bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2-15-04: Clinical Significance of Resection with Curative Intent for Isolated Pulmonary Metastases from Breast Cancer. Multi-Institutional Study in Japan.
Authors: Sato N , Ohsumi S , Iwase T , Inaji H , Mizutani M , Nishimura R , Mukai H 
Published: June 2012

Abstract
OBJECTIVE: Although resection of isolated pulmonary metastases is a common treatment in other primaries such as colon cancer, the role of lung metastasectomy of breast cancer is still unclear. The objective of the present study was to investigate the clinical outcome of our operated patients with isolated pulmonary breast cancer metastases and discuss the clinical implication of resection with curative intent for them.
METHODS: We retrospectively analyzed 86 female patients with histologically proven isolated pulmonary metastases from breast cancer who were treated with surgery of curative intent between January 1980 and September 2010 at 7 Japanese hospitals. The mean age of them was 50 years, the median disease free interval (DFI) from the definitive surgery for the primary breast cancer was 4.6 years (range: 0.5−20.4 years) and the median follow-up after lung metastasectomy was 4.1 years (range: 0.3−30.9 years).
RESULTS: Lung metastasectomy was performed by thoracotomy in 22 patients and by video-assisted thoracoscopic surgical resection in 64 patients. The number of metastatic foci resected was one for 79 patients, two for 6, and unknown for 1. Lymph node resection was performed for 12 patients, was not done for 69, and unknown for 5. Five-year survival rates after lung metastasectomy were 68% in the patients. The main prognostic factor was the DFI. Five-year survival rates for patients with DFI of longer than 2 years (n = 72) and those with DFI of shorter than 2 years (n=14) were 74.5% and 33.8%, respectively (p = 0.0006). Five-year survival rates after lung metastasectomy were 68% in patients without macroscopic residual pulmonary tumor after lung metastasectomy (n = 69) and 34% in those with macroscopic residual tumor (n = 12) (p = 0.023). Five-year disease free survival after lung metastasectomy for patients without macroscopic residual tumor was 51 %. Five-year survival rates were 78% in patient with endocrine hormonal therapy following lung metastasectomy (n = 51) and 53% in those without endocrine hormonal therapy (n = 35) (p = 0.045). No prognostic influence could be demonstrated for age, number of initial axillary node metastases, primary tumor size.
CONCLUSION: The prognosis of the breast cancer patients with isolated pulmonary metastases who underwent metastasectomy with curative intent was good. It was affected by the biological aspects of the primary tumor, “curativity” of the resection, and systemic treatments after lung resection. It may be expected that some of those patients will be cured by surgery with curative intent.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-04.
P2-15-08: New Trends for Surgical Treatment of Large Breast Tumors.
Authors: Zucca Matthes AG , Vieira RAC , Kerr LM , Matthes ACS , Folgueira MAAK , Uemura G 
Published: June 2012

Abstract
Introduction: The locally advanced breast cancer is still common in developing countries. The neoadjuvant chemotherapy (NC) allows converting large tumor into operable one. Oncoplastic surgery (OS) adds new techniques to breast conservative treatment(BCT). The association between NC and OS provides the resection of large amount of breast tissue, including skin, with satisfactory aesthetic results.
Objective: Evaluate the possibilities to indicate oncoplastic techniques to determine BCT after NC for large breast tumors.
Material and Methods: A prospective clinical trial (www.clinicaltrials.gov; NCT00820690) study with women breast cancer patients, clinical stage III, no extense skin involvement, submitted to NC, based on four cycles of doxorubicin 60mg/m2 + cyclophosphamide 600 mg/m2 and 4 cycles of paclitaxel 175mg/m2. Preoperative tattoo was realized for all patients to determine the clinical dimensions of the tumor. Tumor size was controlled by physical and radiological exams. The oncoplastic surgeries were offered in accordance to clinical-imaging previous to NC, final response to chemotherapy, tumor localization, tumor size, breast size, oncologic security, patient comorbidities and experience of the surgeon. The skin-sparing mastectomy with immediate breast reconstruction was also considered an oncoplastic technique. The surgical planning has involved the whole area previously marked by the tattoo regardless of tumor response. A detailed analysis of the pathological specimen was provided to confirm the oncologic safety of the treatment. All patients were followed by radiotherapy after surgery.
Results: 50 patients were enrolled. PE tumor median measurement was 6.5 cm (3.0 to 14.0 cm) and pathologic median tumor was 4.0 cm (0 to 14.5cm). Pathologic response was rated as stable disease, progressive disease, partial response and complete response in 18%, 10%, 68% and 4% of the cases, respectively. Pathologic responses were diverse and included tumor micro-fragmentation and macrofragmentation. PE tumor size before chemotherapy correlated best with MRI (ricc 0.588, p &lt; 0.001), as well as pathologic tumor size measured after chemotherapy correlated best with MRI (ricc 0.738, p &lt;0.001). The surgical approach allowed BCT in 34% (17) of patients. Skin involvement was presented in 38% of pathologic specimen regardless previous clinical exam noticed.
Conclusion: Oncoplastic techniques increase the rates of BCT for selected patients in spite of large locally advanced tumors. The surgical planning is fundamental to this approach. This study recommends the full resection of the tumoral area previous to NC, including marked skin, regardless the response to neoadjuvant treatment. Follow-up of these patients will be important for additional information in the future.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-08.
P2-15-13: Oncologic and Cosmetic Outcome in Breast Cancer Patients Who Underwent “Moving Window” Operation.
Authors: Ohno Y , Noguchi M , Nakano Y , Noguchi M , Kosaka T 
Published: June 2012

