A multi-institutional study of 1,111 men with 4K score, multiparametric magnetic resonance imaging, and prostate biopsy

OBJECTIVE

Prostate magnetic resonance imaging (MRI) and biomarkers are often used in conjunction to enhance the selection process for prostate biopsy. However, the optimal sequence of ordering these tests has not been established. A comprehensive evaluation was conducted on a large multi-institutional cohort of patients who underwent MRI, 4K score, and biopsy of the prostate to examine the impact of utilizing both tests vs. either test alone and to determine if the order in which these tests are administered affects the ability to detect clinically significant prostate cancer (csCaP).

METHODS AND MATERIALS

We evaluated men from 8 different institutions who were referred for prostate cancer evaluation and underwent MRI, 4K score test, and prostate biopsy. The primary outcome was the presence of csCaP, defined as grade group 2 or higher cancer on a biopsy of the prostate. We used logistic regression, calibration plots, and decision curve analysis to evaluate using a 4K score or MRI alone vs. both tests together for detecting csCaP. In addition, we evaluated several strategies using one or both tests for selecting men for biopsy and compared them based on the proportion of biopsies avoided and the csCaP's missed.

RESULTS

Among the 1,111 men who formed the final cohort, 553 (49.8%) had prostate cancer, and 353 (31.8%) had csCaP. We found that using MRI and 4K score together had better discrimination, calibration, and a higher clinical utility on decision curve analysis compared to using either test individually. Using both tests together resulted in fewer biopsies avoided and missed cancers compared to using either test alone. Strategies that sequence MRI and 4K score tests resulted in the largest biopsy reduction, with no appreciable difference between starting with an MRI vs. a biomarker.

CONCLUSIONS

We found that using both an MRI and 4K score together was superior to using either test alone but found no appreciable difference between starting with an MRI vs. starting with a 4K score. Prospective studies are needed to identify the best strategy to sequence MRI and biomarkers in the evaluation of csCaP.

Early results of rapid-deployment aortic prosthesis in multivalvular surgery – a propensity score matching

Background

Multivalvular surgery (MV) requires prolonged extracorporeal circulation (ECC) and aortic cross-clamp times (X-Ao). Rapid-deployment aortic prosthesis (RD-AV) allow lower ECC and X-Ao times in isolated aortic valve surgery (AVR), but have not been studied in MV surgery.

Purpose

To determine if RD-AV use influences early outcomes when compared to biological stented or mechanical aortic valves in MV surgery.

Methods

Retrospectively collected pre, intra and immediate post-operatory data on all MV adult patients with AVR operated on our Department from January 2016 to February 2022. Bentall surgery and aortic dissection patients were excluded. A propensity score matching (PSM) of patients receiving RD-AV (Group A) compared to patients with non-RD-AV (Group B) was performed using sex, age, Euroscore II, type of surgery (involved valves, CABG, ascending aortic replacement), active endocarditis, ventricular function and redo surgery. After PSM, we compared outcomes until death or discharge. Normal distribution of samples was tested using the Kolmogorov-Smirnov test. Normal data was analysed with unpaired t-testing and non-normal data with non-parametric Mann Whitney U test. Categorical data were analysed with Fisher test. A significance level of p<0.05 was accepted.

Results

205 patients received non-RD-AV and 58 patients RD-AV. After PSM, 57 pairs of patients were obtained. Sex, BMI, Euroscore II, age, redo surgery, insulin dependent DM, baseline creatinine, left ventricle ejection fraction, right ventricle dysfunction, pulmonary artery systolic pressure, and active endocarditis were similar in both groups. Intra-operatory, RD-AV valves (Group A) were associated with shorter surgery duration (167.3±52 vs 206.6±91 min, p=0.005), shorter ECC duration (89.5±36.5 vs. 118.9±56.5 min, p=0.002), and aortic X-clamp time (71.6±28 vs. 98.9±38.2 min, p<0.001). No differences were found between both groups A vs. B in ventilation time (1270±1911 vs. 2428±5627 min, p=0.59), inotropic support (113±178 h vs. 85±101 h, p=0.38), transfusion of red cells units (1.1±1.6, vs. 1.2±1.7, p=0.73), Fresh frozen plasma units (0.86±1.9, vs. 0.77±1.8, p=0.77), platelet pools (0.79±1.0 vs. 0.7±0,9, p=0.67), fibrinogen (0.77±1.5 vs. 0.75±1.4 g, p=0.98), intra-aortic balloon pump use (5 vs. 12 patients, p=0.11), chest drain output (804±656 vs. 825±992 ml, p=0.69), new-onset dialysis (10 vs. 10 patients, p=1.0), new-onset atrial fibrillattion (10 vs 13 patients, p=0.6) and permanent pacemaker implantation (8 vs. 3 patients, p=0.20). Total ICU stay (9.25±21 vs. 4.5±4 days, p=0.3), hospital stay (14.4±26 vs. 10.1±13 days, p=0.52) and intra-hospital mortality (7 vs 9 patients, p=0.79) were also similar.

Conclusion

Despite shorter surgery duration, ECC duration and aortic X-clamp duration, RD-AV have similar early outcomes when compared with non-RD-AV in multivalvular surgery.

Funding Acknowledgement

Type of funding sources: None.

The role of histology on endometrial cancer survival disparities in diverse Florida

Background

Endometrial cancer (EC) mortality is particularly high among non-Hispanic Blacks and is twice that of non-Hispanic Whites. However, comparisons of EC survival outcomes by race/ethnicity are often confounded by histology and grade. Here, we analyze EC survival disparities in multiracial Florida with a focus on EC types (1 and 2) and subtypes, defined according to histology and grade.

Methods

All 27,809 cases of EC diagnosed during 2005–2016 were obtained from the Florida Cancer Registry. Age-standardized, 5-year cause-specific survival by race/ethnicity and histological type were calculated. Fine and Gray competing risk regression was used to estimate sub-distribution hazard ratios (sHRs) for associations between risk of death due to EC and potential predictive factors such as histology/grade, age, stage at diagnosis, and insurance.

Results

Type 2 EC accounted for only 38.7% of all incident EC-cases but 74.6% of all EC-deaths. Blacks were disproportionately affected by type 2 EC (57.6%) compared to Whites, Hispanics, and Asians (35.6%, 37.7%, and 43.0%, respectively). Age-adjusted 5-year survival for types 1 and 2 were 85.3% and 51.6%, respectively; however, there was wide variation within type 2 subtypes, ranging from 60.2% for mixed cell EC to as low as 30.1% for carcinosarcoma. In the multivariable model, Blacks with type 2 EC had a 23% higher risk of death due to EC (sHR: 1.23, 95%CI: 1.12–1.36) compared to Whites.

Conclusions

Population-based analyses should consider the histological heterogeneity of EC because the less common type 2 EC drives racial/ethnic survival disparities in EC. Black women have a higher proportion of more aggressive histological types and an overall higher risk of death due to EC than Whites. To the extent that some of these histological types may be considered different diseases and require specific treatment approaches, further research on etiology and prognosis for detailed type 2 EC subtypes is warranted.

