Comparison of two deep-learning image reconstruction algorithms on cardiac CT images: A phantom study

PURPOSE

The purpose of this study was to compare the performance of Precise IQ Engine (PIQE) and Advanced intelligent Clear-IQ Engine (AiCE) algorithms on image-quality according to the dose level in a cardiac computed tomography (CT) protocol.

MATERIALS AND METHODS

Acquisitions were performed using the CT ACR 464 phantom at three dose levels (volume CT dose indexes: 7.1/5.2/3.1 mGy) using a prospective cardiac CT protocol. Raw data were reconstructed using the three levels of AiCE and PIQE (Mild, Standard and Strong). The noise power spectrum (NPS) and task-based transfer function (TTF) for bone and acrylic inserts were computed. The detectability index (d') was computed to model the detectability of the coronary lumen (350 Hounsfield units and 4-mm diameter) and non-calcified plaque (40 Hounsfield units and 2-mm diameter).

RESULTS

Noise magnitude values were lower with PIQE than with AiCE (-13.4 ± 6.0 [standard deviation (SD)] % for Mild, -20.4 ± 4.0 [SD] % for Standard and -32.6 ± 2.6 [SD] % for Strong levels). The average NPS spatial frequencies shifted towards higher frequencies with PIQE than with AiCE (21.9 ± 3.5 [SD] % for Mild, 20.1 ± 3.0 [SD] % for Standard and 12.5 ± 3.5 [SD] % for Strong levels). The TTF values at fifty percent (f50) values shifted towards higher frequencies with PIQE than with AiCE for acrylic inserts but, for bone inserts, f50 values were found to be close. Whatever the dose and DLR level, d' values of both simulated cardiac lesions were higher with PIQE than with AiCE. For the simulated coronary lumen, d' values were better by 35.1 ± 9.3 (SD) % on average for all dose levels for Mild, 43.2 ± 5.0 (SD) % for Standard, and 62.6 ± 1.2 (SD) % for Strong levels.

CONCLUSION

Compared to AiCE, PIQE reduced noise, improved spatial resolution, noise texture and detectability of simulated cardiac lesions. PIQE seems to have a greater potential for dose reduction in cardiac CT acquisition.

Comparison of low-energy virtual monoenergetic images between photon-counting CT and energy-integrating detectors CT: A phantom study

PURPOSE

The purpose of this study was to assess image quality and dose level using a photon-counting CT (PCCT) scanner by comparison with a dual-source CT (DSCT) scanner on virtual monoenergetic images (VMIs) at low energy levels.

MATERIALS AND METHODS

A phantom was scanned using a DSCT and a PCCT with a volume CT dose index of 11 mGy, and additionally at 6 mGy and 1.8 mGy for PCCT. Noise power spectrum and task-based transfer function were evaluated from 40 to 70 keV on VMIs to assess noise magnitude and noise texture (fav) and spatial resolution on two iodine inserts (f50), respectively. A detectability index (d') was computed to assess the detection of two contrast-enhanced lesions according to the energy level used.

RESULTS

For all energy levels, noise magnitude values were lower with PCCT than with DSCT at 11 and 6 mGy, but greater at 1.8 mGy. fav values were higher with PCCT than with DSCT at 11 mGy (8.6 ± 1.5 [standard deviation [SD]%), similar at 6 mGy (1.6 ± 1.5 [SD]%) and lower at 1.8 mGy (-17.8 ± 2.2 [SD]%). For both inserts, f50 values were higher with PCCT than DSCT at 11- and 6 mGy for all keV levels, except at 6 mGy and 40 keV. d' values were higher with PCCT than with DSCT at 11- and 6 mGy for all keV and both simulated lesions. Similar d' values to those of the DSCT at 11 mGy, were obtained at 2.25 mGy for iodine insert at 2 mg/mL and at 0.96 mGy for iodine insert at 4 mg/mL at 40 keV.

CONCLUSION

Compared to DSCT, PCCT reduces noise magnitude and improves noise texture, spatial resolution and detectability on VMIs for all low-keV levels.

Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria

OBJECTIVE

To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA.

METHODS

This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA.

RESULTS

Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ.

CONCLUSIONS

We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.

CLINICAL RELEVANCE STATEMENT

The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis.

KEY POINTS

• Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.

Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration

BACKGROUND

Articular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard.

MATERIALS AND METHODS

Ten fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique).

RESULTS

Standard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001).

