Abstract P5-14-16: Hypofractionated breast irradiation in early-stage breast cancer patients following adjuvant chemotherapy: Evaluation of acute and late toxicities

Purpose

To evaluate the effect of adjuvant chemotherapy (CTX) on acute and late toxicity among women undergoing hypofractionated radiation therapy (HRT) following breast-conserving therapy and to assess the relative impact of breast size.

Materials and Methods

In this retrospective study, patients treated with HRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost (9.6 Gy in 4 fractions) between 2005 and 2009 were evaluated for inclusion. Early-stage (I-II) patients who underwent post-lumpectomy CTX prior to HRT were included. Patients who underwent neoadjuvant CTX were excluded; node positive patients and larger-breasted women (chest wall separation of >25 cm) were included. Toxicity evaluations during HRT and at 2-4 weeks, 3, 6, 9 months, and at yearly intervals were collected and graded using the RTOG Acute and Late Toxicity scales. Relevant data was available in 43 women. The median age was 60 years (35 – 71), and women were primarily of African American (55.8%) and Hispanic (27.9%) ethnicity. The majority of patients had high-grade lesions (69.8%), were Stage II (60.4%), and had T1 primaries (55.8%). Slightly more than half the patients (53.5%) were ER+; 20% were Her2 positive, and 37.2% were triple negative. Thirty-three (76.7%) were treated in the prone position. Lumpectomy cavity boosts were given via photons (58.2%) or electrons. Chemotherapy regimens included ACT (Adriamycin, Cytoxan, and Taxol) in 33/43 (76.7%) and CMF (Cytoxan, methotrexate, and 5FU) in the remainder. The median interval between completion of adjuvant CTX and the start of HRT was 41 days. The median BMI of the women was 31.8 (18.2 – 44.4; normal weight defined as BMI of 18.5 – 24.9); 11 women (25.6%) had a separation of more than 25 cm, and the median PTV volume was 1353cc (589-4213). STATA v 11 was used for all statistical analyses.

Results

The median cosmetic evaluation follow-up was 33.5 months. Forty women (93%) experienced an acute toxicity. The majority of these (31/40) were Grade 1 dermatitis with the remainder Grade 2 dermatitis (moist desquamation). There were no reported acute toxicities > Grade 2. Thirteen women (30.2%) were reported to have a late toxicity: Grade 1 skin in 9, Grade 1 subcutaneous tissue in 5, and Grade 2 subcutaneous in 2 of the 9 women with Grade 1 skin. There were no late toxicities > Grade 2. The acute and late toxicity rates of our main cohort and those with larger breasts were similar to those reported in the literature. On univariate analysis, there was no significant correlation (p>0.05) between toxicity and age, race, BMI, separation, tumor size, grade, or hormone receptor status, CTX regimen, and treatment position and duration. There was, however, a trend toward increased toxicity with a shorter interval between CTX completion and HRT start (p = 0.052).

Conclusions

The addition of adjuvant chemotherapy to the treatment regimen of breast conservation using HRT does not appear to lead to worse cosmetic outcomes. In addition, larger-breasted women, excluded from prior reports on HRT, were at no increased risk of acute or late toxicity. We found a trend toward significance suggesting that shorter intervals between CTX and HRT may be associated with increased toxicity.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-16.

Relation of excess body weight and survival in patients with esophageal adenocarcinoma: a meta-analysis

Excess body weight (body mass index >25 kg/m(2)) is common in patients with esophageal adenocarcinoma. In this study, a meta-analysis was performed by searching PubMed, Cochrane Library, EMBASE, and Science Direct databases from 1960 to June 2012. Data were extracted from studies comparing survival in obese (body mass index >30), overweight (body mass index 25-29), and normal-weight (body mass index 20-24) patients undergoing esophagectomy. A total of six studies with 1988 cases were suitable for this global meta-analysis. Compared with patients of normal weight, the hazard ratio of postoperational survival for overweight and obese patients was 0.79 (95% confidence interval 0.65-0.95, P = 0.108) and 0.80 (95% confidence interval 0.68-0.93, P = 1.00), respectably. Taken together, the excess body weight did not have the value of predicting survival for patients with esophageal adenocarcinoma.

A genome-wide analysis of the ERF gene family in sorghum

The ethylene response factor (ERF) family are members of the APETALA2 (AP2)/ERF transcription factor superfamily; they are known to play an important role in plant adaptation to biotic and abiotic stress. ERF genes have been studied in Arabidopsis, rice, grape, and maize; however, there are few reports of ERF genes in sorghum. We identified 105 sorghum ERF (SbERF) genes, which were categorized into 12 groups (A-1 to A-6 and B-1 to B-6) based on their sequence similarity, and this new method of classification for ERF genes was then further characterized. A comprehensive bioinformatic analysis of SbERF genes was performed using a sorghum genomic database, to analyze the phylogeny of SbERF genes, identify other conserved motifs apart from the AP2/ERF domain, map SbERF genes to the 10 sorghum chromosomes, and determine the tissue-specific expression patterns of SbERF genes. Gene clustering indicates that SbERF genes were generated by tandem duplications. Comparison of SbERF genes with maize ERF homologs suggests lateral gene transfer between monocot species. These results can contribute to our understanting of the evolution of the ERF gene family.

