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Academic Training in Oral and Maxillofacial Surgery - when and how to enter the pathway. Br J Oral Maxillofac Surg 2023; 61:124-130. [PMID: 36774281 DOI: 10.1016/j.bjoms.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
Entering into surgical academia can seem a daunting prospect for an oral and maxillofacial surgery (OMFS) trainee. However, the streamlining of academic training by the NIHR to create the integrated academic training (IAT) pathway has simplified academic training and more clearly defined academic positions and entry points for trainees. In this article we review the current NIHR IAT pathway and the various grades and entry points available to OMF surgeons, both pre- and post-doctoral. We highlight the unique challenges facing OMF trainees and provide advice and insight from both junior and senior OMFS academics. Finally, we focus on the planning and application for a doctoral research fellowship - discussing funding streams available to OMF surgeons.
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Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2023; 61:78-83. [PMID: 36513528 DOI: 10.1016/j.bjoms.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 109/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.
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191. Management of condylar fractures: a national survey of senior clinicians. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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4
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Airway management, intensive care requirement and corticosteroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2022; 60:1228-1233. [DOI: 10.1016/j.bjoms.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/29/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
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5
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Clinical negligence claims in oral and maxillofacial surgery over the last 10 years. Br J Oral Maxillofac Surg 2021; 59:1259-1263. [PMID: 34364713 DOI: 10.1016/j.bjoms.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/14/2021] [Indexed: 11/24/2022]
Abstract
According to NHS Resolution, the cost of harm from clinical activity in the last year was £8.3 billion. The steady increase in litigation within the National Health Service (NHS) has led to concerns being raised regarding the sustainability of the NHS, the increasing practice of defensive medicine, and the psychological impact on healthcare professionals. To our knowledge, litigation within oral and maxillofacial surgery has not been investigated in the UK since 2010, therefore our aims were to identify the trends within our specialty and the common reasons for negligence claims over the last 10 years. A freedom of information request was made to NHS Resolution for all clinical negligence claims from 2010 to 2020. A total of 1,122 claims were registered and the total for damages paid was £32,631,131. The claims were categorised by the primary injury and further divided into groups of cause codes. Four types of primary injury comprised 65.4% (n = 734) of all negligence claims and were as follows: additional or unnecessary operations (n = 313, 27.9%), unnecessary pain (n = 156, 13.9%), nerve damage (n = 139, 12.4%), and dental damage (n = 126, 11.2%). The damages associated with nerve damage were the costliest, with a total of £8,033,737 being paid. The significant increase in the number and cost of clinical negligence claims is concerning. The lessons from these claims must be shared and implemented to reduce the burden on the NHS, and ensure that we are providing a high quality of care with improved patient outcomes.
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Stress hyperglycaemia or diabetes mellitus in cervicofacial infections? a Maxillofacial Surgery Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2021; 60:1049-1055. [DOI: 10.1016/j.bjoms.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
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7
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Book review. Br J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.bjoms.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Character failings in the surgeon fallen from grace: a thematic analysis of disciplinary hearings against surgeons 2016-2020. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106809. [PMID: 33419937 DOI: 10.1136/medethics-2020-106809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
Surgeons are commonly evaluated with respect to outcomes and adherence to rules and regulations, rather than a true holistic examination of the character of the surgeon in question. We sought to examine the character failings of surgeons who faced fitness to practice enquiries under the Medical Practitioner Tribunal Service in the UK. In particular, we examined the absence of virtue as perceived through the lens of Aristotelian ethics using thematic analysis of tribunal hearing transcripts from 2016 to 2020. We identified three overarching themes that are explored in depth: 'the god complex', 'reputation over integrity' and 'wounded pride'. We hope to use this as the foundation for a re-examination of the place of phronesis in postgraduate surgical education, which we argue should be perceived as an exercise in character development and reformation rather than the simplistic teaching of skills to standardised outcomes.
