BCT Group Research Articles

Comparing long-term prognosis following different surgical methods in patients with early stage breast cancer and obesity: a retrospective cohort study in China

ObjectiveBreast-conserving therapy (BCT) includes breast-conserving surgery (BCS) combined with radiation therapy (RT). RT plays a crucial role in improving the prognosis of patients who undergo BCS. However, obesity is a...

The impact of loco-regional treatment modality on the outcomes in breast cancer patients younger than forty years of age

PurposeTo determine the impact of the loco-regional treatment modality, on the loco-regional recurrence (LRR) rates and overall survival (OS) in breast cancer patients younger than 40 years.MethodsData of 623 breast cancer patients younger than 40 years of age were retrospectively reviewed. Patients were stratified according to the locoregional treatment approach into three groups: the mastectomy group (M), the mastectomy followed by radiation therapy group (MRX) and the breast conservative therapy group (BCT).ResultsMedian follow-up was 72 months (range, 6-180). Two hundred and nine patients were treated with BCT, 86 with MRM and 328 with MRX. The 10-year rate LRR rates according to treatment modality were: 13.4% for BCT, 15.1% for MRM and 8.5% for MRX (p 0.106). On univariate analysis, T stage (p 0.009), AJCC stage (p 0.047) and Her 2 status (p 0.001) were associated with LRR. Ten-year overall survival (OS) was 72.7% (78.5% in the BCT group, 69.8% in the MRM group and 69.8% in the MRX group, p 0.072).On Univariate analysis, age < 35 (p 0.032), grade III (p 0.001), N3 stage (p 0.001), AJCC stage III (p 0.005), ER negative status (0.04), Her 2-status positive (0.006) and lack of chemotherapy administration (p 0.02) were all predictors of increased mortality.ConclusionFor patients younger than 40 years of age, similar LRR and overall survival outcomes were achieved using BCT, M or MRX. Young age at diagnosis should not be used alone in recommending one loco-regional treatment approach over the others.

Undescended Testes Growth Potential in Relation to Testis Position from Diagnosis until Puberty.

Background: Testicular volume (TV) and testicular atrophy index (TAI) were used to determine criteria for normal, hypotrophic and atrophic undescended testes (UDT). Objectives: This study aimed to determine changes in TV and TAI in patients with different types of UDT. Materials and Methods: 182 boys (aged 0.3-14.0 years) with 212 UDTs were assessed twice 24 months apart. Testes were unilateral (UCT) or bilateral canalicular (BCT) and intra-abdominal (IAT). Results: At the beginning of the observation, the highest TAI was observed in IAT and the lowest in the BCT group (38.1 vs. 12.5%, p < 0.05). After 2 years, the highest TAI was observed in the BCT and IAT groups (20.5 and 19.1%), while the lowest was in the UCT group (12.0%, p < 0.05). At the beginning and after 2 years, the highest TAI was observed in boys aged < 6 years (25.0%, 18.2%) and the lowest in pubertal boys aged 12-14 years (5.9%, 7.3%, p < 0.05). A total of 78.3% of patients at the beginning and 86.8% at the end of the observation had TAI < 30%. Furthermore, 7% of boys at the beginning and 3% at the end of the observation had TAI > 50%. IATs have the highest testicular growth potential (TGP), while BCTs have the lowest (120.0 vs. 28.6%, p < 0.05). The highest TGP was in boys aged < 3 years (100%, p < 0.05) and boys aged 12-14 years (98.1%, p < 0.05), while the lowest was in boys aged 9-10.9 years (19.5%, p < 0.05). Conclusions: We revealed the continuous growth of UDTs until puberty independently of their position. IATs revealed high growth potential.

Abstract P1-09-04: Comparison of length and quality of life (QoL) and the side effects of therapy between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy for in-breast-recurrence of breast cancer