CONCLUSIONS

Standard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases. Level of Evidence Not applicable.

Brittle Bone Imaging: Diagnostic Procedures in Adults

This article concentrates on generalized disorders causing bone fragility. The most frequent cause of brittle bone disease is osteoporosis, only diagnosed by elimination. First, malignant osteopathy must be ruled out: fracture on metastasis or multiple myeloma, which mimics osteoporosis when presenting as diffuse demineralization. Second, patients should be screened for signs of hyperparathyroidism or osteomalacia. Much more rarely, many other pathologies can lead to brittle bone by demineralization or associated increased bone density.The radiologist needs to know the clinical context and notably the patient's age (childhood or adulthood) at discovery, and known pathologies and ongoing or previous treatments: corticotherapy, bisphosphonates, denosumab, or prior radiotherapy in the affected region. Diagnostic hypotheses are guided by the type of demineralization and the presence of lytic, mixed, or densifying areas. Lastly, the aspect and location of fractures and association with other bone abnormalities refine the diagnosis.

Impact of the automatic tube current modulation (ATCM) system on virtual monoenergetic image quality for dual-source CT: A phantom study

PURPOSE

To assess the impact of the automatic tube current modulation (ATCM) on virtual monoenergetic images (VMIs) quality in dual-source CT(DSCT).

MATERIALS AND METHODS

Acquisitions were performed on DSCT using the Mercury phantom. The acquisition parameters for an abdomen-pelvic examination with single-energy CT(SECT) and dual-energy CT(DECT) imaging were used. Acquisitions were performed for each imaging mode using fixed mAs and ATCM. The mAs value was set to obtain a volume CT dose index of 11 mGy in fixed mAs acquisitions. This value was used as the reference mAs in ATCM acquisitions. The noise power spectrum and task-based transfer function at 40,50,60 and 70 keV levels were computed on VMIs and SECT images. The detectability index (d') was calculated for a lesion with an iodine concentration of 10 mg/mL.

RESULTS

The noise magnitude on VMIs was higher with the ATCM system than with fixed mAs for all energy levels and section diameters of 21,26 and 31 cm. The noise texture and spatial resolution were similar between the fixed mAs and ATCM acquisitions for both imaging modes. The d' values were lower for all energy levels with ATCM than with fixed mAs acquisitions for 21 and 26 cm diameters by -39.82 ± 9.32%, similar at 31 cm diameter -4.13 ± 0.24% and higher at 36 cm diameter 10.40 ± 6.69%. It was higher on VMIs at all energy levels compared to SECT images.

CONCLUSIONS

The ATCM system could be used with DECT imaging to optimize patient exposure without changing the noise texture and spatial resolution of VMIs compared to fixed mAs and SECT.

Tissue-Sparing Outcome of Mohs Micrographic Surgery in Squamous Cell Carcinomas

BACKGROUND

Micrographic Mohs Surgery (MMS) offers the highest cure rates and healthy skin tissue sparing effect compared with standard excision.

OBJECTIVE

To quantify the tissue-sparing properties of MMS in squamous cell carcinoma (SCC) in comparison with standard excision (SE).

METHODS

A bidirectional, descriptive study, including 94 cases of SCC, was performed, on patients with histologic diagnosis of SCC (in situ, well differentiated, moderately differentiated, and undifferentiated), that where operated with MMS between 2013 and 2018 at Hospital de Clínicas Dr. Manuel Quintela in Montevideo, Uruguay. Tumor size and defect area after MMS were measured in 2 perpendicular directions. The suspected defect area was calculated with standard excision using a 4-mm margin for low risk lesions and a 10-mm margin for high risk lesions. The primary outcome of this study was the size of the defect area post MMS compared with the calculated defect area with standard excision.

RESULTS

The median tumor size was 1,41mm², and the median defect size after MMS was 4,12mm². The median defect size calculated for standard surgical excision was 8,36mm².

LIMITATIONS

We do not use all National Comprehensive Cancer Network (NCCN) criteria. We define low and high risk lesions just taking into account anatomical location, size, histopathology and whether it was a primary or recurrent tumor.

CONCLUSION

Our results show that MMS has a tissue-sparing effect of at least 52% compared to SE.

