Abstract P3-12-10: Utilization patterns and temporal trends of internal mammary nodal irradiation (IMNI) at a tertiary cancer centre

Purpose: Despite data from multiple randomized trials, the role and uptake of internal mammary nodal irradiation (IMNI) is variable. This study was designed to quantify the rates and determinants of IMNI at a tertiary cancer centre.

Methods: Treatment records of consecutively treated breast cancer (BC) patients receiving adjuvant locoregional (LR) radiotherapy (RT) from January 1, 2012 to October 31, 2017 was studied. LR-RT and use of IMNI as a function of clinicopathological factors, use of deep inspiratory breath-hold (DIBH) and dosimetric parameters were retrieved. Patients were divided into two groups:Group1 received LR-RT that included the IMN's, supraclavicular (SCLV) ± axillary regions,Group2 received LR-RT directed only to the SCLV±axillary areas. For the purpose of utilization analysis and temporal trends, early(2012-2015) and late(2016-2017) cohorts were examined based on the year of RT delivery. To determine if the use of IMNI was dependent on BC risk, we defined 3 risk categories:1) pT1/2, N0); 2)pT1/2, N1; and 3) pT3/4, N2/3 disease. Differences between the risk categories and groups were evaluated using chi-square/ Fisher's and Mann Whitney test for categorical and continuous variables, respectively. Univariable and multivariable logistic regression analysis was done to determine factors associated with the receipt of IMNI.

Results:A total of 1566 patients met eligibility (Group 1=376; Group 2=1190). Of these patients, the percentage receiving LR-RT remained constant (17%) over the study period but the proportion of patients receiving IMNI increased significantly each year (p<0.0001), and was higher in the late vs. early treatment cohort (55% vs 8%, p<0.0001).On univariable analysis, younger age, LVI positivity, medial/central location, increasing stage, PR negativity, mastectomy, axillary dissection ,receipt of chemotherapy and increasing number of positive nodes had higher odds of receiving IMNI. Radiation oncologists with < or ≥5 years of practice was predictive of IMNI (31.3% vs 20.5%, p<0.0001),staff having <5years in practice being more likely to recommend IMNI. The distribution of patients in the different risk categories was similar between Groups 1 and 2 (p=0.097), and identified that the majority of patients receiving IMNI were in risk category 2(83%). Further comparison of risk categories suggested that the odds of receiving IMNI was lower in risk category 3 vs. category 1 (p=0.033). On multivariable analysis, decreasing age age (p=<0.001) , medial quadrant(p=0.0026),PR negative(p=0.0011), mastectomy(p=0.0055) , increasing nodal positivity (p<0.0001)and late RT cohort (p=0.001) had increased odds of IMNI. Overall use of DIBH was significantly higher in those receiving IMNI (45% vs 26%, p<0.0001). Mean heart (2.2vs1.7Gy, p<0.0001) and total lung doses (7.8vs6.6Gy,p<0.0001) were also significantly higher with IMNI.

Conclusion: There was a significant increase in utilization of IMNI from 2012 to 2017. Younger age, medial location, PR negativity and increasing number of positive nodes predicted for receipt of IMNI. Staff with<5years in practice were more likely to recommend LR-RT that included the IMNs. The use of DIBH significantly increased with IMNI and allowed for acceptable dosimetric constraints.

Citation Format: Misra S, Lee G, Maganti M, Koch CA. Utilization patterns and temporal trends of internal mammary nodal irradiation (IMNI) at a tertiary cancer centre [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-10.

The Origins of Verb Learning: Preverbal and Postverbal Infants' Learning of Word-Action Relations

PURPOSE

This experiment examined English- or Spanish-learning preverbal (8-9 months, n = 32) and postverbal (12-14 months, n = 40) infants' learning of word-action pairings prior to and after the transition to verb comprehension and its relation to naturally learned vocabulary.

METHOD

Infants of both verbal levels were first habituated to 2 dynamic video displays of novel word-action pairings, the words /wem/ or /bæf/, spoken synchronously with an adult shaking or looming an object, and tested with interchanged (switched) versus same word-action pairings. Mothers of the postverbal infants were asked to report on their infants' vocabulary on the MacArthur-Bates Communicative Development Inventories (Fenson et al., 1994).

RESULTS

The preverbal infants looked longer to the switched relative to same pairings, suggesting word-action mapping, but not the postverbal infants. Mothers of the postverbal infants reported a noun bias on the MacArthur-Bates Communicative Development Inventories; infants learned more nouns than verbs in the natural environment. Further analyses revealed marginal word-action mapping in postverbal infants who learned fewer nouns and only comprehended verbs (post-verb comprehension), but not in those who learned more nouns and also produced verbs (post-verb production).

