Contralateral Recurrence Research Articles

A case of neuralgic amyotrophy with contralateral recurrence

Neuralgic amyotrophy is a brachial plexopathy of uncertain etiology which presents as acute neuropathic pain with subsequent weakness and sensory changes. It is believed that this disease process is under recognized in the primary care setting. We present a case of a 58-year-old male who presented to the outpatient clinic with severe pain and new onset weakness in his left arm. The same patient presented several months later with the same presentation in his right arm. By the end of the case report, readers should be able to recognize the common symptoms of neuralgic amyotrophy, as highlighted by this patient’s presentation.

Long-Term Update of NRG Oncology RTOG 0319: A Phase 1 and 2 Trial to Evaluate 3-Dimensional Conformal Radiation Therapy Confined to the Region of the Lumpectomy Cavity for Stage I and II Breast Carcinoma

NRG Oncology RTOG 0319 was the first cooperative group trial in the United States to evaluate 3-dimensional conformal radiation therapy (3D-CRT) accelerated partial breast irradiation (APBI). This report updates secondary endpoints of toxicity and efficacy. Patients with stage I or II invasive breast cancer (tumor size ≤3cm, ≤3 positive lymph nodes, negative margins) were eligible for 3D-CRT APBI: 38.5Gy in 10 twice-daily fractions.Patient characteristics and treatment details have previously been reported. Adverse events were graded with CTCAE v3.0 (National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0).This analysis updates the rates of ipsilateral breast recurrence (IBR), contralateral breast recurrence, ipsilateral node recurrence (INR), metastatic sites (distant metastases [DM]), mastectomy, disease-free survival, mastectomy-free survival, and overall survival. Of 58 enrolled patients, 52 were eligible, with a median age of 61years; 94% had stage I cancer and 83% had estrogen receptor positive disease. The median follow-up period was 8years (minimum-maximum, 1.7-9.0years). The 7-year estimate of isolated IBR (no DM) was 5.9%. The 7-year estimates of all IBRs, INR, mastectomy rate, and DM were 7.7%, 5.8%, 7.7%, and 7.7%, respectively. All 4 IBRs were invasive, of which 3 had a component within the planning target volume. The patterns of failure were as follows: 3 IBRs, 1 INR, 2 DM, 1 INR plus DM, and 1 IBR plus INR plus DM. The 7-year estimates of mastectomy-free survival, disease-free survival, and overall survival were 71.2%, 71.2%, and 78.8%, respectively. Thirteen patients died: 3 of breast cancer and 10 of other causes. Grade 3 (G3) treatment-related adverse events were reported by 4 patients (7.7%). No G3 pain or pulmonary or cardiac toxicities were reported. This phase 1 and 2 trial of 3D-CRT APBI continues to show durable tumor control and minimal G3 toxicity, comparable to other APBI techniques. Mature phase 3 results will determine the appropriateness and limitations of this noninvasive APBI technique.

Axillary contralateral recurrence in breast cancer: case report and literature review

Axillary contralateral lymph nodes recurrence is uncommon after curative breast cancer treatment. When the contralateral axilla is involved in a woman with a breast cancer history, the diagnostic and correct approach are a dilemma. Although it is traditionally considered a distant event, many studies have shown that aberrant lymph drainage is common after previous breast surgery. This might indicate that axillary contralateral lymph nodes recurrence is a regional event. Therefore, its treatment should be with curative rather than palliative intent. The aim of this article was to report the case of a young woman with invasive carcinoma in the left breast and a posterior axillary contralateral recurrence, and to review the literature about this infrequent and controversial issue.