In vitro and in vivo antimicrobial activity of sodium colistimethate and amikacin-loaded nanostructured lipid carriers (NLC)

Sodium colistimethate (SCM) and amikacin (AMK) are among the few antibiotics effective against resistant P. aeruginosa, K. pneumoniae and A. baumannii; however, their toxicity severely limits their use. Enclosing antibiotics into nanostructured lipid carriers (NLC) might decrease drug toxicity and improve antibiotic disposition. In this work, SCM or AMK was loaded into different NLC formulations, through high pressure homogenization, and their in vitro and in vivo effectiveness was analyzed. The encapsulation process did not reduce drug effectiveness since in vitro SCM-NLC and AMK-NLC drug activity was equal to that of the free drugs. As cryoprotectant, trehalose showed better properties than dextran. Instead, positive chitosan coating was discarded due to its limited cost-efficiency. Finally, the in vivo study in acute pneumonia model revealed that intraperitoneal administration was superior to the intramuscular route and confirmed that (-) SCM-NLC with trehalose, was the most suitable formulation against an extensively drug-resistant A. baumannii strain.

0088 Gravity Dreams Following a Virtual Reality Flight Simulation

Introduction

Flying is a prevalent but infrequent experience in dreams. Despite a broad interest in such unique dream experiences, there is still no experimental procedure for reliably inducing them. Our study aimed 1) to induce flying dreams in the laboratory using virtual reality (VR), 2) to examine phenomenological correlates of flying dreams, such as lucidity and emotions and 3) to investigate the dynamics of dreamed gravity imagery in relation to participant state and trait factors.

Methods

A total of 137 healthy participants (24.01±4.03 y.o.; 85 F; 52 M) took part in a custom-built immersive VR task in which they learn how to ‘fly’ as precisely and quickly as possible, engaging vestibular, motor and visuo-spatial systems. Dreams were collected a) from home dream journals for 5 days before and 10 days after the laboratory VR task and b) after a 90-min morning nap in laboratory. Dream reports were scored by 2 independent judges for flying and other gravity-related imagery. Linear mixed models statistics were used to compare dreams from this cohort with a separate control cohort (N=52) that followed a similar protocol in the same lab but did not undertake a virtual flying task.

Results

The VR task successfully increased the likelihood of experiencing flying in dreams from both the laboratory nap (7.1%) and the following night (10.6%) compared to baseline (1.3%) and the control cohort on those days (Lab: 2.4%; following night: 0%). In contrast, the occurrence of other gravity imagery showed no differences. Flying dreams were altered qualitatively, exhibiting higher levels of lucid-control and emotional intensity after VR exposure. Moreover, various factors such as sex, prior dream experiences and sensory immersion in VR differentially modulated flying dream induction.

Conclusion

Our findings provide both quantitative and qualitative insights into flying dreams that may facilitate understanding of these typical dream experiences and future developments in dream flight-induction technologies.

Support

Natural Sciences and Engineering Research Council of Canada

Chronic obstructive pulmonary disease (COPD) in Spain and the different aspects of its social impact: a multidisciplinary opinion document

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.

SEOM clinical guideline in nasopharynx cancer (2017)

Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiation therapy is an essential component of curative-intent of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.

Stability study of sodium colistimethate-loaded lipid nanoparticles

In the last decades, the encapsulation of antibiotics into nanoparticulate carriers has gained increasing attention for the treatment of infectious diseases. Sodium colistimethate-loaded solid lipid nanoparticles (Colist-SLNs) and nanostructured lipid carriers (Colist-NLCs) were designed aiming to treat the pulmonary infection associated to cystic fibrosis patients. The nanoparticles were freeze-dried using trehalose as cryoprotectant. The stability of both nanoparticles was analysed over one year according to the International Conference of Harmonisation (ICH) guidelines by determining the minimum inhibitory concentration (MIC) against clinically isolated Pseudomonas aeruginosa strains and by studying their physico-chemical characteristics. The results showed that Colist-SLNs lost their antimicrobial activity at the third month; on the contrary, the antibacterial activity of Colist-NLCs was maintained throughout the study within an adequate range (MIC ≤16 μg/mL). In addition, Colist-NLCs exhibited suitable physico-chemical properties at 5 °C and 25 °C/60% relative humidity over one year. Altogether, Colist-NLCs proved to have better stability than Colist-SLNs.