Abstract
Background: An inappropriate skin incision on the breast reduces the cosmetic benefit of breast-conserving surgery (BCS).
Methods: To improve the cosmetic outcome, we have performed “Moving window” operation in which BCS can be performed via a periareolar incision (periareolar approach) and/or axillary incision (axillary approach) under direct visualization. Axillary lymph node dissection is also performed via an axillary incision.
Results: Periareolar approach was performed in 65 patients and axillary approach in 43 patients. Average operation time was 130 minutes in periareolar approach and 131 minutes in axillary approach. Average blood loss was 37 mL and 50 mL, respectively. Postoperatively, the surgical margin of breast tissue was histologically confirmed to be negative in 107 (99%) of 108 patients, while two patients underwent reoperation because of positive surgical margin. Fifty-two patients (85%) in periareolar approach and 37 patients (86%) in axillary approach had excellent or good cosmetic results.
With a mean follow-up of 36 months, one patient with DCIS developed in-breast recurrence, while 3 patients who had neoadjuvant chemotherapy developed in-breast recurrence.
Conclusion: The moving window operation can improve a cosmetic outcome of the conserved breast without compromising the oncological safety.
Moreover, it can reduce operating time and blood loss when compared with the endoscope-assisted BCS.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-13.
P2-16-05: Delay of Adjuvant Chemotherapy after Elective Mastectomy and Immediate Reconstruction in Breast Conservation Candidates: A Matched-Pair Analysis.
Authors: Barry PN , Riley EC , Pan J , Crew JB , Lee K , Jain D , Kruse B , Quillo AR , Rai S , Dragun AE 
Published: June 2012

Abstract
Background: To analyze factors that influence the timing of adjuvant chemotherapy in patients who are candidates for breast conservation therapy (BCT) but elect mastectomy with immediate reconstruction (M-IR).
Methods: Using data from the University of Louisville Cancer Registry, we identified 35 consecutively-treated patients with stage I or II breast cancer between 2004 and 2009 who underwent M-IR and adjuvant chemotherapy. These were matched for age and AJCC stage to 35 controls who underwent BCT and adjuvant chemotherapy. We examined the timing of initiation of chemotherapy from the date of surgery and assessed the probability of therapeutic delay using univariate logistic regression and McNemar's test for matched pairs. Results: For the 70 patients included in this study, the median age was 46y (range: 30–65y), and the distribution for stage I, IIA and IIB was 22.9%, 65.7% and 11.4%, respectively. The two groups were well balanced in terms of race, rural/urban status, smoking, diabetes, insurance coverage, and histology. The median time to initiation of adjuvant chemotherapy was 38 days (range: 25–103 days) for BCT and 55 days (range: 30–165 days) for M-IR. Patients undergoing M-IR were more likely to experience any delay (&gt; 45 days; 74.3% vs. 25.7%, p &lt; 0.001) and/or significant delay (&gt;90 days; 20.0% vs. 2.9%, p &lt; 0.001) than those choosing BCT. On univariate logistic regression analysis, the extent of surgery had a major impact on the likelihood of any delay in chemotherapy (OR= 8.35, 95% C.I. = 2.86−24.3, p &lt;0.001). None of the other aforementioned factors predicted for delay. Conclusion: The use of elective mastectomy with immediate reconstruction in breast conservation candidates independently predicts for delay in initiation of adjuvant chemotherapy. Further study is needed to qualify the underlying causes of and ultimate clinical significance of these delays.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-05.
P2-16-06: A Systematic Review of Standardised Clinical Outcomes and Patient Reported Outcome Measures (PROMS) in Breast Reconstruction.
Authors: Winters ZE , Chaudhry A , Benson JR 
Published: June 2012