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Following COVID-19 clinicians now overwhelmingly accept virtual clinics in Oral and Maxillofacial Surgery. Br J Oral Maxillofac Surg 2020; 58:e290-e295. [PMID: 32798104 PMCID: PMC7833799 DOI: 10.1016/j.bjoms.2020.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023]
Abstract
Virtual consultations and telemedicine have been an emerging trend in modern medicine, which has seen acceleration in uptake across a wide range of specialties as a result of the COVID-19 pandemic. Following on from previous work by the authors in 2019 examining clinician and patient appetite for virtual consultations in maxillofacial surgery, we sought to evaluate whether there had been a change in attitudes as a result of the pandemic. A clinician survey of the consultants at a large teaching hospital and prospective data collection of virtual consultation outcomes was carried out from the inception of UK government lockdown measures to tackle the pandemic. From 151 consultations, 149 (98.7%) successfully established a working diagnosis and treatment plan and/or concluded an episode of patient care, without the need to convert to a face-to-face encounter between clinician and patient. The total number of consultations (virtual or otherwise) was significantly lower than the same time period the preceding year however (1,223 compared with 465 consultations). All consultants surveyed felt the pandemic had altered their opinion of virtual clinics and their place in maxillofacial surgery but cited a number of issues. Further work is required to understand the driving forces behind staff attitudes and the long-term adoption of telemedicine within the specialty as services return to some sense of normalcy.
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Maxillofacial education in the time of COVID-19: the West Midlands experience. Br J Oral Maxillofac Surg 2020; 60:52-57. [PMID: 32807595 PMCID: PMC7392048 DOI: 10.1016/j.bjoms.2020.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
COVID-19 has accelerated a reliance on virtual technology for the delivery of postgraduate surgical education. We sought to develop a regional teaching programme with robust quality assurance. Webinars were delivered on a weekly basis by subspecialty experts using Zoom™ augmented with interactive polling software. Trainee feedback comprised Likert item rating on content and delivery, free text comments and self-assessed confidence levels using visual analogue scale (VAS) scores. A focus group was also convened and transcripts assessed with grounded theory analysis. Likert items revealed 442 (93.2%) positive responses regarding content and 642 (96.7%) positive responses regarding trainer delivery. There were statistically significant improvements in VAS scores across all programme content. Key themes from the focus group analysis were the pragmatics of delivering online education, issues surrounding trainer interactivity in the virtual world, the identification of the FRCS as a driving factor and a desire for case-based content and pre-learning of information (the ‘flipped classroom’). We are continuing to be reactive to trainee feedback in developing our online learning programme which will also include a regional Moodle-based virtual learning environment (VLE), the subject of future educational research in our region.
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Birmingham mandible and midface rules: determining variables for inclusion in a clinical predictor rule. Br J Oral Maxillofac Surg 2020; 58:597-601. [DOI: 10.1016/j.bjoms.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
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12
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Phronesis and virtue ethics: the future of surgical training? Br J Oral Maxillofac Surg 2020; 58:125-128. [DOI: 10.1016/j.bjoms.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022]
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13
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Storiform collagenoma (sclerotic fibroma) of the oral mucosa. Br J Oral Maxillofac Surg 2020; 58:231-233. [PMID: 31761569 DOI: 10.1016/j.bjoms.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Storiform collagenoma (also called sclerotic fibroma) is uncommon, occurs as a cutaneous fibrous neoplasm, and is particularly rare in mucosal tissue in the head and neck. We describe an unexpected diagnosis in the oral cavity. Histopathological examination showed a proliferation of fibrous tissue, which was well circumscribed but unencapsulated, with thick laminated bundles of eosinophilic collagen that exhibited a storiform or "whorled" pattern. First described by Weary et al in 1972, storiform collagenoma is a marker for Cowden's disease or PTEN hamartoma tumour syndrome. Identification of other synchronous lesions should prompt chromosomal analysis for a mutation in the PTEN gene on chromosome 10q23.
