[Neuroendocrine carcinoma of the digestive tract: a literature review]

Neuroendocrine carcinoma is a rare and agressive malignant tumor, mainly developing at the expense of the respiratory and of the digestive tract. Among the digestive tract, appendix, small bowel, and pancreas are the preferential sites of involvement, other locations have been more rarely reported. Neuroendocrine digestive tumors may present with various symptoms in relationship with their localization and a complex pathophysiology. Diagnosis is often made at an advanced stage, explaining partly the bad prognosis of these tumors. The optimal management of digestive neuroendocrine tumors is rendered difficult by their rarity and by a low number of randomized trials. We review the literature regarding epidemiologic and prognostic features of these rare tumors, their diagnostic and therapeutic care. Potential complications are also discussed.

Abstract P5-21-03: Concurrent loco-regional radiotherapy and trastuzumab in early-stage breast cancer: Long term results of prospective single-institution study

Purpose: To evaluate the early and late heart and skin toxicities, as well as the efficacy of concurrent adjuvant trastuzumab-radiotherapy (RT) for breast cancer (BC), with group with internal mammary chain (IMC) RT.

Material and methods: Prospective study of 308 patients (pts) treated between 2000 and 2009 by concurrent trastuzumab with normofractionated RT for non-metastatic BC. Left ventricular ejection fraction (LVEF) was assessed by echocardiography or myocardial scintigraphy at baseline, before and after RT, every three months for one year, then annually. A LVEF strictly lower than 55%, was considered as altered. Trastuzumab was delivered every three weeks (8 mg/kg in the first infusion then 6 mg/kg) during a median time of 12 months (3–62). All toxicities were evaluated using the Common Terminology Criteria for Adverse Effects version 3.0. Survival data were defined as the time from the histological diagnosis of BC until occurrence of the event. Loco-regional recurrence free- and alive pts were censored at the date of their last known contact. Survival and interval rates as well as their confidence interval (CI) were calculated using the Kaplan–Meier method.

Results: Median age was 52 years (25–83). Median follow-up was 50 months (13–126). The clinical tumour staging was: T0 or T1 in 131 pts (43.4%), T2 in 122 pts (40.4%), T3 or T4 in 49 pts (16.2%). The regional lymph nodes were histologically involved in 132 pts (43.0%). The left breast was treated in 155 pts (50.3%). The IMC was irradiated in 227 pts (73.7%), among them 114 (37.0%) in the left side. Before trastuzumab, anthracycline-based regimens were administered in 280 pts (90.9%). The median dose of trastuzumab was 6145 mg (1845–29180). Acute skin toxicity was acceptable with 226 (74.1%) grade 1, 67 (22.0%) grade 2 and 12 (3.9%) grade 3 skin reactions. Esophagitis was observed in 31 pts (10.0%): 26 (8.4%) grade 1; 4 (1.3%) grade 2, and 1 (0.3%) grade 3. Out of 286 pts with assessments at the median time of 23 months, late telangiectasia grade 1 occurred in 14 pts (4.9%) and grade 2 in 10 pts (3.5%), local pain grade 1 in 39 pts (13.7%) and grade 2 in 8 pts (2.8%), fibrosis grade 1 in 53 pts (18.6%) and grade 2 in 20 pts (7.0%). At the completion of RT, 11 pts (3.6%), whose cardiologic assessment at baseline was normal, presented a clinically silent LVEF alteration. During follow-up, 44 patients experienced cardio-vascular morbidity revealed by: asymptomatic LVEF alteration (50.0%), thrombo-embolic event (18.2%), tachycardia (15.9%), ischemic cardiomyopathy (6.8%), pericarditis (4.5%), hypertrophic cardiomyopathy (2.3%) or arterial hypertension (2.3%). The cumulative incidence of these events at 48 months was 13.3% CI95% [9.4; 17.2]. A symptomatic congestive heart failure was reported for 3 pts (1.0%). No death of cardiac origin was observed. At 48 months, loco-regional control was 95% CI95% [92; 98] and overall survival was 98% CI95% [96; 100].

