Abstract P5-16-18: Oncologic outcomes and reconstruction quality of immediate autologous breast reconstruction in intermediate and locally advanced breast cancer

Purpose: We analyzed oncologic outcomes and reconstruction quality in locally advanced stage breast cancer after performing immediate autologous breast reconstruction (IABR).

Methods: From 2007 to 2014, data of patients with stage II-III breast cancer of ≤ 70-years-old who received total mastectomy (TM) from two institutions were extracted. Exclusion criteria were: previous contralateral breast cancer, follow-up loss before adjuvant therapy completion, and artificial reconstruction. Patients were divided into two groups; 1) TM alone and 2) TM+IABR. Overall survival (OS) and loco-regional recurrence free survival (LRRFS) were calculated and minor revision, abnormal volume on CT, and breast height change were observed.

Results: Sixty-one of 188 patients received IABR after TM. Neoadjuvant chemotherapy and postoperative radiotherapy was done in 27 and 80 patients, respectively. Fifty-nine percent, 19.2%, and 21.8% of patients were in stage II, IIIA, and IIIB-C, respectively. Stage IIIB-C was the most important prognostic factor for OS and LRRFS. In a median of 56.8 follow-up months, 5-year TM and TM+IABR OS rate were 96.8% and 100% for stage II (P=0.324) and 57.6%, 95.5% and 91.7% for stage IIIA (P=0.698), and 62.5% for stage IIIB-C (P=0.544), respectively. Five-year TM and TM+IABR LRRFS were 98.1% and 95.7% for stage II (P=0.998)91.1% and 100% for stage IIIA (P=0.277), and 70.8% and 62.5% for stage IIIB-C (P=0.378), respectively. However, two locoregional failures after 5-years were developed in stage IIIB-C of TM+IABR at 71 and 94 months. Minor revisions 3 months of IABR, including two major complications, were done in 49.2%. The reduction of breast height was 21.2% (11/52) and 31.9% (15/47) in about 18 months and about 42 months observations after IABR, respectively. The volume of abnormal imaging was over 10 cc in 27.3% (15/55) on CT of 6 months after IABR. Although minor revisions, abnormal volume on CT, and breast height change were common, they were not related to therapeutic methods, including radiotherapy and tumor stage.

Conclusions: In about 5-years follow-up, IABR did not aggravate oncologic outcomes, and adjuvant radiotherapy was not closely related with quality of reconstruction. It must be considered, however, that absolute oncologic outcomes of advanced stage were not sufficient, and minor problems post-IABR were commonly developed.

Citation Format: Yoon WS, Yang DS, Son GS, Woo SU, Kim D-W, Dhong E-S, Chang YW. Oncologic outcomes and reconstruction quality of immediate autologous breast reconstruction in intermediate and locally advanced breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-18.

Abstract P3-12-17: Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique?

Aim: Although modern radiotherapy such as field-in-field technique decreased the radiation toxicity, skin reaction is still frequent and main problem during adjuvant whole breast irradiation. Our study investigated various radiation dosimetric and clinical parameters as the risk factors of severe skin reaction.

Methods: From January 2012 to December 2014, total 219 patients with breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients took both whole breast irradiation (50 Gy/25 fractions) and boost to the tumor bed (10 - 15 Gy). Skin reaction was measured by comparing the photography of radiation field between the first day of whole breast irradiation and boost therapy. For each axilla and inferior fold, the intensity (score 1 to 5) and extent (score 0 to 1) of erythema were recorded and summed. The severe skin reaction was defined as score 5 or 6. The relations of various radiation dosimetric parameters for radiotherapy planning, personal breast characteristics and clinical factors to severe skin reaction were evaluated using the Logistic regression tests.

Results: Total 75 (34%) and 57 (26%) patients showed the severe skin reaction to axilla and inferior fold, respectively. The variables of P < 0.2 in univariate analyses including age, the body mass index, the breast height, the V100, the calculated point dose in radiation planning system, the breast separation, the field size, and the gradient of inferior fold entered the multivariate analyses. Age (P=0.013 (OR = 0.950, 95% CI 0.913 - 0.989)), the body mass index (P = 0.015 (OR = 1.123, 95% CI 1.023 - 1.233)), the calculated axilla point dose (P = 0.091 (OR = 1.064, 95% CI 0.990 - 1.142)), and the gradient of inferior fold (P = 0.073 (OR = 1.029, 95% CI 0.997 - 1.063)) were risk factors for severe axilla skin reaction, whereas age (P = 0.018 (OR = 0.948, 95% CI 0.907 - 0.991)) and the V100 (P < 0.001 (OR = 1.005, 95% CI 1.003 - 1.007)) were for severe inferior fold skin reaction.

Conclusion: In addition to clinical factor and personal breast characteristics, the radiation dosimetric parameters such as calculated point dose and V100 could be another predictive factors of severe skin reaction.

Citation Format: Yoon WS, Lee NK, Lee JA, Yang DS, Kim CY, Son GS, Chang YW. Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-17.