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Storiform collagenoma of the head and neck: an uncommon diagnosis. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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A snapshot audit of the management of benign obstructive salivary gland diseases at the Queen Elizabeth hospital, Birmingham. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Review of emerging temporomandibular joint total joint replacement systems. Br J Oral Maxillofac Surg 2019; 57:722-728. [DOI: 10.1016/j.bjoms.2019.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
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17
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Management of temporomandibular disorders (TMD): a national survey of physiotherapists’ attitudes and training. Br J Oral Maxillofac Surg 2018. [DOI: 10.1016/j.bjoms.2018.10.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Conservative management of condylar fractures with open repair of a second mandibular fracture: is pre-op the same as post-op? Br J Oral Maxillofac Surg 2018. [DOI: 10.1016/j.bjoms.2018.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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“Flipped” lectures for dental core trainees in trauma skills: a step ahead of the didactic lecture. Br J Oral Maxillofac Surg 2018. [DOI: 10.1016/j.bjoms.2018.10.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Pharyngo-pleuro-cutaneous fistula associated with parapharyngeal abscess: The importance of multi-disciplinary decision-making in managing complex cases. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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“Flipped classrooms” in training in maxillofacial surgery: preparation before the traditional didactic lecture? Br J Oral Maxillofac Surg 2018; 56:384-387. [DOI: 10.1016/j.bjoms.2018.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
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22
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Abstract PD5-08: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd5-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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23
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A service evaluation of surgical tracheostomies in the emergency theatre at University Hospital, Coventry: time for a dedicated tracheostomy team? Br J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.bjoms.2017.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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The impact of fixation method selection on neurosensory disturbance following bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.bjoms.2017.08.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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UK temporomandibular joint replacement database: a report on one-year outcomes. Br J Oral Maxillofac Surg 2017; 55:927-931. [DOI: 10.1016/j.bjoms.2017.08.361] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/21/2017] [Indexed: 11/17/2022]
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26
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The provision of surgical tracheostomies by maxillofacial surgeons in the UK: time for a dedicated tracheostomy team? Ann R Coll Surg Engl 2017; 100:116-119. [PMID: 29046086 DOI: 10.1308/rcsann.2017.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Surgical tracheostomy is a commonly provided service by surgical teams for patients in intensive care where percutaneous dilatational tracheostomy is contraindicated. A number of factors may interfere with its provision on shared emergency operating lists, potentially prolonging the stay in intensive care. We undertook a two-part project to examine the factors that might delay provision of surgical tracheostomy in the intensive care unit. The first part was a prospective audit of practice within the University Hospital Coventry. This was followed by a telephone survey of oral and maxillofacial surgery units throughout the UK. In the intensive care unit at University Hospital Coventry, of 39 referrals, 21 (53.8%) were delayed beyond 24 hours. There was a mean (standard deviation) time to delay of 2.2 days (0.9 days) and the most common cause of delay was surgeon decision, accounting for 13 (61.9%) delays. From a telephone survey of 140 units nationwide, 40 (28.4%) were regularly involved in the provision of surgical tracheostomies for intensive care and 17 (42.5%) experienced delays beyond 24 hours, owing to a combination of theatre availability (76.5%) and surgeon availability (47.1%). There is case for having a dedicated tracheostomy team and provisional theatre slot to optimise patient outcomes and reduce delays. We aim to implement such a move within our unit and audit the outcomes prospectively following this change.
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Use of buccal cortex as interpositional graft in mandibular setbacks. Br J Oral Maxillofac Surg 2017; 55:853-854. [PMID: 28818503 DOI: 10.1016/j.bjoms.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/14/2017] [Indexed: 11/28/2022]
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28
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When the cows come home: occupational tinea barbae in a cattle farmer. Br J Oral Maxillofac Surg 2017; 55:e31-e32. [DOI: 10.1016/j.bjoms.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
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29
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Thyrolingual trunk: aberrant branches of the external carotid artery. Br J Oral Maxillofac Surg 2017; 55:437-438. [DOI: 10.1016/j.bjoms.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
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Abstract P2-08-06: A phase 1 study of RAD1901, a novel, oral selective estrogen receptor degrader, for the treatment of ER-positive advanced breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The majority of breast cancers are defined as estrogen receptor positive (ER+) breast cancer. Despite availability of standard therapies, such as aromatase inhibitors, many women eventually relapse with aggressive disease due to acquisition of endocrine resistance, including ESR1 mutations. To help address some of the challenges associated with current therapies including exposure limitations and intramuscular administration, we have developed RAD1901, a novel, non-steroidal, oral selective estrogen receptor degrader (SERD). Preclinical studies with RAD1901 have demonstrated a dose dependent degradation of ER consistent with a SERD mechanism of action. In multiple in vivo models of breast cancer, including patient-derived xenograft models that are sensitive or resistant to standard endocrine therapies, RAD1901 has anti-tumor efficacy both as a single agent and in combination with palbociclib and everolimus. Importantly, RAD1901 has shown superior efficacy compared to fulvestrant in a number these models including those harboring and ESR1 mutation.
