A Phase I/II Clinical Trial of Accelerated Partial Breast Irradiation Using External Beam and Image-Guidance in Early-Stage Breast Cancer Patients Treated with Breast Conservative Surgery

Purpose: To evaluate the early therapeutic outcome of accelerated partial breast irradiation(APBI) in low-risk breast cancer patients treated with breast conservative surgery(BCS) in a Chinese population, to analyze the intra-fractional and residual error with image-guidance.Material and methods: Eligible patients were age ≥18 years, unicentric Stage I invasive carcinoma or ductal carcinoma in situ(DCIS), treated with BCS with margin>2mm. Sixteen patients were enrolled between June 2008 and April 2009, with median age 53 ys (46-71). Clinical target volume(CTV) is defined by surgical cavities plus 1.5cm margin, another 1cm is expanded to form the planning target volume(PTV), with edition to no closer than 5 mm to the skin surface and no deeper than the anterior chest wall. Three-dimensional treatment plannings with field in field technique were generated with dose of 38.5Gy/10F, bid with interval≥6 hours. Two online cone beam CTs (CBCT) was acquired for each fraction, using Elekta Synergy, X- Ray Imaging system. One is after setup with skin-markers and the other at the end of fraction. Three different registrations: bony structure, grey and grey with manual adjustment(gmanual) were compared. The clip box included: whole breast, ipsilateral lung and part of the vertebras. The registration results of each fraction were recorded. The mean shifts and standard deviation (SD) were calculated on the CBCT pre and post-treatment.Results: The ratio of APBI PTV/whole breast PTV was 25%-40% (median 29.3%). 6MV photon with median fields of 4(3-6) was used. Grade I skin toxicity was found in all the 16 patients after 15-20(median 17) days of treatment, grade II skin reaction occured in 2 patients.The setup errors detected by the initial CBCT are 7mm in lateral(X), 10mm in longitudinal(Y) and 7mm in vertical directions(Z).Table 1 Setup errors detected by the differences between pre-treatment CBCT with skin marker and planning CT  grey  gmanual  x (cm)y(cm)z(cm)x (cm)y(cm)z(cm)Mean-0.010.14-0.1 0.15-0.13SD0.260.370.290.280.370.28system error0.210.320.230.210.310.23random error0.180.190.180.180.230.2margin0.650.930.700.650.940.72 The bony algorithm showed statistical difference with grey or gmanual algorithms (p<0.05). Shift was applied when the registration result by gmanual was >3mm in any directions. The residual error and intra-fraction error was then analyzed after on-line shift and the post-fraction CBCT, which resulted in 6.9mm(X)l, 6.4mm(Y)and 7.3mm (Y) directions, see Table 2.Table 2 The summary of residual errors and intra-fraction errors after shift alignment x (cm)y (cm)z (cm)mean0.010.00-0.07SD0.260.290.29system error0.210.200.23random error0.230.200.22margin0.690.640.73 Conclusion: APBI with 3-D conformal external beam and image guidance is a feasible technique. Grey registration with manual adjustment is recommended for clinical application. The initial set-up error data confirmed the safety of 1cm margin from CTV to PTV. With online shift of any error above 3mm, the combination of residual error and intra-fraction error is 6.9mm, 6.4mm and 7.3mm in X, Y and Z directions, which might provide potential for margin reduction with image guidance.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4111.