Abstract
Introduction: Failure to prospectively define and report surgical complications across a range of study designs is a confounding factor that fundamentally compromises the interpretation of data on health-related quality of life (HRQL) and PROMS. The UK National Mastectomy and Breast Reconstruction audit on 5000 breast reconstruction patients found higher than expected levels of complications (including rates of reoperation and levels of infection). We aimed to analyze the reporting of complications in a systematic review of all studies evaluating PROMS in breast reconstruction since 19781.
Methods: Efficace criteria for HRQL methodology were used to assess the inclusion eligibility for each study1. Two out of 34 eligible studies were excluded due to overlapping patient datasets and small numbers (n&lt;5) of breast reconstruction cases. Two reviewers examined the reporting of complications. The study designs comprised: 2 randomised controlled trials (RCT); 10 prospective longitudinal studies (PLS) and 20 retrospective studies (RS). RCTs and PLS were evaluated for predefined complications, their grading according to Clavien-Dindo2 and their integration into the evaluation of PROMS results. RS were evaluated for the reporting of complications and their statistical methodology.
Results: A total of 3213 patients were included in the 32 studies. The type of reconstruction was only recorded in 71% of patients. The majority of patients in these studies underwent abdominal flap reconstruction, compared to implant only techniques (32%), and less than 10% comprising Latissimus dorsi flaps. Only 19% of studies recorded complications with the majority (81%) failing to report any complications. Only 3 studies provided details of the numbers and level of complications amongst a total of 44 patients (1.4% of the total number of patients). Reported complications were graded and classified either as major (requiring surgical intervention) or minor comprising 55% and 45%, respectively. None of the RCT or PLS studies defined either the type or level of complications a priori, nor stratified complications based on risk factors such as age, body mass index, smoking and diabetes.
Conclusion: There is a significant under estimation of the contribution of complications to HRQL and PROMS reporting. This fact diminishes the current evidence on the effects of breast reconstruction on PROMS. There should be collective efforts to improve the standards of documentation for clinical outcomes in breast reconstruction. This together with standardized reporting of PROMS will consolidate clinical evidence upon which decision-making and provision of patient information can be confidently based.
1. Winters ZE, Benson JR, Pusic AL. Annals of Surgery 2010;252(6):929–42
2. Dindo D et al. Annals of Surgery 2004;240(2):205–213
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-06.
P2-16-09: Nipple-Areolar Sparing Mastectomy: Utility of the Lateral Inframammary Incision in Immediate Implant-Based Reconstructions.
Authors: Guth AA , Blechman K , Levovitz C , Small K , Axelrod D , Karp N , Choi M 
Published: June 2012