Methods: RAD1901-005 is a Phase 1 study currently enrolling ER+ advanced metastatic breast cancer patients (ClinicalTrials.gov identifier: NCT02338349) with a dose escalation cohort based on a standard 3+3 design followed by a safety expansion cohort at a tolerated dose. Key inclusion criteria include postmenopausal women aged 18 years or older, with advanced ER+, HER2-negative breast cancer, who have received ≤ 2 prior chemotherapy regimens in the metastatic setting and > 6 months of prior endocrine therapy. In addition, circulating tumor DNA (ctDNA) was evaluated to determine ESR1 mutation status and to correlate it with clinical response.
Results: As of the cut-off date in March, 13 patients were enrolled in the dose escalation part of the study (3+3 design) at doses of 200 mg qd, 400 mg qd and 600 mg qd. RAD1901 exposure was dose dependent and the PK profile was comparable to PK data from a previous study in healthy volunteers. RAD1901 was well tolerated with the most common adverse events being low-grade nausea and dyspepsia. No DLTs were observed. A safety expansion cohort (Part B, n=20) was opened. At the cut-off date 4 of the 13 patients had been on study 4 or more months. Updated outcomes and biomarker data, including ctDNA, will be presented at the meeting.
Conclusion: RAD1901, a novel, non-steroidal, oral SERD, is well-tolerated with manageable adverse effects, and is associated with preliminary evidence of clinical activity in patients with advanced ER+ advanced postmenopausal breast cancer, including patients with ESR1 mutant tumors.
Citation Format: Kaklamani VG, Kabos P, Elledge R, Harb W, Purandare D, O'Neill A, Garner F, Bardia A. A phase 1 study of RAD1901, a novel, oral selective estrogen receptor degrader, for the treatment of ER-positive advanced breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-08-06.
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Re: Should we consider devolution of "head and neck" surgery from the specialties of oral and maxillofacial surgery; ear, nose and throat surgery; and plastic surgery? Br J Oral Maxillofac Surg 2017; 55:566. [PMID: 28214026 DOI: 10.1016/j.bjoms.2016.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
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32
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Training in surgery of the temporomandibular joint: the UK trainers’ perspective. Br J Oral Maxillofac Surg 2017; 55:61-66. [DOI: 10.1016/j.bjoms.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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33
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Extra-oral implants for prosthetic rehabilitation of craniofacial defects at University Hospitals Birmingham 2005-2015. Br J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.bjoms.2016.11.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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34
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Training in surgery of the temporomandibular joint: perceptions of trainees in oral and maxillofacial surgery in the United Kingdom. Br J Oral Maxillofac Surg 2016; 54:941-945. [DOI: 10.1016/j.bjoms.2016.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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35
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De-epithelialised radial forearm free flap to recontour the buccal commissure. Br J Oral Maxillofac Surg 2016; 55:205-206. [PMID: 27449951 DOI: 10.1016/j.bjoms.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
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36
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Use of a virtual learning environment for training in maxillofacial emergencies: impact on the knowledge and attitudes of staff in accident and emergency departments. Br J Oral Maxillofac Surg 2016; 54:166-9. [DOI: 10.1016/j.bjoms.2015.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 12/02/2015] [Indexed: 11/29/2022]
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37
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Free flaps in the elderly: does age make a difference to outcome? Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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38