Impact of IL17B on Endothelial Cells and Angiogenesis

Introduction:Tumour angiogenesis plays a vital role in cancer development and spread. In the current study, IL17B was found to be unregulated in endothelial cells in response to Hepatocyte Growth Factor (HGF). IL17B shares structural similarities to IL17A, which has been previously proposed to promote angiogenesis and tumourgenicity, though currently the role of this cytokine in cancer or angiogenesis is largely unknown.Methods:HECV gene expression in response to HGF treatment was examined over a wide range of genes using micro array analysis to detect differential gene expression over the U133+2 chip. Recombinant human IL17B (rhIL17B) was subsequently used to treat human HECV endothelial cells over a range of concentrations. The impact of rhIL17B on HECV cell motility and angiogenic potential was assessed using Matrigel migration/wounding and tubule formation.Results:Micro array analysis detected a significant increase in IL17B expression in response to 4 hour treatment of HECV human endothelial cells with 40ng/ml HGF (p < 0.05 vs HGF untreated HECV cells). rhIL17B negatively influenced HECV tubule formation at the higher concentrations with substantial reduction in tubule formation being seen following treatment with 250ng/ml rhIL17B. Higher concentrations of rhIL17B were also seen to reduce the capacity of HECV cells to migrate in a scratch wounding assay and significant differences in migrated distance were observed following 75 minute incubation (P < 0.05 vs control untreatment group).Conclusions:Micro array analysis suggests that IL17B gene expression in the HECV human endothelial cell line can be upregulated in response to treatment with HGF. Subsequently high levels of rhIL17B were seen to negatively impact on the tubule formation and migratory capacity of this cell line. Together this data suggests that IL17B is unlikely to play a key role in the pro-angiogenic response initiated through HGF signalling but at higher concentrations may itself be able to negatively impact the angiogenic potential of the HECV endothelial cell line.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2157.

Adiposity indicators and dementia over 32 years in Sweden

BACKGROUND

High midlife and late-life adiposity may increase risk for dementia. Late-life decrease in body mass index (BMI) or body weight within several years of a dementia diagnosis has also been reported. Differences in study designs and analyses may provide different pictures of this relationship.

METHODS

Thirty-two years of longitudinal body weight, BMI, waist circumference, and waist-to-hip ratio (WHR) data, from the Prospective Population Study of Women in Sweden, were related to dementia. A representative sample of 1,462 nondemented women was followed from 1968 at ages 38-60 years, and subsequently in 1974, 1980, 1992, and 2000, using neuropsychiatric, anthropometric, clinical, and other measurements. Cox proportional hazards regression models estimated incident dementia risk by baseline factors. Logistic regression models including measures at each examination were related to dementia among surviving participants 32 years later.

RESULTS

While Cox models showed no association between baseline anthropometric factors and dementia risk, logistic models showed that a midlife WHR greater than 0.80 increased risk for dementia approximately twofold (odds ratio 2.22, 95% confidence interval 1.00-4.94, p = 0.049) among surviving participants. Evidence for reverse causality was observed for body weight, BMI, and waist circumference in years preceding dementia diagnosis.

CONCLUSIONS

Among survivors to age 70, high midlife waist-to-hip ratio may increase odds of dementia. Traditional Cox models do not evidence this relationship. Changing anthropometric parameters in years preceding dementia onset indicate the dynamic nature of this seemingly simple relationship. There are midlife and late-life implications for dementia prevention, and analytical considerations related to identifying risk factors for dementia.

Role of shear stress on nitrite and NOS protein content in different size conduit arteries of swine

AIM

Inherent fundamental difference exists among arteries of different sizes. The purpose of this study was to evaluate the relation between regional difference of wall shear stress (WSS) in various sizes arteries and contents of nitrite and NO synthase (NOS) isoforms.

METHODS

Five different conduit arteries in a wide range of diameter (1-8 mm) were examined in the hind limbs of 13 pigs. Blood flow rate and outer diameter were measured in vivo to determine WSS. Arterial tissues were harvested for the measurement of nitrite and NOS protein contents. The concentration of nitrite, a product of NO synthesis, was determined by high-performance liquid chromatography method. Western blot analysis was used to assess the protein contents of endothelial NOS (eNOS), inducible NOS (iNOS) and neuronal NOS (nNOS).