Abstract
Purpose: Nipple and/or areola-sparing mastectomy as a therapeutic or prophylactic procedure for breast cancer is rapidly gaining popularity as the literature continues to support it safety. The lateral inframammary fold (IMF) approach provides adequate exposure and eliminates visible scars on the anterior surface of the breast, making this incision cosmetically superior to radial or periareolar approaches.
Methods: We reviewed 58 consecutive nipple and/or areola-sparing mastectomies performed through a lateral IMF incision with immediate implant-based reconstruction, with or without tissue expansion, between June 2008 and February 2011. Prior to incision, breasts were lightly tumesced with dilute anesthetic solution with epinephrine. Sharp dissection, rather than electrocautery, was used as much as possible to minimize thermal injury to the mastectomy flap. When indicated, acellular dermal matrix was placed as an inferolateral sling. Subsequent fat grafting to correct contour deformities was performed in select patients. Three-dimensional (3D) photographs assessed changes in volume, antero-posterior projection, and ptosis. Retroareolar/nipple tissue underwent routine intraoperative frozen section analysis in cancer cases.
Results: Mean patient age was 44 years, and mean follow-up time was 14 months. Depending upon the judgment of the oncologic surgeon, 44 (76%) mastectomies were nipple/areola-sparing, and 14 (24%) were areola-sparing. Thirteen mastectomies (22%) were therapeutic, the remaining 45 mastectomies (78%) were prophylactic. Five of the nine sentinel lymph node biopsies (56%) were performed through the lateral IMF incision without the need for a counter-incision. Acellular dermal matrix was used in 44 (76%) breasts. Average permanent implant volume was 313 cc (range 170 to 750 cc), and average fat grafting volume was 90 cc (range 36 to 177 cc). Mastectomy flap necrosis, requiring operative debridement, occurred in three breasts (5%). One of these breasts required a salvage latissimus dorsi myocutaneous flap to complete the reconstruction. Of the 44 nipple/areola sparing mastectomies, three (7%) required operative debridement and reconstruction for partial nipple necrosis. No statistically significant differences existed between therapeutic and prophylactic mastectomies for developing partial skin or nipple necrosis (p = 0.65). Morphologic outcomes using 3D scan measurements showed reconstructed breasts were larger, more projected, and less ptotic (196 vs. 248 cc, 80 vs. 90 mm, 146 vs. 134 mm, p &lt; 0.01 for each parameter).
Conclusion: Excellent results can be achieved with immediate implant-based reconstruction of nipple and/or areola-sparing mastectomy through a lateral IMF incision. NAC survival is reliable, and complication rates are low.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-09.
P2-16-10: Practice Variations in Post-Mastectomy Breast Reconstruction: What Are the Roles of Clinical Factors, Access Barriers, and Delayed Reconstruction?
Authors: Cox D , Milucky J , Dominik R , Lee C 
Published: June 2012

Abstract
Background: Breast reconstruction rates vary widely by race, income, and location. Proposed explanations have included clinical contraindications to reconstruction, access barriers, and patient or surgeon preference for delayed reconstruction. We sought to determine whether clinical contraindications (planned radiation, comorbidities) or access barriers (distance to care, surgeon) were associated with reconstruction and to estimate the frequency of delayed reconstruction over time.
Methods: A retrospective cohort study was conducted among women treated with mastectomy for Stage 0-IIIa breast cancer between 2002 and 2007 at one institution. Demographics, stage, comorbidities, adjuvant therapy plans, and treatments were obtained from the medical record. Multivariable modified Poisson regression analyses were performed, with immediate and any reconstruction (immediate or delayed) as outcomes. Interaction terms were added to examine surgeon effects. Kaplan-Meier survival analysis was performed. Results: Among 539 women, 18.9% had a plan for chemotherapy; 13.7% had a plan for radiation. Comorbidities were: obesity 17.1%, diabetes 11.9%, smoking 16.3%, heart disease 5.6%, immunodeficiency 2.2%. Most patients (59.8%) lived within 50 miles of the hospital. 33.8% had immediate reconstruction; 5.6% had delayed. Patients who had a plan for adjuvant therapy or comorbidity were less likely to have reconstruction. Patients who lived farther from the hospital were slightly more likely to have reconstruction, but this was not statistically significant (p&lt;0.08). None of the associations varied significantly by surgeon. Few patients had reconstruction more than 2 years after mastectomy.

Conclusion: Clinical contraindications may explain some breast reconstruction practice variations. Few patients who defer immediate reconstruction, however, ever have delayed reconstruction.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-10.
P2-19-01: Impact of Zoledronic Acid on Fractures, Bone Mineral Density and Bone Remodeling in the AZURE Trial (BIG 01–04).
Authors: Coleman R , Woodward E , Turner L , Marshall H , Collinson M , Dodwell D , Davies C , Bell R , Cameron D , Brown J 
Published: June 2012