Biopsy positivity in prostate cancer patients undergoing mpMRI-targeted radiation dose escalation

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Background: Radiation (RT) dose escalation improves prostate cancer outcomes, but when the whole gland is treated to high doses complications can arise. We used prostate multiparametric MRI (mpMRI) findings for targeted dose escalation (MTDE) in prospective clinical trials in which prostate biopsy at 2-3 years after completion of RT was planned. Biopsy positivity is a known predictor of biochemical failure. These findings are compared to those in another cohort in which standard whole gland RT doses were used. Methods: Patients enrolled on three investigator initiated clinical trials incorporating MTDE (n=30) were eligible for inclusion. All patients were assessed for response by prostate biopsy 2-3 years after RT. Patients were compared to a reference group treated with standard RT doses to the whole prostate on a randomized trial at Fox Chase Cancer Center (FCCC trial). Univariable and multivariable analysis (MVA) was performed to assess for correlation with biopsy positivity, defined as carcinoma with or without RT effect. Results: Of those treated with MTDE: 3 (10%) were low, 23 (77%) intermediate, and 4 (13%) high risk. Assuming an α/β ratio of 1.5, MTDE patients received an equivalent dose (EQD2) of 76 Gy to the prostate, with focal dose escalation to an EQD2 of 98-122 Gy to mpMRI lesions. The MTDE cohort was compared with 115 patients from the FCCC trial, where 23 (20%) were low, 74 (64%) intermediate, and 18 (16%) high risk. The FCCC trial patients received an EQD2 of 76 Gy (n=64) or 84.24 Gy (n=51) without boost. Median time from RT to biopsy was 2 years (range, 1.6-3.3). The post-treatment biopsy results were negative in 50% (n=73), atypical in 12% (n=17), carcinoma with RT effect in 31% (n=45) and frank carcinoma in 7% (n=10). On MVA, patients with tumor volume >20% were more likely to have positive post-RT biopsies (OR: 3.21, 95% CI: 1.34-7.68, p= 0.009). MTDE patients were less likely to have positive post-RT biopsies, 10% vs. 45%, (OR: 0.13, 95% CI: 0.03-0.46, p=0.002). Conclusions: Focal dose-escalation to mpMRI-defined lesions significantly reduces biopsy positivity, a measure associated with long term outcomes including distant metastasis.

Phase I Trial of MRI-Guided Prostate Cancer Lattice Extreme Ablative Dose (LEAD) Boost Radiation Therapy

PURPOSE

A phase I clinical trial was designed to test the feasibility and toxicity of administering high-dose spatially fractionated radiation therapy to magnetic resonance imaging (MRI)-defined prostate tumor volumes, in addition to standard treatment.

METHODS AND MATERIALS

We enrolled 25 men with favorable to high-risk prostate cancer and 1 to 3 suspicious multiparametric MRI (mpMRI) gross tumor volumes (GTVs). The mpMRI-GTVs were treated on day 1 with 12 to 14 Gy via dose cylinders using a lattice extreme ablative dose technique. The entire prostate, along with the proximal seminal vesicles, was then treated to 76 Gy at 2 Gy/fraction. For some high-risk patients, the distal seminal vesicles and pelvic lymph nodes received 56 Gy at 1.47 Gy/fraction concurrently in 38 fractions. The total dose to the lattice extreme ablative dose cylinder volume(s) was 88 to 90 Gy (112-123 Gy in 2.0 Gy equivalents, assuming an α-to-β ratio of 3).

RESULTS

Dosimetric parameters were satisfactorily met. Median follow-up was 66 months. There were no grade 3 acute/subacute genitourinary or gastrointestinal adverse events. Maximum late genitourinary toxicity was grade 1 in 15 (60%), grade 2 in 4 (16%), and grade 4 in 1 (4%; sepsis after a posttreatment transurethral resection). Maximum late gastrointestinal toxicity was grade 1 in 11 (44%) and grade 2 in 4 (16%). Two patients experienced biochemical failure.

CONCLUSIONS

External beam radiation therapy delivered with an upfront spatially fractionated, stereotactic high-dose mpMRI-GTV boost is feasible and was not associated with any unexpected events. The technique is now part of a follow-up phase II randomized trial.

The nab-paclitaxel/gemcitabine regimen for patients with refractory advanced pancreatic adenocarcinoma

The phase III MPACT trial for metastatic pancreatic cancer (PC) showed improved overall survival (OS), progression free survival (PFS) and response rates (RRs) for first-line nab-paclitaxel (Abraxane) and gemcitabine (the AG combination) compared to gemcitabine monotherapy. The safety and efficacy of the AG combination has not been systematically studied as second-line therapy or beyond for metastatic PC. We conducted an IRB-approved retrospective analysis of all patients diagnosed between September 2010 and August 2014 with advanced refractory PC that received combination treatment with AG at our institution. Demographic and survival data were extracted from the registry. Patients received nab-paclitaxel 125 mg/m² and gemcitabine 1,000 mg/m² and on days 1, 8 and 15 of a 28-day cycle with subsequent dose modifications based on tolerance. Data on 59 patients was available; the median age was 61; 55% were male; 56% received AG as second line therapy and 44% received it as third-line or beyond. Five (10%) patients had a confirmed partial response (PR), 23 (47%) had stable disease (SD) and 21 (43%) had disease progression as their best response. Among the 31 (52%) patients who received prior gemcitabine, 18 (58%) had clinical benefit; 3 had a PR and 15 had SD. The median OS was 3.9 months and the median progression-free survival was 3 months. Toxicity was similar to what was reported in the MPACT trial. This retrospective analysis suggests that AG is active in PC patients previously treated with either fluoropyrimidine-based therapy or gemcitabine-based therapy with manageable toxicities.

Inflammatory pathology markers (activated microglia and reactive astrocytes) in early and late onset Alzheimer disease: a post mortem study

AIMS

The association between the pathological features of AD and dementia is stronger in younger old persons than in older old persons suggesting that additional factors are involved in the clinical expression of dementia in the oldest old. Cumulative data suggests that neuroinflammation plays a prominent role in Alzheimer's disease (AD) and different studies reported an age-associated dysregulation of the neuroimmune system. Consequently, we sought to characterize the pattern of microglial cell activation and astrogliosis in brain post mortem tissue of pathologically confirmed cases of early and late onset AD (EOAD and LOAD) and determine their relation to age.

METHODS

Immunohistochemistry (CD68 and glial fibrillary acidic protein) with morphometric analysis of astroglial profiles in 36 cases of AD and 28 similarly aged controls.

RESULTS

Both EOAD and LOAD groups had higher microglial scores in CA1, entorhinal and temporal cortices, and higher astroglial response in CA1, dentate gyrus, entorhinal and temporal cortices, compared to aged matched controls. Additionally, EOAD had higher microglial scores in subiculum, entorhinal and temporal subcortical white matter, and LOAD higher astrogliosis in CA2 region.