Abstract Background: Mastectomy is the treatment recommended by most national and international guidelines for in-breast-recurrence of breast cancer after breast conserving surgery (BCS) and external beam radiation therapy (EBRT). In selected cases it is possible to preserve the breast if TARGIT-IORT can be given during the second lumpectomy. We present a comparative analysis of overall survival, QoL and side effects. Methods: We identified patients who had local recurrence of breast cancer after BCS and EBRT in our prospectively maintained database. Patients were included if they had undergone either a mastectomy or BCS along with TARGIT-IORT. Patients with distant disease were excluded. Identified patients were contacted and offered participation in a prospective QoL-analysis using the BREAST-Q questionnaire. The cohorts were compared for confounding parameters, overall survival, side effects, physical, sexual and psychosocial wellbeing and satisfaction with the surgical result. Results: 36 patients treated for local recurrence were included in this analysis, 21 had received a mastectomy and 16 patients had chosen to preserve their breast and after interdisciplinary tumor board decision received BCS and TARGIT-IORT. Mean follow-up was 12.8 years since primary diagnosis and 4.2 years since recurrence. There were no significant differences between both groups regarding age, ER, PR, HER2neu, tumor size or nodal status at primary diagnosis or at recurrence and the distribution of invasive versus non-invasive recurrences. 1 patient in the BCT and TARGIT-IORT group (6.7%) and 3 patients in the mastectomy group (14.3%) died during follow up. Overall survival was numerically longer for BCS and TARGIT-IORT either calculated from primary diagnosis (median 18 years versus 8 years) or from recurrence (median 5.1 years versus 3.2 years). The numbers were too small for formal statistical analysis. No patient had another local recurrence of breast cancer during follow-up. 12 patients in the mastectomy group and 10 patients in the BCS and IORT group returned the BREAST-Q questionnaire. Psychosocial wellbeing, sexual wellbeing and satisfaction with the surgeon did not differ between both groups. Physical wellbeing was significantly superior for those whose breast could be preserved (median score for BCS and TARGIT-IORT group was 91 (71-100) vs. 66 (14-100) for the mastectomy group, p-value = 0.021). Whereas most side effects were comparable and showed no significant differences, patient-reported incidence and severity of lymphedema of the arm on the side of surgery was significantly worse in the mastectomy group (p=0.007). Conclusion: Many patients who have local recurrence of breast cancer are reluctant to lose their breast. We found that preserving the breast by use of TARGIT-IORT was safe with no re-recurrence and no detriment to overall survival. This is necessarily a small series, because local recurrence is rare, yet, this novel approach led to a statistically significant improvement in physical wellbeing and incidence and severity of lymphedema. These data increase the confidence in offering breast preservation and TARGIT-IORT for surgery of in-breast-recurrence of breast cancer. Citation Format: Hans-Christian Kolberg, Helena Niesing, Jayant S Vaidya, Leyla Akpolat-Basci, Abdrhman Maguz, Oliver Hoffmann, György Lövey, Miltiades Stephanou, Cornelia Kolberg-Liedtke. Comparison of length and quality of life (QoL) and the side effects of therapy between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy for in-breast-recurrence of breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-04.

Identification of potential genes in endobronchial tuberculosis after bronchoscopic cryotherapy by transcriptome sequencing.

Bronchoscopic cryotherapy facilitates the treatment of endobronchial tuberculosis (EBTB) and helps suppress progressive bronchial stenosis. However, the molecular mechanism of bronchoscopic cryotherapy in EBTB patients has not been reported. Transcriptome sequencing was performed to explore differentially expressed mRNAs (DEGs) in EBTB patients before and after bronchoscopic cryotherapy. Gene Ontology (GO) and KEGG analyses were carried out. Five genes (MKLN1, HIGD1A, PTGES, SKIL, and MCEMP1) were selected and validated using real-time qPCR (RT- qPCR). In transcriptome analysis, 448 DEGs with p<0.05 and|logFC|>1 were identified; of these, 171 and 277 DEGs were significantly up- and down-regulated after bronchoscopic cryotherapy, respectively. Results displayed 337 biological process (GO-BP), 48 cellular component (GO-CC) and 62 molecular function (GO-MF) terms and 20 KEGG pathways. RT- qPCR results were consistent with the sequencing data. These data provide informative evidence and recommendations for further scientific research on bronchoscopic cryotherapy for EBTB.

Breast preservation after local recurrence of breast cancer: Comparison of length and quality of life (QoL) between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy.

e12573 Background: Mastectomy is the standard treatment of in-breast-recurrence of breast cancer after breast conserving surgery (BCS) and external beam radiation therapy (EBRT). In selected cases it is possible to preserve the breast if TARGIT-IORT can be given during the second lumpectomy. We present a comparative analysis of overall survival and QoL. Methods: We identified all patients who had local recurrence of breast cancer after BCS and EBRT in our prospectively maintained database. Patients were included if they had undergone either a mastectomy or BCS along with TARGIT-IORT. Patients with distant disease were excluded. Identified patients were contacted and offered participation in a prospective QoL-analysis using the BREAST-Q questionnaire. The cohorts were compared for confounding parameters, overall survival, psychosocial/physical/sexual wellbeing and satisfaction with the surgical result. Results: 36 patients treated for local recurrence were included in this analysis, 21 had received a mastectomy and 16 patients had chosen to preserve their breast and after due discussion, received BCS along with TARGIT-IORT. Mean follow-up was 12.8 years since primary diagnosis and 4.2 years since recurrence. There were no significant differences between both groups regarding age, ER, PR, HER2neu, tumor size or nodal status at primary diagnosis or at recurrence and the distribution of invasive versus non-invasive recurrences. 1 patient in the BCT and TARGIT-IORT group (6.7%) and 3 patients in the mastectomy group (14.3%) died during follow up. Overall survival was numerically longer for BCS and TARGIT-IORT either calculated from primary diagnosis (median 18 years versus 8 years) or from recurrence (median 5.1 years versus 3.2 years), but the numbers were too small for formal statistical analysis. No patient had further in-breast-recurrence of cancer. 12 patients in the mastectomy group and 10 patients in the BCS and IORT group returned the BREAST-Q questionnaire. Psychosocial wellbeing, sexual wellbeing and satisfaction with the surgeon did not differ between both groups. Physical wellbeing was significantly superior for those whose breast could be preserved (median score for BCS and TARGIT-IORT group was 91 (71-100) vs. 66 (14-100) for the mastectomy group, p-value = 0.021). Conclusions: Many patients who have local recurrence of breast cancer are reluctant to lose their breast. We found that preserving the breast by use of TARGIT-IORT was safe with no re-recurrence and no detriment to overall survival. This is necessarily a small series, because local recurrence is rare, yet, this novel approach led to a statistically significant improvement in physical wellbeing. These data should increase the confidence in offering breast preservation after in-breast-recurrence of breast cancer.