Ground-Truthing Validation to Assess the Effect of Facility Locational Error on Cumulative Impacts Screening Tools

Researchers and government regulators have developed numerous tools to screen areas and populations for cumulative impacts and vulnerability to environmental hazards and risk. These tools all rely on secondary data maintained by government agencies as part of the regulatory and permitting process. Stakeholders interested in cumulative impacts screening results have consistently questioned the accuracy and completeness of some of these datasets. In this study, three cumulative impacts screening tools used in California were compared, and ground-truth validation was used to determine the effect database inaccuracy. Ground-truthing showed substantial locational inaccuracy and error in hazardous facility databases and statewide air toxics emission inventories of up to 10 kilometers. These errors resulted in significant differences in cumulative impact screening scores generated by one screening tool, the Environmental Justice Screening Method.

SEOM clinical guidelines for the treatment of head and neck cancer (HNC) 2013

Head and neck cancer represents 5 % of oncologic cases in adults. Early stage treatments are local with surgery and/or radiotherapy. For locally advanced stages, treatment requires radiotherapy combined with platinum-based drugs or cetuximab. Induction chemotherapy should be considered for selected cases. In the case of metastatic disease, adjuvant or palliative treatment is based on platinum agents and cetuximab.

SEOM clinical guidelines for the treatment of nasopharyngeal carcinoma 2013

Nasopharyngeal carcinoma cases are not frequently encountered in our environment. Local stages are treated with radiotherapy. For advanced local stages, the association of chemotherapy with radiotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum-based chemotherapy and patients may achieve a long survival time.

The state-of-the-art of approved and under-development cholera vaccines

Cholera remains a huge public health problem. Although in 1894, the first cholera vaccination was reported, an ideal vaccine that meets all the requirements of the WHO has not yet been produced. Among the different approaches used for cholera vaccination, attenuated vaccines represent a major category; these vaccines are beneficial in being able to induce a strong protective response after a single administration. However, they have possible negative effects on immunocompromised patient populations. Both the licensed CVD103-HgR and other vaccine approaches under development are detailed in this article, such as the Vibrio cholerae 638 vaccine candidate, Peru-15 or CholeraGarde(®) and the VA1.3, VA1.4, IEM 108 VCUSM2 and CVD 112 vaccine candidates. In another strategy, killed V. cholerae vaccines have been developed, including Dukoral(®), mORCAX(®) and Sanchol™. The killed vaccines are already sold, and they have successfully demonstrated their potential to protect populations in endemic areas or after natural disasters. However, these vaccines do not fulfill all the requirements of the WHO because they fail to confer long-term protection, are not suitable for children under two years, require more than a single dose and require a distribution chain with cold storage. Lastly, other vaccine strategies under development are summarized in this review. Among these strategies, vaccine candidates based on alternative drug delivery systems that have been reported lately in the literature are discussed, such as microparticles, proteoliposomes, LPS subunits, DNA vaccines and rice seeds containing toxin subunits. Preliminary results reported by many groups working on alternative delivery systems for cholera vaccines demonstrate the importance of new technologies in addressing old problems such as cholera. Although a fully ideal vaccine has not yet been designed, promising steps have been reported in the literature resulting in hope for the fight against cholera.

Molecular modeling and simulation of membrane lipid-mediated effects on GPCRs

Functioning of G protein-coupled receptors (GPCRs) is tightly linked to the membrane environment, but a molecular level understanding of the modulation of GPCR by membrane lipids is not available. However, specific receptor-lipid interactions as well as unspecific effects mediated by the bulk properties of the membrane (thickness, curvature, etc.) have been proposed to be key regulators of GPCR modulation. In this review, we examine computational efforts made towards modeling and simulation of (i) the complex behavior of membrane lipids, (ii) membrane lipid-GPCR interactions as well as membrane lipid-mediated effects on GPCRs and (iii) GPCR oligomerization in a native-like membrane environment. We propose that, from the perspective of computational modeling, all three of these components need to be addressed in order to achieve a deeper understanding of GPCR functioning. Presently, we are able to simulate numerous lipid properties applying advanced computational techniques, although some barriers, such as the time-length of these simulations, need to be overcome. Implementing three-dimensional structures of GPCRs in such validated membrane systems can give novel insights in membrane-dependent receptor modulation and formation of higher order receptor complexes. Finally, more realistic GPCR-membrane models would provide a very useful tool in studying receptor behavior and its modulation by small drug-like ligands, a relevant issue for drug discovery.