Robotic thyroid surgery using bilateral axillo-breast approach: personal initial experience over two years

AIM

Although endoscopic thyroid surgery is gaining wide acceptance, however, manual endoscopic operation also has shown several limitations. The advent of robotic surgical systems, such as the da Vinci surgical system (Intuitive Surgical, Mountain View, CA, USA), is expected to make it possible to overcome some limitations of manual endoscopic operation. Herein we report a single surgeon (H.Y.K.)'s initial two-year experience of new robotic thyroid operations using the bilateral axillo-breast approach (BABA), the approach which has definite advantages and recently has been widely used for the traditional endoscopic thyroid surgery.

METHODS

Between July 2008 and July 2010, 93 patients underwent robotic thyroid surgery using the BABA, with the da Vinci-S surgical system, at the Korea University Anam Hospital, Seoul, Korea. The data on the patients' clinicopathological characteristics, operation types, operation times, surgical results, postoperative hospital stays and complications were collected in a prospective manner, and later evaluated.

RESULTS

Seventy-two total thyroidectomies with or without central neck dissections mostly for the papillary carcinomas, twenty lobectomies with or without central neck dissections for the minute ‑ smaller than 0.5 cm in their maximal diameter ‑ papillary carcinomas, follicular neoplasms and benign tumors, and a bilateral subtotal lobectomy for the multinodular goiter were performed robotically. There was no conversion of robotic procedure to traditional endoscopic or open procedure. The mean total operation time was 288.5±48.0 minutes. The mean number of retrieved lymph nodes by the central neck dissection was 5.1±1.97 (range, 0-12). The mean hospital stay of the patients was 2.8±1.2 days. And the mean postoperative 3rd month serum thyroglobulin level in patients undergone total thyroidectomy was 0.3±0.14 ng/mL (range, 0.08-1.95). Three (3.2%) patients suffered from transient hoarseness postoperatively, but all of them recovered in three months. Transient hypocalcemias were observed in 17 out of 72 (23.6%) patients who had undergone total thyroidectomy, but none of them left permanent. No other complication, such as bleeding, infection, neither fluid collection, was observed.

CONCLUSION

Our initial surgical results of robotic thyroid surgery using BABA demonstrate the feasibility and safety of the procedure in the treatment of benign tumors and early differentiated carcinomas.

Lympho-Vascular Invasion by Detecting D2-40 Was the Potent Prognostic Predictor in Breast Cancer Patients

(Introduction) Distant metastasis and recurrence are the major factors of prognosis in breast cancer patients. Both of lymphovascular invasion (LVI) and blood vascular invasion (BVI) are known to be the important route for metastasis to regional lymph nodes and systemic metastasis. Despite the importance of vascular invasion as a prognostic factor, the application of vascular invasion as a histopathologic criterion is controversial. The aims of this study were to distinguish between LVI and BVI for the role of prognosis and recurrence in breast cancer patients by using an endothelial subtype specific immunohitochemical stain (podoplanin, D2-40 and CD31)Methods) Sections from 80 paraffin-embedded archival specimens of invasive breast cancer were stained for expression of podoplanin, D2-40, and CD31. The results of immunohistochemical staining were correlated with clinicopathologic features, such as tumor size, the status of lymph node metastases, estrogen receptor status, progesterone receptor status and HER2 expression, and recurrence. The patients with ductal carcinoma in situ and stage 4 breast cancer were excluded.Results) A significant correlation was found in the higher expression of D2-40, and lymph node metastasis. (P=0.02) We found a significant correlation between the expression of D2-40 and the recurrence of breast cancer. (P=0.04) However, there was no significant correlation between BVI and recurrence. A poorer disease free survival was shown in the higher expression of D2-40. (P<0.01) In multivariate analysis, the higher expression of D2-40 revealed a significant association with decreased disease-free survival.Conclusion) The higher expression of D2-40 was the more prognostic predictor than blood vascular invasion in breast cancer patients.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6171.

Nuclear factor {kappa}B inactivation in the rat liver ameliorates short term total warm ischaemia/reperfusion injury

BACKGROUND

In hepatic ischaemia/reperfusion injury, activated liver macrophages (Kupffer cells) are dominantly regulated by a transcription factor, nuclear factor kappaB (NFkappaB), with respect to expression of inflammatory cytokines, acute phase response proteins, and cell adhesion molecules.

AIMS

We assessed whether inactivation of NFkappaB in the liver could attenuate total hepatic warm ischaemia/reperfusion injury.

METHODS

We studied rats with hepatic overexpression of inhibitor kappaBalpha super-repressor (IkappaBalpha SR) caused by a transgene introduced using an adenoviral vector. Hepatic ischaemia/reperfusion injury was induced under warm conditions by total occlusion of hepatoduodenal ligament structures for 20 minutes, followed by reperfusion. Controls included uninfected and control virus (AdLacZ) infected rats.