CONCLUSIONS

Overall, we found that the neuroinflammatory pathological markers in late stage AD human tissue to have a similar pattern in both EOAD and LOAD, though the severity of the pathological markers in the younger group was higher. Understanding the age effect in AD will be important when testing modifying agents that act on the neuroinflammation.

Effect of petroleum hydrocarbons in copper phytoremediation by a salt marsh plant (Juncus maritimus) and the role of autochthonous bioaugmentation

This work aimed to investigate, under controlled but environmental relevant conditions, the effects of the presence of both inorganic and organic contaminants (copper and petroleum hydrocarbons) on phytoremediation potential of the salt marsh plant Juncus maritimus. Moreover, bioaugmentation, with an autochthonous microbial consortium (AMC) resistant to Cu, was tested, aiming an increase in the remediation potential of this plant in the presence of a co-contamination. Salt marsh plants with sediment attached to their roots were collected, placed in vessels, and kept in greenhouses, under tidal simulation. Sediments were contaminated with Cu and petroleum, and the AMC was added to half of the vessels. After 5 months, plants accumulated significant amounts of Cu but only in belowground structures. The amount of Cu was even higher in the presence of petroleum. AMC addition increased Cu accumulation in belowground tissues, despite decreasing Cu bioavailability, promoting J. maritimus phytostabilization potential. Therefore, J. maritimus has potential to phytoremediate co-contaminated sediments, and autochthonous bioaugmentation can be a valuable strategy for the recovery and management of moderately impacted estuaries. This approach can contribute for a sustainable use of the environmental resources. Graphical abstract ᅟ.

Updated survival analysis of two sequential prospective trials of R-MACLO-IVAM followed by maintenance for newly diagnosed mantle cell lymphoma

A phase II trial of R-MACLO-IVAM followed by thalidomide maintenance for mantle cell lymphoma (MCL) demonstrated promising progression-free survival (PFS) and overall survival (OS) rates. Thalidomide maintenance was associated with significant toxicity and was subsequently modified to rituximab maintenance. Herein, we present updated results and follow-up. Two sequential phase II trials included chemotherapy-naïve patients with MCL up to 75 years old. Four cycles of R-MACLO-IVAM chemotherapy were delivered as previously described. Patients who achieved complete responses (CR) were eligible for thalidomide or rituximab maintenance therapy. Among 36 patients enrolled, the MCL International Prognostic Index (MIPI) was low in 53%, intermediate in 36% and high in 11%. Thirty-five patients completed at least 2 cycles of chemotherapy; 34 (94%) achieved a CR. After a median follow-up of 74.4 months, the 5-year PFS was 51% (95% CI 33-68%) and the 5-year OS was 85% (95% CI 73-97%). Two deaths occurred during the chemotherapy phase due to disease progression and neutropenic sepsis, respectively. One patient developed secondary acute myeloid leukemia after 7 years. R-MACLO-IVAM chemotherapy is effective for patients with newly diagnosed MCL.

A meta-analysis of health-related quality of life after primary treatment for prostate cancer as measured by the Expanded Prostate Cancer Index Composite

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Background: Health-related quality of life (HRQoL) outcomes are important in treatment selection for prostate cancer. The Expanded Prostate Cancer Index Composite (EPIC) is a validated and widely-utilized HRQoL survey which accounts for newer radiotherapeutic, surgical, and hormonal treatment methods. We present a meta-analysis of patient reported HRQoL outcomes collected with EPIC and compare HRQoL trends with radiation therapy, surgery, or active surveillance as primary treatment. Methods: The PubMed database was systematically searched for all studies which presented data directly derived from the use of EPIC on patients with prostate cancer prior to 07/09/2014. All eligible studies were selected for either inclusion and analysis or exclusion based on pre-determined criteria. The data from included studies was compiled and a simulation-based estimation method using Approximate Bayesian Computation was performed to obtain missing standard deviation estimate. A longitudinal meta-analysis was conducted to estimate EPIC-profiles for each component using Bayesian p-spline method. Results: Over 4,000 studies were searched, 152 were deemed eligible, and 39 were included. The calculated mean summary score estimates are shown in the attached table. Conclusions: In the urinary domain, radical prostatectomy (RP) has lower acute scores than active surveillance (AS) or radiation therapy (RT) without long-term difference. In the bowel domain, RT has lower scores than AS or RP acutely and long-term. In the sexual domain, RT and RP have lower acute scores than AS. RP has lower scores than RT without long-term difference. In the hormonal domain, little difference was noted between modalities. [Table: see text]

Gemcitabine (Gem) and nab-paclitaxel (nab-P) in patients (pts) with refractory advanced pancreatic cancer

413

Background: The combination of nab-P and Gem improves survival compared to Gem alone in first-line therapy of metastatic pancreatic cancer. Efficacy data with this doublet in previously treated pts are scant. Our group presented preliminary results on 10 pts treated with this two-drug combination in the second and third line setting and herein present updated data on 59 pts. Methods: This IRB approved analysis identified all pts diagnosed with advanced refractory pancreatic cancer, treated with second-line Gem and nab-P at University of Miami and Sylvester Comprehensive Cancer Center between September 2010 and June 2014. Response by RECIST, CA19-9, and symptomatic improvement were assessed. Progression-free survival (PFS) and overall survival (OS) were calculated from the start of Gem + nab-P and were analyzed using the Kaplan-Meier method. Clinical benefit was defined as the percentage of patients with a partial response (PR) or stable disease (SD). Results: Data from59 pts were analyzed. The median age was 60; 55% were male; 54% received Gem + nab-P as second line therapy and 46% received it as third-line or beyond. Five (10%) pts had confirmed PR, 23 (47%) SD and 21 (43%) progressed. Among the 31 (52%) pts who received prior Gem, 18 (58%) had clinical benefit, 3 PR and 15 SD. The median OS was 3.9 months. The median PFS was 3 months. Toxicity appears similar to what has been reported on the MPACT trial with the combination. Conclusions: The clinical benefit seen withGem and nab-P in this group of pretreated pancreatic cancer pts suggests that it can be considered as an option. Additionally, prior Gem treatment appears not to decrease Gem and nab-P benefit in this population. Since nab-P monotherapy has modest activity in pre-treated pancreatic cancer pts, our data suggests a positive interaction between Gem and nab-P that may overcome resistance to Gem. [Table: see text]

Deep inspiration breath-hold technique for left-sided breast cancer: An analysis of predictors for organ-at-risk sparing

To identify anatomic and treatment characteristics that correlate with organ-at-risk (OAR) sparing with deep inspiration breath-hold (DIBH) technique to guide patient selection for this technique. Anatomic and treatment characteristics and radiation doses to OARs were compared between free-breathing and DIBH plans. Linear regression analysis was used to identify factors independently predicting for cardiac sparing. We identified 64 patients: 44 with intact breast and 20 postmastectomy. For changes measured directly on treatment planning scans, DIBH plans decreased heart-chest wall length (6.5 vs 5.0cm, p < 0.001), and increased lung volume (1074.4 vs 1881.3cm(3), p < 0.001), and for changes measured after fields are set, they decreased maximum heart depth (1.1 vs 0.3cm, p < 0.001) and heart volume in field (HVIF) (9.1 vs 0.9cm(3), p < 0.001). DIBH reduced the mean heart dose (3.4 vs 1.8Gy, p < 0.001) and lung V20 (19.6% vs 15.3%, p < 0.001). Regression analysis found that only change in HVIF independently predicted for cardiac sparing. We identified patients in the bottom quartile of the dosimetric benefits seen with DIBH and categorized the cause of this "minimal benefit." Overall, 29% of patients satisfied these criteria for minimal benefit with DIBH and the most common cause was favorable baseline anatomy. Only the reduction in HVIF predicted for reductions in mean heart dose; no specific anatomic surrogate for the dosimetric benefits of DIBH technique could be identified. Most patients have significant dosimetric benefit with DIBH, and this technique should be planned and evaluated for all patients receiving left-sided breast/chest wall radiation.