Total thyroidectomy versus lobectomy in conventional papillary thyroid microcarcinoma: Analysis of 8,676 patients at a single institution

Because there is a controversy regarding the management of papillary thyroid microcarcinoma, the purpose of this study was to compare lobectomy with total thyroidectomy as a primary operative treatment for papillary thyroid microcarcinoma. Loco-regional recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy via the previous scar. However, reoperation for operation bed (thyroidectomy site) or regional lymph node (central or lateral) recurrence generally is associated with morbidity. Therefore, we analyzed overall loco-regional recurrence and loco-regional recurrence outside of the contralateral remnant lobe separately. We retrospectively reviewed 8,676 conventional patients with papillary thyroid microcarcinoma who underwent thyroidectomy. Lobectomy was performed in 3,289 (37.9%) patients, and total thyroidectomy was performed in 5,387 (62.1%) patients. Total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.398, P<.001). However, total thyroidectomy did not significantly decrease the risk of loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.880, P=.640). Particularly in conventional papillary thyroid microcarcinoma patients with multifocality, total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.284, P=.002) and loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.342, P=.020). Although lobectomy is associated with contralateral remnant lobe recurrence, lobectomy did not increase the risk of loco-regional recurrence outside of the contralateral remnant lobe in patients with papillary thyroid microcarcinoma, except in those with multifocality. Because recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy, lobectomy may be a safe operative option for select patients with papillary thyroid microcarcinoma without multifocality.

Axillary contralateral recurrence in breast cancer: case report and literature review

Axillary contralateral recurrence in breast cancer: case report and literature review

Unilateral radiotherapy for surgically resected lateralized squamous cell carcinoma of the tonsil.

The purpose of this study was to determine the rate of contralateral neck recurrence after surgery and unilateral neck radiotherapy, for lateralized tonsillar cancers with ipsilateral neck disease, in order to inform future clinical trial protocols for this disease. Patients with lateralized tonsillar squamous carcinoma (T1-T2, N0-N2b), treated with surgery and unilateral adjuvant radiotherapy in a single United Kingdom center were retrospectively identified. Rates of recurrence in the contralateral, unirradiated neck were analyzed, together with survival and toxicity data. Of 81 patients included, after a median follow-up of 5.7 years, no contralateral recurrences were identified. Five-year overall survival, progression-free survival, and locoregional control were 91.0%, 93.0%, and 95.4%, respectively. Unilateral radiotherapy is an effective and safe treatment option for the postoperative management of lateralized tonsillar cancers, even in patients with N2b disease, and should be recommended in future clinical trial protocols. © 2016 Wiley Periodicals, Inc. Head Neck 39: 17-23, 2017.

Pseudorecurrence following female laparoscopic inguinal hernia repair in children

Laparascopic repair of inguinal hernias in female children can be achieved using the inversion and ligation technique in which the hernia sac is inverted into the peritoneal cavity and ligated using endoloops. This technique has been shown to reduce operative time and post-operative complications such as missed contralateral hernia, wound infection and hernia recurrence. We describe a case of a 3-month old female who underwent laparoscopic repair of bilateral inguinal hernias, and presented one year post-operatively with bilateral groin bulges. On re-operation the bulges were determined not to be true hernia recurrences, but rather pseudorecurrences of accumulated fluid distal to the ligation point after incomplete inversion. They were successfully repaired in an open fashion, without subsequent development of groin bulges.

Recurrence pattern and TP53 mutation in upper urinary tract urothelial carcinoma.

TP53 mutation patterns are associated with prognosis of various cancers. This study was designed to investigate the association between TP53 mutation patterns and recurrence patterns in upper urinary tract urothelial carcinoma (UTUC) patients. A total of 165 consecutive UTUC patients who underwent nephroureterectomies were enrolled for measuring mutation patterns of TP53 gene from exome 2 to 11. Bladder recurrence, contralateral UTUC recurrence, and metastases were compared among groups by using log-rank test and Cox proportional hazard model. Single base substitution as an A:T to T:A transversion was noted in 55 (33.3%) patients (AT group). Forty-two (25.5%) patients had TP53 mutations with only other than A:T to T:A transversion (NAT group), and 68 patients (41.2%) had wide-type TP53 (WT group). AT group was predominately female (64%, 52%, 29%, respectively), had a higher incidence of end-stage renal disease (24%, 14%, 10%, respectively), and had more high-grade tumors (82%, 74%, 62%, respectively) compared to NAT and WT groups. With adjustment of tumor grade/stages, bladder and contralateral UTUC recurrence-free survival duration was shortest in NAT (p < 0.001) and AT group (p < 0.001), respectively. NAT group had a shorter metastasis-free survival duration than the other two groups combined (p = 0.018). As a result, A:T to T:A transversion increased contralateral UTUC recurrence risk, but other mutations in TP53 raised the hazard of bladder recurrence and metastases. Therefore, TP53 mutation pattern may be a useful biomarker to predict recurrence patterns of UTUC patients.