RESULTS

IkappaBalpha SR was overexpressed in Kupffer cells as well as in hepatocytes, blocking nuclear translocation of NFkappaB (p65) into the nucleus after reperfusion. Gene transfection with IkappaBalpha SR, but not with LacZ, markedly attenuated ischaemia/reperfusion injury, suppressing inducible nitric oxide synthase and nitrotyrosine expression in the liver. Moreover, no remarkable hepatocyte apoptosis was detected under IkappaBalpha SR overexpression.

CONCLUSIONS

Adenoviral transfer of the IkappaBalpha SR gene in the liver ameliorates short term warm ischaemia/reperfusion injury, possibly through attenuation of hepatic macrophage activation.

Numerical simulation and experimental validation of the dynamics of multiple bubble merger during pool boiling under microgravity conditions

Numerical simulation and experimental validation of the growth and departure of multiple merging bubbles and associated heat transfer on a horizontal heated surface during pool boiling under variable gravity conditions have been performed. A finite difference scheme is used to solve the equations governing mass, momentum, and energy in the vapor liquid phases. The vapor-liquid interface is captured by a level set method that is modified to include the influence of phase change at the liquid-vapor interface. Water is used as test liquid. The effects of reduced gravity condition and orientation of the bubbles on the bubble diameter, interfacial structure, bubble merger time, and departure time, as well as local heat fluxes, are studied. In the experiments, multiple vapor bubbles are produced on artificial cavities in the 2-10 micrometer diameter range, microfabricated on the polished silicon wafer with given spacing. The wafer was heated electrically from the back with miniature strain gage type heating elements in order to control the nucleation superheat. The experiments conducted in normal Earth gravity and in the low gravity environment of KC-135 aircraft are used to validate the numerical simulations.

Thoracoscopic parasternal lymph node dissection for the staging of breast cancer

With the advent of advanced thoracoscopic techniques, new applications have been expanding their roles in thoracic surgery. The aim of this paper is to introduce our new thoracoscopic approach in performing parasternal lymph node dissection of advanced breast cancer for its staging. This technique does not need the removal of any costal cartilage which is usually done in the conventional classical technique after radical mastectomy. Thoracoscopic procedure, in which wide and complete parasternal lymph node dissection is done, is minimally invasive and easy to perform. Therefore, the thoracoscopic technique may be a suitable alternative to the conventional approach in the future.

Dynamics of single and multiple bubbles and associated heat transfer in nucleate boiling under low gravity conditions

Experimental studies and numerical simulation of growth and lift-off processes of single bubbles formed on designed nucleation sites have been conducted under low-gravity conditions. Merging of multiple bubbles and lift-off processes during boiling of water in the parabola flights of KC-135 aircraft were also experimentally studied. The heating area of the flat heater surface was discretized and equipped with a number of small heating elements that were separately powered in the temperature-control mode. As such, the wall superheat remained nearly constant during the growth and departure of the bubbles, whereas the local heat flux varied during the boiling process. From numerical calculation it is found that peak of heat flux occurs locally at the contact line of bubble and heater surface. Dry conditions exist inside the bubble base area, which is characterized through a zero heat flux region in the numerical calculation and a lower heat flux period in the experimental results. During the merger of multiple bubbles, dry-out continues. In both the numerical calculations and experimental results, the bubble lift-off is associated with an apparent increase in heat flux. Wall heat flux variation with time and spatial distribution during the growth of a single bubble from numerical simulations are compared with experimental data.

[A case of advanced gastric cancer with multiple liver metastases in an elderly patient that responded dramatically to UFT therapy]

An 88-year-old female patient suffering from Borrmann type 3 advanced gastric cancer complicated by multiple hepatic metastases underwent a total gastrectomy. A small dose of 200 mg/day of UFT was administered orally every day postoperatively. At postoperative month 6, a marked diminishment of the hepatic metastatic lesions was noted. Resection of the primary lesion with a regimen of a small oral dose of UFT was remarkably effective in this elderly gastric cancer patient with complications from multiple hepatic metastases.

Base specific complex formation of norfloxacin with DNA

We examined the base specificity of the norfloxacin-DNA interaction by measuring the binding constant of norfloxacin to various synthetic polynucleotides, using the Stern-Volmer and the Benesi-Hildebrand methods. The equilibrium constants were largest for poly[d(G-C)2] and poly(dG).poly(dC), suggesting that norfloxacin binds preferentially to the G-C bases of calf thymus DNA. We also found that norfloxacin has a greater affinity for purine than for pyrimidine. The binding mode of norfloxacin to double-stranded polynucleotide was studied using circular and linear dichroism (CD and LD). When the norfloxacin was complexed to poly[d(G-C)2], poly(dG).poly(dC) and DNA, all of the complexes exhibited a similar weak, positive CD band and negative LD in the 300-350-nm region. A closer examination of the LD spectra suggests that the molecular plane of norfloxacin is near perpendicular relative to DNA helix axis that excludes the groove binding mode or surface binding of norfloxacin.