Survival Outcomes After Breast-Conserving Therapy Compared With Mastectomy for Patients With Early-Stage Invasive Micropapillary Carcinoma of the Breast: A SEER Population-Based Study.

BackgroundInvasive micropapillary breast carcinoma (IMPC) is a relatively rare pathological type of invasive breast cancer. Little is currently known on the efficacy and safety of breast-conserving treatment (BCT, lumpectomy plus postsurgical radiation) compared with mastectomy in women diagnosed with early-stage IMPC. Accordingly, we sought to investigate the long-term prognostic differences between BCT and mastectomy in patients with T1-3N0-3M0 invasive micropapillary breast carcinoma using data from the Surveillance, Epidemiology, and End Results (SEER) database.Materials and MethodsWe retrospectively analyzed 1,203 female patients diagnosed with early-stage IMPC between 2004 and 2015 from the SEER database. The impact of different surgical approaches on patient prognosis was assessed by the Kaplan-Meier method and Cox proportional risk models.ResultsA total of 609 and 594 patients underwent mastectomy and BCT, respectively. Compared with patients who underwent a mastectomy, patients in the BCT group were older and had lower tumor diameters, lower rates of lymph nodes metastasis, and higher rates of ER receptor positivity and PR receptor positivity (p < 0.05). Kaplan-Meier plots showed that the overall survival (OS) and breast cancer-specific survival (BCSS) were higher in the BCT group than in the mastectomy group. In subgroup analysis, patients with T2 stage in the BCT group had better OS than the mastectomy group. Multivariate analysis showed no statistical difference in OS and BCSS for patients in the mastectomy group compared with the BCT group (hazard ratio (HR) = 0.727; 95% confidence interval (95% CI) 0.369–1.432, p = 0.357; HR = 0.762; 95% CI 0.302–1.923, p = 0.565; respectively). During the multivariate analysis and stratifying for the T stage, a better OS was found for patients with T2 stage in the BCT group than the mastectomy group (HR = 0.333, 95% CI: 0.149–0.741, p = 0.007). There was no significant difference in OS for patients with T1 and T3 stages between the BCT and mastectomy groups (p > 0.05).ConclusionIn women with early-stage IMPC, BCT was at least equivalent to mastectomy in terms of survival outcomes. When both procedures are feasible, BCT should be recommended as the standard surgical treatment, especially for patients with T2 disease.

Combined skin-sparing mastectomy and immediate implant-based breast reconstruction: Outcome following mantle field irradiation versus outcome following whole-breast irradiation

Mastectomy may be needed in the context of previous radiotherapy in cases of breast carcinoma following mantle field radiotherapy for Hodgkin lymphoma or in cases of local relapse or second primary tumours after breast conserving therapy including whole-breast irradiation (BCT). The outcome of combined skin-sparing mastectomy and immediate implant-based breast reconstruction (SSM-IIBR) has been reported to be unfavourable in these cases. To compare the outcome of SSM-IIBR after mantle field radiotherapy to that after BCT and to compare both to the outcome observed in non-irradiated breasts. The prevalences of short-term events, device loss, long-term corrections and secondary reconstructions, and reversion to autologous tissue techniques of 42 SSM-IIBRs performed after mantle field irradiation were compared to those of 47 salvage SSM-IIBRs following BCT. Both outcomes were compared to the outcome in the contralateral, non-irradiated breast of the subgroup of 23 women in the BCT group. The groups were comparable in terms of patient- and procedure-related risk factors, except for time lapse after previous therapy, intraoperative device weight, and the fraction of immediate use of a definitive implant. The outcome of SSM-IIBR after mantle field irradiation significantly differs favourably from that after BCT. It matches the outcome observed in non-irradiated breasts. Skin-sparing mastectomy combined with immediate implant-based breast reconstruction is a fully justifiable option for women who previously underwent mantle field irradiation for Hodgkin lymphoma. We feel that the unfavourable outcome observed in women who previously underwent BCT necessitates an alternative reconstructive modality.

The Effects of Prioritizing Lead or Boulder Climbing Among Intermediate Climbers.