Primary spontaneous pneumothorax: simultaneous treatment by bilateral non-intubated videothoracoscopy.

Through a retrospective study, we assessed the feasibility and safety of simultaneous bilateral thoracoscopic wedge resection of blebs or bullae for the treatment of primary spontaneous pneumothorax (PSP) under thoracic epidural anaesthesia with spontaneous ventilation. This retrospective analysis involved a cohort of 37 consecutive patients undergoing simultaneous bilateral thoracoscopic bullectomy under spontaneous ventilation thoracic epidural anaesthesia (n = 15) or intubated general anaesthesia (n = 22) between July 2011 and September 2015. The perioperative data, short-term outcomes and recurrence rates of the two groups were compared. The two groups had comparable preoperative demographic profiles. There were no conversions to thoracotomy or intubated single-lung ventilation. The peak end-tidal carbon dioxide in the non-intubated group was significantly higher than that in the intubated group (mean: 48 vs 34 mmHg, P < 0.001). Both groups had comparable surgical duration, blood loss and lowest intraoperative pulse oxygen saturation level. Postoperatively, the two groups had comparable chest tube duration, volume of fluid administration, length of hospital stay and complication rates. No mortality occurred. The total anaesthesia cost in non-intubated group was significantly lower (mean: CNY 4584 vs 5649, P = 0.016). The mean follow-up was 23.6 ± 12.9 months in the non-intubated group and 21.1 ± 13.4 months in the intubated group. Two recurrent pneumothoraxes in 2 patients were observed after surgical procedures for PSP. One recurrence developed in the non-intubated group (7%) and one in the intubated group (5%). Simultaneous bilateral non-intubated thoracoscopic bullectomy is not only well tolerated and technically feasible but also a safe alternative for selected patients with simultaneous bilateral PSP or with high risk of contralateral recurrence.

Accelerated Partial Breast Irradiation Using Multicatheter High-Dose-Rate Brachytherapy for Selected Early-Stage Breast Cancer

Accelerated Partial Breast Irradiation Using Multicatheter High-Dose-Rate Brachytherapy for Selected Early-Stage Breast Cancer

Long-Term Cancer Outcomes From Study NRG Oncology/RTOG 9517: A Phase 2 Study of Accelerated Partial Breast Irradiation With Multicatheter Brachytherapy After Lumpectomy for Early-Stage Breast Cancer

Toexamine 10-year rates of local, regional, and distant recurrences, patterns of recurrence, and survival rates for breast cancer patients enrolled on Study NRG Oncology/Radiation Therapy Oncology Group 9517, a multi-institutional prospective trial that studied one of the earliest methods of accelerated partial breast irradiation (APBI), multicatheter brachytherapy (MCT). Eligibility included stage I/II unifocal breast cancer <3cm in size after lumpectomy with negative surgical margins and 0 to 3 positive axillary nodes without extracapsular extension. The APBI dose delivered was 34Gy in 10 twice-daily fractions over 5days for high-dose-rate (HDR); and 45Gy in 3.5 to 5days for low-dose-rate (LDR) brachytherapy. The primary endpoint was HDR and LDR MCT reproducibility. This analysis focuses on long-term ipsilateral breast recurrence (IBR), contralateral breast cancer events (CBE), regional recurrence (RR), and distant metastases (DM), disease-free, and overall survival. The median follow-up was 12.1years. One hundred patients were accrued from 1997 to 2000; 98 were evaluable; 65 underwent HDR and 33 LDR MCT. Median age was 62years; 88% had T1 tumors; 81% were pN0. Seventy-seven percent were estrogen receptor and/or progesterone receptor positive; 33% received adjuvant chemotherapy and 64% antiendocrine therapy. There have been 4 isolated IBRs and 1 IBR with RR, for 5.2% 10-year IBR without DM. There was 1 isolated RR, 1 with IBR, and 1 with a CBE, for 3.1% 10-year RR without DM. The 10-year CBE rate was 4.2%, with 5 total events. Eleven patients have developed DM, 8 have died of breast cancer, and 22 have died from other causes. The 10-year DFS and OS rates are 69.8% and 78.0%, respectively. This multi-institutional, phase 2 trial studying MCT-APBI continues to report durable in-breast cancer control rates with long-term follow-up.