A Morphological Study of 608 Cases of Canine Malignant Lymphoma in France With a Focus on Comparative Similarities Between Canine and Human Lymphoma Morphology

This study reports cytomorphological, histomorphological, and immunological characterization of 608 biopsy cases of canine malignant lymphoma, with epidemiological and clinical data, collected from 7 French veterinary pathology laboratories. It compares morphological characteristics of malignant lymphoma in canines, per the updated Kiel classification system, with those reported in humans, per the World Health Organization (WHO) classification system. Of tumors described, 24.5% and 75.5% were classified as low- and high-grade malignant lymphomas, respectively. Presenting clinical signs included generalized or localized lymphadenopathy (82.4%) and extranodal diseases (17.6%) involving the skin (12.34%) and other sites (5.26%). Immunohistochemistry confirmed 63.8% B-cell (CD3–, CD79a+), 35.4% T-cell (CD3+, CD79a–), and 0.8% null-cell (CD3–, CD79a–) lymphomas. Most B-cell cases (38.49%) were of high-grade centroblastic polymorphic subtype; most T-cell cases (8.55%), high-grade pleomorphic mixed and large T-cell lymphoma subtypes. Some B-cell tumors showed morphologic characteristics consistent with follicular lymphomas and marginal zone lymphomas per the Revised European American Classification of Lymphoid Neoplasms and WHO canine classification systems and the WHO human classification system. Unusual high-grade B-cell subtypes included an atypical high-grade small B-cell lymphoma (0.66%), Burkitt-type B-cell lymphoma (1.64%), plasmacytoid lymphoma (0.99%), and mediastinal anaplastic large B-cell lymphoma (0.16%). Unusual T-cell subtypes included a previously undescribed high-grade canine immunoblastic T-cell type (1.15%), a rare low-grade prolymphocytic T-cell lymphoma (0.16%), and a recently described high-grade canine T-cell entity—aggressive granulocytic large-cell lymphoma (0.16%). Marginal zone lymphomas were common (10.86%); follicular lymphomas were rare (0.49%). Canine primary cutaneous malignant lymphoma subtypes were present (11.84%). There was no significant difference between B- and T-cell malignant lymphoma in regard to canine age and sex. A significant overrepresentation of Boxers (24.19%) was found for T-cell lymphomas.

Impact on Survival of Primary Tumor Resection in Women with Metastatic Breast Cancer at Initial Diagnosis. The Alamo Project

Background: Recent medical and scientific reports suggest that surgery of the primary tumor (PT) could be taken into account, although far from the current standard of care, in metastatic breast cancer (MBC) patients. The mechanistic basis for these findings stem from crosstalk between the PT and metastatic foci, immunosuppressive effects, and/or the avoidance of metastatic re-seeding from the primary source. We have focused on implementing surgical excision of the PT in certain settings and tumor types in order to ascertain whether this aggressive treatment modality can be justified in a classic palliative setting. Methods: The ALAMO Project (A) is a retrospective analysis of patients (pts) diagnosed with BC between 1990 and 1997 across 43 GEICAM hospitals. Patterns of BC presentation (tumor and host characteristics), treatment and survival were recorded in 2 cohorts, AI (1990-93, 4532 pts, closed by 2000) and AII (1994-97, 10849 pts, closed by 2003). Only MBC pts at first diagnosis were included, excluding those with secondary tumors, without a minimum of 2 months follow-up at the same institution, and without complete information regarding their PT surgery. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Results: 6.12% of the ALAMO database pts were initially diagnosed with MBC (605 fulfilled the present analysis criteria), with a medium age of 61.6 years (yrs). 54.2% had single-organ metastasis, anatomically distributed in skin/soft tissue (18.8%), bone (35.9%), lung (9.8%), and other viscera (35.5%). 26.3% of pts had surgery of the PT (83.7% of them radical procedures, 73.3% of them axillary dissected and 5.6% received radiotherapy). Chemotherapy (30.7%), endocrine therapy (23.1%) or both (41.7%) were the systemic approaches, and 4.5% received supportive care. Women in the surgery (S) group (159 pts) were younger, with skin/soft tissue or bone metastasis and oligometastatic disease. 5-yr overall survival (OS) was 18.84%, 2.94 yrs median OS in the S-group versus 1.83 yrs in the nS-group (p&lt;0.001). A stratified analysis by organ showed relevant effects of surgery for pts with skin/soft tissue metastasis, 4.52 yrs versus 1.77 yrs median OS in the S and nS arms respectively. The multi-adjusted HR for surgery in this subgroup was 0.30 (p&lt;0.001), which was not significantly modified considering a propensity score (PS) factor (HR 0.29, p&lt;0.001). Surgery (p&lt;0.001), systemic treatment (p&lt;0.001), and the interaction between surgery and metastatic location (p&lt;0.004) were included in the multivariate predictive model of survival for the whole series. Discussion: Local surgery of the PT is associated with an increase in OS for pts with skin/soft tissue metastasis and is maintained in multi-adjusted models. These analyses suggest that loco-regional control of the PT should be considered for the treatment of advanced disease in selected patients, but must be further investigated in randomized controlled trials in MBC at first diagnosis.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3104.

