Community experience with bortezomib in patients with multiple myeloma

Community practice experience allows a nonselective care of patient using information derived from a more controlled clinical trial environment. We present our community experience with multiple myeloma patients with advanced age, long disease duration since diagnosis, advanced stage, multiple prior therapies including stem cell transplantation, co-morbidities, and other poor prognostic features, such as low albumin, high B-2 microglobulin, renal failure, and the presence of poor risk chromosomal abnormalities. Our response rates are comparable to those from clinical trials. Bortezomib is well tolerated in this population of multiple myeloma patients with the exception of infection adverse events that are generally mild grade 1-2.     

CA2-04: Variation in Mastectomy Rate for Invasive Breast Cancer: Results from the Breast Cancer Surgical Outcomes Study

Background/Aims In 1999, the National Institutes of Health Consensus Conference recommended breast conserving therapy (BCT) as a viable alternative to mastectomy based on several long-term studies and meta-analyses. Since then BCT has been the procedure of choice for most women with early stage breast cancer. However, several recent studies have reported a shift toward increasing use of total mastectomy (TM). We evaluated patterns of mastectomy use and factors associated with mastectomy rates in the Breast Cancer Surgical Outcomes (BRCASO) study. Methods BRCASO is a collaborative study between University of Vermont, Kaiser Permanente, Colorado; Group Health, Seattle; and Marshfield Clinic, Wisconsin and includes detailed data on 4580 women diagnosed with incident invasive or in situ breast cancer between 2003-2008 obtained from administrative data and medical record abstraction. For this analysis, we included 2384 women with an incident diagnosis of stage 1-3 breast cancer with no history of chest radiation. We excluded cases of inflammatory or multifocal breast cancer. Results We found rates of TM as the initial surgical procedure varied by study site (p<0.0001), age at diagnosis (p=0.0005), and by use of preoperative MRI (p<0.0001). TM frequency ranged from 10.4% - 21.0% across the four institutions. Increased TM use was associated with increasing pre-operatively estimated tumor size (p<0.0001), ER/PR negative status (p=0.0007), high grade (p<0.0001) and lobular (vs. ductal) carcinoma (p=0.001). We did not find TM increasing over time. When we limited our analysis to the 1712 cases with tumor size <20 mm, we continued to observe variability in initial TM frequency across institutions from 5.2% to 14.2% (p<0.0001). Discussion Our TM rates were low compared to those reported in previous studies. Variation in TM rates was associated with several patient, tumor, and facility characteristics and may reflect differences in the patient population presenting with breast cancer, or in patients' treatment preferences. This variation persisted even when limited to women with small tumors. While TM rates were relatively low, the two-fold variation by study site suggests inconsistent surgical practices across facilities despite several studies showing BCT and mastectomy provide equal survival benefit.     

Michels syndrome: The first case report from India and review of literature

A 2-year 7-month-old girl born out of a consanguineous marriage, presented at our facility with clinical features characterized by the eyelid triad of blepharophimosis, blepharoptosis and epicanthus inversus in association with hypertelorism, cleft palate and craniosynostosis. This constellation of features is suggestive of Michels syndrome. At the time of writing this report, there were only ten reported cases worldwide and to the best of our knowledge, there have been no published reports from India.     

Perioperative infection rate in patients with osteosarcomas treated with resection and prosthetic reconstruction

Background  

The incidence of perioperative infection after segmental tumor endoprosthetic replacement in previous reports varies from a high of 7.4% to a low of 2.6%. Appropriate antibiotic use for this group is unknown and controversial, whereas the relationship of antibiotic use and perioperative infection is unclear.