CONCLUSIONS

These findings on verb learning from inside and outside the laboratory suggest a developmental shift from domain-general to language-specific mechanisms. Long before they talk, infants learning a noun-dominant language learn synchronous word-action relations. As a postverbal language-specific noun bias develops, this learning temporarily diminishes.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5592637.

The Dynamics of Infant Attention: Implications for Crossmodal Perception and Word-Mapping Research

The present review is a novel synthesis of research on infants' attention in two related domains-crossmodal perception and word mapping. The authors hypothesize that infant attention is malleable and shifts in real time. They review dynamic models of infant attention and provide empirical evidence for parallel trends in attention shifts from the two domains that support their hypothesis. When infants are exposed to competing auditory-visual stimuli in experiments, multiple factors cause attention to shift during infant-environment interactions. Additionally, attention shifts across nested timescales and individual variations in attention systematically explain development. They suggest future research to further elucidate the causal mechanisms that influence infants' attention dynamics, emphasizing the need to examine individual variations that index shifts over time.

The sooner the better: Genetic testing following ovarian cancer diagnosis

OBJECTIVE

As treatment based genetic testing becomes a reality, it is important to assess the attitudes and preferences of women newly diagnosed with ovarian cancer regarding genetic testing. The objective of this study was to determine when women with a diagnosis of high grade serous ovarian cancer would prefer to undergo genetic testing and factors that influence this preference.

METHODS

Women over 18years of age with a known diagnosis of high grade serous ovarian cancer diagnosed between October 2010-2013 were identified via the Princess Margaret Cancer Center Registry. Participants completed a questionnaire, which obtained preferences and attitudes towards genetic testing, cancer history, and demographic information.

RESULTS

120 of the 355 women identified (33.8%) completed the questionnaires. The median age at time of ovarian cancer diagnosis was 57years (range 35-84). The majority of participants in this study were offered (94.6%) and pursued (84.8%) genetic testing. In this cohort, testing was most frequently offered at diagnosis (41.8%) or during treatment (19.1%). In this study, women with high grade serous ovarian cancer felt that genetic testing should be offered before or at the time of diagnosis (67.8%). Having a family history of breast or ovarian cancer was significantly (p=0.012) associated with preferring genetic testing at an earlier time point in the disease course.

CONCLUSIONS

Our results demonstrate that women with high grade serous ovarian cancer acknowledge the personal and clinical utility of genetic testing and support test implementation at the time of cancer diagnosis.

Cross-cultural evidence for multimodal motherese: Asian Indian mothers' adaptive use of synchronous words and gestures

In a quasi-experimental study, 24 Asian Indian mothers were asked to teach novel (target) names for two objects and two actions to their children of three different levels of lexical mapping development: prelexical (5-8 months), early lexical (9-17 months), and advanced lexical (20-43 months). Target naming (n=1482) and non-target naming (other, n=2411) were coded for synchronous spoken words and object motion (multimodal motherese) and other naming styles. Indian mothers abundantly used multimodal motherese with target words to highlight novel word-referent relations, paralleling earlier findings from American mothers. They used it with target words more often for prelexical infants than for advanced lexical children and to name target actions later in children's development. Unlike American mothers, Indian mothers also abundantly used multimodal motherese to name target objects later in children's development. Finally, monolingual mothers who spoke a verb-dominant Indian language used multimodal motherese more often than bilingual mothers who also spoke noun-dominant English to their children. The findings suggest that within a dynamic and reciprocal mother-infant communication system, multimodal motherese adapts to unify novel words and referents across cultures. It adapts to children's level of lexical development and to ambient language-specific lexical dominance hierarchies.

Neutrophil/lymphocyte ratio as a prognostic factor in biliary tract cancer

BACKGROUND

Biliary tract cancers (BTCs) include intrahepatic (IHC), hilar, distal bile duct (DBD) and gallbladder carcinoma (GBC). Neutrophil/lymphocyte ratio (NLR), a marker of host inflammation, is prognostic in several cancers but has not been reviewed in large BTC series, or advanced BTC (ABTC) at diagnosis.

PATIENTS AND METHODS

Baseline demographics and NLR at diagnosis were retrospectively evaluated in 864 consecutive patients with BTC treated from January 1987 to December 2012. The association between NLR and overall survival (OS) was determined using a multivariable Cox proportional hazards model.