Genetic and environmental risk indicators in canine non-Hodgkin's lymphomas: breed associations and geographic distribution of 608 cases diagnosed throughout France over 1 year

BACKGROUND

The etiology of non-Hodgkin's lymphomas (NHL) is multifactorial. Environmental and genetic factors are frequently incriminated both in humans and dogs.

OBJECTIVES

Our purpose was to study the geographic distribution of canine NHL (CNHL) in France and to evaluate genetic and environmental influences.

ANIMALS

Six hundred and eight cases of CNHL, diagnosed throughout France over 1 year, were collected from 7 Veterinary Histopathologic Laboratories.

METHODS

Retrospective study. Breeds affected by lymphomas were compared with the national population and associations between breed and immunophenotype were studied. The distribution of CNHL and canine T-cell NHL per 100,000 dogs per department was compared with the distribution of waste incinerators, polluted sites, and radioactive waste.

RESULTS

The breeds significantly overrepresented among lymphoma cases were Boxer, Setter, and Cocker Spaniel (P < .001). There was a significant association between Boxer and T-cell NHL (P < .001), and between German Shepherd and Rottweiler and B-cell NHL (P < .01). The geographic distribution of CNHL and canine T-cell NHL indicated significant heterogeneity. Significant association between distributions of CNHL and waste incinerators (rho= 0.25, P < .05), polluted sites (rho= 0.36, P < .001), and radioactive waste (rho= 0.51, P < .001) was found.

CONCLUSIONS AND CLINICAL IMPORTANCE

Influence of genetics in the development of CNHL was supported by the existence of an association between breed and immunophenotype. Waste incinerators, polluted sites, and radioactive waste could just be considered as risk indicators of CNHL, but not as risk factors. Case-control studies around critical sites are necessary to confirm the implication of those environmental factors in the development of CNHL.

Combination or sequential single agent for the treatment of metastatic breast cancer (MBC) patients (pts). Impact of further chemotherapy (CT) in overall survival (OS) in the Alamo registry

Abstract #2121

Introduction: Combinations can improve OS in MBC; however sequential single agent is sometimes preferred. In a recent report, pts receiving paclitaxel monotherapy in first line had a significantly worse OS if they were not receiving post study CT (PSC); no difference was seen in pts receiving paclitaxel+gemcitabine (Llombart, EBCC 2008). In this trial only 58% of pts received PSC.&#x2028; Purpose: To assess, outside the context of a clinical trial, the amount of MBC pts receiving CT beyond first line, as well as the impact of combination use and further CT lines in their OS.&#x2028; Methods: Alamo 1-2 is a breast cancer patient registry run by the GEICAM. 15482 pts diagnosed from 1990-1997 in 54 sites were included in the database. 4668 pts were stage IV; 778 (16.7%) metastatic at diagnosis and 3890 (83.3%) have had a recurrence.&#x2028; Results: 3045 (65%) pts received CT in first line, 83% were combinations (with anthracyclines 42%, CMF 16%, taxane+anthracyclines 9.4% or +other agents 8%) and 16% were monotherapy. Among other variables studied, only previous treatment (in early stage) was influencing the choice of a combination (pts without previous CT received more combinations than pts receiving CMF, than pts receiving anthracyclines). Median survival for pts receiving single agent was significantly shorter compared to pts receiving combination, 16.2 and 21.85 months (m) respectively, HR=1.37 (IC 95%: 1.21-1.55; p&lt;0.0001). Several covariates showed significant prognostic value in survival in the Cox multivariate model: monotherapy treatment in first line, anthracyclines pre-exposure, age &gt; 65, negative hormonal receptor status, hepatic disease, Grade 3 and ≥ 3 disease sites. Half of the pts never received further CT after first line treatment. Only age and number of disease sites were influencing this decision in the Cox multivariate model. Median survival was 24.9 m in pts receiving further CT and 14.5 m in the ones not receiving it. In pts not receiving further CT, median OS was significantly shorter if they were treated with single agent in first line in comparison to those receiving previous combination: HR= 1.59 (IC 95%: 1.33-1.89; p&lt; 0,00001). This difference was not significant in pts receiving further CT: HR= 1.15 (IC 95%: 0.97-1.37; p=0.101).&#x2028; Conclusion: Our data show that only half of the MBC pts receive further CT after first line; they have longer survival. We found significant evidence that further CT is impacting the OS in pts treated with single agent in first line, but not in those receiving previous combination. Those facts should be taken into consideration when selecting single agent or a combination in first line.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2121.