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Integra® dermal regeneration template in the reconstruction of complex scalp defects: initial experiences at Worcestershire Royal Hospital. Br J Oral Maxillofac Surg 2014. [DOI: 10.1016/j.bjoms.2014.07.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Clinical and biologic features of triple-negative breast cancers in a large cohort of patients with long-term follow-up. Breast Cancer Res Treat 2012; 136:795-804. [PMID: 23124476 PMCID: PMC3513514 DOI: 10.1007/s10549-012-2315-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 12/31/2022]
Abstract
Studies on well characterized, large populations of estrogen receptor (ER)/progesterone receptor (PgR)/HER2-negative [triple-negative (TN)] breast cancer (BC) patients with long-term follow-up are lacking. In this study, we analyze clinical outcomes of TN BC and implications of epidermal growth factor receptor (EGFR) expression. Clinical and biologic features, time to first recurrence (TTFR), and overall survival (OS) were compared in 253 TN versus 1,036 ER positive, PgR positive, HER2-negative [estrogen-driven (ED)] BC. Compared to ED, TN tumors were larger (p = 0.02), more proliferative (high S-phase 54 vs. 17 %, p < 0.0001), more aneuploid (64 vs. 43 %, p < 0.0001) and more likely EGFR positive (≥10 fmol/mg by radioligand-binding assay, 49 vs. 7 %, p < 0.0001). Among TN, EGFR-positive BC were larger (p = 0.0018), more proliferative (p < 0.0001), and more aneuploid, (p < 0.0001) than EGFR-negative BC. Adjuvant-treated TN patients had shorter TTFR (p = 0.0003), and OS (p = 0.0017), than ED patients. However, in untreated patients, no differences in TTFR and OS were observed at 8 years median follow-up. Among TN patients, EGFR expression was not associated with worse outcome. TN tumors have a worse outcome in systemically treated patients but not in untreated patients. EGFR expression, does not predict for worse long-term survival.
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MESH Headings
- Aged
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Chemotherapy, Adjuvant
- ErbB Receptors/metabolism
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Multivariate Analysis
- Ploidies
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Treatment Outcome
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Is it cost effective to introduce intra-operative molecular analysis of sentinel lymph nodes using one step nucleic acid amplification (OSNA)? Int J Surg 2011. [DOI: 10.1016/j.ijsu.2011.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elledge R, Baskar V. . West J Med 2010; 341:c7134-c7134. [DOI: 10.1136/bmj.c7134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Blindness. West J Med 2010. [DOI: 10.1136/bmj.c5680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A library based ecological study to investigate the contribution of ethnicity to oral cancer incidence. Br J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.bjoms.2009.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Current concepts in research related to oncogenes implicated in salivary gland tumourigenesis: a review of the literature. Oral Dis 2009; 15:249-54. [PMID: 19317835 DOI: 10.1111/j.1601-0825.2009.01529.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Salivary gland tumours are relatively uncommon and there exists considerable difficulty in decisions regarding prognosis and management, as well as diagnostic uncertainty that has implications for treatment. METHOD Literature pertaining to individual oncogenes has been reviewed and commented upon, specifically looking at the role of these as diagnostic and prognostic markers and as potential targets for treatments. RESULTS kit, PLAG1, Mect1-Maml2, HMGIC, HER2/neu, ras, c-fos and Sox-4 all have seminal small-scale studies in the literature with potential for further research and eventual clinical applications. CONCLUSION A wide variety of oncogenes are implicated in salivary gland tumourigenesis, with evidence being confined to small murine or in vitro studies more often than not. There are possible roles for different oncogenes in therapeutics, prognosis and management of specific salivary gland tumours.
