Adequate Local Control Research Articles

Hypofractionation with concomitant boost using intensity-modulated radiation therapy in early-stage breast cancer in Mexico.

To evaluate whether hypofractionation with integrated boost to the tumour bed using intensity-modulated radiation therapy is an acceptable option and to determine whether this treatment compromises local control, toxicity and cosmesis. Retrospective studies have demonstrated that patients who are treated with HF and integrated boost experience adequate local control, a dosimetric benefit, decreased toxicity and acceptable cosmesis compared with conventional fractionation. A retrospective, observational and longitudinal study was conducted from January 2008 to June 2015 and included 34 patients with breast cancer (stage 0-II) who were undergoing conservative surgery.The prescribed doses were 45 Gy in 20 fractions (2.25 Gy/fraction) to the breast and 56 Gy in 20 fractions (2.8 Gy/fraction) to the tumour bed. Thirty-four patients were included. The mean follow-up was 49.29 months, and the mean age was 52 years. The mean percentage of PTV from the mammary region that received 100% of the prescribed dose was 97.89% (range 95-100), and the mean PTV percentage of the tumour bed that received 100% of the dose was 98% (95-100).The local control and the overall survival were 100%, and the cosmesis was good in 82% of the patients. Grade 1 acute toxicity was present in 16 patients (47%), and grade 1 chronic toxicity occurred in 6 cases (18%). The results of the present study demonstrate that hypofractionation with integrated boost using intensity-modulated radiation therapy is an acceptable option that provides excellent local control and low toxicity.

Abstract OT2-01-04: Freezing instead of resection of small breast tumors (FROST): A study of cryoablation in the management of early stage breast cancer

Abstract Background/Objective: ACOSOG Z1072 demonstrated complete target tumor ablation in 92% of stage I invasive breast cancers treated with cryoablation prior to resection. We hypothesize that cryoablation can achieve complete tumor ablation and adequate local control in a selected population of women with early stage invasive breast cancer managed with cryoablation alone, without planned surgical resection. Methods: The trial is a phase II, single-arm, multicenter study open to women age 50 and older with core needle biopsy-proven clinical stage I, T1, clinically node negative (N0), unifocal, hormone receptor positive, HER2/neu-negative invasive ductal carcinoma measuring ≤1.5 cm by mammography (MG), ultrasound (US), and MRI. Once registered, subjects will undergo US-guided cryoablation followed 6 months later by an US-guided core biopsy of the cryoablated lesion to confirm the absence of residual viable disease. Following cryoablation, subjects will also begin a minimum 5-year course of adjuvant endocrine therapy and serial MG, US, and MRI. Whole breast radiotherapy (WBRT) is optional for subjects age 70+ (stratum I) and mandatory for women age 50-69 (stratum 2). Sentinel node biopsy (SNBx) is optional in both cohorts. All subjects found to have residual or recurrent disease will undergo standard surgical resection. Study SchemaRegistrationCryoablation6 MonthsSemiannualAnnualResectionAge 50+, tumor size ≤ 1.5 cm, unifocal, N0, biopsy proven invasive breast cancerFollowed by endocrine therapy (all patients); WBRT (Stratum 2); SNBx (optional)MG, US, MRI, needle biopsy; resection of residual cancer or serial follow up if absentUnilateral US or MG X 3 yearsBilateral MG and MRIRecurrent/residual breast or axillary cancer The trial was activated in June 2016. The study is currently open at 6 sites with up to 30 sites planned. A total of 110 eligible subjects will be enrolled in each stratum for total accrual goal of 220. Enrollment is planned over 3 years followed by 5 years of follow-up. Results: The primary endpoint of the study will be to determine the rate of complete tumor ablation in patients treated with cryoablation, defined as absence of residual viable carcinoma detected by core needle biopsy of the ablation site performed 6-months post-cryoablation. The secondary endpoint will be to determine the 5-year ipsilateral breast tumor recurrence rate in patients treated with cryoablation without subsequent resection. Local recurrence will be defined as recurrence of cancer within the index quadrant confirmed histologically by needle biopsy. Breast cosmesis (assessed by BCCT.core) and adverse events will also be evaluated. Conclusions: If the FROST Trial is successful at achieving complete ablation in ≥ 80% of study subjects, the trial will provide an important foundation for establishing cryoablation as an alternative to conventional therapy in selected women with early stage invasive breast cancer. If interested, please contact Pam Ellis, clinical coordinator, at (925)460-6080 or pellis@sanarus.com. Citation Format: Coronado GM, Ho ET, Holmes DR. Freezing instead of resection of small breast tumors (FROST): A study of cryoablation in the management of early stage breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-01-04.