Locoregional outcomes in clinical stage IIB breast cancer after neoadjuvant therapy and mastectomy with or without radiation

Low rates of locoregional recurrence (LRR) in patients with clinical stage IIB breast cancer (cT2N1 or cT3N0) who undergo neoadjuvant therapy (NAT) and mastectomy have been reported. We aimed to quantify the risk of LRR and the relationship between LRR and potential risk factors in this subset of patients. We conducted a retrospective review of 116 patients with clinical IIB breast cancer who underwent NAT followed by mastectomy +/- postmastectomy radiotherapy (PMRT) between 2000 and 2009. We estimated the rate of LRR by cumulative incidence. The effect of prognostic factors was examined by Gray's test and Fine and Gray's test. Median follow-up: 63 months. Median age: 49. 28.4% cT2N1 and 71.6% cT3N0. 62.1% of tumors were ER+, 22.6% HER2+, 19% triple negative (TN). All patients underwent NAT and mastectomy. The majority of patients (87%) received PMRT; 32.3% were treated to chest wall (CW) only, and 67.7% to CW plus supraclavicular (SCV) field. Compared to cT2N1, patients with cT3N0 disease were more likely to be pN0 (60% vs 27%, P = 0.005). There was no significant relationship between risk of LRR and pathologic complete response (pCR), use of PMRT, RT to SCV field, or TN status, but there was higher risk of LRR in cT2N1 than cT3N0 (HR 6.03, P = 0.015). LRR was more common in cT2N1 than in cT3N0 disease, emphasizing the negative prognostic implication of clinically node-positive presentation.

Copper phytoremediation by a salt marsh plant (Phragmites australis) enhanced by autochthonous bioaugmentation

Here we evaluated whether the potential of Phragmites australis to phytoremediate Cu contaminated sediments could be enhanced by bioaugmentation with an autochthonous microorganism consortium (AMC) that is resistant to Cu. Saltmarsh plants with sediment attached to their roots were collected, placed in vessels and kept in greenhouses, under tidal simulation. Sediments were contaminated with Cu and the AMC was added to half of the vessels. After two months, plants accumulated significant amounts of Cu (2-10 times more) in all tissues although in higher amounts (7-10 times more) in belowground structures. AMC addition increased Cu bioavailability (5-10%) in sediments leading to a decrease in belowground structures biomass. However, bioaugmentation increased Cu translocation, with higher amounts (2 times more) of Cu in the plant stems, without significant visual toxicity signs. Therefore, autochthonous bioaugmentation can increase Cu phytoextraction potential of P. australis, which can be a valuable strategy for the recovery and management of moderately impacted estuaries.

Abstract 4683: Neuropathic pain in breast cancer patients undergoing radiotherapy

Post-surgery radiotherapy (RT) significantly reduces recurrence of early-stage breast cancer. However, many patients experience side effects from RT, such as neuropathic pain (NP), experienced by one third of patients during RT. Breast cancer survivors report moderate to severe NP symptoms, including hypersensitivity to cold/mechanical stimuli, itching, and numbness, which not only impact patient's functional performance and health-related quality of life, but also may interfere with treatment. Therefore, we evaluated prevalence of pain and neuropathic pain symptom (NPS) in 330 breast cancer patients undergoing RT for changes over time in these pain scales, and to determine the effect of body mass index (BMI) on the RT-induced NP (RINP) at baseline, immediately post-RT, and 1 month after completion of RT. Pain prevalence was assessed using Brief Pain Inventory (0-10) for pain at the worst over the past 4 weeks. NPS index (NPSI, 0-33) was developed using 9 questions from the National Surgical Adjuvant Breast Cancer and Bowel B39 Quality of Life questionnaire specific for breast cancer patients. Changes in these pain scales over time were assessed using a multivariate mixed model. The study consists of 56 Non-Hispanic Whites, 209 Hispanic Whites, and 66 African Americans. There were significant racial/ethnic differences in BMI (p&lt;0.001) and cancer stage at diagnosis (p=0.018). About 85% of cases received the standard RT (50-50.4 Gy in a 200 cGy fraction) and 83% received boost of 10 Gy to the breast scar. Pain prevalence changed over time (p&lt;0.001): 58% at baseline, 78% at the end of RT, and 71% at 1 month after RT. NPSI also changed over time; 4.9 at baseline, 10.0 at the end of RT, and 6.7 at 1 month after RT. There were significant differences in NPSI by race/ethnicity and BMI. Obese patients have worse NPS at RT completion and 1 month after RT compared to women with BMI&lt;30. Obese patients had a higher prevalence and NPSI at both RT completion (21.7% and 6.9) and follow-up (16.0% and 3.6) while normal, over-weight patients showed less increase in prevalence and NPSI at RT completion (11.8% and 5.3) and recovered to the baseline levels after 1 month of RT. In summary, our data suggest that RT-related NP is associated with race/ethnicity and obesity in breast cancer patients. To improve quality of life, including NP, as an important survivorship issue for cancer patients, our ongoing biomarker studies are warranted to elucidate the molecular mechanisms and identify potential targets for intervention.

