A Retrospective Review of Association between Clinico-Pathologic Prognostic Factors and Disease Outcome in Node-Positive or High-Risk Node Negative Breast Cancer Patients Treated with Adjuvant Cyclophosphamide, Doxorubicin Followed by Paclitaxel: A Venezuelan Study

Background: Breast cancer is a disease with a biologic and clinical heterogeneity explained by differences in the genetic composition, which translate into variability in estrogen receptor (ER), progesterone receptors (PR), Her2–Neu receptor (HER2) expression and permit to identify subgroups that show different prognoses and that also respond differently to treatment. The goal of this study was to determine disease-free survival (DFS) in relation to clinico-pathologic features and ER/PR/HER2 subgroups, in node-positive or high-risk breast cancer patients in a Venezuelan single institution. Methods: We reviewed data between May 1999 to July 2006, from our breast tumor registry with attention to clinical and pathologic prognostic factors. All patients were treated with either mastectomy or breast conserving surgery-with axillary node assessment for stage and adjuvant chemotherapy with doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2 both IV day 1 x 4 cycles, followed by paclitaxel 175mg/m2 day 1 x 4 cycles every 3 weeks or every 2 weeks. All patient received radiation therapy and adjuvant hormonal therapy when indicated. Disease-free survival (DFS) was measured from the date of biopsy to the date of relapse. DFS was estimated using the univariate Kaplan-Meier method. Twelve clinico-pathologic factors that could influence relapse were selected and analyzed using the Cox Proportional Hazards Model. All analyses were carried out using Stata (version 6.0).Results: A total of 92 breast cancer patients all received adjuvant chemotherapy and radiotherapy, 79% of the patients received hormonal therapy with either Tamoxifen or an Aromatase Inhibitor according to their menopausal status. The median follow-up is 55.42 months (range 9.5-110 months). Median age was 50 years (27-70). Local and distant failures were 3% and 11% respectively. For the overall population, the probability of DFS at 2, 5 and 9 years was respectively 93%, 83% and 83%. The results of univariate analysis showed that the mayor significant prognostic factor for influencing relapse was Estrogen receptor (HR:0.29) (p=0.06). Univariate survival analyses comparing grade of differentiation, stage of disease and number of metastasis in axillary lymph nodes with respect to Disease-free survival were performed and showed no significant difference. Patients with triple negative tumors showed an increased risk of relapse with a significant decrease in 9-year disease-free survival 38.1% (p<0.001) and patients with ER+/PR+/HER2- had the best DFS 90% (p<0.001). Conclusions: Estrogen receptor expression was the most significant biologic prognostic factors for relapse in this population. Triple negative tumors were associated with worse DFS. Different DFS in ER/PR/HER2 subgroups clearly illustrates the heterogeneity of this disease and support the importance of tailored therapy in this era.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6056.

Treatment of glioblastoma in Venezuela: Limitations using the current standard of care

e13036

Background: The EORTC/NCIC phase III clinical trial using chemoirradiation with temozolomide (TMZ) 75 mg m-2 x 42d, followed by adyuvant TMZ 150–200 mg m-2 daily x 5d q28d x six cycles set a new standard of care for newly diagnosed glioblastoma (GBM). The applicability of this regimen in developing countries can be problematic. Objectives: To review our experience in Venezuela, contrasting overall survival (OS), 6-month progression-free survival (6PFS), and toxicity in our patients with corresponding outcomes from the EORTC/NCIC trial. Methods: We treated 30 patients with this regimen from March 2001 through July 2004. Results: The median age was 51 years; 17 (60%) were men; 27 (90%) had biopsy or partial resection; 27 (90%) took prophylactic anticonvulsants; and 23 (77%) had prophylaxis against P. jiroveci. Most patients (83%) took the full TMZ treatment during radiation, 7% interrupted TMZ during RT, and 10% could not afford the drug. One patient had Stevens-Johnson syndrome and did not complete RT. Twelve (40%) patients had stereotactic radiosurgery for recurrent disease during the adjuvant phase. The 24-month OS was 30%, median OS was 7.5 months, median PFS was 5 months, and 6PFS was 41%. SRS did not have any effect on OS (p = 0.17, logrank). Grade 3–4 hematologic toxicity was seen in two patients (7%). Conclusions: Except for differences in median OS (7.1 mo) and in 6-PFS (12.6 percentage points) all other measures were reasonably close to the EORTC/NCIC trial. Of concern is the high rate of anticonvulsant prophylaxis using enzyme-inducing drugs and the difficult access to TMZ.

No significant financial relationships to disclose.