This study compared the effects of prioritizing lead climbing or boulder climbing on climbing-specific strength and endurance, as well as climbing performance. Fourteen active climbers were randomized to a boulder climbing training group (BCT: age = 27.2 ± 4.4 years, body mass = 65.8 ± 5.5 kg, height = 173.3 ± 3.8 cm) or a lead-climbing training group (LCT: age = 27.7 ± 6.1 years, body mass = 70.2 ± 4.4 kg, height = 177.7 ± 4.4 cm). The groups participated in a 5-week training period consisting of 15 sessions, performing either two weekly bouldering sessions and one maintenance-session of lead-climbing (BCT) or two weekly lead-climbing sessions and one maintenance-session of bouldering (LCT). Pre- and post-training, maximal force and rate of force development (RFD) were measured during isometric pull-ups performed on a jug hold and a shallow rung, and during an isolated finger-strength test. Lead-climbing and bouldering performance were also measured, along with an intermittent forearm endurance test. The pre-to-post changes were not significantly different between the groups for any of the parameters (P = 0.062–0.710). However, both the BCT (ES = 0.30, P = 0.049) and LCT (ES = 0.41, P = 0.046) groups improved strength in the isometric pull-up performed using the jug, whereas neither group improved force in the rung condition (P = 0.054 and P = 0.084) or RFD (P = 0.060 and P = 0.070). Furthermore, climbing and bouldering performance remained unchanged in both groups (P = 0.210–0.895). The LCT group improved forearm endurance (ES = 0.55, P = 0.007), while the BCT group improved isolated finger strength (ES = 0.35, P = 0.015). In addition to isometric pull-up strength, bouldering can increase isolated finger strength while lead-climbing may improve forearm endurance. A 5-week period prioritizing one discipline can be safely implemented for advanced to intermediate climbers without risking declined performance in the non-prioritized discipline.

Effects of Chemotherapy Treatment on Muscle Strength, Quality of Life, Fatigue, and Anxiety in Women with Breast Cancer.

The study aimed to evaluate the effects of chemotherapy treatment on muscle strength, quality of life, fatigue, and anxiety in women with breast cancer. Nineteen women who were undergoing a chemotherapy treatment (breast cancer treatment [BCT] group, 52.2 ± 13.1 years) and 18 women without cancer (control [CNT] group, 55.8 ± 8.4 years) answered questionnaires for evaluation of fatigue (Fatigue Scale), quality of life (Short-Form Healthy Survey [SF-36] questionnaire), and anxiety (State-Trait Anxiety Inventory [IDATE]) levels. Muscle strength was also assessed by an isometric grip test and an isokinetic knee extension test. Physical limitations, social and emotional domains of quality of life were lower in the BCT group in comparison to the CNT group (p = 0.002; p = 0.003; p = 0.0003, respectively). The other domains did not differ between groups (p > 0.05). There were no differences in fatigue and anxiety levels between both the BCT and CNT groups (p > 0.05). Additionally, isometric grip strength was higher in the CNT group when compared to the BCT group (p = 0.048). However, there were no differences between the BCT and CNT groups for peak torque and total work at both 60°.s−1 (p = 0.95 and p = 0.61, respectively) and 180°.s−1 (p = 0.94 and p = 0.72, respectively). These results suggest that three cycles of chemotherapy treatment may impair handgrip isometric strength and quality of life in women with breast cancer.

The Association Between Illness Acceptance and Quality of Life in Women with Breast Cancer.

IntroductionBreast cancer is the most common cause of cancer death in women.AimThe aim of the study was to investigate the association between illness acceptance and quality of life (QoL) in patients with breast cancer.Patients and MethodsThe study included 150 patients who had undergone surgery for breast cancer. The following standardized questionnaires were used: the Acceptance of Illness Scale (AIS), the EORT QLQ–C30 (The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30), and the EORT QL–BR 23 (Quality of Life Questionnaire for Breast Cancer) for QoL evaluation. Socio-clinical data were obtained from the patients’ medical records.ResultsIn the study group, the overall QoL score was 62.67±17.11 in the BCT group, 63±14.3 in the MTX group, and the highest: 65.5±20.2 in the reconstruction group. Comparative analysis showed that patients in the BCT group reported significantly more fatigue (p=0.007) and appetite loss (p=0.032) than those in the MTX+R group. Patients in the MTX group were significantly less satisfied with their body image (p=0.001) and experienced more financial troubles (p=0.013) than the remaining patients. Patients in the MTX+R group reported significantly better sexual function and more sexual enjoyment than the remaining patients (p<0.001). All patients scored high for illness acceptance, though patients in the MTX group had lower scores (28.17±7.2) than the others: 31.84±6.51 in the BCT group and 32.78±7.97 in the MTX+R group. The comparative analysis of QoL according to the level of AIS showed the significantly better QoL and less intense symptoms within all the domains except for the insomnia and hair loss domains in the group of high AIS in comparison with medium and lack of AIS. Acceptance of illness significantly correlated with 4 domains of the QLQ-C30 (p<0.05). The correlation between illness acceptance and overall QoL was positive (r=0.243; p=0.003) – the higher the acceptance, the better the QoL. Correlations with pain, diarrhoea, and financial difficulties were negative. Illness acceptance was positively correlated with QoL in 3 domains of the EORTC–BR23: body image (p<0.001), sexual function (p=0.015), and sexual enjoyment (p=0.047), and negatively with the “treatment side effects” (p=0.011).ConclusionThe level of illness acceptance varies depending on the treatment method, and is the lowest in the group of women having undergone a mastectomy, and the highest in patients after a mastectomy with immediate breast reconstruction. Acceptance of illness improves the QoL of women treated for breast cancer, regardless of the specific treatment method.