Change of paradigm in the surgical treatment of metastatic diseases of the bone. Part II. Treatment of spinal metastases

The incidence of spinal metastases is constantly growing, but due to the advancements in oncologic treatment methods, the survival and the quality of life of the patients are persistently improving. Choosing the optimal treatment method is essential, and several factors should be considered: type of the primary tumor, segmental stability, the symptoms caused by the metastasis and the general condition of the patient. Using modern radiotherapeutic methods combined with minimally invasive surgical techniques (minimally invasive stabilization, separation surgery) in the majority of patients permits adequate local control with low complication rate. In our review, we describe the state-of-the-art, modern spinal metastasis treatment options based on the recently published evidence. Orv Hetil. 2018; 159(8): 297-302.

Tumors of the oral cavity: CO2 laser management.

BackgroundCancer of the oral cavity combined with oropharyngeal cancer is the sixth leading cause of death for cancer worldwide. Surgery remains the standard treatment for this disease in early clinical and locally advanced stages. Numerous studies have shown that laser management is useful for premalignant lesions in the oral cavity; however, there is no conclusive evidence that its use is appropriate in cancer of the oral cavity and that results are comparable with traditional surgery. The objective of this study is to determine cancer control after wide local resection with CO2 laser for oral malignant neoplasms.Material and MethodsRetrospective study in patients with tumors of the oral cavity who were considered for surgical resection with CO2 laser from January 2006-December 2015. Demographic data, treatment modalities, histopathological diagnosis and clinical stage variables were obtained. All resections were done with the use of the microspot. Patients with cancer of the tongue were not included because a specific protocol for these patients does exist in our institution.ResultsThere were twenty patients, 10 male and 10 female with a average age of 58 years (range: 20-92 years). Mean age was 53.5 years for females and 63 years for males. Twelve (60%) patients are alive and disease free and four (20%) were lost free of disease.ConclusionsCO2 laser is an acceptable surgical method for the management of small lesions in the oral cavity. We cannot rule out that small lesions of the oral cavity with positive neck could be managed in this manner, adding treatment to the neck, producing an adequate local regional control. However, this hypothesis requires additional studies. Key words:CO2 Laser, oral cavity, cancer, treatment.

Predictors for a further local in-brain progression after re-craniotomy of locally recurrent cerebral metastases.

Treatment of recurrent cerebral metastases is an emerging challenge due to the high local failure rate after surgery or radiosurgery and the improved prognosis of patients with malignancies. A total of 36 patients with 37 metastases who underwent surgery for a local in-brain progression of a cerebral metastasis after previous metastasectomy were retrospectively analyzed. Degree of surgical resection on an early postoperative MRI within 72h after surgery was correlated with the local in-brain progression rate and overall survival. Complete surgical resection of locally recurrent cerebral metastases as confirmed by early postoperative MRI could only be achieved in 37.8%. Detection of residual tumor tissue on an early MRI following recurrent metastasis surgery correlated with further local in-brain progression when defining a significance level of p = 0.05 but not after Šidák or Bonferroni significance level correction for multiple testing: However, definite local tumor control could finally be achieved in 91.9% after adjuvant therapy. Overall survival after recurrent metastasectomy was significantly higher as predicted by diagnosis-specific graded prognostic assessment (12.9 ± 2.3 vs. 8.4 ± 0.7months; p < 0.0001). However, our series involved a limited number of heterogeneous patients. A larger, prospective, and controlled study is required. Considering the adequate local tumor control achieved in the vast majority of patients, surgery of recurrent metastases may represent one option in a multi-modal treatment approach of patients suffering from locally recurrent cerebral metastases.

Surgical management of pelvic bone sarcoma with internal hemipelvectomy: Oncologic and Functional outcomes.