Phase II study of combination cetuximab and weekly paclitaxel in patients with metastatic/recurrent squamous cell carcinoma of head and neck (SCCHN): Spanish Head and Neck Cancer Group (TTCC)

6012

Background: Cetuximab and paclitaxel have shown to be active in SCCHN pts and preclinical data has demonstrated a possible synergy for the combination. In a variety of tumor types, weekly paclitaxel has demonstrated an improved safety profile and activity as compared to every 3 weeks paclitaxel, providing the rationale to study the combination of cetuximab and weekly paclitaxel in metastatic/recurrent SCCHN. Methods: Pts were required to have a y performance status (KPS) = 70%, measurable disease using RECIST criteria, and may have received one regimen of induction and/or concomitant chemotherapy, but not within the recurrent/metastatic setting. Treatment included weekly paclitaxel 80 mg/m2 and cetuximab (initial dose of 400 mg/m2, followed by a weekly infusion of 250 mg/m2). Biopsies of tumors and samples of blood are being analyzed for correlative markers including EGFR gene copy number -FISH-, polymorphisms of intron 1 of the EGFR, and downstream EGFR pathway markers and mutations. Results: 46 planned pts were enrolled from Ap-2006 to Sep-2006. Median age is 60 years (range 42–78). Median KPS is 80% (range 70–100%). 35 pts are evaluable for response. Complete responses have been observed in 7 pts, partial responses in 18 pts, and stable disease in 6 pts for an overall response rate of 71% and disease control rate of 88%. 44 pts are evaluable for safety. Main grade 3/4 toxicities(NCI): 8 pts had acne- like rash; 7 neutropenia but only 1 febrile neutropenia; 6 asthenia; 3 mucositis; 2 infusion related reactions to paclitaxel and 1 to cetuximab; 2 peripheral neuropathies; 1 diarrhea; 1 vomiting; and 1 conjunctivitis. Conclusions: This trial shows that the combination of cetuximab and weekly paclitaxel is well tolerated and provides very encouraging activity in advanced/recurrent SCCHN. The full data, including biomarker results, will be presented at the annual meeting.

No significant financial relationships to disclose.

The «El Álamo» project (1990–1997): two consecutive hospital-based studies of breast cancer outcomes in Spain

BACKGROUND

The "Alamo" project is a retrospective analysis of 14,854 patients diagnosed of breast cancer between 1990 and 1997 in 50 Spanish hospitals.

METHODS

Alamo I (AI) consisted of 4,532 patients diagnosed with breast cancer between 1990 and 1993. Data were collected in 2000. Alamo II (AII) consisted of 10,322 patients diagnosed between 1994 and 1997. Data were collected in 2003.

RESULTS

At presentation, there were (AI vs. AII) 17.6% vs. 24.3% at stage I; 55.5% vs. 53.1% at stage II; 18.7% vs. 15% at stage III; 7.2% vs. 5.9 at stage IV. Median age was 57 (AI) vs. 58 years (AII) and 65.9% vs. 67.2% (AI vs. AII) were post-menopausal. Firstline treatment for disease stages I, II and III was surgery in 91% of patients in both studies. Breast conserving surgery rate increased from 20.2% (AI) to 32.7% (AII). Adjuvant systemic treatments were administered to 87.6% (AI) and 92.8% (AII) of patients. Recurrence rate diminished from 36.6% (AI) to 22.5% (AII) and the 9-year survival rate increased from 63.2% (95% CI: 61.5-64.9) to 70.1% (95% CI: 68.5-71.8).

CONCLUSION

Breast cancer outcomes in Spain have improved from 1990-1993 to 1994-1997, likely because of breast cancer screening program implementation and new therapies.