Conclusions: In this prospective study of BC pts treated with trastuzumab and RT, both the rates of skin and esophageal toxicities were acceptable with excellent local control. Further follow-up is warranted to assess late cardiac toxicity.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-21-03.

[Gated radiotherapy in breast cancer]

Postoperative radiotherapy is a cornerstone of the local treatment in breast cancer. It has been proved with high level of evidence that it decreases local relapse and improves survival of patients. However, radiotherapy comes with healthy tissue toxicity, heart and lung in particular. With constant improvement of radiation techniques, several methods have been developed to decrease the dose to the heart and the lungs. Sometimes, respiratory maneuvers can help, due to patient's anatomy: the radiotherapy is gated with patient's breath. The Deep Inspiration Breath Hold technique is the most popular and there are several ways to perform it. This note will describe the different systems with published data in order to help the radiation oncologist in the daily practice.

Single-agent duloxetine ingestions

Duloxetine is a serotonin and norepinephrine reuptake inhibitor, which is mainly used to treat depression. This retrospective study describes the demographic and clinical effects of duloxetine ingestions reported to the National Poison Data System (NPDS). NPDS data were searched for duloxetine exposures between 2004 and 2010. A total of 11,373 patients were included and exposures were divided into three groups of ages ≤6 years old, 7–12 years and >12 years. Neurological clinical effects occurred in 6.1% of the patients aged ≤6 years, 13.0% of the patients aged 7–12 years and 24.6% of the patients aged >12 years. Cardiovascular effects occurred in 1.4% of the patients aged ≤6 years old, 2.5% of the patients aged 7–12 years and 11.6% of the patients aged >12 years. Gastrointestinal effects occurred in 4.1% of the patients aged ≤6 years old, 16.6% of the patients aged 7–12 years and 13.8% of the patients aged >12 years. Tachycardia, nausea, vomiting, agitation/irritability, dizziness/vertigo and drowsiness were among the most common clinical effects in all three groups. Overall, 61.4% of the patients aged ≤6 years and 77.5% of the patients aged 7–12 years were managed in a non–health care facility, while 55.8% of the patients aged >12 years were referred to or already in a health care facility. We conclude that the majority of ingestions are benign in both pediatrics and adults. Most symptomatic patients have neurologic, gastrointestinal and cardiovascular effects. Most pediatric patients will be able to be managed in a non–health care facility.

[A case of cutaneous mammary re-irradiation]

In early-stage breast cancer, radiotherapy delivered after conservative surgery leads to a reduction in the risk of local recurrences by approximately two thirds. However, some local recurrences can occur in a previously irradiated region and be relevant for a second radiotherapy, exposing to an increased risk of adverse effects. We describe here the observation of a 66-year-old woman treated for a triple negative ductal infiltrative carcinoma of the left breast, who presented an early locoregional recurrence, notably as skin nodules, developed within the irradiated volume and progressing on chemotherapy. The patient was treated by re-irradiation performed concomitantly to oral chemotherapy by capecitabine.

Prediction and hydrogen acceleration of ordering in iron-vanadium alloys

Ab initio calculations of binary metallic systems often predict ordered compounds in contrast to empirical reports of solid solutions or disordered phases. These discrepancies are usually attributed to slow kinetics that retains metastable structures at low temperatures. The Fe-V system is an example of this phenomenon, in which we predict two ordered stable ground states, Fe3V and FeV3, whereas a disordered σ phase is reported. We propose to overcome this difficulty by hydrogen absorption, which facilitates metal atom mobility through vacancy formation and separation between the two elements due to their opposite affinities towards it, thus accelerating transformation kinetics. Hydrogen also increases the relative stability of the ordered structures compared with that of the σ phase without affecting the shape of the phase diagram. The hydrogen-induced formation of the ordered structures is expressed by a reversible decrease of the electrical resistivity with increasing hydrogen pressure. Such behavior has not been reported before in thin H absorbing films. Formation of the ordered structures is further substantiated by the kinetics of the resistivity changes upon variation of the hydrogen pressure, where two stages are distinguished: a fast initial stage and a much slower subsequent process in which the resistivity changes direction, associated with hydrogen dissolution and phase transformation, respectively.