RESULTS

Eight hundred and sixty-four patients were included in the analysis, of which 62% had ABTC and 38% had surgery with curative intent. Median age was 65 years, 444 (51%) were male and 727 (84%) had performance status (PS) ⩽ 2. A NLR ⩾ 3.0, PS >2, IHC primary, stage, lack of surgery, haemoglobin <110 g/L and albumin <40 g/L were associated with significantly worse OS on multivariable analysis. A NLR ⩾ 3.0 was an independent prognostic factor for OS for the entire cohort; median OS was 21.6 months versus 12.0 months for patients with NLR <3.0 versus NLR ⩾ 3.0 respectively (adjusted hazard ratio (HR)-1.26, 95% confidence interval (CI); 1.06-1.50, P = 0.01). NLR was also prognostic in patients with ABTC (HR-1.26, 95% CI; 1.02-1.56, P = 0.035) and hilar cancer: overall group (N = 149) (HR-1.70, 95% CI; 1.10-2.50, P = 0.01) and advanced group (N = 111) (HR-1.57, 95% CI; 1.04-2.44, P = 0.048).

CONCLUSION

Baseline NLR is a readily available and inexpensive prognostic biomarker in patients with BTC and likely warrants validation in large prospective clinical trials.

Preterm and term infants’ perception of temporally coordinated syllable–object pairings: implications for lexical development

PURPOSE

This experimental study examined term infants (n = 34) and low-risk near-term preterm infants (gestational age 32–36 weeks) at 2 months chronological age (n = 34) and corrected age (n =16). The study investigated whether the preterm infants presented with a delay in their sensitivity to synchronous syllable–object pairings when compared with term infants.

METHOD

First, infants were habituated to a single syllable, [tah] or [gah], spoken in synchrony with the motions of 1 of 4 toy objects, a crab, a porcupine, a star, or a lamb chop. Next, the infants received 2 syllable- and 2 object-change test trials, counterbalanced for order.

RESULTS

After factoring out differential looking time during habituation, the study found that preterm infants showed attenuated looks to the change in the object and the change in the syllable relative to term infants.

CONCLUSIONS

These findings suggest that even near-term preterm infants present with a delay in their sensitivity to synchrony in syllable–object pairings relative to term infants. Given the important role that synchrony plays in word mapping at 6–9 months, this early delay in sensitivity to synchrony might be an indicator of word mapping delays found in older preterm infants.

Keeping it simple: genetics referrals for all invasive serous ovarian cancers

OBJECTIVE

In the province of Ontario, all women diagnosed with invasive serous ovarian cancer are eligible for genetic testing for mutations in the BRCA1 and BRCA2 genes. This study aimed to determine the proportion of these women who are seen for genetic counseling and to identify potential predictors and barriers to having genetic counseling.

METHODS

All women who were diagnosed with invasive serous ovarian cancer and had genetic counseling at Princess Margaret Hospital (PMH) between 2002 and 2009 were identified. Logistic regressions and trend analyses explored age at diagnosis, year at diagnosis, and the time between diagnosis and genetic counseling. Genetic counseling outcomes were also examined.

RESULTS

Of 623 women diagnosed with invasive serous ovarian cancer, 144 (23%) were seen for genetic counseling. As age at diagnosis increased, the likelihood of genetic counseling decreased (p=0.005). With a more recent date of diagnosis, the probability of having genetic counseling increased (p=0.032) while the time to genetic counseling decreased (p=0.001). Of women who pursued genetic testing, 31% were found to have a BRCA1 or BRCA2 mutation, 16% of whom had no family history of breast or ovarian cancer.

CONCLUSIONS

Despite the availability of genetic testing, only a small proportion of women with invasive serous ovarian cancer were seen for genetic counseling. Over time, an improvement in the proportion of women being seen for genetic counseling was noted; however barriers to seeing women with a later age at diagnosis or those with no family history of breast or ovarian cancer clearly exist.

Maternal naming of object wholes versus parts to preverbal infants: a fine-grained analysis of scaffolding at 6-8 months

Maternal naming of object wholes versus parts was examined during interactive free-play. Forty-two Caucasian- and Hispanic-American mothers and their preverbal infants of 6-8 months were video-taped interacting naturally during toy play. For the purpose of fine-grained analyses, maternal naming of object wholes versus parts were coded for bimodal naming (e.g., temporal synchrony) and object motion (e.g., shaking) to examine any differences in these measures across the two word types. The results revealed that during naming, mothers simultaneously moved object wholes more often than they did object parts to highlight the object wholes in their infants' visual field. To further highlight object wholes during naming, mothers predominantly shook or loomed object wholes in synchrony with their naming more often than object parts. These empirical findings suggest that very early during infants' word-mapping development, maternal scaffolding is manifold and assists in infants' disambiguation of names for object wholes versus parts.