Comparison of overall survival, local recurrence and distant metastasis of breast-conserving therapy with modified radical mastectomy in Iranian women with stage I and II breast cancer

Introduction: Breast cancer effects on younger patients and how it behaves more severely in Iran. This matter may influence the efficacy of breast conservation surgery (BCT) and radical mastectomy (MRM) as common treatments. The aim of this study was to compare the overall survival, local recurrence and distant metastasis of these two surgical methods in Iranian women with stage I and II of breast cancer. Material and methods :This historical cohort study was performed on women with stage I&amp;II of breast cancer who had undergone MRM and BCT and had referred to Shahid Ramezanzadeh Radiotherapy Center, Yazd, Iran, from 2005 to 2012.Patient’s characteristics, tumor information, treatment modalities, local recurrence, distant metastasis and overall survival were collected. Data were analyzed by SPSS software using chisquare, t-test, log-rank and Kaplan-Meier tests. The study code of ethics is IR.SSU.MEDICINE.REC.1394.318. Results: 506 patients were included in this study, 285 (56.3%) in the MRM group and 221 (43.7%) in the BCT group. The mean age of the patients was 47.69 ± 10.62 years. Most of the patients (408 patients or 80.6%) were in stageII and the rest (98 patients or 19.4%) were in stage Iof the disease. Distant metastasis occurred in 23.94% (17 cases) of the patients in the BCT group and in 76.05% (54 cases) of the patients in the MRM group. The MRM group was indicative of more distant metastasis (p = 0.001). There was no significant difference between the two groups regarding local recurrence (p = 0.83). Overall survival in the BCT group was 105.43 ± 2.06 months and in the MRM group it was 96.26 ± 2.16 months, indicating a higher overall survival in the BCT group (p = 0.002). Conclusion: The findings of the study showed that women with MRM had higher metastasis and lower overall survival. Also, local recurrence was not significantly different between the two groups. Considering the results, it is possible to recommend BCT as the treatment of choice for Iranian women.

Effects of Tinnitus Sound Therapy depending on Air- and Bone-Conduction Transducers

Purpose: The purpose of this study was to determine to compare the effects of sound therapy depending on air- and bone-conduction transducers (ACT and BCT). Methods: Participants were twenty adults who have diagnosed as subjective tinnitus in this study. All participants conducted a sound therapy using the level of mixing point for three months. Participants were randomly assigned to different groups, such as the ACT group, or BCT group. To identify the effects of sound therapy, Korean tinnitus primary function questionnaire (K-TPFQ) and visual analogue scale (VAS) were administered at pre- and post-treatment (3 months) sessions. Results: In a result of mixed model analysis of variance, all subcategories for VAS showed significant decrements of scores to the measurement session (pre- vs. post-session), but there was no different between groups. Also, the overall and all subcategories for K-TPFQ showed significant decrements of scores to the measurement session (prevs. post-session), but there was no different between groups. Conclusion: As a result of this study, the sound therapy using portable hearing devices with transducers is effective for subjective tinnitus sufferers. Because the transducer type does not significantly affect effectiveness of the sound therapy, therefore, audiologists or hearing professionals may recommend transducers, which the tinnitus sufferer prefers when they consider sound therapy.

Effect of two postpartum intramuscular treatments with β-carotene (Carofertin®) on the blood concentration of β-carotene and on the reproductive performance parameters of dairy cows

The aim of the study was to determine whether two postpartum intramuscular treatments with 200 mg of beta-(β-)carotene (Carofertin; Alvetra u. Werfft, Vienna, Austria) in a 14-day interval increases β-carotene concentrations in blood, particularly around the time of the first artificial insemination (AI), and to test the effect of the treatment on fertility parameters, luteal size, and progesterone blood levels of dairy cows. A total of 297 Holstein dairy cows were enrolled in the study. Between 28 and 34 days postpartum (dpp) β-carotene concentrations were measured in blood samples using an on-site test (iCheck carotene; BioAnalyt, Teltow, Germany). Cows with a β-carotene concentration <3.5 mg/L, indicating a deficiency of β-carotene, were allocated either to the β-carotene treatment group BCT (n = 123) or to the control group CON (n = 121). Cows with concentrations ≥3.5 mg/L were assigned to an optimally supplied reference group (REF; n = 53). Cows in the BCT group received 200 mg of β-carotene intramuscularly at 28–34 dpp and at 42–48 dpp. Further blood samples were collected at 35–41 dpp, 42–48 dpp, 49–55 dpp, and in the week after the first AI and their β-carotene concentrations were analyzed. Between day 10 and 14 after the first AI, the blood progesterone concentration was measured and the size of the corpus luteum (CL) was determined by ultrasound. Blood β-carotene concentrations increased in the BCT cows in the week after the treatment with a peak at 49–55 dpp and were significantly higher than in the CON group at each time point after the first treatment. Logistic regression models, however, revealed that the treatment with β-carotene had no effect on first service conception rate, days to first service, time to pregnancy, or percentage of pregnant cows within 150 dpp. Furthermore, there was no effect on progesterone concentration or the size of the CL between the groups. In conclusion, two treatments with Carofertin postpartum increased β-carotene blood concentrations but had no effect on the fertility parameters in this study.