Rise in the number of notified human hantavirus infections since October 2011 in Baden-Württemberg, Germany

Binary file ES_Abstracts_Final_ECDC.txt matches

Rise in the number of notified human hantavirus infections since October 2011 in Baden-Wurttemberg, Germany

From October 2011 to April 2012, 852 human hantavirus infections were notified in Germany, of which 580 (68%) were in Baden-Württemberg. Case numbers started to rise earlier than they did before the previous outbreaks in 2007 and 2010, and are the largest ever reported in this state during October to April of any year. The early rise could be due to a beech mast year in 2011, followed by an early and massive reproduction of the reservoir bank vole populations during winter 2011 and spring 2012.

Studying semblances of a true killer: experimental model of human ventricular fibrillation

It is unknown whether ventricular fibrillation (VF) studied in experimental models represents in vivo human VF. First, we examined closed chest in vivo VF induced at defibrillation threshold testing (DFT) in four patients with ischemic cardiomyopathy pretransplantation. We examined VF in these same four hearts in an ex vivo human Langendorff posttransplantation. VF from DFT was compared with VF from the electrodes from a similar region in the right ventricular endocardium in the Langendorff using two parameters: the scale distribution width (extracted from continuous wavelet transform) and VF mean cycle length (CL). In a second substudy group where multielectrode phase mapping could be performed, we examined early VF intraoperatively (in vivo open chest condition) in three patients with left ventricular cardiomyopathy. We investigated early VF in the hearts of three patients in an ex vivo Langendorff and compared findings with intraoperative VF using two metrics: dominant frequency (DF) assessed by the Welch periodogram and the number of phase singularities (lasting >480 ms). Wavelet analysis (P = 0.9) and VF CL were similar between the Langendorff and the DFT groups (225 ± 13, 218 ± 24 ms; P = 0.9), indicating that wave characteristics and activation rate of VF was comparable between the two models. Intraoperative DF was slower but comparable with the Langendorff DF over the endocardium (4.6 ± 0.1, 5.0 ± 0.4 Hz; P = 0.9) and the epicardium (4.5 ± 0.2, 5.2 ± 0.4 Hz; P = 0.9). Endocardial phase singularity number (9.6 ± 5, 12.1 ± 1; P = 0.6) was lesser in number but comparable between in vivo and ex vivo VF. VF dynamics in the limited experimental human studies approximates human in vivo VF.

The presence of disseminated tumour cells in the bone marrow is inversely related to circulating free DNA in plasma in breast cancer dormancy

BACKGROUND

The aim of this study was to gain insight into breast cancer dormancy by examining different measures of minimal residual disease (MRD) over time in relation to known prognostic factors.

METHODS

Sixty-four primary breast cancer patients on follow-up (a median of 8.3 years post surgery) who were disease free had sequential bone marrow aspirates and blood samples taken for the measurement of disseminated tumour cells (DTCs), circulating tumour cells (CTCs) by CellSearch and qPCR measurement of overlapping (96-bp and 291-bp) amplicons in circulating free DNA (cfDNA).

RESULTS

The presence of CTCs was correlated with the presence of DTCs measured by immunocytochemistry (P=0.01) but both were infrequently detected. Increasing cfDNA concentration correlated with ER, HER2 and triple-negative tumours and high tumour grade, and the 291-bp amplicon was inversely correlated with DTCs measured by CK19 qRT-PCR (P=0.047).

CONCLUSION

Our results show that breast cancer patients have evidence of MRD for many years after diagnosis despite there being no overt evidence of disease. The inverse relationship between bone marrow CK19 mRNA and the 291-bp amplicon in cfDNA suggests that an inverse relationship between a measure of cell viability in the bone marrow (DTCs) and cell death in the plasma occurs during the dormancy phase of breast cancer.