Effectiveness of bisphosphonate use and risk of contralateral breast cancer and recurrence in women with early-stage breast cancer treated with tamoxifen

The effectiveness of bisphosphonates (BP) in reducing risk of second breast cancer and recurrence in observational studies has been minimally studied. We examined the association of oral BP use on risk of contralateral breast cancer (CBC) and recurrence in 16,781 women diagnosed with early-stage breast cancer from 1996 to 2007, treated with tamoxifen, and followed through December 31, 2009 at Kaiser Permanente Northern California (KPNC, n=8857) and Southern California (KPSC, n=7924). Sociodemographic, clinical, and pharmacy information were extracted from electronic medical records and cancer registries. CBC was identified from cancer registries, and recurrences from electronic health records and chart reviews. Multivariate Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) treating BP use and hormonal therapy as time-varying variables. After mean 6.4years of follow-up, 494 (3.0%) women developed CBC. BP use post-breast cancer diagnosis (>93% alendronate) ranged from 14.5 to 24.9% at both study sites. Overall, there was no association of BP use with reduced risk of CBC (ever use, HR=0.96; 95% CI 0.67-1.38 and continuous use, HR=1.03; 95% CI 0.88, 1.20). Similar null associations were observed for recurrence (ever use, HR=0.98; 95% CI 0.82, 1.17 and continuous use, HR=1.00; 95% CI 0.92, 1.09). Associations varied somewhat by site yet confidence intervals overlapped. BP use was not associated with reduced risk of recurrence or new primary disease among women diagnosed with early breast cancer and treated with tamoxifen.

Prospective, single-center cohort study analyzing the efficacy of complete laparoscopic resection on recurrent hepatocellular carcinoma.

BackgroundLaparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). However, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efficacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence.MethodsWe conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31) underwent laparoscopic hepatectomy, and the control group (n = 33) underwent conventional open surgery. Operation time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient could walk, anal exsufflation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse-free survival was compared between the two groups.ResultsAll surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differences between the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraoperative blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6 vs. 2.2 ± 0.8 days, P < 0.05), anal exsufflation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days, P = 0.014). During the 1-year postoperative follow-up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse-free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufflation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recurrence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was significantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence.ConclusionsFor the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraoperative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.

Hemangiolymphangioma of the spermatic cord in a 17 year-old: A case report

Abstract Background Hemangiolymphangiomas are extremely rare tumours arising from blood and lymphatic vessels. It is a benign disorder, and 95% are of the neck and axilla. Objective To present a case of hemangiolymphangioma of the spermatic cord with contralateral recurrence. Clinical case A 17-year-old patient with a progressively growing tumour in the right inguinoscrotal region. Examination revealed a painless, movable and soft right inguinoscrotal tumour, mobile and soft. Surgical resection showed a 25 cm × 25 cm tumour from spermatic cord, right testicle, and subcutaneous cellular tissue. Histopathological study reported a hemangiolymphangioma. Conclusions The spermatic cord is an unusual location of hemangiolymphangiomas with contralateral recurrence. Surgical treatment, with histopathological diagnosis, is associated with good prognosis.

