely to have grade 3 invasive disease (p=0.0323) but less likely to have residual disease found at re-excision (2/49 vs. 32/101 margins, p=0.0033); there were no differences when in-situ characteristics were compared.
Conclusions: Re-excision of involved anterior margins rarely excises residual disease and may be unnecessary. Multidisciplinary teams should consider whether further therapy for an involved anterior margin is required on a patient by patient basis.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-12-04.
P3-13-08: Survival Analysis and Recurrence Patterns in Locally Advanced Breast Cancer Following Neoadjuvant Chemotherapy and Preoperative Concurrent Chemo Radiotherapy.
Authors: Shaw RJ , Lara F , Robles CD , Vilar D 
Published: June 2012

Abstract
Introduction: Although not widely used, preoperative concurrent chemo radiotherapy (CCRth) following poor response to neo adjuvant chemotherapy (CT) has been recently associated with an improved prognosis in patients with locally advanced breast cancer (LABC) and high recurrence risk, showing acceptable toxicity profiles, acceptable post surgical complication rates and increases in both clinical and pathologic response rates and local control rates. The objective of this study was to assess disease free survival (DFS), overall survival (OS) and patterns of recurrence in a cohort of patients with LABC treated with pre operative CCRth following poor response to neo adjuvant CT.
Methods: This longitudinal study included a total of 287 patients with LABC treated with pre operative CCRth following poor response to neo adjuvant CT between February 2000 and December 2002. Demographic, clinical/pathologic, therapeutic and follow up data were collected from patient charts to determine DFS, OS and recurrence patterns.
Results: Stages IIB, IIIA and IIIB accounted for 22.3, 37.6 and 40% of the population, respectively. Clinical response rates compared to pathologic response rates following anthracyline based CT and CCRth were minimal or stable in 16% vs 62.4%, partial in 53 vs 76.3% and complete in 30 vs 23.3%. No significant treatment related toxicities were identified. Post surgical complications included flap ischemia in 16%, partial flap necrosis in 18%, both ischemia and partial flap necrosis in 13.2% and partial wound dehiscence in 7.7%. With an average follow up of 64.1 ± 37.2 months, (0-126.3 months), 36.9% of the population relapsed and 55.1% remained disease free. With regard to recurrence patterns, 22.6% presented loco regional relapse, 67.7% recurred at a distant site and 9.8% showed presented both. Median OS was 64.2 months (0-126 months). Five and ten year survival probability was shown to be 75% and 60%, respectively.
Conclusions Despite improvements in local control rates and overall outcomes with current therapeutic regimens combining chemotherapy, surgery, and radiotherapy, 30 to 40% of patients with locally advanced breast cancer develop post treatment loco regional recurrence and 5 year overall survival remains low (50%). Multimodal treatment integrating pre operative CCRth is therefore a valid alternative in the LABC setting, showing promising results in regard to OS, DFS and recurrence rates. Prospective clinical studies to evaluate its use are warranted.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-08.
P3-13-11: Survival Benefit Associated with Post-Mastectomy Radiation for Node-Positive, Intermediate-Risk Breast Cancer Patients: Results of a Study from the SEER Registry Data.
Authors: Horowitz DP , Ng J , Burri RJ 
Published: June 2012

Abstract
Background
The role of post-mastectomy radiation therapy (PMRT) for breast cancer patients with intermediate-risk (1-3 positive nodes) disease remains controversial. This Surveillance, Epidemiology, and End Results (SEER) study investigated the impact of PMRT in the intermediate-risk breast cancer patient population on cause-specific survival (CSS) and overall survival (OS). The study also investigated the impact of estrogen receptor (ER) status, which has been reported in the SEER database since 2004, on the impact of PMRT in this patient population on CSS and OS.
Methods: The SEER database was used to identify all breast cancer patients who were treated between 2004–2007, who had undergone mastectomy, and who had T1-2 tumors and 1–3 pathologically positive lymph nodes. The status of radiation therapy, ethnicity, tumor grade, TNM stage, year of diagnosis, number of LNs sampled, number of LNs positive, and estrogen/progesterone receptor status was recorded. Patients missing pathologic or treatment-related information were excluded. Statistical analysis for CSS and OS was performed using the Kaplan-Meier method and analyzed using the log-rank test. Multivariable analysis was performed using the Cox proportional hazards regression model. Statistical analyses were performed using PASW, version 18.
Results: 10,517 patients were identified, with a median follow-up of 21.8 months (range 0–47 months). 2339 patients (22.2%) received PMRT. Younger patients, increasing tumor size, increasing tumor grade, and ER negative tumors were more likely to receive PMRT. PMRT was associated with improved OS, 92.8% (95% CI 91.294.4%) versus 88.7% (95% CI 87.7−89.7%), p &lt; 0.001. However, there was no overall CSS benefit to PMRT, p = 0.197. In the subgroup with ER positive tumors, PMRT was associated with both improved OS, 95.5% (95% CI 93.9−97.1%) versus 91.0% (95% CI 90.0−92.0%), p &lt; 0.001, and improved CSS, 97.6% (95% CI 96.6−98.8%) versus 96.1% (95% CI 95.3−96.9%), p = 0.009. Multivariate analysis showed that PMRT was significantly associated with improved survival (HR 0.744, p = 0.011); increasing age, tumor grade, ER negative tumors, increasing tumor stage, and increasing positive nodal ratio were associated with increased risk of death.
Conclusion: Patients with intermediate risk breast cancer who received PMRT have improved OS compared to those who did not receive PMRT. For patients with ER positive tumors, PMRT also appears to be associated with improved CSS. Greater consideration for post-mastectomy radiation therapy use may be warranted for this patient population.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-11.