Autologous dendritic cells combined with cytokine-induced killer cells synergize low-dose chemotherapy in elderly patients with acute myeloid leukaemia

OBJECTIVES

To investigate the possibility of culturing dendritic cells (DCs) and cytokine-induced killer (CIK) cells, obtained at initial diagnosis of AML in elderly patients, and to investigate the safety and efficacy of treatment with autologous DCs and CIK cells when administered to these patients in combination with low-dose chemo therapy.

METHODS

DCs and CIK cells obtained at initial diagnosis of AML in elderly patients were cultured and used in combination with low-dose chemo therapy to treat these patients (immunotherapy group). Elderly patients with AML treated only with low-dose chemotherapy served as the control. Before treatment and on day 7 after treatment with autologous DCs and CIK cells, T cell subsets and cytokine levels were evaluated in the immunotherapy group.

RESULTS

A total of 21 elderly patients with AML were included in the immunotherapy group and 23 in the control group. The clinical efficacy in the immunotherapy group was greater than in the control group. The percentages of T cell subsets and cytokine levels after immunotherapy treatment were significantly higher than before the treatment.

CONCLUSION

Immuno therapy with autologous DCs and CIK cells was found to be a promising candidate for treatment of AML in elderly patients.

Vulvar melanoma and endometrial polyp following breast carcinoma: a case report

The authors describe the occurrence of a 55-year-old female patient presenting with a vulvar melanoma, endometrial polyp, and a prior history of breast carcinoma excised from the left chest wall, radiotherapy, chemotherapy, and tamoxifen maintenance for two years. This case exemplified second primary vulvar melanoma following breast cancer and supported that radiotherapy might play a role in the onset of secondary cancer. This case report also emphasizes the onset of endometrial polyp induced by tamoxifen.

A model of isolated, vascular whole thymus transplantation in nude rats

BACKGROUND

We used a model of vascularized thymus lobes as a whole isolated organ transplantation in rats.

MATERIALS AND METHODS

Male Fisher rats (F344, RT11v1; n = 10) and male homozygous Rowett nude rats (rnu/rnu; n = 10) were used as donors and recipients, respectively. Both vascular lobes of the thymus as a whole isolated organ were heterotopically transplanted to the neck of recipients. The right common carotid artery of the donor thymus was anastomosed end-to-end to the homonymous artery of the recipient. The anterior vena cava and the left brachiocephalic vein of the donor thymus were anastomosed end-to-side to the right and left external jugular veins of the recipient, respectively. Histological examination was used to monitor graft viability; graft function was assessed using flow cytometry (FCM) and immunologic effects by skin grafts in vivo.

RESULTS

All recipients survived. Preparation of the donors and recipients took 35.6 ± 5.5 minutes and 60.3 ± 15.1 minutes, respectively. The blood supply to the thymus graft was patent. Histology of the thymus on postoperative days 14, 56, and 112 revealed viable grafts with preserved microarchitecture. FCM analysis showed 37.18 ± 11.1% CD3+ T cells at day 21 after transplantation. Skin grafts from F344 and Rowett rats survived 8-10 and more than 30 days, respectively, whereas all third-party Sprague Dawley grafts were rejected within 5 days.

CONCLUSION

We developed a novel model of isolated, direct vascularized whole thymus transplantation in nude rats, in which both lobes of the fully vascularized thymus were harvested en bloc for successful transplantation.

Diet creates metabolic niches in the "immature gut" that shape microbial communities

Although diet composition has been implicated as a major factor in the etiology of various gastrointestinal diseases, conclusive evidence remains elusive. This is particularly true in diseases such as necrotizing enterocolitis where breast milk as opposed to commercial formula appears to confer a "protective effect" to the "immature gut." Yet the mechanism by which this occurs continues to remain speculative. In the present study we hypothesize that the basic chemical composition of diet fundamentally selects for specific intestinal microbiota which may help explain disparate disease outcome and therapeutic direction. Complimentary animal and human studies were conducted on young piglets (21 d.)(n = 8) (IACUC protocols 08070 and 08015) and premature infants (adjusted gestational age 34-36 weeks) (n = 11) (IRB Protocol 15895A). In each study, cecal or stool contents from two groups (Breast milk-fed (BF) vs. Formula-fed (FF)) were analyzed by gas chromatography/mass spectrometry (GC/MS) and comprehensive metabolic profiles generated and compared. Concurrently, bacterial community structure was assayed and respective representative microbiota of the groups determined by 16S rRNA gene amplicon pyrosequencing. Statistical modeling and analysis was done using SIMCA-P+ and R software. GC/MS metabolomics identified clear differences between BF and FF groups in the intestinal environment of piglets and humans. Sugars, amino-sugars, fatty acids, especially unsaturated fatty acids, and sterols were identified as being among the most important metabolites for distinguishing between BF and FF groups. Joint analysis of microbiota and metabolomics pinpointed specific sets of metabolites (p < 0.05) associated with the dominant bacterial taxa. The chemical composition of diet appears to have a significant role in defining the microbiota of the immature gut. Tandem analysis of intestinal microbial and metabolic profiles is potentially a powerful tool leading to better understanding of the role of diet in disease perhaps even leading to specific strategies to alter microbial behavior to improve clinical outcome.