Abstract P5-08-27: Estrogen receptor beta expression is prognostic among chemotherapy-treated patients – Results from a population-based breast cancer cohort

Abstract Background and aim Estrogen receptor beta (ERβ) expression has been suggested to hold prognostic and predictive information, especially for endocrine treatment. The role of ERβ may depend on the expression of estrogen receptor alpha (ERα). The aim of this study was to evaluate ERβ expression in relation to tumor characteristics and risk for early events (disease-free survival, DFS) – overall and in different treatment groups, in a population-based cohort of primary breast cancer patients. Materials and methods Patients with primary breast cancer were invited at the preoperative visit between October 2002 and June 2012. After exclusion of patients who received preoperative treatment and patients with in situ carcinoma, the study population consisted of 1026 patients. Tumor specimens mounted in tissue microarrays were analyzed for ERβ expression using immunohistochemistry (antibody PPG5/10, Dako, dilution 1:20). Two cut-offs for positivity were evaluated (&amp;gt;10% and &amp;gt;75% of stained nuclei, respectively). Cox regression analyses yielding hazard ratios (HRs) with 95% confidence intervals (CIs) were adjusted for ERα status, tumor size, axillary lymph node involvement, histological grade, age at inclusion and body mass index. Events were defined as ipsi- or contralateral recurrences, regional or distant metastases. DFS was calculated from inclusion to event, non-breast cancer related death or last follow-up by June 30 2014, whichever came first. Patients were followed for up to 11 years (median follow-up 5.0 years for patients still at risk). Results ERβ expression was available for 911 patients (89%). ERβ positivity defined as &amp;gt;10% (ERβ10+, 92.1%) was positively associated with ERα (P&amp;lt;0.0001). ERβ10+ was not associated with DFS, overall or in patients who received tamoxifen and/or aromatase inhibitors. ERβ positivity defined as &amp;gt;75% (ERβ75+, 72.7%) was associated with ERα and PR positivity, lower histological grade, smaller invasive tumor size and no involvement of axillary nodes (all Ps≤0.03). In survival analyses among all patients, ERβ75+ was inversely associated with risk of early events (LogRank P=0.0005, adjHR 0.62: 95% CI 0.42-0.90; P=0.013). The magnitude of the association was larger in patients with ERα negative tumors (LogRankERα- P=0.011, adjHRERα- 0.42: 95% CI 0.17-1.02; P=0.05) compared to patients with ERα positive tumors (LogRankERα+ P=0.069, adjHRERα+ 0.74: 95% CI 0.48-1.14; P=0.18). In analyses stratified for chemotherapy, ERβ75+ expression was significantly associated with lower risk of early events among the 232 patients who had received chemotherapy (Log Rank P=0.0005, adjHR 0.31: 95% CI 0.15-0.63; P=0.001), but not among the 670 patients without chemotherapy (Log Rank P=0.14, adjHR 0.81: 95% CI 0.50-1.31; P=0.38). ERβ75+ was not associated with early events in patients with ERα+ tumors who received tamoxifen and/or aromatase inhibitors. Conclusion This study provides support for high tumor ERβ expression as a prognostic marker in breast cancer, for patients who received chemotherapy. Previous reports of ERβ as a predictor of endocrine therapy response could not be confirmed. Citation Format: Elebro K, Borgquist S, Rosendahl A, Markkula A, Simonsson M, Jirström K, Rose C, Ingvar C, Jernström H. Estrogen receptor beta expression is prognostic among chemotherapy-treated patients – Results from a population-based breast cancer cohort. [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 P5-08-27.

Abstract P5-17-08: Study of boost radiotherapy's influence on local control in 646 pure ductal carcinoma in situ breast cancer with long-term follow-up