Breast-Conserving Therapy Including Whole-Breast Irradiation is Associated with Better Overall Survival Compared to Mastectomy Alone in Patients with Early-Stage, Lymph Node-Negative Breast Cancer with High OncotypeDX Recurrence Score: an NCDB Analysis

Previous single-institutional retrospective studies suggest improved overall survival (OS) in women with early stage, lymph node negative breast cancer treated with breast conserving therapy including whole breast irradiation (BCT), compared to those treated with mastectomy alone. In this study, we compared OS between these two cohorts using the NCDB. Additionally, we examined OS after stratifying by OncotypeDX recurrence score. We performed a retrospective cohort analysis of NCDB patients with non-metastatic, pT1-2, pN0 breast cancer treated between 2006 and 2014. Patients were classified into two categories: those undergoing BCT (breast conserving surgery followed by whole breast irradiation), and those undergoing mastectomy without post-mastectomy irradiation. Patients were matched using propensity scores with inverse probability of treatment weighting (IPTW) with stabilized weights. Patients were matched for race, age, grade, pT stage, LVI, receptor status, hormone therapy, chemotherapy, OncotypeDX recurrence score, comorbidity score, year of diagnosis, treatment facility type, insurance status, median income, US region, laterality, and tumor quadrant. The primary objective was to compare OS between BCT and mastectomy patients. After IPTW-matching, the analysis included 149,273 and 87,073 patients undergoing BCT and mastectomy, respectively. There were no differences between the matched groups in any of the included variables after matching. Median follow up for the matched cohorts were 48.5 (BCT) and 47.3 months (mastectomy). OS was better in the BCT group at 5 years (94% vs 92%, P<0.0001) and 7 years (81.1% vs 73.3%, P<0.0001). In univariate Kaplan-Meier (UV) and multivariate cox proportional hazard analyses (MVA), treatment with BCT was a positive predictor of OS with a mastectomy HR of 1.4 in MVA (95% CI 1.3-1.4, P=0.0001), when setting BCT as reference. We then stratified patients by OncotypeDX RS into low RS (≤25), 36, 571 patients with BCT and 17,785 with mastectomy, or high RS (>25), 7,018 patients with BCT and 3,811 patients with mastectomy. Median follow up for patients with available RS were 42.3 months (BCT) and 41.6 months (mastectomy). OS was not different for patients undergoing BCT or mastectomy in the low RS cohort at 5 or 7 years (P=0.339 and 0.289). For those with high RS, OS was better in the BCT group at 5 years (95% vs 93%, P=0.001) and 7 years (93% vs 88%, P=0.0001). In MVA, treatment with BCT was a positive predictor of OS with a mastectomy HR of 1.5 (95% CI 1.2-1.9, P<0.0001), when setting BCT as reference. Our analysis suggests that BCT is associated with better OS compared to mastectomy alone in patients with early stage, lymph node negative breast cancer with a high OncotypeDX recurrence score. We hypothesize that incidental irradiation to regional lymphatics, may underly the improvement in OS with BCT in this high-risk cohort. Further investigation into patterns of failure in these patient cohorts is needed.

Second breast-conserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results

PurposeThe purpose of this study was to report the clinical outcomes of a second breast-conserving therapy (2nd BCT) with perioperative interstitial brachytherapy (iBT) vs. those of salvage mastectomy (sMT) in the treatment of ipsilateral breast tumor recurrences (IBTRs). Methods and MaterialsBetween 1999 and 2015, 195 patients with IBTR after a previous breast-conserving treatment were salvaged either with reexcision and perioperative high-dose-rate iBT (n = 39), or with sMT (n = 156). In the 2nd BCT group, a total dose of 22 Gy in five fractions of 4.4 Gy was delivered to the tumor bed with intraoperatively implanted catheters for 3 consecutive days. ResultsThe median followup time was 59 months (1–189) in the 2nd BCT, and 56 months (3–189) in the sMT group. The mean size of IBTR was 16 mm (2–70) vs. 24 mm (2–90), respectively (p = 0.0005), but there were no other significant differences in patient- or IBTR-related parameters between the two groups. During the followup period, 4 of 39 (10.2%) and 28 of 156 (17.9%) second local recurrences (2nd LR) occurred in the 2nd BCT and the sMT group, respectively. The 5-year actuarial rate of 2nd LR was 6% vs. 18% (p = 0.22), the 5-year probability of disease-free, cancer-specific and overall survival was 69% vs. 65% (p = 0.13), 85% vs. 78% (p = 0.32), and 81% vs. 66% (p = 0.15), respectively. In the 2nd BCT group, the rate of good to excellent cosmesis was 70%. Conclusions2nd BCT with perioperative high-dose-rate iBT is a safe and feasible option for the management of IBTR, resulting in similar 5-year oncological outcomes and better cosmetic results compared with sMT.