The management of pelvic sarcoma is challenging and goals of surgery are adequate oncologic local control, maintenance of optimum function with good quality of life. We have evaluated the results of internal hemipelvecotmy including age, type of resection, reconstruction, radiotherapy or chemotherapy. From 2010 to 2016, 23 patients with pelvic bone tumors (13 with Ewing's sarcoma, 9 with Osteosarcoma, 1 with chondrosarcoma) were treated by surgical resection. The mean follow-up was 18 months (0.5-5) years. In 12 patients reconstruction was performed and 11 were without reconstruction. A total of 3 patients (13%) had an infection develop at a mean follow up of 1 month. Surgical debridement's and antibiotics in three patients led to complete recovery. One patient had sciatic nerve injury.One patient had injury to femoral vein; was treated with femoral vein reconstruction. Two patients (9%) developed a local recurrence and were treated with best supportive treatment. Distal pulmonary metastases were seen in four patients and treated with supportive treatment. Five-year disease-specific survival rates of all patients were 83%. The mean functional MSTS score was 18(14-24). Proper selection of patients, preopertive planning and wide surgical margins with reconstruction provides good functional outcomes following internal hemipelvectomy. The surgical site infection and flap necrosis tend to be minor complication and can be managed leading to optimal outcomes and justifies the need for this complex surgery. The oncological and functional outcome after internal hemipelvectomy suggests that it's an effective method for treatment of patients with pelvic sarcomas.

A Gingiva-Derived Mesenchymal Stem Cell-Laden Porcine Small Intestinal Submucosa Extracellular Matrix Construct Promotes Myomucosal Regeneration of the Tongue.

In the oral cavity, the tongue is the anatomic subsite most commonly involved by invasive squamous cell carcinoma. Current treatment protocols often require significant tissue resection to achieve adequate negative margins and optimal local tumor control. Reconstruction of the tongue while preserving and/or restoring its critical vocal, chewing, and swallowing functions remains one of the major challenges in head and neck oncologic surgery. We investigated the in vitro feasibility of fabricating a novel combinatorial construct using porcine small intestinal submucosa extracellular matrix (SIS-ECM) and human gingiva-derived mesenchymal stem cells (GMSCs) as a GMSC/SIS-ECM tissue graft for the tongue reconstruction. We developed a rat model of critical-sized myomucosal defect of the tongue that allowed the testing of therapeutic effects of an acellular SIS-ECM construct versus a GMSC/SIS-ECM construct on repair and regeneration of the tongue defect. We showed that the GMSC/SIS-ECM construct engrafted at the host recipient site, promoted soft tissue healing, and regenerated the muscular layer, compared to the SIS-ECM alone or nontreated defect controls. Furthermore, our results revealed that transplantation of the GMSC/SIS-ECM construct significantly increased the expression of several myogenic transcriptional factors and simultaneously suppressed the expression of type I collagen at the wounded area of the tongue. These compelling findings suggest that, unlike the tongue contracture and fibrosis of the nontreated defect group, transplantation of the combinatorial GMSC/SIS-ECM constructs accelerates wound healing and muscle regeneration and maintains the overall tongue shape, possibly by both enhancing the function of endogenous skeletal progenitor cells and suppressing fibrosis. Together, our findings indicate that GMSC/SIS-ECM potentially served as a myomucosal graft for tongue reconstruction postsurgery of head and neck cancer.

Metastatic disease in long bones : Review of surgical treatment options

Surgery in metastatic bone disease is currently the most frequent type of surgery in orthopedic oncology. Improved survival rates and an increasing incidence of bone metastasis have led to an increase in complications caused by metastatic disease, such as pathological fractures or hardware failure after operative treatment. Although surgery of metastatic lesions remains apalliative therapy concept, because of sufficient therapy for the primary carcinomas, tumor-specific-oriented follow-up protocols and avariation in the prognosis for the individual entities, an individually adapted treatment strategy is necessary. Depending on the life expectancy, more aggressive surgical procedures with the goal of adequate local tumor control have come into focus. Therefore, prognosis-tailored treatment requires an experienced team and should be performed in amultidisciplinary tumor center. The current article provides an overview of recent therapy concepts for the surgical treatment including endoprosthetic reconstruction, internal fixation with either intramedullary nailing or plate fixation devices, often augmented with bone cement.

Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note.

OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment. METHODS The authors retrospectively reviewed a consecutive series of patients with ESCC and spinal instability who were considered to be poor surgical candidates and instead were treated with sLITT and percutaneous spinal stabilization. Demographic data, Spine Instability Neoplastic Scale score, degree of epidural compression before and after the procedure, length of hospital stay, and time to return to oncological treatment were analyzed. RESULTS Eight patients were treated with thermal ablation and percutaneous spinal stabilization. The primary tumors included melanoma (n = 3), lung (n = 3), thyroid (n = 1), and renal cell carcinoma (n = 1). The median Karnofsky Performance Scale score before and after the procedure was 60, and the median hospital stay was 5 days (range 3-18 days). The median Spine Instability Neoplastic Scale score was 13 (range 12-16). The mean modified postoperative ESCC score (2.75 ± 0.37) was significantly lower than the preoperative score (4.5 ± 0.27) (Mann-Whitney test, p = 0.0044). The median time to return to oncological treatment was 5 days (range 3-10 days). CONCLUSIONS The authors present the first cohort of sLITT associated with a percutaneous spinal stabilization for the treatment of ESCC and spinal instability. This minimally invasive technique can allow a faster recovery without prejudice of adjuvant systemic treatment, with adequate local control and spinal stabilization.

P13.11 Outcome evaluation of oligometastatic patients with single, large brain metastases treated with gross total resection (GTR) followed by hypofractionated stereotactic radiosurgery (HSRS) on the tumor bed

AbstractIntroduction:In case of large brain metastases (BMs), treatment option include whole-brain-radiation-therapy (WBRT), surgery, single dose radiosurgery (SRS) or Hypofractionated stereotactic radiosurgery (HSRS). None of these, when given as a single modality are able to obtain and adequate local control rate. Therefore a combined approach, if feasible, is recommended. The aim of this study was to evaluate the benefit of a combined treatment, gross total resection (GTR) followed by adjuvant hypofractionated-stereotactic-radiosurgery (HSRS) on the tumor bed, in oligometastatic patients with single, large BMs.Methods and Materials:From January 2011 to March 2015, 69 patients with single, large BMs, controlled primary tumor and extracranial disease were treated. All patients underwent gross total resection (GTR) followed by HSRS on the tumor bed with a total dose of 30 Gy in 3 daily fractions. Clinical outcome was evaluated by neurological examination and MRI 2 months after RT and then every 3 months. Local progression was defined as radiographic increase of the enhancing abnormality in the treated brain volume and brain distant progression (BDP) as the presence of new brain metastases or leptomeningeal enhancement outside the treated brain volume. Surgical morbidity and radiation-therapy toxicity, local control (LC), brain distant progression (BDP), and overall survival (OS) were evaluated.Results:The median preoperative volume and maximum diameter of BMS was 18.45 cm3 (range 4.06–64.23 cm3) and 3.6 cm (range 2.1–5.4 cm); the median clinical target volume (CTV) was 29 cm3 (range 4.06–203.10 cm3) and the median planning target volume (PTV) was 55.19 cm3 (range 17.18–282.90 cm3). The median follow-up was 24 months (range 4–33 months). The 1-and 2-year LC in site of treatment was 100%; the median, 1-and 2-year BDP was 11.9 months, 19.6% and 33 %; the median, 1-and 2-year OS was 24 months (range 4–33 months), 91.3% and 73%. No severe postoperative morbidity or radiation toxicity occurred in our series.Conclusions:Multimodal approach, surgery followed by HSRS, can be an effective treatment option for selected patients with single, large brain metastases from different solid tumors.Keywords: brain metastases, surgical resection, hypofractionated-stereotactic-radiosurgery

212. Difficult mastectomies subsequent to unsuccessful breast conserving operations of peripheral cancers: When oncoplastic approach meets the history of surgery

Background: Oncoplastic techniques allow adequate local control with excellent cosmetic outcomes in more and more breast cancer patients. When breast conservation approach is unsuccessful, subsequent mastectomy is performed, usually with ease. However, in peripheral cancers choosing mastectomy incision to remove tumour bed all together with scars produced by prior oncoplasty can be a surgical challenge. The aim of the study was to investigate what incisions had been used in those difficult cases.