Abstract BACKGROUND: Boost radiotherapy (B-RT) improves outcome in patients (pts) with invasive breast cancer. It's use in patients with pure ductal carcinoma in situ (DCIS) is unclear. There are two ongoing randomize trials, results are expected in ten years. Twelve retrospective observational studies have been published since 2006, the recent meta-analysis, support boost in the presence of positive margins. PATIENTS and METHODS: We analyse a retrospective women's cohort of 646 pure DCIS patients (pts) treated mainly in two Hospitals (n=518) from 1993 to 2014. The other ten Hospitals included 128 pts all 2005 long. Proportions were compared by boost status, using the chi-square tests. The impact of boost radiation on the development of local recurrence (LR) was determined using survival analyses. In the comparison of Kaplan-Meier (K-M) was used log-rank test. RESULTS: B-RT subgroup is 394 pts (61%), noB-RT 252 (39%). Median follow-up (FU) is 8.8 years. High risk factors: young age, size, margin status and tamoxifen (TMX) show differences among B-RT (p&amp;lt;0.05). 46% were Estrogen Receptor positive (ER+), 30% B-RT and 16% noB-RT. 22% RE+ in B-RT take TMX vs 9.4 % RE+ noB-RT. Total LR 65 (10%). In situ LR 30 pts (4,6%) and Invasive (Inv) 35 (5,4%). By subgroup, LR in B-RT 47 (12%) vs. 18 (7%) in noB-RT. By subtype, In situ LR in B-RT 20 (5.1%) vs. noB-RT 10 (4%). Inv LR in B-RT 27 (6.9%) vs. noB-RT 8 (3.2%). In uni &amp; multivariate analysis, tumour size, Re-Excision, and TMX, are significant LR risk factors (p&amp;lt;0.05). Boost total doses &amp;gt;16 Gy in the B-RT subgroup is a LR significant risk factor related to 10-16 Gy (p∼0.05). TMX and Dose Boost are related (p&amp;lt;0.001). When Dose is introduced in multivariate analysis model, TMX lost signification. Contralateral local recurrence (CLR) in 29 pts (7%). Second tumours 9 pts (NSD between subgroups). Global disease free survival (DFS) is 80.5%, 77% in B-RT vs. 85% in noB-RT. Four pts have a LR combined with CLR; 2 pts have a LR and a second tumor; 1 pt with CLR and second tumour; 1 pt a Inv regional recurrence; 1 pt mixosarcoma in ipsilateral breast and lung metastases. Deaths: 3 pts (0.5%) after an Inv LR; 3 pts (0.5%) after Inv CR; 20 pts other causes; 10 pts lost their FU. Median FU in B-RT subgroup was 9y vs. 8.3y in noB-RT. The maximum FU according LR in B-RT is 20.6y vs. 17.4y in noB-RT. RL is not significant according to Boost (K-M p=0.398). Median LR in situ or inv depending of B-RT vs. noB-RT shows NSD (p=0.663). CONCLUSIONS: In this large cohort retrospective study with long-term follow-up B-RT was associated with similar LR as noB-RT despite being used more frequently with higher risk disease. Dose boost &amp;gt;16 Gy has a protective effect. Tamoxifen and boost dose are related variables. Further evidence, based on ongoing randomized trials results is essential. Citation Format: Cambra MJ, Moreno F, Sanz X, Anglada L, Moià M, Reyes V, Arenas M, Pedro A, Ballester R, García V, Sanjosé S, Cusidó M, Jimenez C, Macià M, Solé JM, Farrus B. Study of boost radiotherapy's influence on local control in 646 pure ductal carcinoma in situ breast cancer with long-term follow-up. [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 P5-17-08.

Abstract P4-12-01: Long term follow up of patients (pts) with HER2positive (H+) early stage breast cancer (ESBC) treated with trastuzumab (T)