Citation Format: Eunkyung Lee, Cristiane Takita, Jean L. Wright, Wei Zhao, Isildinha Reis, Omar L. Nelson, Jennifer J. Hu. Neuropathic pain in breast cancer patients undergoing radiotherapy. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4683. doi:10.1158/1538-7445.AM2014-4683

Abstract 3548: CD44, protein, demographics and risk factor data: A combined approach to detect head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma (HNSCC) is a debilitating and deadly disease. The main risk factors are tobacco and alcohol use and human papillomavirus (HPV) infection. Early detection tests are needed because the majority of patients present in late stage when cure rates reach only 40%. Our group has developed a simple, inexpensive, noninvasive diagnostic test based on soluble CD44 (solCD44) and total protein levels. We used a case-control design to evaluate soluble markers for HNSCC in 150 oropharyngeal (OP) and lip/oral cavity (Lip/OC) patients and 150 controls frequency matched for age, gender, race, ethnicity, tobacco use and socioeconomic status. We compared patient groups with respect to important covariates using the chi-square, Fisher's exact test, or t-test. Markers’ mean levels were compared either by t-test or ANOVA, followed by pairwise multiple comparisons. Logistic regression analysis was used to evaluate predictivity of the salivary markers univariately and multivariately with adjustment for demographics and risk factors. We report odds ratio (OR) estimates with corresponding 95% confidence interval (95% CI) and area under the curve (AUC) of the operating characteristic curve (ROC) for fitted models. The case-control groups did not differ in regards to age, gender, race, ethnicity, history of ever vs. never smoking, current alcohol use, number of teeth removed, or county vs. private hospital system. The mean log2CD44 and protein levels were elevated in cases (log2 CD44= 1.94 ng/ml, protein=0.93 mg/ml) compared to controls (log2 CD44= 1.28 ng/ml, protein= 0.76 mg/ml), (p&lt;.0001; p=.003, respectively). Log2CD44 levels were significantly elevated in older vs. younger cases (p&lt;0.05). There were no significant mean log2 CD44 level differences between Lip/OC and OP cases, TNM or HPV status in cancer patients. In the cases for which HPV status was available (as measured by the surrogate marker p16), log 2 CD44 levels varied by smoking status (lower in never smokers), by drinking status in HPV + cases (lower in non-drinkers) and N-stage (higher levels in N0, Nx vs. N1-N3 in HPV-positive and the opposite effect in HPV-negative tumors). For protein, there were no differences in either the case or the control group based on demographic or risk variables. When we stratified by HPV status, race/ethnicity and drinking status did have an effect (higher levels in blacks vs. WNH and higher in current vs. former and never/mild drinkers in HPV positive tumors only). A specific model was developed for each of the 3 race/ethnicity groups with the highest AUC for blacks (AUC= .835) and WNH (AUC= .831) followed by HW (AUC= .777). Models included log2CD44, protein, smoking, gender and age; strongly suggesting that these factors play an important role for HNSCC early detection studies.

Citation Format: Lutecia H. Mateus Pereira, Isildinha Reis, Robert Duncan, Judy Wen, Erika Reategui, Stephanie Bayers, Laurian Walters, Aymee Perez, Jennifer Hu, W Jarrard Goodwin, Elizabeth J. Franzmann. CD44, protein, demographics and risk factor data: A combined approach to detect head and neck squamous cell carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3548. doi:10.1158/1538-7445.AM2013-3548

Salivary markers and risk factor data: a multivariate modeling approach for head and neck squamous cell carcinoma detection

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) is a debilitating and deadly disease largely due to late stage diagnosis. Prior work indicates that soluble CD44 (solCD44) and total protein may be useful diagnostic markers for HNSCC. In this study we combine the markers solCD44, IL-8, HA, and total protein with demographic and risk factor data to derive a multivariate logistic model that improves HNSCC detection as compared to our previous data using biomarkers alone.

METHODS

We performed the solCD44, IL-8, HA, and total protein assays on oral rinses from 40 HNSCC patients and 39 controls using ELISA assays. Controls had benign diseases of the upper aerodigestive tract and a history of tobacco or alcohol use. All subjects completed a questionnaire including demographic and risk factor data.

RESULTS

Depending on cancer subsite, differences between cases and controls were found for all markers. A multivariate logistic model including solCD44, total protein and variables related to smoking, oral health and education offered a significant improvement over the univariate models with an AUC of 0.853. Sensitivity ranged from 75-82.5% and specificity from 69.2-82.1% depending on predictive probability cut points.

CONCLUSION

A multivariate model, including simple and inexpensive molecular tests in combination with risk factors, results in a promising tool for distinguishing HNSCC patients from controls.

IMPACT

In this case-control study, the resulting observations led to an unprecedented multivariate model that distinguished HNSCC cases from controls with better accuracy than the current gold standard which includes oral examination followed by tissue biopsy. Since the components are simple, noninvasive, and inexpensive to obtain, this model combining biomarkers, risk factor and demographic data serves as a promising prototype for future cancer detection tests.

Abstract B86: Head and neck squamous cell carcinoma and disparities: A model for early detection

Introduction: Oral cancer is a multifactorial disease marked by racial and economic disparities. The burden of oral cancer is greater for African Americans (AA) than for Whites (W) with both incidence and disease-specific mortality higher in AA. Soluble CD44 (solCD44) and total protein may be useful diagnostic markers for HNSCC. In this preliminary analysis we combine solCD44 and total protein with demographic data to derive a multivariate logistic model for oral cancer prediction.

Methods: Subjects included 150 oral cancer patients (25 AA, 124 W, 1 other) and 148 control patients (31 AA, 116 W, 1 other) recruited equally from University of Miami Hospital and Clinics (UMHC) and Jackson Memorial Hospital (JMH), a county hospital serving primarily low-income patients. An additional reference control group included 129 AA controls from Liberty City (LC), an impoverished community in north Miami-Dade County. We compared patient groups with respect to the distribution of potentially important covariates using the chi-square, Fisher's exact test, or t-test. Markers' mean levels were compared either by t-test or ANOVA, followed by pairwise multiple comparisons. Logistic regression analysis was used to evaluate predictivity of the salivary markers univariately and multivariately with adjustment for demographics. We report odds ratio (OR) estimates with corresponding 95% confidence interval (95% CI) and area under the curve (AUC) of the operating characteristic curve (ROC) for fitted models.

Results: The case-control groups did not differ in regards to age, gender, race, ethnicity, history of ever smoking, current alcohol use or county versus private hospital system. Within AA, LC controls did differ significantly from UMHC and JMH controls in regards to age (LC were younger, p=.022) and ethnicity (LC had less Hispanics, p=.013). With respect to log2CD44 and protein, there were no significant mean differences between UMHC/JMH Lip/oral cavity (Lip/OC) and oropharynx (OP) cases, however means of either subset of cases (p&lt;0.03), as well as all cases (p&lt;.0001), were significantly higher than for UMHC/JMH controls. Similarly, within AA, the overall group and both the Lip/OC and OP tumor groups had significantly higher marker levels than the 31 UMHC/JMH controls and 129 LC controls for both control groups (log2CD44 and protein, p&lt;.0001). Significant between case group differences were seen in all cancer patients for log2CD44 by stage (III/IV higher than I/II), tumor (T4 higher than T0-T3) and node status (N1-N3 higher than N0, Nx) at p&lt;.05. Neither levels of log2CD44 or protein showed significant differences with respect to p16 staining (surrogate for HPV status) in cancer patients. However, race and gender did have an effect on protein levels (p=.045 and p=.033, respectively). Models were better for men compared to women and AA compared to Whites. The best model included male AA cases versus male AA LC controls (AUC=0.983).

Conclusions: Our preliminary data on AA underserved populations show great promise for detecting HNSCC. In addition, our findings strongly suggest that solCD44, protein, race, gender and age are very important components for HNSCC early detection studies.