Sex pheromone of tomato fruit borer, Neoleucinodes elegantalis

Five candidate pheromone components were identified by analyzing pheromone gland extracts by gas chromatography (GC), coupled GC-electroantennographic detection (EAD), and coupled GC-mass spectrometry (MS) : (E)-11-hexadecenol(E11-16 : OH), (Z)-11-hexadecenol (Z11-16 : OH), (E)-11-hexadecenal, (E)-11-hexadecenyl acetate, and (Z)-3,(Z)-6,(Z)-9-tricosatriene (Z3,Z6,Z9-23 : Hy). In electroantennogram (EAG) recordings, synthetic E11-16 : OH elicited stronger antennal responses at low doses than other candidate pheromone components. Field tests demonstrated that synthetic E11-16 : OH as a trap bait was effective in attracting males, whereas addition of Z11-16 : OH inhibited the males' response. Z3,Z6,Z9-23 : Hy strongly enhanced attractiveness of E11-16 : OH, but was not attractive by itself. A pheromone blend with synergistic behavioral activity of an alcohol (E11-16 : OH) and hydrocarbon (Z3,Z6,Z9-23 : Hy) component is most unusual in the Lepidoptera. The synthetic two-component pheromone is approximately 60 times more attractive than the female-produced blend and might facilitate the control of this pest.

Interim results of a randomized trial of mitomycin C as an adjunct to radical radiotherapy in the treatment of locally advanced squamous-cell carcinoma of the cervix

The purpose of this study was to determine the efficacy of mitomycin C as an adjunct to radiotherapy for the treatment of locally advanced cervix cancer. Patients with squamous-cell carcinoma of the cervix, stages IB2-IVA, were randomized to receive radiotherapy alone or radiotherapy with concomitant mitomycin C. An initial cohort of 160 patients, having a mean follow-up of 46 months, is analyzed. Intravenous mitomycin C, 15 mg/M(2), was given on the first and sixth week of radiotherapy. The 78 patients in the radiotherapy with mitomycin C group and 82 patients in the radiotherapy alone group have a comparable distribution by age and stage (mean age 47 years; stage IB 3%, IIA 11%, IIB 48%, IIIA 1%, IIIB 36%, IVA 3%). The four-year actuarial survival rates for radiotherapy with mitomycin C and radiotherapy alone were 72% and 56%, respectively (P = 0.13). The four-year actuarial disease-free survival rates for radiotherapy with mitomycin C and radiotherapy alone were 71% and 44%, respectively, a statistically significant difference (P = 0.01). The four-year actuarial local recurrence-free survival rates for patients receiving radiotherapy with mitomycin C and radiotherapy alone were 78% and 63%, respectively (P = 0.11). Differences in four-year distant recurrence-free survival between radiotherapy plus mitomycin C and radiotherapy alone were significantly different at 85% vs. 61% (P = 0.01); this analysis is not adjusted for local failure. On subgroup analysis, stage III-IVA patients had a four-year actuarial disease-free survival of 75% for radiotherapy plus mitomycin C compared with 35% for radiotherapy alone (P = 0.03). There were no treatment- related deaths. Mild hematologic toxicity was seen only in the group treated with mitomycin C. No excess in non-hematologic toxicity has been observed thus far with combined mitomycin C and radiotherapy. In this open phase III trial of mitomycin C as an adjunct to radical radiotherapy for squamous-cell carcinoma of the cervix, there were minimal hematologic effects and no increase in acute radiation reactions. A statistically significant difference in favor of patients receiving mitomycin C is shown for disease-free survival. Thus far, there are trends in favor of those patients receiving mitomycin C for survival and local control. Patients with more advanced stage disease, predominantly stage IIIB, appear to have the most benefit. These preliminary results support the hypothesis that targeting hypoxic cells may lead to a therapeutic enhancement in the radiotherapy of cervix cancer. This trial continues to accrue patients and follow-up data. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 206-223 (2000).

A dosimetric analysis of Morris, Fletcher, and Henschke systems for treatment of uterine cervix carcinoma