Technologies, technical steps, and early postoperative results of transanal TME

Introduction: First described in 1982, TME overcomes most of the concerns regarding adequate local control after anterior rectal resection. TME requires close sharp dissection along the so-called Heald’s plane down to the levators, with distal dissection often cumbersome. In recent years, Transanal TME was introduced with the aim to improve distal rectal dissection and quality of mesorectal excision.Material and methods: A prospective, non-randomized study, started in 2013, is currently ongoing in two Italian Centers. Study objectives were assessing the safety of TaTME and TME quality. TaTME technique and technologies as performed in these centers and cumulative results at ≤30 postoperative days of the first 102 patients are reported.Results: Early postoperative morbidity and mortality rates were 33.3% (34 pts, 16 Clavien-Dindo I + II and 18 Clavien-Dindo III + IV + V), and 1.96% (two deaths), respectively. The quality of mesorectal excision according to Quirke was: complete in 97.1% and nearly complete in 2.9% of the cases.Conclusions: The results confirm the effectiveness of TaTME, especially regarding the quality of the mesorectal dissection. Open questions regarding standardization, anatomical landmarks, indications, morbidity (with special regard to local infection and sepsis), learning curve and oncological outcomes require further answers from larger studies and RCTs before definitive validation of this procedure.

Enrofloxacin enhances the effects of chemotherapy in canine osteosarcoma cells with mutant and wild-type p53.

Adjuvant chemotherapy improves survival time in dogs receiving adequate local control for appendicular osteosarcoma, but most dogs ultimately succumb to metastatic disease. The fluoroquinolone antibiotic enrofloxacin has been shown to inhibit survival and proliferation of canine osteosarcoma cells in vitro. Others have reported that fluoroquinolones may modulate cellular responses to DNA damaging agents and that these effects may be differentially mediated by p53 activity. We therefore determined p53 status and activity in three canine osteosarcoma cell lines and examined the effects of enrofloxacin when used alone or in combination with doxorubicin or carboplatin chemotherapy. Moresco and Abrams canine osteosarcoma cell lines contained mutations in p53, while no mutations were identified in the D17 cells or in a normal canine osteoblast cell line. The addition of enrofloxacin to either doxorubicin or carboplatin resulted in further reductions in osteosarcoma cell viability; this effect was apparent regardless of p53 mutational status or downstream activity.

Resected tumours of the sublingual gland: 15 years’ experience

Sublingual gland tumours are rare, and we have evaluated the clinical features and prognosis of patients treated at a tertiary medical centre in eastern Taiwan. We retrospectively reviewed the cases of nine patients with sublingual gland tumours that were resected from December 1993 to November 2008, four of whom were men and five women. The median (range) age at diagnosis was 52 (39-63) years. Seven had malignant tumours, of which adenoid cystic carcinoma was the most common. All patients with malignant tumours had neck dissections, and four had cervical lymph node metastases. The incidence of lymph node metastases was much higher in patients with advanced primary tumours (T1/2 compared with T3/4: one out of three compared with three out of four). All patients with malignant tumours were given adjuvant radiotherapy. There were no local failures. One patient had regional recurrence in the neck and had a successful further resection. Three patients developed distant metastases, and two died during the follow-up period. Our results suggest that radical resection with postoperative radiotherapy offers adequate local and regional control for malignant sublingual gland tumours. Neck dissection is beneficial, especially for T3/4 disease.

Is It Possible and Safe to Perform Acetabular-preserving Resections for Malignant Neoplasms of the Periacetabular Region?