Citation Format: Lutecia H. Mateus Pereira, Isildinha Reis, Robert Duncan, Judy Wen, Erika Reategui, Laurian Walters, Aymee Perez, Elizabeth J. Franzmann. Head and neck squamous cell carcinoma and disparities: A model for early detection. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B86.

Achyranthes aspera (Apamarg) leaf extract inhibits human pancreatic tumor growth in athymic mice by apoptosis

ETHNOPHARMACOLOGICAL RELEVANCE

Achyranthes aspera (Family Amaranthacea) is used for cancer therapy by ayurvedic medical practitioners in India. However, due to the non formal nature of its use, there are no systematic studies validating its medicinal properties. Thus, it's utility as an anti cancer agent remains anecdotal. Earlier, we demonstrated A. aspera to exhibit time and dose-dependent preferential cytotoxicity to cultured human pancreatic cancer cells. In this report we validate in vivo anti tumor properties of A. aspera.

MATERIALS AND METHODS

The in vivo anti tumor activity of leaf extract (LE) was tested by intraperitoneal (IP) injections into athymic mice harboring human pancreatic tumor subcutaneous xenograft. Toxicity was monitored by recording changes in behavioral, histological, hematological and body weight parameters.

RESULTS

Dosing LE to athymic mice by I.P. injection for 32 days showed no adverse reactions in treated mice. Compared to the control set, IP administration of LE to tumor bearing mice significantly reduced both tumor weight and volume. Gene expression analysis using Real time PCR methods revealed that LE significantly induced caspase-3 mRNA (p<0.001) and suppressed expression of the pro survival kinase Akt-1 (p<0.05). TUNEL assay and immunohistochemistry confirmed apoptosis induction by activation of caspase-3 and inhibiting Akt phosphorylation in treated sets. These results are in agreement with RT PCR data.

CONCLUSION

Taken together, these data suggest A. aspera to have potent anti cancer property.

Abstract 3627: Head and neck squamous cell carcinoma in African Americans: A simple oral rinse detection test using solCD44 and total protein

The burden of head and neck squamous cell carcinoma (HNSCC) is greater for African Americans (AA) than for Whites with both incidence and disease-specific mortality higher in AA. Early detection tests are needed because the majority of patients present in late stage when cure rates reach only 40%. Our group has developed a prototype early detection test based on soluble CD44 (solCD44) and total protein levels that is simple, inexpensive and noninvasive. Subjects included 21 HNSCC AA patients and 68 AA controls recruited from the University of Miami Hospital and Clinics, Jackson Memorial Hospital and Liberty City Community in Miami-Dade County. The majority of cases and controls come from underserved populations of low SES. A one-way ANOVA of the two cancer types and controls followed by pairwise comparisons using the Student t-test, and comparison of all cases vs. controls using the contrast method were computed. The effects of solCD44 and total protein on the risk of being a case was evaluated using univariate and multivariate logistic regression analyses. We report odds ratio (OR) estimates with corresponding 95% confidence interval (95% CI) and area under the curve (AUC) of the operating characteristic curve (ROC) for all fitted models. The groups did not differ in regards to gender (p=0.684), but did differ significantly in age (cases were older, mean 60 vs. 50, p&lt;.0001) and ethnicity (19% Hispanic in cases vs. none in controls, p=.003). Log2solCD44 and total protein showed significantly elevated levels in cases compared to controls (2.12 vs. 0.76, p&lt;.0001 and 1.19 vs. 0.72, p=.001, respectively). Lip/oral cavity and oropharynx cancer cases and controls were significantly different with respect to log2solCD44 and total protein at p&lt;0.05. Among cancer patients, difference in means by disease site was only statistically significant for log2solCD44 (lower for oropharynx than lip/oral cavity (1.86 vs. 3.21) at p&lt;0.05). Univariately, both markers seemed to have good predictive ability (log2solCD44 AUC=0.814, OR=4.52, p=.0001 and total protein AUC=0.714, OR=5.66, p=.0015). The best models were log2solCD44 (OR=3.66) adjusted for age and gender (AUC=0.930), total protein (OR=5.25) adjusted for age and gender (AUC=0.899), and log2solCD44 (OR=3.17) and protein (OR=1.80) together adjusted for age and gender (AUC=0.930). In this last model, log2solCD44 maintained its effect in the presence of protein; however log2solCD44 appears to be a confounder for protein, reducing considerably its effect. Tests of effect modification (interactions) of ethnicity and age on log2 solCD44, on total protein, and between markers were carried out, and there were no interactions found. Our preliminary data on AA underserved populations show great promise for detecting HNSCC. In addition, our findings strongly suggest that race, gender and age are very important components for HNSCC early detection studies.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3627. doi:1538-7445.AM2012-3627

Abstract 4297: Racial/ethnic disparities in breast cancer radiosensitivity

Purpose: To evaluate radiotherapy (RT)-related skin toxicity and its relationship to quality of life (QOL) outcomes in a tri-racial/ethnic cohort. Methods: We evaluated the first 172 patients in an ongoing prospective study of conservatively managed breast cancer patients using the validated Breast Cancer Treatment Outcome Scale (BCTOS) questionnaire to assess RT-related QOL, and NCI CTCAE v3.0 criteria to assess skin toxicity (ST). BCTOS was completed prior to and at RT completion, and skin toxicity was assessed at week 3 and RT completion. We recorded patient demographics, body mass index (BMI), disease and treatment characteristics and used Student's t-test and regression for statistical analysis. We divided BCTOS parameters into 3 domains: physical appearance/function, personal reaction to RT, and worst pain in the last 4 weeks. Results: Completed BCTOS questionnaires were available for 145 patients (84%) included in this analysis. Patients were 17.2% non-Hispanic white (NHW), 60.7% Hispanic white (HW), 19.3% black (B), and 2.8% other. 18.6% had DCIS, 52.4% stage I, and 29% stage II-III invasive breast cancer. 30.3% had BMI &lt;25, 28.3% 25-29.99, and 41.4% γ30. All patients had BCS followed by RT +/− systemic therapy; median breast dose 50 Gy + 10 Gy boost. At RT completion, all patients had ST: 46.2% Grade (Gr) 1, 50.3% Gr 2, and 3.4% Gr 3. In the entire cohort, there was a significant increase from baseline to RT completion in all QOL domains: Post minus baseline mean difference in physical appearance/function was 7.7 points (p&lt;0.001), personal reaction to RT 8.1 points (p&lt;0.0001), and pain 3.9 points (p&lt;0.001). For physical appearance/function, greater differences were found with higher ST grade (10.4 for Gr 2/3 vs. 4.5 for Gr 1, p=0.01), by race (15.6 points for B vs. 5.9 points for HW and 5.3 points for NHW/other, p=0.003), and increasing BMI (3.6 for &lt;25, 6.8 for 25-29.99, and 11.2 for α30, p=0.019). For worst pain in last 4 weeks, greater differences were found with increasing BMI (1.8 for &lt;25, 2.8 for 25-29.99, and 6.1 for α30, p=0.037) and borderline significant increase with ST grade (2.3 for Gr 1 vs. 5.2 for Gr 2/3, p=0.057). There were no significant differences in personal reaction to RT. With respect to physical appearance/function, there was significant interaction between race/ethnicity and BMI (p=0.015). Among women with BMI α30, there were significant effect of B race (p=0.010) and worst toxicity grade (p=0.02). Conclusion: In a diverse cohort of breast cancer patients, RT affected all QOL domains of the BCTOS. RT-induced ST was more common among B patients and those with higher BMI and correlated with physical appearance/function and pain. Underlying etiology for variation in RT-related breast symptoms is unknown and may relate to genetic, biologic, and/or environmental factors. Our ongoing study with a targeted sample size of 1,000 may shed light on the mechanisms of racial/ethnic disparities in RT outcomes of breast cancer patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4297. doi:1538-7445.AM2012-4297

