Management of the positive pathologic circumferential resection margin in rectal cancer: A national cancer database (NCDB) study

BackgroundThe circumferential resection margin (CRM) is a primary predictor of local recurrence and survival in rectal cancer, and an important consideration in guiding treatment. CRM is usually predicted preoperatively, so optimal management of an unexpected pathologic positive CRM involvement is debatable. We aimed to investigate the postoperative management of T3N0 rectal cancers with a positive pathologic CRM, and the impact of each strategy on survival.MethodsThe NCDB was reviewed for pathological T3N0 rectal cancer cases from 2010 to 2015, that received neoadjuvant chemotherapy, had surgical resection with pathological clear margins, but a positive pathologic CRM(disease≤2 mm from radial margin). The main outcomes were the incidence, treatment modalities used, and impact of each modality on survival. Univariate analysis evaluated the demographic and provider characteristics across treatment groups. Kaplan-Meier and Cox regression analysis assessed survival and factors associated with overall survival (OS).ResultsOf 1607 cases with a positive CRM, 65% (1045) received no adjuvant treatment and 35% (n = 562) received adjuvant chemotherapy (AC). After matching, the 1-, 3-, and 5-year OS rates were 98.5%, 88.6% and 76.6% for AC and 96.9%, 84.6% and 68.4% for with no treatment (p = .027). Factors independently associated with improved OS were treatment at an academic/research facility (p = .009), minimally invasive approach (p = .005), well and moderately differentiated tumor (p < .001), absence of perineural invasion (p = .015) and AC administration (p = .047).ConclusionIn T3N0 rectal cancers resected with local clear margins but a positive pathologic CRM, AC improved OS. However, only a third received this option. Further study is needed to investigate the disparities in AC use in these patients with unexpected pathologic results.     

Olaparib Use in Patients With Metastatic Breast Cancer Harboring Somatic BRCA1/2 Mutations or Mutations in Non-BRCA1/2, DNA Damage Repair Genes

BackgroundPoly-ADP ribose polymerase (PARP) inhibitors (PARPi) are active in patients with germline BRCA1/2 (gBRCA1/2)-mutated breast cancer, accounting for 5% to 10% of all breast cancers. Another 5% to 10% harbor somatic BRCA1/2 (sBRCA1/2) mutations or mutations in non-BRCA1/2, homologous recombination repair (HRR) genes but until recently, there were no data for the use of PARPi in these patients. This study examines the use of olaparib in patients with metastatic breast cancer harboring sBRCA1/2 or germline or somatic non-BRCA1/2, HRR mutations and demonstrates potential activity of PARPi in this setting.MethodsIn this retrospective, single institution study, patients who were treated with off-label, off-protocol olaparib for metastatic breast cancer harboring sBRCA1/2 or germline or somatic non-BRCA1/2, HRR mutations were identified. The primary aim was to describe these patients’ demographics, tumor characteristics, mutations, safety and tolerability, response rates, progression free survival, PARPi-associated survival and subsequent treatment.ResultsSeven patients were treated off-label, off-trial with olaparib for sBRCA1/2-mutated cancers (n = 4) or non-BRCA1/2, HRR-mutated cancers (n = 3). All patients with sBRCA1/2-mutated cancers responded to PARP inhibition; patients with non-BRCA1/2, HRR-mutated cancers did not respond. The median progression free survival in patients with a sBRCA1/2 mutation was 6.5 months (range 5-9 months) vs. 3 months (range 2-4 months) in patients with non-BRCA1/2, HRR mutations.ConclusionThis single institution experience adds to recent larger reports confirming evidence for PARPi therapy in patients with metastatic breast cancer harboring sBRCA1/2 mutations. No activity was observed in patients with either germline or somatic non-BRCA1/2, HRR-mutated cancers.     

