Abstract P6-11-11: Characteristics of long-term survivors after brain metastases in breast cancer patients

Background: Brain metastases (BM) occur in 10%-15% patients of breast cancer patients. It is associated with poor prognosis, requiring great effort to manage local and systemic treatment for BM. The purpose of this study was to analyze the clinico-pathological characteristics of long-term survivors with BM in breast cancer patients.

Method: 63 patients with breast cancer BM diagnosed from 2002 to 2010 at the Tokyo Metropolitan Komagome hospital were included. Long–term survival group (Long) was defined as to be consisted of the patients with survival duration more than 36 months after diagnosed with BM and the patients with less than 36 month was into Short-term survival group (Short) in this study. The clinico-pathological characteristics were compared between these two groups. Survival rate and prognostic factors of BM were analyzed by the Kaplan–Meier method and employed by Log–Rank test. Multivariate analysis was performed by the Cox proportional hazard model.

Results: Median age of the 63 patients was 53 years (range, 35–78). Median survival time after BM was 12 months (range, 1–168), with about 90 percent of cause of death related to BM (e.g. failure of PS due to BM). As for ER and HER2 status, the number of ER+/HER2- (Luminal:Lum), ER+or-/HER2+ (HER2-enrich:Her2-E), ER-/HER2- (Basal:Bas) were 18, 27, 18, respectively. Among those 63 patients, 11 survived 36 months or more after BM. However, there was no difference in the rate of ER status between Long (55%) and Short (38%), there were significantly high rate of Her2-E case in Long (73%) as compared with Short (29%). Median survival duration after diagnosed with BM of Lum, Her2-E and Bas were 11, 37, 3 months, respectively. Prognosis of Bas was significantly poor (Bas vs. Her2-E p<0.001), and although Her2-E was not significant as compared with ER (p = 0.188), survival time after BM of Her2-E was the tendency to be long. In univariate analysis, Karnofsky performance status (KPS≥70 or <70), HER2 status, disease free interval (from initial diagnosis to first recurrence, DFI≥2years or <2years) had significant impact on survival time after BM. (p = 0.0458, 0.0398, 0.0385, respectively). Meningitis status was a borderline. (p = 0.052) In multivariate analysis, KPS, HER2 status and DFI were significant prognostic factors. (KPS: RR 2.08, 95% CI 1.08-4.07; HER2: RR 2.911, 95% CI 1.396- 6.484; DFI: RR 1.933, 95% CI 0.83-4.102)

Conclusions: Although, it was believed that the prognosis after BM was poor, Her2-E BM had a comparatively good prognosis. An existing report supports extension of the survival time after BM by HER2–targeted treatment in BM cases with Her2 positive breast cancer. This newest study reviles the median survival after BM as 37 months in Her2-E BM group, but that of Bas group was only 3 months and this is not improved at all compared with historically reported survival duration (2.4-4.9months). Our reports suggested that the innovation of Her2–targeted treatment leads this surprising improvement of life extension in HER2 positive BM patients but innovation of cytotoxic agents could not contribute toward improvement of clinical outcome in triple negative BM patients. So the necessity of examining the medical treatment of breast cancer BM according to subtype from now on is also considered.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-11.

Comparison of non-vertebral fracture between minodronate and risedronate therapy in elderly female patients with Alzheimer disease

OBJECTIVES

Minodronate is a nitrogen-containing bisphosphonate that is commercially available for the treatment of osteoporosis in Japan. Preclinical studies demonstrated that minodronate is at least 10 times more potent than alendronate in inhibiting bone resorption in vivo. A high incidence of fractures, particularly of the hip, represents an important problem in Alzheimer disease (AD) patients who are prone to falls and may have osteoporosis.

METHODS

A total of 256 elderly patients with AD were assigned to daily treatment with 1.0 mg of minodronate or a daily treatment with risedronate combined with daily 1000 IU ergocalciferol and 1200 mg elemental calcium, and followed up for 12 months.

RESULTS

At baseline, patients of both groups showed low 25-hydroxyvitamin D with compensatory hyperparathyroidism. Non-vertebral fractures occurred in 5 patients in the minodronate group and 7 patients in the risedronate group (5 hip fractures; one fracture each at the distal forearm and pelvis). There was no difference in risk of hip fracture between the two groups (p=.70; odds ratio=0.8).