Abstract 4352: Radiotherapy-induced plasma cytokine changes and skin toxicity in breast cancer patients

Breast cancer is the most common neoplasm and the second leading cause of cancer death in American women. Radiotherapy (RT) is an effective adjuvant treatment after breast-conserving surgery for early-stage breast cancer. However, the majority of breast cancer patients undergoing RT develop acute skin reactions. We pilot tested the effects of RT on immune system and inflammatory cytokines in 12 breast cancer patients (6 with high and 6 with low skin toxicity). Using the Human Cytokine ELISA Plate Array I (Signosis Inc., Sunnyvale, CA), we evaluated 31 plasma cytokines in RT-related skin toxicity. The National Cancer Institute Common Terminology Criteria for Adverse Effects (version 3.0) was used to evaluate skin toxicity grade. Our data showed that RT induced epidermal growth factor (EGF); at baseline EFG was not detectable while post RT-treatment significant levels of EFG was observed (mean+SD: 395±620.4, p=0.0496). Interleukin (IL)-2 was significantly elevated by RT (6.5x106±1.01x106 vs. 4.85x106±1.44x106, p=0.0004). Adiponectin was significantly higher at post RT (3.09x106±1.31x106) than pre RT (1.77x106±1.52x106, p=0.0002). RT-related changes of IL-4 was significantly associated with skin toxicity at week 3 (p=0.018); IL-4 was decreased in patients without toxicity (-668.3±1691.5) and increased in patients with grade 2 toxicity (1830.0±1365.4). IL-12 showed similar trend but with marginal significance (p=0.076). RT-related changes of EGF was significantly associated with skin toxicity at week 6 (p=0.045); EGF was not changed in patients with no or low toxicity (grade 0/1) and increased in patients with grade 2/3 toxicity (592.5±686.4). In summary, our pilot data suggest that RT induces EGF, IL-2, and adiponectin. RT-related changes of IL-4 and EGF were associated with skin toxicity. Our ongoing study with a targeted sample size of 1,000 may shed light on the molecular mechanisms of cytokines in RT-related skin toxicity of breast cancer patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4352. doi:1538-7445.AM2012-4352

Pb5.0(1)In8.4(1)Bi1.6(1)S20, a new quaternary lead indium bismuth sulfide

The title phase, first detected in the early 1980s but hitherto unpublished, has been resynthesized and structurally characterized. Unambiguous determination of the chemical composition was not possible by structure analysis alone, but required additional analytical methods. The complex structure shows a close similarity to the structures of two related compounds, one known by the formula Pb(1.6)In(8)Bi(4)S(19) and the other being the ternary compound Pb(6)In(10)S(21). This is despite the fact that the three phases correspond to very different Pb:Bi ratios. A geometric mechanism is described by which the three structures can be transformed into each other, provided that the heavy atoms Pb and Bi are treated as equivalent.

Association between race and BMI with response to neoadjuvant endocrine therapy in postmenopausal women with large estrogen receptor-positive breast cancers

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Background: Neoadjuvant endocrine therapy is increasingly used in the treatment of breast cancer. There is a need to define which patients will benefit the most from this form of therapy.

Methods: Retrospective review of medical records from University of Miami/Jackson Memorial Hospital from 1998 to 2011. Response to neoadjuvant endocrine therapy was evaluated through comparison of palpable breast mass size at presentation with pathological tumor size in surgical specimens. Response was stratified as “No Response” (NR), indicating no change or increase in size, “Moderate Response” (MR) as up to 50% decrease in size, and “Good Response” (GR) > 50% decrease in size. Data was analyzed by body mass index (BMI), type of endocrine therapy, race and histology.

Results: Data from 62 postmenopausal, estrogen receptor-positive women who received neoadjuvant hormonal therapy was analyzed. Median age was 62 (range 50-91). Clinical stage: II 24.2%, IIIA 25.8%, IIIB 35.5%, IIIC 6.5%. Endocrine therapy used was tamoxifen (14.5%) or aromatase inhibitor (AI) (85.5%). Response rate was NR in 22.6%, MR in 43.5% and GR in 33.9%. Fifty two patients had available height and weight information. In patients receiving AI, BMI was significantly higher in the NR group vs. GR group (mean BMI 38.68 vs. 27.56, p=0.041). Mean BMI in MR was 32.18, not statistically different from either group. Analysis of both AI and tamoxifen treated patients yielded similar results (results not included). The rate of GR was higher in the Caucasian vs. African American population (40.4% vs. 14.3%, p=0.017). Inversely, the rate of NR was higher in African Americans (50.0% vs. 14.9%, p=0.017). There was a trend towards more favorable tumor size change in Caucasian vs. African American women (mean 36.19% reduction vs. 11.69% increase in tumor size, p=0.058). The mean tumor size change was more favorable in ductal vs. lobular carcinomas (34.75% decrease vs 8.69% increase, p=0.184).

Conclusions: Lower BMI and Caucasian ethnicity were associated with higher frequency of GR (> 50% decrease in tumor size) to neoadjuvant endocrine therapy. No association was found between response and stage, PR status or HER2 expression.

Salivary protein and solCD44 levels as a potential screening tool for early detection of head and neck squamous cell carcinoma

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) is a devastating disease usually diagnosed at a late stage when cure rates are 40%. We examined a simple and inexpensive molecular tool that may aid HNSCC detection.

METHODS

Building on prior findings that total protein levels are elevated in 102 HNSCC cases versus 84 control subjects, we further analyzed these levels with respect to important risk and demographic variables and compared the results to soluble CD44 (solCD44). Using multivariate adaptive regression splines (MARSs)-logit modeling and logistic regression, we determined whether total protein, solCD44, or the combination best identifies HNSCC.

RESULTS

Combined higher levels of solCD44 and protein were significantly associated with HNSCC (odds ratio [OR] = 24.90; 95% confidence interval [CI], 9.04-68.57; area under the curve [AUC] = 0.786). A model including protein plus solCD44 resulted in a better area (AUC 0.796) than either marker alone.

CONCLUSION

Oral rinse levels of solCD44 and protein seem to hold promise for detection of HNSCC.