Ⅱ级胶质瘤术后调强放射治疗疗效分析

目的分析Ⅱ级胶质瘤术后调强放射治疗的疗效及预后影响因素。方法对2010年1月至2018年12月期间收治的接受术后调强放射治疗的109例Ⅱ级胶质瘤患者进行回顾性分析。主要研究终点为无复发生存率、次要研究终点为总生存率。分析年龄、性别、手术切除状态、病灶最大径、肿瘤跨中线、含星形细胞瘤成份、同步放化疗、辅助化疗等因素对无复发生存的影响。结果全组随访率91.75%,随访期间10例死亡,27例复发。照射野内复发24例,占88.9%;照射野外复发3例,占11.1%。其中,肿瘤全切组81例复发14例,占17.3%;部分切除组28例复发13例,占46.4%。部分切除组复发率明显高于全切组(χ^2=9.484,P<0.05)。全组患者1、2、3、4、5年无复发生存率分别为92.5%、86.0%、80.6%、77.5%、66.8%,2、3、4、5年总生存率分别为97.2%、90.8%、87.7%、84.5%。多因素分析显示,手术部分切除(HR=3.608,P<0.05)、肿瘤跨中线(HR=3.183,P<0.05)患者更容易复发进展。结论Ⅱ级胶质瘤行术后调强放射治疗,可获得较好的无复发生存。照射野内复发为主要的治疗失败模式,手术切除状态、肿瘤是否跨中线是影响无复发生存的重要因素。     

Feasibility of ABUS as an Alternative to Handheld Ultrasound for Response Control in Neoadjuvant Breast Cancer Treatment

IntroductionThe Invenia Automated Breast Ultrasound Screening (ABUS) is indicated as an adjunct to mammography for breast cancer screening in asymptomatic women with high-density breast tissue. ABUS provides time-efficient evaluation of the 3-dimensional recordings within 3 to 6 minutes. The role and advantages of ABUS in everyday clinical practice, especially in routine examination during neoadjuvant chemotherapy (NACT), is not clear. The aim of this monocentric, noninterventional retrospective study is to evaluate the use of ABUS in patients who are under NACT treatment for response control.MethodsRegular sonographic response check with handheld ultrasound (HHUS) examination and with ABUS were conducted in 83 women who underwent NACT. The response controls were conducted every 3 to 6 weeks during NACT. The handheld sonography was performed with GE Voluson S8. Handheld sonographic measurements and ABUS measurements were compared with the final pathologic tumor size.ResultsThere was no statistical difference between the measurements with HHUS examination or ABUS compared with final pathologic tumor size (P = .47). The average difference from ABUS measured tumor size to final pathologic tumor size was 9.8 mm. The average difference from handheld measured tumor size to final pathologic tumor size was 9/3 mm. Both the specificity of ABUS and HHUS examination in predicting pathologic complete remission was 100%.ConclusionABUS seems to be a suitable method to conduct response control in neoadjuvant breast cancer treatment. ABUS may facilitate preoperative planning and offers remarkable time saving for physicians compared with HHUS examination and thus should be considered for clinical practice     

Associations between Spiritual Health Locus of Control,Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City

BackgroundWe sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women.MethodsA total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test.ResultsMost women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50–59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test.ConclusionThe spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.     

Intraoperative Touch Imprint Cytology in Breast Cancer Patients After Neoadjuvant Chemotherapy

BackgroundIntraoperative touch imprint cytology (ITIC) is used for intraoperative detection of sentinel lymph node (SLN) metastases with intention to spare the patients another surgery. However, ITIC prolongs surgery, and ads costs. It is less likely positive in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC) due to low axillary tumor burden. We aimed to evaluate ITIC in patients after NAC and assess how often it changes the ongoing surgery.Materials and MethodsBC patients treated with NAC followed by surgery at the Institute of Oncology Ljubljana, Slovenia, from January 2008 to July 2020 with ITIC performed were selected for analysis. Sensitivity, specificity, and the proportion of positive ITIC were calculated for different subgroups.ResultsOverall, 144 patients were identified. 73 of 144 (50.7%) patients were N0 before NAC and 71 of 144 (49.3%) were initially N1 and downstaged to N0 after NAC. ITIC was positive in 30 of 144 (20.8%) of patients, 7 of 73 (9.6%) in N0 group and 23 of 71 (32.4%) in N1 group. In N0 group, ITIC was positive in 1 of 20 (5%) if the tumor size was ≤ 20 mm after NAC, and 2 of 39 (5.1%) if the tumor was triple negative (TN) or Her-2+. In the N1 group ITIC was positive in > 20% in all subgroups. The sensitivity and specificity of ITIC was 50.8% and 100%, respectively and did not differ between groups.ConclusionITIC after NAC is accurate with comparable sensitivity to ITIC in upfront surgery. We suggest omission of ITIC after NAC in initially N0 patients, particularly for tumors ≤ 20 mm after NAC, and in TN or Her-2+ subtypes.