Abstract Background. H+BC is an aggressive variant of BC with earlier and more frequent metastatic relapse than HER2 normal disease. Following the reports in 2005 of several large random assignment trials which showed that the anti-HER2 monoclonal antibody T improved the outcome of pts with H+ESBC receiving chemotherapy, we introduced Trastuzumab (T) as a routine component of standard adjuvant (AdjRx) and neo-adjuvant (NAdjRx) therapy for all pts with H+ESBC at our institution. Others had received it investigationally from 2000-2004. We report our 14 year experience with Adj and NAdjRx with T. Methods. We compiled a comprehensive database of all patients ever treated at our institution with Adj or neo-Adj T for H+ESBC. All pts were cross-checked through the Pathology, Pharmacy and Med Onc datasets, and all cases were individually reviewed. Results. Out of 764 pts included in the H+BC medical oncology database, we identified 518 pts (AdjT=373, NAdjT=145) with stage I-III disease treated with T between August 2000 and October 2014. Pts characteristics: median (range) age: 54 (26-86) yrs, hormone-receptor (HR) status: HR positive (HR+) 64%/HR negative (HR-) 35%/HR unknown 1%, lymph node positive (LN+): 52% (AdjT: 44%/NAdjT 72%), systemic therapy+T: TCH [docetaxel/carboplatin/trastuzumab] 306 (59%), anthracycline and taxane regimens-85 (16%), single-agent taxane 48 (9%), other regimens or T without chemotherapy-79 (15%). The database lock out date was May 31st 2015. The median follow-up (FU) time is 50.6 (1.4-156.6) months. The overall relapse rate (RR) in the whole population is 8.9% (AdjT 9.4%/NAdjT 7.6%) and distant RR is 8.3% (AdjT 9.1%/NAdjT 6.2%). OS rate in the whole study population is 93.4% (AdjT 92.5%/NAdjT 95.9%). RR was lower in pts with HR+ [7.2% (AdjT 7.1%/NAdjT 7.8%)] than in those with HR- [10.6% (AdjT 11.9%/NAdjT 7.4%)] disease. Among all the subgroups the lowest RR was observed in the HR+/LN- subgroup (2.7%) whilst the highest was in the HR-/LN+ subgroup (15.5%). Pts treated in the NAdjT cohort had a pathological complete response (pCR) rate of 38.6%. In the whole study population the median time to relapse (TTR) was 31.8 (7.9-97.6) months with no difference between AdjT and NAdjT cohorts. 87% of all relapses happened within 60 months of first T. Out of 6 delayed relapses (after month 60) 4 were HR+, 1was HR unknown and 1 was HR- in the form of a contralateral axillary recurrence, possibly from a second occult breast primary. Among pts treated prior to March 2010 (N=267), who have a minimum FU of 5 yrs, the RFS is 86.5% and the OS rate of 89.1%. Conclusions. The prognosis of pts with HER2+ ESBC in the T era is excellent. Despite the large proportion of pts with LN+ disease in our database, over 90% are alive at almost 5 years. HR+ confers a better prognosis than HR- in both LN+ and LN- disease. Long-term outcome data show that nearly 90% of all relapses occur within 5 yrs from initiation of anti-HER2 therapy especially in the HR- subgroup. Late relapse is rare in HR- pts. Adjuvant hormonal therapy is likely to contribute meaningfully to the favourable outcome of HR+/HER2+ ESBC and may explain the discordance between the improved survival of ER+ Adj pts and the improved pCR reported for neoAdj T in ER+ pts. Citation Format: Bose R, Zanoni D, Gullo G, Fennelly D, Walshe J, Ballot J, Defrein A, O'Donovan N, Mc Dermott E, Evoy D, Silva N, Crown J. Long term follow up of patients (pts) with HER2positive (H+) early stage breast cancer (ESBC) treated with trastuzumab (T). [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 P4-12-01.

Abstract P5-17-05: Local recurrence rates after mastectomy undertaken for pure ductal carcinoma in situ