Comparative study of complications of modified radical mastectomy and breast conservation therapy in early invasive breast cancer

Background: All early breast cancer patients admitted in surgery department were distributed in MRM and BCS groups. All operated cases of early breast cancer in Dept. of Surgery, Amaltas Institute of Medical Sciences, Dewas. The study will include prospective cases 1 year from June 2017 to June 2018. Method: In all MRM group patients all breast tissue, skin, nipple areola complex and level 1, 2, 3 lymph nodes removed. In all BCS group patients lump was removed with an envelope of normal appearing breast tissue. In all resected specimens free surgical margin was ensured via histopathology reports. Patients were reviewed in early post operative period for complications and followed at the end of 1st, 3rd, 6th and 12th month for recurrence. Result: In MRM group two patients developed Seroma formation and one developed Marginal Necrosis. In BCT group one patient had Seroma formation. Complications were present in 20% of MRM group (3 out of 15 cases), while they were absent in 80% (12 out of 15). However, in the BCS group, complications were present in 6.66% cases only (1 out of 15 cases), while were absent in 93.33% (14 out of 15). P value by statistical analysis being 0.283, the difference being statistically insignificant. Recurrence were present in 6.66% of MRM group (1 out of 15) while they were absent in 93.34 % (14 out of 15). However in BCS group recurrence were present in 6.66 % (1 out of 15) and were absent in 93.34% (14 out of 15). P value by statistical analysis being 1, the difference being statistically insignificant. Conclusion: There is no significant difference in the recurrence rate, whether the patient had undergone BCS or MRM based on our short term follow-up. However a delay long term follow-up is required.

Radiotherapy May Play an Important Role in Improving the Efficacy of Breast-Conserving Therapy Compared with Mastectomy in Patients with T1-2N1M0 Breast Cancer

To evaluate if breast-conserving therapy achieved superior efficacy to modified radical mastectomy in patients with T1-2N1M0 breast cancer. 2776 women with T1-2N1M0 breast cancer treated from 1999 to 2013 were retrospectively reviewed. All had received lumpectomy or mastectomy and axillary lymph node dissection without neoadjuvant chemotherapy. The median age was 49 years. 2484 patients underwent modified radical mastectomy (MRM), 580 (23.3%) of them received postoperative RT (MRM + RT). 292 patients received breast-conserving surgery (BCT), all of them received postoperative RT. For the whole group, 92.7% of received postoperative chemotherapy and 4.9% received trastuzumab targeted therapy. Of the 2148 patients with ER and/or PR positive, 87.7% received hormonal therapy. Survival and recurrence rates were calculated by using the Kaplan-Meier method and compared by log-rank test. Multivariable analysis was estimated by using the Cox proportional hazards model. At a median follow-up of 59 months (range, 1-257 months), the 5-year overall survival (OS) of the BCT and MRM groups was 97.9% and 92.9% (p= 0.014), and the 5-year locoregional recurrence (LRR) was 2.3% vs 6.1% (p= 0.022). Of MRM group, the 5-year OS was 92.7% in MRM alone and 93.5% in MRM + RT (p = 0.037), and the 5-year LRR was 6.3% and 5.2%, respectively (p = 0.188). Furthermore, the 5-year OS of BCT group was significantly higher than that of MRM alone (p = 0.007), however there was no significant difference in OS between BCT and MRM + RT (P = 0.160). The 5-year LRR of BCT group was significantly lower than that of MRM alone (p = 0.016), but had no significant difference with MRM + RT (p = 0.094). Univariate analysis showed that age ≤ 60 years, tumor grade I-II, T1, luminal subtype, no lymph-vascular invasion, BCT, RT, chemotherapy and hormonal therapy were favorable factors of OS (P <0.05). Age > 60 years, tumor grade I-II, T1, one axillary lymph node metastasis, luminal subtype, BCT, RT and hormonal therapy were favorable factors of LRR (P <0.05). Multivariate analysis showed that age (p = 0.009), T stage (p <0.001), molecular subtype (p = 0.009) and chemotherapy (p <0.001) were independent prognostic factors for OS. RT (p = 0.054) and hormonal therapy (p = 0.063) had a trend to improve OS. Age (p = 0.034), T stage (p = 0.002), molecular subtype (p <0.001), RT (P = 0.001) and the number of positive axillary lymph node (P <0.001) were independent prognostic factors for LRR. The type of breast surgery had no significant effect on OS (p = 0.388) and LRR (p = 0.836). The type of breast surgery had no significant effect on the prognosis of patients with T1-2N1M0 breast cancer. Postoperative radiotherapy significantly reduces the risk of locoregional recurrence and might improve overall survival, suggesting that it may be required for majority of patients with mastectomy.