Primary malignant tumors located near the acetabulum are usually managed by resection of the tumor with wide margins that include the acetabulum. These resections are deemed P2 resections by the Enneking and Dunham classification. There are various methods to perform the subsequent hip reconstruction. Unfortunately, there is no consensus as to the best management. In general, patients undergoing resection at this level will have substantial levels of pain and disability as measured by the Musculoskeletal Tumor Society (MSTS) scoring system. We believe there is a subset of patients whose tumors in this location can be resected while preserving all or most of the weightbearing acetabulum using navigation and careful surgical planning. (1) What complications were associated with this resection; (2) what oncological outcomes (histological margins and local recurrence) were achieved; and (3) what is the function achieved by these patients? This was a retrospective study of patients with periacetabular primary malignancy. From 2008 to 2014, we treated 12 patients who had periacetabular primary malignant tumors and in five, we performed resection with the weightbearing portion spared. During this period, our general indications to perform a resection that spared the acetabulum were the tumor with its resection margin not involving the weightbearing portion of the acetabulum. However, we did not perform this procedure in patients who had more cranial lesion involving the weightbearing portion or whose hip stability might be in question after the tumor excision. Three patients were women and the other two were men. Four were chondrosarcomas, whereas the other one was synovial sarcoma. Ages ranged from 46 to 60 years (average, 53 years). Minimum followup was 14 months (median, 37 months; range, 14-88 months); no patients were lost to followup before a 1-year minimum was achieved, and all patients have been seen within the last 9 months. There were no intraoperative or early postoperative complications. None of the five patients had a positive margin by histological assessment. No local recurrences were detected. The median functional score by MSTS was 28 out of 30 (range, 27-30). The roof of the acetabulum is the weightbearing portion of the acetabulum. It also maintains the stability of the hip. With precise preoperative planning of the resection and accurate execution of the procedure, the hip-sparing approach through partial acetabular resection can be performed in selected patients with malignant periacetabular neoplasms. Navigation makes it possible to minimize the amount of bone resection. In this preliminary report of a small number of patients, we had adequate short-term local tumor control. We believe the function is good, but we do not have a comparison group of patients to document improved function. Level IV, therapeutic study.

Abstract OT2-01-01: Endocrine therapy alone as primary treatment for elderly patients with clinical stage I to III estrogen receptor positive breast cancer with low recurrence score

Abstract Background: Approximately 20% of breast cancers are diagnosed in women 75 years of age or older. Elderly patients with breast cancer are at a higher risk for over- or under-treatment. In general, older patients are more likely to die from comorbidities than from their breast cancer. The 21-gene Recurrence Score (RS) predicts 10-year distant recurrence rate in the adjuvant setting in women with early stage ER+ breast cancer. In elderly patients, a large percentage of the cancers diagnosed are ER+. It is likely that a subpopulation of elderly women with good prognosis ER+ tumors can be identified who may benefit from endocrine therapy alone, without surgery, to treat their cancer without compromising clinical outcome. We hypothesize that endocrine therapy alone will provide adequate local and systemic control of breast cancer in the subpopulation of women 75 or older with ER+ breast cancer and low RS. Trial Design: This is a single arm phase II trial in pts with newly diagnosed early stage ER+ breast cancer, age 75 or greater. RS will be obtained on core biopsies collected at the time of diagnosis. Patients whose scores are &amp;lt; 18 will be enrolled into the trial and receive endocrine therapy only. Patients whose scores are ≥ 18 will receive standard of care (SOC) treatment. Tumor assessment will occur every 6 months. Patient can continue on endocrine therapy for up to 10 years. If there is progression of disease, then an alternative endocrine agent may be prescribed or the patient can opt for SOC treatment. Objectives: Primary: To determine the rate of loco-regional progression in women with early-stage ER+ breast cancer, 75 years or older with low RS who are treated with endocrine therapy alone. Secondary: To determine the breast cancer-specific survival and overall survival of women with early-stage ER+ breast cancer who are 75 years or older treated with endocrine therapy alone. To correlate response to treatment with RS. Eligibility: Newly diagnosed invasive breast cancer defined as cT1 or T2, N0-1, M0, age 75 years of age or older and ECOG performance status ≤ 2. Disease must be ER+ (Allred score ≥ 5) and HER2- and measurable defined as lesions that can be accurately measured in at least one dimension by ultrasound or mammogram. Statistical Methods: A Kaplan-Meier model will be used to estimate the 5-year local or systemic progression rate with a Brookmeyer-Crowley confidence interval. If the true 5-year progression rate is 10%, a sample size of 50 will provide power = .90 at a one-sided .05 significance level to demonstrate that the rate is less than 25.5%. A point estimate of the cumulative incidence of local progression at 5 years will be calculated using a Kaplan-Meier model or, if covariate adjustment is desired, a Cox proportional hazards model. The upper bound of a 95% confidence interval will be used to determine whether the rate may plausibly fall above 25.5%. Accrual: Target 50 patients with an RS score &amp;lt; 18 will be enrolled. Anticipated opening is July 2015. Citation Format: Aft R, Trinkaus K, Ma C. Endocrine therapy alone as primary treatment for elderly patients with clinical stage I to III estrogen receptor positive breast cancer with low recurrence score. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-01-01.