CONCLUSIONS

The study medications were well tolerated with relatively few adverse events and were equivalent in reducing the risk of a fracture in elderly patients with AD.

Mycobacterium avium genotype is associated with the therapeutic response to lung infection

Factors that can interfere with the successful treatment of Mycobacterium avium lung infection have been inadequately studied. To identify a potent predictor of therapeutic responses of M. avium lung infection, we analyzed variable number tandem repeats (VNTR) at 16 minisatellite loci of M. avium clinical isolates. Associations between the VNTR profiling data and a therapeutic response were evaluated in 59 subjects with M. avium lung infection. M. avium lung infection of 30 subjects in whom clarithromycin-containing regimens produced microbiological and radiographic improvement was defined as responsive disease, while that of the remaining 29 subjects was defined as refractory disease. In phylogenetic analysis using the genotypic distance aggregated from 16-dimensional VNTR data, 59 M. avium isolates were divided into three clusters, which showed a nearly significant association with therapeutic responses (p 0.06). We then subjected the raw 16-dimensional VNTR data directly to principal component analysis, and identified the genetic features that were significantly associated with the therapeutic response (p <0.05). By further analysis of logistic regression with a stepwise variable-selection, we constructed the highest likelihood multivariate model, adjusted for age, to predict a therapeutic response, using VNTR data from only four minisatellite loci. In conclusion, we identified four mycobacterial minisatellite loci that together were associated with the therapeutic response of M. avium lung infections.

Life span extensions associated with upregulation of gene expression of antioxidant enzymes in Caenorhabdms elegans; studies of mutation in the AGE-1, PI3 kinase homologue and short-term exposure to hyperoxia

Life span could be modified by genetic or environmental perturbations in Caenorhabditis elegans. Here we show that two extensions of life span are associated with oxidative stress resistance and upregulation of the gene expression of antioxidant enzymes. First, mutations in age-1 gene (PI3 kinase homologue) that confer life span extension, display oxidative stress resistance and increase in the gene expression of sod-3, one of two Mn-superoxide dismutases (SOD) and ctl-1, cytosolic catalase. In this study, these traits appear to be regulated by the following genetic pathway: daf-2 (insulin receptor family)-> daf-18 (PTEN homologue)-> age-1-> daf-16 (Fork head transcription factor family), similar to the genetic pathway for the life span extension. Second, we show that short-term exposure to hyperoxia extends life span slightly but significantly. This treatment increases oxidative stress resistance and the gene expression of three types of SOD isoforms. These results suggest that both of these two life span extensions are closely related with increase in the antioxidant defense function.

Chronic atherosclerotic mesenteric ischemia that started to develop symptoms just after anaphylaxis

An 83-year-old woman was referred to our emergency department with acute urticaria and sudden shortness of breath approximately 30 min after taking rectal diclofenac potassium for lumbago. After treatment with adrenaline and corticosteroids, the patient became hemodynamically stable and left the hospital on the next day. She attended our hospital 1 week after the onset of anaphylaxis because of repeated postprandial epigastric pain. No abnormal lesions were found in endoscopy. Radiographic selective catheter angiography revealed chronic mesenteric ischemia caused by atherosclerosis and abundant collateral arteries between the celiac trunk, the superior mesenteric artery and the inferior mesenteric artery. Patients with chronic mesenteric ischemia usually present with a clinical syndrome characterized by painful abdominal cramps and colic occurring typically during the postprandial phase. Fear of eating resulted in malnutrition. She was prescribed proton pump inhibitor, digestants, anticholinergic agents, serine protease inhibitors, prokinetics, antiplatelet agents and transdermal nitroglycerin intermittently, but these had no beneficial effects. It was most probable that this patient with chronic atherosclerotic mesenteric ischemia was suffering from functional abdominal pain syndrome induced by anaphylaxis. Since psychiatric disorders were associated with alterations in the processing of visceral sensation, we facilitated the patient's understanding of functional abdominal pain syndrome with the psychologist. Postprandial abdominal pain gradually faded after administration of these drugs and the patient left the hospital. Developing a satisfactory patient-physician relationship was considered more effective for the management of persistent abdominal pain caused by complicated mechanisms.