RESULTS

Our data show that WSS increases with a decrease in artery diameter. Nitrite level increases with increasing WSS and hence decreases with artery diameter. The eNOS protein contents decrease with an increase in diameter. No significant difference for iNOS and nNOS protein contents was found with different artery diameter. A significant positive correlation between tissue nitrite and eNOS protein contents was also observed. Finally, the WSS-normalized eNOS is not significantly different in various size vessels.

CONCLUSION

Regional difference in blood flow has no effect on iNOS and nNOS protein contents in these conduit arteries. Regional difference in eNOS expression and nitrite contents may be related to the WSS-induced NO by the endothelium under normal physiological conditions.

Resistive Switching in Ge0.3Se0.7 Films by Means of Copper Ion Migration

Cu/Ge0.3Se0.7/Pt cells were prepared and bipolar resistive switching in Ge0.3Se0.7 films by means of copper ion migration was examined. The cell was switched from the high to the low resistance state at about -50mV, and it was switched back to the high resistance state at about 100mV. The resistance ratio between the high and the low state was up to 200. Up to approximately 104 switching cycles were achieved. Pulse measurements showed that the two resistance states were tuneable by varying the applied voltage and the pulse length. Therefore, it is possible to store more than one bit per cell. The current density is independent of the electrode diameter, indicating that the cell can be scaled down to the range of nanometers. Due to the low switching voltages, non-destructive read out operation, high storage density, and scalability, such cells are promising for future memory applications.

Relationship between a family history of malignancy and the incidence of laryngeal carcinoma in the Liaoning province of China

OBJECTIVE

The purpose of this study was to determine the contribution of family history of malignancy to the incidence of laryngeal squamous cell carcinoma.

DESIGN

We performed a retrospective review of classified statistics from the detailed information of cases and matched controls.

SETTING

First Hospital of China Medical University in the Liaoning province of China, between October 2005 and November 2007.

PARTICIPANTS

A total of 288 previously untreated patients with laryngeal cancer and 296 control subjects with non-malignant diseases were analysed by use of a hospital-based case-control study.

MAIN OUTCOME MEASURES

Incidence rates and family history of malignancy.

RESULTS

Single-factor logistic regression analysis indicated that the odds ratio value of a family history of malignancy was 2.0 (95% confidence interval: 1.3-3.2). Multiple logistic regression analysis confirmed this result, with an odds ratio value of 2.3 (95% confidence interval: 1.2-4.5). There was significant association between a family history of malignancy and the development of laryngeal squamous cell carcinoma.

CONCLUSIONS

A family history of malignancy plays an important role in and is an independent risk factor for the incidence of laryngeal carcinoma.

Identification of a novel mutation in a Chinese family with X-linked ocular albinism

PURPOSE

The purpose of the study was to evaluate the GPR143 gene (G-protein coupled receptor 143) in a Chinese three-generation family with OA1, including four carriers and a proband with clinical features of X-linked ocular albinism.

METHODS

The proband underwent a detailed ophthalmologic evaluation. Blood samples of family members were obtained and genomic DNA isolated. Mutational analysis by SSCP and direct sequencing of the GPR143 gene was used to screen all nine exons including the intron/exon junctions. The novel mutation c.943G>T (p.G315X) found in the study was confirmed by DHPLC to exclude the possibility of polymorphism.

RESULTS

Ophthalmic features of the proband were characteristic of X-linked ocular albinism. The authors identified a novel nonsense mutation p.G315X on exon 8 that was not found in 100 non-albinism subjects by DHPLC. This novel mutation in the GPR143 gene is predicted to subject to nonsense mediated decay.

CONCLUSIONS

The novel mutation p.G315X in the OA1 gene was identified in a Chinese family with ocular albinism, which is predicted to generate a premature stop codon. These findings extend the mutational spectrum of GPR143 gene and will be useful for gene diagnosis and genetic counseling in Chinese OA1 patients.