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Characteristics of a high-risk minority population. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21141 Background: Black and Hispanic breast cancer patients have a worse outcome when compared to Caucasians. This could be due to socioeconomic, cultural or biologic factors. We hypothesized that host and tumor biologic characteristics associated with a poor outcome may be found more often in minority women. Methods: Race/ethnicity, menopausal status, tumor histological features, and patient characteristics including age and body mass index (BMI) were reviewed from a prospective neoadjuvant trial of docetaxel vs. doxorubicin/cyclophosphamide at Baylor College of Medicine Breast Center, from September 2002 to September 2006. The data were analyzed using Chi-square and Fisher's exact tests, while the Kruskal-Wallis method was used to analyze BMI. Results: Of the 167 patients, 63% (n=105) were Caucasian, 15% (n=26) were Hispanic and 22% (n=36) were Black. The mean age was 47.6 years (range: 30–72). Fifty-nine percent were premenopausal. Overall, mean BMI was 29, with Caucasians having a mean BMI of 27.5, Hispanics with 29.8 and Blacks with a BMI of 34.6 (P<0.001). Sixty-five percent of the Caucasians and 58% of Hispanics were ER+ or PR+ versus 44% of Blacks (P=0.09). Sixteen percent of Caucasians were HER-2 positive compared to 4% of Hispanics and 9% of Blacks (p=0.25). In addition, 22% of Caucasians and 38% of Hispanics were ER-, PR-, HER-2- compared to 50% of tumors from Blacks (p=0.007). There was a trend linking BMI and triple negative status in breast cancers, which did not achieve statistical significance (p=0.21). Conclusion: In this study we found that black and Hispanic women were more likely to be obese and have ER-, PR-, HER-2- tumor phenotypes, both of which have been associated with poorer outcomes. Ongoing studies are being performed to elucidate the link between clinical and biological characteristics and understand the underlying molecular mechanisms associated with these findings. No significant financial relationships to disclose.
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A phase II study of anastrazole and fulvestrant in combination with gefitinib in patients with newly diagnosed ER-positive breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1050 Background: Endocrine therapy for ER+ breast cancer is effective and relatively nontoxic, but is limited by de novo and acquired resistance. Preclinical studies suggest that complete ER blockade along with inhibition of co-expressed growth factor receptors enhances endocrine response and overcomes resistance. Methods: We conducted a phase II trial of combined anastrazole and fulvestrant with gefitinib, an EGFR tyrosine kinase inhibitor, as intial therapy in postmenopausal women with locoregional or metastatic ER+ breast cancer. A tumor core biopsy was done at baseline and after 3 weeks. Patients received treatment for 4 months. Surgery was then offered if the tumor was operable. Primary endpoint was clinical response as defined by RECIST criteria and secondary endpoints were safety/tolerability, complete pathologic response rate (pCR), and biomarker analysis. Planned sample size was 60 patients, but the study closed after 15 patients were enrolled because of poor accrual. Results: Median age at diagnosis was 67 years. Median clinical tumor size was 7 cm and 4 patients had metastases. 11 patients (73%) had ER+/PgR+ tumors and 4 (27%) had ER+/PgR- disease. 3 patients withdraw from the study before response was assessed. Of the12 remaining patients there were 2 complete responses (17%), 5 partial responses (42%), 5 with stable disease (42%), and 2 (17%) with progressive disease. Of the 7 patients who had surgery at 4 months, none had pCR. Most common adverse events were rash in 4 patients, Diarrhea in 4, joint symptoms in 3, and abnormal LFT’s in 3. All adverse events were reversible. Biomarkers, including arrays and Ki67, are pending and will be presented at the meeting. Conclusions: Complete ER blockade using anastrazole and fulvestrant with EGFR inhibition is well-tolerated and has activity in this cohort of patients with relatively advanced ER+ breast cancer. Despite its documented benefit and low toxicity, accrual to neoadjuvant endocrine therapy studies remains poor in the US, largely because of physician hesitance to refer patients for non-chemotherapy studies. More effort is needed to increase physician awareness about the value of endocrine therapy, and to increase accrual to trials that address the question of endocrine resistance. [Table: see text]
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Predictive gene expression patterns of response to adriamycin and cyclophosphamide (AC) in human breast cancers. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
527 Background: Adriamycin and cyclophosphamide (AC) and docetaxel (D) are widely used in the treatment of breast cancer. We conducted a prospective, randomized, multicenter trial to discover predictive markers of AC and D and hypothesized that gene expression profiles can select appropriate patients who may respond to AC, and that these patterns are different from our published docetaxel (D) profiles Methods: One hundred and twenty patients were randomized to either 4 cycles of AC (60/600 mg/m2) or D (100mg/m2) prior to surgery. Core biopsies from 60 patients were obtained before treatment with neoadjuvant AC. Pathologic responses were assessed after AC. Gene expression patterns were determined using Affymetrix U133A GeneChips. Differential genes for AC response were then validated by QRT-PCR in an independent cohort of 33 patients treated with AC. Results: The median age was 48 yrs (range 30–72), clinical response rates were 57% (34/60), and pathological complete response (pCR) or near pCR (npCR) was observed in 22% (12/60) in AC arm. Differential expression between sensitive and resistant tumors with a low false discovery rate (FDR 5–10%) was obtained. Of these 82 differentially expressed genes, pathways up-regulated in sensitive tumors included TOP2A, metabolism (LYZ), survival (CFLAR, CASP3), cell cycle (MKI67), cytokines and other inflammatory genes. This molecular portrait for AC was not predictive of docetaxel response. By QRT-PCR of 4 genes (LYZ, CFLAR, MKI67 and TOP2A) in the independent tumor set, LYZ was predictive of AC pathologic complete response. Additional genes will be validated in the second cohort. Conclusions: The molecular profile for AC is different from the docetaxel expression profile. This potential predictive test may allow selection of the most appropriate chemotherapy schedule for women with breast cancer. No significant financial relationships to disclose.