[Biventricular repair with end-to-side aorta to pulmonary artery central shunt for ventricular septal defect, severe pulmonary stenosis with hypoplastic pulmonary artery]

The case was 11-month-old girl diagnosed as tetralogy of Fallot with severe pulmonary valve stenosis and suffering from severe cyanosis. A catheter study demonstrated pulmonary artery (PA) was well arborized, but severely hypoplastic in spite of previous transcatheter pulmonary valve dilatation; PA index was calculated as 69 mm²/m². A central end-to-side aorta to PA shunt was created. Cyanosis was well improved, but congestive heart failure occurred after 1 month from the operation. Subsequent catheter study demonstrated pulmonary artery growth, 166 mm²/m² of PA index and major aortopulmonary collateral artery (MAPCA) coil embolization was performed. Patient underwent Rastelli type definitive repair 9 month after palliation. The central end-to-side aorta to PA shunt is reported as useful measure for promoting PA size increase and definitive repair achievement in patient with pulmonary atresia, ventricular septal defect and severely hypoplastic PA. Appropriate consideration of criteria, carefull follow up and treatments are necessary.

Acute liver dysfunction in the course of norovirus gastroenteritis

A 48-year-old female with abdominal pain and malaise who showed delayed symptom of acute gastroenteritis came to see us. Her illness was diagnosed as norovirus infection, but liver dysfunction accompanied this gastroenteritis. We investigated the pathogenesis of this hepatitis for all causes including drugs, but we could not detect norovirus infection. The liver damage improved shortly in course of the gastroenteritis. She recovered completely within 2 weeks without any damage left. Norovirus-induced liver dysfunction is not known, and there is no report in the literature. We report, for the first time, the case of liver dysfunction with norovirus gastroenteritis.

Compositional Microstructure and Micromagnetics of Co-Based Thin Film Media

Elemental segregation of CoCrTa and CoCrPt thin films for longitudinal and perpendicular media is investigated using high spacial resolution transmission electron microscopes equipped with compositional analysis facilities. Strong Cr segregation exceeding 20 at% within 1.5-2 nm width is observed along the grain boundaries for both types of CoCrTa films prepared at elevated substrate temperatures. Weaker Cr segregation is observed along the grain boundaries of the longitudinal and the perpendicular CoCrPt films. The strong Cr segregation at grain boundaries is related with the small magnetic cluster size and the low media noise characteristics of CoCrTa thin film media. The Cr content inside the grain is several % lower than the average composition of the CoCrTa films. The magnetocrystalline anisotropy constants(Ku) for different Cr compositions are determined using single crystalline thin film technology to discuss the thermal stability of recorded information.

Selective Area Growth of GaN by MOVPE and HVPE

Recent successful results on the selective area growth (SAG) of GaN that has been done by MOVPE and HVPE are shown. The SAG were carried out on MOVPE-grown GaN (0001) / sapphire substrates with lined or dotted SiO2 masks. Sub-micron GaN dot and line structures are fabricated by the SAG in MOVPE, so that smoothly overgrown GaN layers are successfully realized using the epitaxially lateral overgrowth (ELO) technique. The ELO structures are confirmed to be good quality GaN single crystal with a smooth surface, no grain boundaries, and low-dislocation densities. In addition, thick GaN bulk single crystals without any cracks are grown by the SAG in HVPE. Crystalline and optical properties of the GaN bulk are much improved. The reduction in the thermal strain due to the growth on the limited area as well as the ELO are found to be effective to reduce crystalline defects of the GaN bulk single crystals.