Effect of metronomic use of zoledronic acid (ZOL) on antitumor and antiosteoclastic effects in breast cancer patients with bone metastasis

e14603

Background: Zoledronic acid (ZOL) can reduce the risk of skeletal-related events (SREs) and may have direct and indirect antitumor effects, which have been shown in animal models, pilot clinical studies as well as in recent phase III randomized trials. However, the pharmacokinetics of the drug in breast cancer patients remains to be elucidated and optimized. The purpose of this randomized study was to compare the effects of ZOL on osteoclasts and angiogenesis between a weekly low-dose versus a conventional dosage. Methods: Sixty breast cancer patients with bone metastases were recruited in this randomized phase II clinical study. The participants either received ZOL 1mg IV weekly for 4 doses or a single dose of ZOL 4mg IV. No other antitumor treatments were administered. During the first month after initial infusion of ZOL, serial blood samples were collected on day 1, 15 and 29 measuring markers for bone resorption (NTx), angiogenesis (VEGF), and tumor burden (CEA and CA15–3). Results: Compared to a single-dose administration, weekly low dose of ZOL resulted in a greater reduction in serum levels of VEGF and NTx, with a significant trend over time during one month observation. There were no statistically significant differences in circulating levels of CEA and CA15–3 between the two dosing regimens. Patients who received metronomic ZOL had a longer median time to disease progression (TTP) (7.0 months, 95%CI, 6.1–7.9 months) than those who had a single dose of ZOL (2.8 months, 95%CI, 0–5.7 months; p=0.076). Conclusions: The metronomic use of low-dose ZOL 1 mg appeared to be more effective than the conventional regimen in the long-lasting reduction of VEGF and NTx, and in prolonging TTP. This dosing schedule should be further assessed in phase III trials as we demonstrated that ZOL 1mg has greater antitumor properties in our study.

No significant financial relationships to disclose.

[Establishment of a rabbit model of Acanthamoeba keratitis]

AIM

To establish an animal model of Acanthamoeba keratitis.

METHODS

Six New Zealand white rabbits were each injected intrastromally with Acanthamoeba suspension 3 days after subconjunctival injection with dexamethasone.

RESULTS

All of the 6 rabbits developed keratitis. Acanthamoeba protozoa were identified by the methods of corneal scraping with 10% potassium hydroxide wet mount examined under microscope, corneal protozoa culture and pathological section examination.

CONCLUSION

A rabbit model of Acanthamoeba keratitis was established.

Cluster characterization of mouse embryonic stem cell-derived pluripotent embryoid bodies in four distinct developmental stages

The formation of embryoid bodies (EBs) is the principal step in the differentiation of embryonic stem (ES) cells. In this study, the morphological characteristics and gene expression patterns of EBs related to the sequential stages of embryonic development were well defined in four distinct developmental groups over 112 days of culture: early-stage EBs groups (1-7 days of differentiation), mid-stage EBs groups (9-15 days of differentiation), maturing EBs groups (17-45 days of differentiation) and matured EBs groups (50 days of differentiation). We first determined definite histological location of apoptosis within EBs and the sequential expression of molecular markers representing stem cells (Oct4, SSEA-1, Sox-2 and AKP), germ cells (Fragilis, Dazl, c-kit, StellaR, Mvh and Stra8), ectoderm (Neurod, Nestin and Neurofilament), mesoderm (Gata-1, Flk-1 and Hbb) and endoderm (AFP and Transthyretin). Our results revealed that developing EBs possess either pluripotent stem cell or germ cell states and that three-dimensional aggregates of EBs initiate mES cell differentiation during prolonged culture in vitro. Therefore, we suggest that this EB system to some extent recapitulates the early developmental processes occurring in vivo.