Abstract Currently over 30% of patients with ductal carcinoma in situ (DCIS) are treated by mastectomy. Local recurrence rates (LRR) after simple mastectomy for DCIS have historically been reported as low1. Recent UK and US data has indicated 5-year local recurrence rates after mastectomy for DCIS are increasing2. Skin sparing mastectomy (SSM) offers a better cosmetic outcome however there is little work in the literature comparing local recurrence rates between simple and SSM for pure DCIS. Local recurrence rates may be higher after SSM compared to simple mastectomy3. Aims: 1. To evaluate what local recurrence rates were after mastectomy performed for pure DCIS. 2. To compare LRR in simple against SSM. Methods: We undertook a retrospective analysis of all patients who underwent a mastectomy for pure DCIS at one breast unit between 2000-2010. Operation reports were reviewed and data collected on the type of mastectomy and reconstruction used. Pathology reports were reviewed and the histological type, grade, size of DCIS as well as the presence of micro-invasion, excision margin and molecular phenotype were recorded. We excluded those patients who were having surgery for recurrent ipsilateral disease, gynaecomastia and risk reduction. Results: One hundred and ninety-nine patients had a mastectomy to treat pure DCIS between 2000-2010. Median follow up time was 65 (0-152) months. 102 patients had an SSM compared to 97 who had a simple mastectomy. The mean age was younger in the SSM group 53 as opposed to 61 (p = &amp;lt;0.01, t-test). Overall local recurrence rates were 3.1% at 5 years and 5.6% at 8 years. Fiver-year contralateral recurrence rates were 4.2% and 8.5% at 8 years. All of the recurrences occurred in the SSM group which had 8/102 local recurrences compared to 0/97 in the simple mastectomy group. All 8 of the recurrence were invasive ductal carcinoma with a median disease free survival time of 55 months. Univariate analysis demonstrated that a young age and close margins predicted recurrence. Conclusion: Our overall 5-year local recurrence rate was 3.1%. This is higher than historical data however in line with emerging UK and US data. Five-year LRR was significantly higher after SSM 5.9% compared to simple mastectomy 0%. All recurrences were invasive disease, which represented a loss of control of disease. Further work is needed to evaluate if there is a benefit of undertaking post reconstruction mammography to detect recurrences whilst still in situ disease. Our work corroborates with the literature highlighting the importance of achieving clear margins to prevent recurrence.

Is a modification of the radiotherapeutic target volume necessary after resection of glioblastomas with opening of the ventricles?

Extensive surgical resection of centrally localized, newly diagnosed glioblastoma can lead to opening ventricles and therefore carries a potential risk of spreading tumor cells into the cebrospinal fluid. However, whether ventricle opening consequently implies a greater frequency of distant tumor recurrence after radiation therapy-and, therefore, reduced survival-remains unknown. Therefore, is an adaption of target volumes in radiation therapy necessary to account for a potential tumor cell spread into the ventricle system? The present study assessed the resection statuses of 311 primary-glioblastoma patients who underwent radiation therapy. Overall, in 78 cases (25.1%) the ventricle system was opened during surgical resection. This study assessed the connection between ventricle opening and progression-free survival, overall survival, and distant and multifocal recurrence. OS rates of patients that underwent gross total resection were superior to patients with subtotal resection (p=0.002). PFS (p=0.53) and OS (p=0.18) did not differ due to ventricle opening during surgical resection. However, in a subsample of STR cases increased survival was observed when the ventricle system was opened (16.8 vs. 14.3months; p=0.03). The occurrence of distant (p=0.75) and contralateral recurrence (p=0.87) was not influenced by ventricle opening. Newly diagnosed glioblastoma patients whose ventricle systems were opened during microsurgical resection did not experience decreased survival or show increased likelihoods of distant and contralateral progressions following radiation therapy. In short, patients profit from surgical resections that are as extensive as reasonably possible, even if this entails ventricle opening. Thus, additional inclusion of the ventricles in the radiation therapy target volume after ventricle opening does not seem to be indicated.

Primary and metastatic lymphoma of the testis – a review of the literature

Primary lymphoma of the testis is rare. The commonest type of lymphoma of the testis is diffuse large B-cell lymphoma, but other types of primary and metastatic lymphoma of the testis also occur. Diffuse large B-cell lymphoma usually manifests as a painless unilateral mass in older men. Children can also develop lymphoma of the testis. Constitutional symptoms may be experienced. Specimens for histological confirmation of this type of lymphoma are obtained through orchiectomy. Chemotherapy and radiotherapy are used to avoid or reduce recurrences. Intrathecal chemotherapy is also used to reduce recurrence in the central nervous system, but despite this central nervous system recurrences do occur. There is no consensus on the best chemotherapy regimen. It is important that a correct diagnosis is made based upon the microscopic and immunohistochemical characteristics of the tumour, because differentiation of diffuse large B-cell lymphoma from other types of lymphoma is helpful in selecting the correct chemotherapeutic regimen, and the appropriate regimen differs depending upon the specific type of lymphoma. There is a need for a global multicentre trial to identify the best treatment option for improving the long-term survival of patients and reducing central nervous system, extranodal and contralateral testis recurrences.