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Predictive value of apoptosis, proliferation, HER-2, and topoisomerase IIα for anthracycline chemotherapy in locally advanced breast cancer. Breast Cancer Res Treat 2005; 92:69-75. [PMID: 15980993 DOI: 10.1007/s10549-005-1721-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Laboratory evidence indicates that tumor growth depends on the balance between cell proliferation and cell death, and many anticancer agents may exert their therapeutic effect by decreasing proliferation and increasing apoptosis. Additionally, clinical observations indicate that overexpression of HER-2 or topoisomerase IIalpha (topo IIalpha) may be predictors of better response to anthracyclines in breast cancer. The objective of this study was to determine if proliferation (Ki-67), apoptosis (TUNEL), and expression of HER-2 and topo IIalpha are affected by anthracycline treatment, and if these molecular markers predict anthracycline responsiveness. EXPERIMENTAL DESIGN Thirty-three women with primary breast tumors > or =3 cm received either doxorubicin (75 mg/m(2)) or epirubicin (120 mg/m(2)) for 4 cycles before surgery. Clinical response was evaluated after 4 cycles of treatment. Changes in molecular markers were assessed from core needle taken before treatment (D0), at 24-48 h (Dl) and on day 7 (D7) while on treatment, and from the surgical specimen excised on day 84 (D84) after the fourth cycle of chemotherapy. RESULTS The overall response rate was 51% (17 of 33 patients), with a 12% complete clinical response rate (4 of 33 patients). There were trends for tumors with higher apoptosis and topo IIalpha at baseline (D0) to be more responsive to anthracyclines, p = 0.1 and p = 0.08, respectively. Median apoptosis increased from D0 to Dl (p = 0.06) while median Ki-67 decreased (p = 0.07). Overall, expression of HER-2 remained stable throughout the chemotherapy administration. By Day 84, topo IIalpha had significantly decreased from baseline in responders, while it increased in non-responders, p = 0.03. CONCLUSIONS In human primary breast cancer, anthracycline treatment causes an early increase in apoptosis and a decrease in proliferation. In this pilot study, higher apoptosis and topo IIalphaa levels in primary tumors were associated with greater responsiveness to anthracyclines, and topo IIalpha levels declined in responsive tumors.
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MESH Headings
- Adult
- Aged
- Antibiotics, Antineoplastic/pharmacology
- Antibiotics, Antineoplastic/therapeutic use
- Antigens, Neoplasm/biosynthesis
- Apoptosis/drug effects
- Biomarkers, Tumor/biosynthesis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/physiopathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/physiopathology
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/physiopathology
- Cell Proliferation/drug effects
- DNA Topoisomerases, Type II/biosynthesis
- DNA-Binding Proteins/biosynthesis
- Doxorubicin/pharmacology
- Doxorubicin/therapeutic use
- Epirubicin/pharmacology
- Epirubicin/therapeutic use
- Female
- Genes, erbB-2/physiology
- Humans
- Middle Aged
- Neoplasm Staging
- Pilot Projects
- Predictive Value of Tests
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Clinical response to neoadjuvant docetaxel predicts improved outcome in patients with large locally advanced breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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50
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Clinical and biologic features of ER- PR- HER-2- breast cancer compared to estrogen or HER-2 driven phenotypes. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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