A comparative study on urinary purine derivative excretion of yak (Bos grunniens), cattle (Bos taurus), and crossbred (Bos taurus x Bos grunniens) in the Qinghai-Tibetan plateau, China

Two experiments were conducted to determine the urinary purine derivative (PD) excretion rates and to analyze potential variations in PD excretions between yak, Tibetan indigenous cattle, and their crossbreds under similar ecological environment, and to develop prediction equations based on PD excretion for estimating rumen microbial protein supply. Three Tibetan castrated male yaks, and similar numbers of indigenous cattle and their crossbreds, were used in a fasting trial followed by a feeding trial, using three 3 x 3 Latin squares (1 for each breedtype), to measure responses of PD excretion to different feeding levels. The results showed that i) daily endogenous PD excretion for yak, indigenous cattle, and their crossbreds was 134, 163, and 138 micromol/kg of BW(0.75) (P = 0.38), respectively; and ii) crossbreds have greater PD excretion rate per unit digestible OM intake than indigenous cattle (P = 0.03). However, there were no significant differences between yaks and the crossbreds (P = 0.24) or between yaks and the indigenous cattle (P = 0.25). The proportion of allantoin to total PD in urine ranged from 0.83 to 0.88, with the crossbreds having greater values compared with the 2 parents (P = 0.03). Daily glomerular filtration rate, calculated using endogenous creatinine as an internal marker, for the above animals was 3.85, 4.23, and 3.61 L/kg of BW(0.75), respectively, in fasting trial (P = 0.59). The alpine animals may develop special regulating mechanisms in the kidney in terms of glomerular filtration rate and PD excretion, which would help the animals in adapting to the harsh environment of the Qinghai-Tibetan plateau.

Radiotherapeutic management of isolated local-regional recurrence following mastectomy

Abstract #5135

Background: Postmastectomy isolated local-regional recurrence(ILRR) remains a therapeutic challenge. This retrospective study aims to evaluate the role of radiotherapy(RT) in these patients and to analyze factors that influence local-regional control and survival.
 Methods: 255 pts with chest-wall(CW) and/or regional nodes recurrence(supraclavicular SC, axillary AXI and internal mammary nodes IMN) as first failure and received RT during 1990 and 2005 were analyzed, included 109 CW recurrence only, 114 regional nodes only and 32 pts with both, resulted in 304 recurrent sites. The median dose was 60Gy(47-74). Systemic treatment was give to 190 pts, including chemotherapy in 171, endocrine therapy(ET) in 69, and both in 41 pts.
 Results: The median disease-free interval(DFI) was 22 mo(2-260 mo), which were 37 and 17 mo in pts with positive hormonal receptor (HR) and negative HR respectively. Median follow-up was 45 mo (9 mo -15.5 yrs). The 2, 5 and 8-yr overall survival rate was 86.4%, 56.5% and 35% respectively. Median survival time after recurrence was 79 mo. The 2, 5 and 8-yr local control rate was 56.1%, 36.3% and 27.6% respectively. 79 second recurrence in the initial recurrent region and 83 subsequent recurrence in other local-regional sites were found.
 
 CW is the most common site of second recurrence. Multivariate analysis showed that no CW involvement, non-diffuse recurrence and radiation to the entire recurrent region were independent prognostic factors on local control of initial recurrent sites. ET proved to be the only independent prognostic factors on subsequent recurrence in other sites. In pts with CW recurrence, small field(67 pts) resulted in significantly lower 5-yrs local control compared to entire CW irradiation(74 pts) (33.6% vs 55.6%, p=0.023). Cox regression model found that DFI≥1yr, positive HR, solitary CW or non-supraclavicular nodal recurrence were independent favorable prognostic factors on overall survival .
 Conclusions: RT is an effective approach for ILRR after mastectomy. Radiation fields should cover the entire recurrent region. Elective irradiation to the CW in pts with nodal recurrence is recommended. Prognostic Index based on the positive multivariate analysis could be established as to stratify different prognostic sub-groups.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5135.