The role of intracavitary irradiation in the treatment of uterine cervix carcinoma is well established, and over the years a number of different systems for intracavitary irradiation have been developed. To compare the clinical efficacy of different systems and to develop guidelines for the design of applicators with new sources such as americium-241, we present a dosimetric comparison of three systems: (a) the Morris system, a modified Stockholm technique; (b) the Henschke system; and (c) the Fletcher system. Using a computerized planning system, dose distributions with different configurations of each system were calculated. For each case, doses to point A, B, and a set of reference points representing bladder and rectum were also calculated. Also, the 60 Gy reference volumes, as defined by ICRU Report No. 38, 1985, were calculated for six different treatment regimens. These treatment regimens employ widely different combinations of whole pelvis external beam dose, split pelvis external beam dose, and intracavitary irradiation dose to achieve similar clinical outcomes for the treatment of various stages of cervix carcinoma. From this analysis we observe the following: (a) The Morris system produces a higher dose rate to point A (70 to 90 cGy/hr) compared to the Fletcher or Henschke system (50 to 70 cGy/hr); (b) the doses to point B relative to point A dose are about the same for all three systems at 28 to 32%; (c) the doses to reference rectum and bladder points relative to point A dose for clinically equivalent configurations are about the same for Fletcher and Henschke systems (58-65%) not including the effects of shields in the vaginal ovoids, and somewhat higher for the Morris system (72-79%); (d) the volume treated to a given dose rate by each intracavitary system alone is about the same; and (e) the 60 Gy volume depends critically upon the external beam whole pelvis dose, rising steeply as the external beam whole pelvis dose approaches 30 Gy. Since different groups have used widely different prescriptions of external beam whole pelvis dose, ranging from 0 to 50 Gy depending upon stage, the 60 Gy volumes for these various dose prescriptions are strikingly different. Because the Morris system uses lower values for the external beam whole pelvis dose than the others, its 60 Gy volume for the advanced Stage IIB and IIIB is 2 to 4 times lower than others. This choice makes the Morris system more conservative than others, probably resulting in slightly lower cure rates for the advanced stage disease.

Olfactory neuroblastoma. Observations on seven patients treated with radiation therapy and review of the literature

Seven patients with olfactory neuroblastoma were treated, using the staging classification proposed by Kadish (stage A two patients, stage B one, stage C three, and local recurrence one patient). Treatment was not uniform. Radiation therapy was employed initially as the only treatment modality in three patients who had stage A, B, and C, respectively. In one instance, it was used to treat a local recurrence after surgical treatment. Surgery and radiation therapy was employed in three patients: one with stage A and two with stage C. Chemotherapy was used as an adjuvant to radiation and surgery in one patient with stage C, and in three individuals, it was used for advanced disease. Four of the seven patients are alive without evidence of disease from 23 months to 16 years 8 months after treatment. A review of 11 series from the recent medical literature is presented. It is essential to follow these patients for long periods of time because of the slow growth and the propensity of local recurrence that some of these tumors have. The actual tendency in the management of this neoplasm seems to be combined therapy with surgery and radiation. The role of adjuvant chemotherapy is not well established, but has been recommended for locally advanced disease.

Evaluation of allograft perfusion by radionuclide first-pass study in renal failure following renal transplantation

To assess the diagnostic value of indices measured on a first-pass curve, we performed 72 radionuclide renal first-pass studies (RFP) in 21 patients during the early weeks following renal allograft transplantation. The diagnosis was based on standard clinical and biochemical data and on fine needle aspiration biopsy (FNAB) of the transplant. Aortic and renal first-pass curves were filtered using a true low-pass filter and five different indices of renal perfusion were computed, using formulae from the literature. Statistical analysis performed on the aortic and renal indices indicated excellent reproducibility of the isotopic study. Although renal indices presented a rather large scatter, they all discriminated well between normal and rejection. Three indices have a particularly good diagnostic value. In the discrimination between rejection and Acute Tubular Necrosis (ATN), only one index gave satisfying results. The indices, however, indicate that there are probably ATN with an alternation of renal perfusion and rejection episodes where perfusion is almost intact. We conclude that radionuclide first-pass study allows accurate and reproducible quantitation of renal allograft perfusion. The measured parameters are helpful to followup the course of a post-transplantation renal failure episode and to gain more insight into renal ischemia following transplantation.

Chromophobe adenoma manifesting as a nasopharyngeal mass

A 64-year-old woman had a sphenoid sinus tumor and nasopharyngeal mass verified to be a nasopharyngeal chromophobe adenoma with no evidence of sellar enlargement or involvement. The possibility that this mass arose from ectopic hypophyseal tissue located in the pharynx is proposed.

Cancer of the nasopharynx: review of 43 cases treated with supervoltage radiation therapy

Forty-three cases of cancer of the nasopharynx treated at the Yale-New Haven Hospital in the last 15 years were analyzed. The clinical aspects of the disease, the technique of therapy and results of treatment are presented. The five-year cumulative survival in all the cases treated was 27%. Patients with lymphoepitheliomas seem to do better than those with squamous cell carcinoma. Even in patients with advanced disease, a cure is still possible after radical radiation treatment. Retreatment of recurrent disease is frequently successful in these tumors. The complications after curative radiotherapy even with the use of supervoltage are still relatively frequent. The incidence of distant metastases was 29%.

Breast cancer in brothers: case reports and a review of 30 cases of male breast cancer

Two brothers with breast cancer are presented. One died 8 years after diagnosis and the other is presently living at 1 year with metastatic disease. The courses of 28 other previously unreported male patients with carcinoma of the breast are reviewed, and the possibility of male breast carcinoma being metastatic disease from the prostate is discussed. Useful etiologic information might be obtained from following the offspring of male breast cancer patients to see if they are at increased risk of developing the disease.