Accelerated partial breast irradiation is safe and effective using intensity-modulated radiation therapy in selected early-stage breast cancer

PURPOSE

To report the feasibility, toxicity, cosmesis, and efficacy of using intensity-modulated radiation therapy (IMRT) with respiratory gating to deliver accelerated partial breast irradiation (APBI) in selected Stage I/II breast cancer after breast-conserving surgery.

METHODS AND MATERIALS

Eligible patients with node-negative Stage I/II breast cancer were prospectively enrolled in an institutional review board approved protocol to receive APBI using IMRT after breast-conserving surgery. The target volume was treated at 3.8 Gy/fraction twice daily for 5 days, to a total dose of 38 Gy.

RESULTS

Thirty-six patients were enrolled for a median follow-up time of 44.8 months. The median tumor size was 0.98 cm (range, 0.08-3 cm). The median clinical target volume (CTV) treated was 71.4 cc (range, 19-231 cc), with the mean dose to the CTV being 38.96 Gy. Acute toxicities included Grade 1 erythema in 44% of patients and Grade 2 in 6%, Grade 1 hyperpigmentation in 31% of patients and Grade 2 in 3%, and Grade 1 breast/chest wall tenderness in 14% of patients. No Grade 3/4 acute toxicities were observed. Grade 1 and 2 late toxicities as edema, fibrosis, and residual hyperpigmentation occurred in 14% and 11% of patients, respectively; Grade 3 telangiectasis was observed in 3% of patients. The overall cosmetic outcome was considered "excellent" or "good" by 94% of patients and 97% when rated by the physician, respectively. The local control rate was 97%; 1 patient died of a non-cancer-related cause.

CONCLUSIONS

APBI can be safely and effectively administered using IMRT. In retrospective analysis, IMRT enabled the achievement of normal tissue dose constraints as outlined by Radiation Therapy Oncology Group 04-13/NSABP B-13 while providing excellent conformality for the CTV. Local control and cosmesis have remained excellent at current follow-up, with acceptable rates of acute/late toxicities. Our data suggest that cosmesis is dependent on target volume size. Further prospective multi-institutional trials should be performed to evaluate IMRT to deliver APBI.

Loss of Yes-associated protein (YAP) expression is associated with estrogen and progesterone receptors negativity in invasive breast carcinomas

Yes-associated protein (YAP) is a well characterized transcriptional coactivator that interacts with various transcription factors and modulates their transcriptional activities. Phosphorylation of YAP by specific kinases regulates its cellular distribution and transcriptional activation functions. Sequestration of phosphorylated YAP in cytoplasm results in the reduction of transcription from its target genes. Since, YAP has been characterized as a coactivator of estrogen (ER) and progesterone (PR) receptors, we examined the immunohistochemical expression profile of YAP and correlation of YAP expression with that of ER and PR in normal (40 samples) and tumor breast (226 samples) from microarray tissue samples using immunohistochemistry. Here we show that YAP expression is significantly reduced in invasive carcinoma samples compared to normal breast tissues, which express high levels of YAP (YAP was positive for 45.1% of invasive carcinoma samples versus 82.5% of normal samples P < 0.0001). Furthermore, the data shows that reduced expression of YAP in invasive carcinoma samples is significantly associated with ER negativity (YAP was negative for 59.9% in ER negative versus 38.9% in ER positive invasive carcinoma samples, P = 0.007) and PR negativity (YAP was negative for 60.1% in PR negative versus 28.9% in PR positive, P = 0.0004). Among invasive carcinoma samples, 42.9% were YAP, ER, and PR negative, whereas only 7.5% were found to be YAP, ER, and PR positive. On the contrary, 20 out of 23 (87%) normal breast tissues that were positive for ER and PR were also positive for YAP. These data suggest that YAP may act as a tumor suppressor in invasive breast carcinomas and it can also be used as a molecular marker for ER and PR negative breast tumors.

EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video)

BACKGROUND

EUS-guided celiac plexus neurolysis (EUS-CPN) improves pain control in patients with pancreatic cancer. EUS allows visualization of the celiac ganglion.

OBJECTIVE

To determine predictors of response to EUS-CPN in a cohort of 64 patients with pancreatic malignancy.

DESIGN

Retrospective analysis of prospective database.

SETTING

Academic medical center.

PATIENTS

Sixty-four patients with pancreatic cancer referred for EUS between March 2008 and January 2010.

INTERVENTIONS

EUS-CPN injected directly into celiac ganglia when visible by linear EUS or bilateral injection at the celiac vascular trunk.

MAIN OUTCOME MEASUREMENTS

Predictors of pain improvement at week 1 by univariate and multivariate analysis.

RESULTS

At week 1, 32 patients (50%) had a symptomatic response. In a multivariate model with 8 potential predictors, visualization of the ganglia was the best predictor of response; patients with visible ganglia were >15 times more likely to respond (odds ratio 15.7; P<.001). Tumors located outside the head of the pancreas and patients with a higher baseline pain level were weakly associated with a good response.

LIMITATIONS

Retrospective design and lack of blinding.

CONCLUSIONS

Visualization of celiac ganglia with direct injection is the best predictor of response to EUS-CPN in patients with pancreatic malignancy.

A phase II study of neoadjuvant and adjuvant chemotherapy with 5-fluorodeoxyuridine, leucovorin, oxaliplatin and docetaxel in the treatment of previously untreated advanced esophageal adenocarcinoma

OBJECTIVE

A complete pathologic response to neoadjuvant chemotherapy, without the use of radiation, has infrequently been reported in operable chemo-naïve stage III esophageal adenocarcinoma patients.

METHODS

Twenty-nine eligible patients were enrolled in the study. Neoadjuvant therapy consisted of 5-fluorodeoxyuridine, leucovorin, oxaliplatin and docetaxel and was administered in two 4-week cycles. Following therapy, patients underwent surgical resection. Those patients having residual disease were offered adjuvant chemotherapy. Patients having a complete pathologic response were not offered any further chemotherapy.

RESULTS

Twenty-four out of 29 patients finished neoadjuvant therapy and underwent curative esophagectomy. Two patients were declared inoperable after treatment, and three patients died prior to surgery. The median follow-up on all patients was 20.2 months. Median progression-free survival and median overall survival were 13.6 and 21.4 months, respectively. Clinical response to neoadjuvant chemotherapy was seen in 21 out of 29 patients (72.4%). Complete pathologic response with neoadjuvant chemotherapy was seen in 4 out of 24 patients (16.7%). Those four patients have been alive and progression-free for 20-37 months. Grade 3-4 toxicities occurred in 16 of the 29 patients during neoadjuvant therapy. Grade 3-4 toxicities were seen in 6 out of 14 patients during adjuvant therapy. (18)F-fluorodeoxyglucose-positron emission tomography standardized uptake values of ≥8 correlated with better progression-free survival.

CONCLUSION

5-Fluorodeoxyuridine, leucovorin, oxaliplatin and docetaxel regimen is active in patients with esophageal adenocarcinoma. Toxicity profiles are manageable. Neoadjuvant chemotherapy allowed achievement of complete pathologic response without radiation. (18)F-fluorodeoxyglucose-positron emission tomography standardized uptake values might be prognostic.