Accelerated bone remodeling in patients with poststroke hemiplegia

A significant bone-mass reduction occurs on the hemiplegic side of stroke patients because of disuse and vitamin D deficiency. This may explain why hip fractures in poststroke patients occur almost exclusively on the hemiplegic side. To further evaluate this osteopenia, bone mineral density (BMD) in both second metacarpals was assessed in 61 patients and 28 control subjects. Serum concentrations of intact parathyroid hormone (PTH), osteocalcin (OC), tartrate-resistant acid phosphatase (TRAP), 25-hydroxyvitamin D (25-OHD), and calcium also were determined. The patients' BMD values were higher on the hemiplegic side than on the nonhemiplegic side. BMD on the hemiplegic side correlated positively with serum concentrations of PTH, OC and TRAP, which exceeded those in control subjects. Serum 25-OHD was low in patients, correlating negatively with BMD on the hemiplegic side. Serum PTH correlate positively with the levels of OC and TRAP and negatively with 25-OHD concentrations. The results indicate that skeletal remodeling is accelerated in patients with hemiplegia, with resorption predominating. We concluded that vitamin D deficiency and compensatory secondary hyperparathyroidism stimulating skeletal turnover is an important cause of osteopenia in the hemiplegic limbs of stroke patients. This osteopenia might be corrected by administration of etidronate to inhibit osteoclastic bone resorption together with a vitamin D supplement.

Appositional Bone Formation by OCP-Collagen Composite

Synthetic octacalcium phosphate (OCP) has been shown to enhance bone formation and to biodegrade if implanted into bone defects. Here, we hypothesized that an OCP-atelocollagen complex (OCP/Col) is biodegradable and can induce bone formation in a thickness-dependent manner when implanted into the calvaria. OCP/Col disks (diameter, 9 mm; thickness, 1 or 3 mm) were implanted into a subperiosteal pocket in the calvaria of 12-week-old Wistar rats for 4, 8, and 12 weeks and subsequent bone formation was monitored. X-ray diffraction analysis and Fourier transform infrared spectroscopy showed that OCP in the OCP/Col implants was converted into a carbonate-rich apatite after 4 weeks. Although thinner disks tended to be replaced by new bone, thicker disks were progressively resorbed by osteoclast-like cells until 12 weeks, possibly via the increased mechanical load in the subperiosteal pocket. Therefore, OCP/Col can increase appositional intra-membranous bone formation if the appropriate size of the implant is applied.

PDGFB quantification is a useful tool in the diagnosis of dermatofibrosarcoma protuberans: a study of 10 cases

BACKGROUND

Genetic aberrations involving the platelet-derived growth factor-beta (PDGFB) gene and the collagen type 1 alpha1 (COL1A1) gene have been implicated in the pathogenesis of dermatofibrosarcoma protuberans (DFSP), a slow-growing and locally infiltrative dermal tumour.

AIM

To investigate the genetic rearrangements in 10 patients who presented with a clinical diagnosis of DFSP.

METHODS

Total RNA was obtained from frozen sections and sections embedded in paraffin wax, and used for direct sequencing of the cDNA produced from reverse transcription (RT) PCR. The expression of PDFGB mRNA in each of these cases was also examined.

RESULTS

Of the 10 samples examined, 9 had the COL1A1/PDGFB fusion transcript by DNA sequencing. The sequenced products showed that there was a fusion between the end of exons 6, 8, 29 (two cases), 38, 25 or 47 (three cases) and the start of exon 2 of the PDGFB gene. Quantitative RT-PCR identified all samples as having significantly higher expression of the PDGFB gene compared with normal skin or dermatofibroma.

CONCLUSIONS

Detection of the COL1A1/PDGFB fusion transcript may be important for the diagnosis of DFSP. Furthermore, relative PDGFB gene quantification by real-time PCR may also provide a good diagnostic tool when other methods fail to give conclusive results.

A system for respiratory motion detection using optical fibers embedded into textiles

In this contribution, a first prototype for mobile respiratory motion detection using optical fibers embedded into textiles is presented. The developed system consists of a T-shirt with an integrated fiber sensor and a portable monitoring unit with a wireless communication link enabling the data analysis and visualization on a PC. A great effort is done worldwide to develop mobile solutions for health monitoring of vital signs for patients needing continuous medical care. Wearable, comfortable and smart textiles incorporating sensors are good approaches to solve this problem. In most of the cases, electrical sensors are integrated, showing significant limits such as for the monitoring of anaesthetized patients during Magnetic Resonance Imaging (MRI). OFSETH (Optical Fibre Embedded into technical Textile for Healthcare) uses optical sensor technologies to extend the current capabilities of medical technical textiles.