Randomized Phase II Multi-Center Trial of Busulfan, Etoposide, and Cyclophosphamide Versus Busulfan, Etoposide, and Melphalan As Conditioning Therapy for Autologous Transplantation in Patients with Non-Hodgkin's Lymphoma: A Multicenter Study from Consortium for Improving Survival of Lymphoma (CISL)

BackgroundHigh dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become the standard approach for relapsed or high risk non-Hodgkin's lymphoma (NHL). Several different high dose therapy (HDT) conditioning regimens have been used for NHL, such as BEAM(carustine, etoposide, cytosine arabinoside, melphalan), BEAC( carmustine, etoposide, cytosine arabinoside, cyclophosphamide), and CBV(cyclophosphamide, carmustine etoposide). Carmustine is an active drug in the HDT of NHL but the supply of carmustine is limited in some countries. Intravenous busulfan containing regimens as conditioning regimen have been used for both allogeneic and autologous stem cell transplantation in patients with hematologic and non-hematologic malignancies. We and CISL have previously studied that conditioning regimen of i.v. busulfan/melphalan/etoposide was well tolerated and effective in patients with relapsed or high risk NHL. And busulfan/cyclophosphamide/etoposide conditioning regimen has been extensively utilized in ASCT for NHL. Therefore, based on the encouraging results, we conducted a randomized phase II multicenter trial of busulfan/etoposide/cyclophosphamide (BCT) versus busulfan/etoposide/ melphalan/ (BMT) as conditioning therapy for ASCT in patients with NHL.MethodsPatients with chemosensitive high risk NHL or relapsed or primary refractory NHL underwent high dose chemotherapy at 16 centers in Korea. Patients were randomly assigned to receive BCT conditioning chemotherapy or BMT conditioning chemotherapy. BCT regimen consisted of iv busulfan 3.2 mg/kg/day i.v. on days -8,-7, and -6, etoposide 400mg/m2 day i.v. on days -5 and -4 and cyclophosphamide 50mg/kg/day i.v. on days -3 and -2 and BMT regimen were iv busulfan 3.2 mg/kg/day i.v. on days -8,-7, and -6, etoposide 400mg/m2 day i.v. on days -5 and -4 and melphalan 50mg/m2/day i.v. on days -3 and -2. The primary efficacy end points were 2 year progression free survival.ResultsSeventy five patients were enrolled onto the study. Patients randomly assigned to the BCT group (39 patients) or the BMT group (36 patients). Main subgroups were DLBCL (n=42, 56%) and T cell lymphoma (n=27, 36%). Thirteen patients (33.3%) in the BCT group and 11 patients (30.5%) in the BMT group had disease progression or died. 2 year progression free survival rate was 62.5% in the BCT group and 63.1% in the BMT group (p=0.924) (Fig 1). There was no treatment related mortality.ConclusionsNo significant differences were observed in progression free survival between BCT group and BMT group. Accordingly, busulfan based conditioning regimen may be regarded as an important treatment option to substitute for BEAM regimen. Further, considering R-CHOP or CHOP regimes are standard induction regimens, BMT conditioning will be good alternative to patients who can't be used cyclophosphamide. [Display omitted] DisclosuresKim:Celltrion, Inc.: Consultancy, Honoraria.

Thyroid Function after Postoperative Radiation Therapy in Patients with Breast Cancer

Objective:The aim of this study was to assess thyroid function in breast cancer patients exposed to therapeutic external beam radiation. The focus was on possible progressive changes and any relationships between the incidence of primary hypothyroidism, the time required to become hypothyroid, and factors such as chemotherapy, hormonotherapy and immunotherapy.Materials and Methods:Seventy females undergoing 3D conformal and IMRT radiation therapy for breast cancers were enrolled in a non-randomized prospective study. The patients was divided into two groups: those after mastectomy or breast conserving surgery (BCS) were irradiated to a scar of the chest wall/breast and the ipsilateral supraclavicular and the axillary areas (supraclavicular radiotherapy group - SC-RT group – 32 patients) and the control group receiving adjuvant chest wall/breast RT only (BCT group - 38 patients). The total doses were 50.0 to 70 Gy in 5 to 7 weeks. The median follow-up term was 24 months (range, 1–40 months). Thyroid function was evaluated by measuring thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. The minimum, maximum and mean thyroid gland doses for 20 Gy (V20) were calculated for all patients.Results:Statistically significant results were obtained for the SC-RT group. Two yearsa fter the end of RT the chance of an event was increased in 6% of the population (p=0.009) in the SC-RT group. In the BCT group no significance was noted. No statistically significant differences were found for V20, chemio-, immunotherapy and hormonotherapy or Ki67 values (p=0.12). No significant results were obtained for development of hypothyroidism and clinical factors (age, thyroid volume, treatment modalities).Conclusion:Radiotherapy is associated with a higher incidence of thyroid toxicity in breast cancer patients. Routine thyroid function monitoring should be recommended in such cases.