Abstract
Background: The AZURE trial was designed to determine whether the addition of zoledronic acid (ZOL) to standard adjuvant therapy improves disease free survival (DFS) in patients (pts) with stage II/III breast cancer. Although in a recent analysis after 752 events and a median follow-up of 59 months no difference in overall DFS was seen between ZOL and control pts, significant benefits were seen in women &gt;5years post menopause. Here, we report the impact of ZOL on fractures in the main study, and on bone mineral density (BMD) and bone remodeling evaluated within a sub-study.
Materials and methods: 3360 pts were randomized to receive (neo) adjuvant chemotherapy (CT) and/or endocrine therapy with (n=1681) or without (n=1678) up to 19 doses of ZOL 4mg over 5 years. Pts with osteoporosis and those using bisphosphonates, either at baseline or in the previous year, were excluded from study entry. BMD was assessed in 228 patients within a sub-study; 40 of these also underwent quantitative bone scanning (QBS), a novel imaging technique that yields values for 99mTc-MDP/HMDP whole skeleton plasma clearance (Kbone) as a surrogate for the rate of bone remodeling and enables assessment of specific regions of interest within the skeleton.
Results: Fractures occurred in 152 (4.5%) pts; 60 (3.6%) ZOL pts compared with 92 (5.5%) control (CTRL) pts (difference −1.9%; 95%CI −3.3%, −0.5%). The difference in fracture incidence appeared early and persisted throughout the follow-up period. Fifty-six (86.2%) of the fractures in the ZOL group and 68 (61.8%) in the CTRL group occurred in the absence of, or prior to a DFS event. The fracture rates before disease recurrence were similar at 3.0% (51 pts) in the ZOL group and 3.4% (57 pts) in the CTRL group (difference −0.4%; 95%CI −1.6%, 0.8%). In contrast, 2.1% (8 ZOL pts) and 9.1% (34 CTRL pts) experienced a fracture after a DFS event (difference −6.9%; 95% CI −10.2%, −3.7%). For pts with a DFS event, the majority of fractures occurred after a skeletal recurrence; 87.5% (7 of 8) ZOL and 88.2% (30 of 34) CTRL pts. BMD Z-scores at completion of protocol treatment were higher in patients treated with ZOL. Kbone was lower in ZOL patients (26.5 vs 29.8 ml min−1 using 99mTc-MDP and 34.3 vs 39.3 ml min−1 with 99mTc-HMDP). Expressed as a percentage of whole skeleton clearance, regional values in the mandible were similar 1.15% (ZOL) vs. 1.22% (CTRL).
Conclusions: Adjuvant ZOL given in the schedule studied in AZURE reduced the fracture rate in patients who developed recurrence of breast cancer. BMD was higher and the rate of bone remodeling less in patients treated with ZOL. Further follow-up will determine the duration and clinical relevance of these effects on bone health.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-19-01.
P2-19-03: Influence of Zoledronic Acid on BMD in Premenopausal Women with Breast Cancer and Neoadjuvant or Adjuvant Chemotherapy and/or Endocrine Treatment – The ProBone Studies.
Authors: Hadji P , Kauka A , Bauer T , Kalder M , Albert U , Birkholz K , Baier M , Muth M , Ziller M 
Published: June 2012

Abstract
Background: Based on baseline bone mineral density (BMD), adjuvant chemotherapy or endocrine therapy for early breast cancer patients can lead to substantially increased fracture risk. A significant decrease of BMD &gt;10% after 2 years of chemotherapy (CT) and/or endocrine therapy (ET) has been reported. In recent studies, zoledronic acid (ZOL) produced an increase in BMD in premenopausal and postmenopausal patients with breast cancer (ABCSG-12, Z-FAST, ZO-FAST, etc). In addition, a significant increase in disease-free survival (DFS) with ZOL vs no ZOL was observed in most of these studies.
Methods: The aim of 2 single-center, placebo-controlled, randomized studies—Probone I and Probone II—was to investigate the effect of adjuvant treatment with ZOL on BMD in premenopausal women with early breast cancer treated with CT and/or ET. Patients with hormone-receptor-negative (HR−) breast cancer (Probone I) were treated with (neo)adjuvant CT; patients with hormone-receptor-positive (HR+) breast cancer (Probone II) were treated with ET alone or in combination with (neo)adjuvant CT. Randomized patients received ZOL 4 mg or placebo IV every 3 months for 24 months. The primary objective was the change in BMD at the lumbar spine between baseline and month 24 (measured by dual-energy X-ray absorptiometry [DXA]). Secondary objectives included DFS; BMD at total hip, femur, and os calcis; quantitative ultrasonometry (QUS) at os calcis and phalanges; markers of bone turnover (C-telopeptide of type I collagen [CTX] and N-terminal propeptide of type I procollagen [P1NP]); endocrine hormones (follicle-stimulating hormone [FSH], estradiol, testosterone, sex hormone-binding globulin [SHBG], parathyroid hormone [PTH], vitamin D, anti-Müllerian hormone [AMH], inhibin A/B, etc); pathologic fractures; and safety and tolerability.
Results: 70 HR+ and 11 HR− breast cancer patients have been enrolled into the studies. The last patient will have been treated for 24 months by the end of June 2011.
Conclusions: The effects of ZOL on lumbar spine BMD at 24 months and secondary endpoints will be presented at the meeting.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-19-03.