Impact of Preoperative Chemo-radiation Therapy on Systemic Failure in Locally Advanced Rectal Cancer

Background and objectives: Advanced rectal cancers require local and systemic control. Chemo radiotherapy (CRT) is adequate to achieve adequate local control. Systemic control, however, is a dominant obstacle remained in debates. We compared oncology outcome in both arms in patients with advanced rectal cancers in order to identify high-risk group of distant metastasis. Methods: Data for 723 patients for advanced rectal cancer from 2005 to 2013 retrieved retrospectively. Patients were classified to CRT (n=364) or no CRT (n=359) arms. Results: CRT group showed greater local control and achieved pT stage 0, 1, or 2 in 43.7% vs. 28.4% in no CRT (p<0.001) and less CEA marker (11.17 ± 25.2 vs. 6.14 ± 11.3, p<0.001), respectively. Although CRT group had higher rates of advanced tumors, cT3 or T4 (341(93.7%) vs. 294(81.9%), p<0.001) and CRM threat (167 (45.9%) vs. 30(8.4%); p<0.001). Overall local recurrence rate observed in no CRT 3% compared to 2.1% in CRT arm, (p<0.005). Systemic recurrence rate was similar in both groups, (22.5% vs. 23%), respectively. Conclusion: CRT is efficient to downstage locally advanced rectal cancer, not systemic control though. Early recognition of high-risk group is recommended in order to consider CRT modification ahead of planned surgery.

The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures.

Background:Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.Methods:A retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.Results:In the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group.Conclusions:Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.

Organ preservation in rectal cancer: current status and future perspectives

With the introduction of population screening initiatives, more patients may be amenable to local, transanal excision (LE) of early-stage rectal cancer. The most important drawback of LE is the risk of understaging node-positive disease. The most powerful predictors of node-positive disease are lymphatic invasion, submucosal invasion depth and width, tumor budding and poor differentiation. Therefore, LE should be reserved for low-risk T1 tumors in those reluctant or unable to undergo major surgery. Neoadjuvant chemoradiation followed by LE for T2 tumors allows adequate local control, and is currently being compared with anterior resection alone in randomized trials. A mere watchful waiting approach has been proposed in clinical complete responders to chemoradiation. However, given the very poor accuracy of current imaging modalities to predict a true pathological complete response, this strategy should not be offered outside of well-controlled trials.

Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients With Osteosarcoma of the Proximal Tibia?

Joint-sparing surgery of a patient's native joint for osteosarcoma likely affords better function and comparable survival. However, it sometimes is challenging to resect a juxtaarticular osteosarcoma in a way that preserves the affected epiphysis because wide margins are necessary to minimize the risk of local recurrence. If there was a method to resect a tumor close to the joint and treat a potentially positive margin to prevent recurrence, it might allow salvage of a joint that otherwise might be lost. We therefore asked (1) whether joint-preserving tumor resection could be performed for juxtaarticular osteosarcoma after microwave ablation of the tumor edge under navigation without leading to local recurrences, (2) what is the resulting function, and (3) what are the complications associated with this procedure. Between 2009 and 2011, we treated 11 patients who had juxtaarticular osteosarcoma of the proximal tibia (mean age, 12 years; range, 9-16 years) with joint-preserving surgery by transepiphysis tumor resection after navigation-assisted microwave ablation of the tumor edge; they were followed a minimum of 37 months (mean, 48 months; range 37-62 months), and none was lost to followup. Patients were considered eligible for this procedure if they had a distance from the tumor edge to the articular surface between 10 to 15 mm, good chemotherapy responses, no pathologic fracture and no tumor involvement of major neurovascular structures. Allograft in combination with a vascularized fibula flap was used for segmental reconstruction. We recorded local tumor control, complications, and functional outcomes using the Musculoskeletal Tumor Society score, which ranges from 0 to 30, with higher scores indicating better function. There were no local recurrences. Major complications included osteonecrosis of part of the epiphysis in two patients and deep infection in one. The Musculoskeletal Tumor Society score ranged from 26 to 30 with a mean of 29. In selected patients with osteosarcoma invading the epiphysis, navigated resection facilitates performing joint-sparing surgery, and in our small series, the adjuvant microwave ablation seemed to provide adequate local tumor control. Although more experience and longer followup are needed, this approach may make it possible to salvage more native joints when performing limb salvage for osteosarcoma. Level IV, therapeutic study.