A generalized Maxwell model for creep behavior of artery opening angle

An artery ring springs open into a sector after a radial cut. The opening angle characterizes the residual strain in the unloaded state, which is fundamental in understanding stress and strain in the vessel wall. A recent study revealed that the opening angle decreases with time if the artery is cut from the loaded state, while it increases if the cut is made from the no-load state due to viscoelasticity. In both cases, the opening angle approaches the same value in 3 h. This implies that the characteristic relaxation time is about 10,000 s. Here, the creep function of a generalized Maxwell model (a spring in series with six Voigt bodies) is used to predict the temporal change of opening angle in multiple time scales. It is demonstrated that the theoretical model captures the salient features of the experimental results. The proposed creep function may be extended to study the viscoelastic response of blood vessels under various loading conditions.

RNA interference-mediated silencing of the polo-like kinase 1 gene enhances chemosensitivity to gemcitabine in pancreatic adenocarcinoma cells

Gemcitabine is the first-line chemotherapeutic agent for advanced adenocarcinoma of the pancreas; however, chemoresistance to gemcitabine remains a major cause of failure for the clinical treatment of this disease. Polo-like kinase 1 (Plk-1) is highly expressed in pancreatic cancer cell lines and pancreatic tumour tissues, and is involved in a wide variety of cell cycle processes. Nevertheless, its biological role and implication for gemcitabine resistance are not clearly defined. In this study, we used RNA-interference (RNAi)-mediated depletion of Plk-1 to determine its potential for sensitizing pancreatic tumour cells to gemcitabine. We showed that the level of Plk-1 protein was correlated significantly with gemcitabine resistance in human pancreatic adenocarcinoma cells and that overexpression of Plk-1 reduced sensitivity to gemcitabine in these cells. In addition, small interfering RNA (siRNA)-mediated knockdown of Plk-1 caused cell cycle arrest at G2/M and the reduction of cellular proliferation. More importantly, the treatment of pancreatic cancer cells with Plk-1 siRNA followed by exposure to gemcitabine dramatically decreased cell viability and increased cellular apoptosis, as compared with treatment with either agent alone. These observations indicate that down-regulation of Plk-1 expression by RNAi enhances gemcitabine sensitivity and increases gemcitabine cytotoxicity in pancreatic tumour cells. This is the first demonstration that the combination of Plk-1 gene therapy and gemcitabine chemotherapy has synergistic anti-tumour activity against pancreatic carcinoma in vitro. This combination treatment warrants further investigation as an effective therapeutic regimen for patients with resistant pancreatic cancer and other tumours.

Prevalence of CT-detected cerebral abnormalities in an elderly Swedish population sample

OBJECTIVE

To measure the prevalence of computed tomography (CT)-detected cerebral lesions in a population-based sample of elderly persons living in Göteborg, Sweden.

METHODS

Cerebral CT-scans were performed in the case of 466 women (mean age 74.3 +/- 5.1 years) and 191 70-year-old men. A single rater assessed white matter lesions (WML) using four different scales, lacunar lesions, large infarcts, cortical atrophy, and basal ganglia calcifications.

RESULTS

White matter lesions frequency assessed by different scales ranged between 54.5% and 68.5%. Lacunar lesions were detected in 46.7% (30.1% had lacunes >5 mm) and cerebral infarcts in 3.0% of participants. Overall, 72.8% of participants evidenced cerebral vascular abnormalities. Severe cortical atrophy was more common in temporal (6.4%) and frontal (6.7%) lobes, than in parietal (1.7%) and occipital (1.1%) lobes. Basal ganglia calcifications were found in 38.7% of participants. WML, lacunar lesions, large infarcts, and degree of cortical atrophy correlated positively with age. More lacunes, basal ganglia calcifications, and occipital lobe atrophy were associated with male gender.

CONCLUSIONS

Vascular and other brain lesions are very common on CT-scan in an elderly population, but large vascular lesions are rare. This study provides the first reference for the prevalence of CT-detected abnormalities in an elderly Swedish population.