Ipsilateral Recurrence Research Articles

Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study.

High-resolution magnetic resonance vessel wall imaging (HRMR-VWI) is a promising technique for identifying intracranial vulnerable plaques beyond lumen narrowing. However, the association between HRMR-VWI characteristics and recurrent stroke remains uncertain. This study aimed to investigate the association between HRMR-VWI characteristics and recurrent ipsilateral stroke in patients with symptomatic intracranial atherosclerotic steno-occlusive disease (ICAS). This multicenter, observational study recruited first-ever acute ischemic stroke patients attributed to ICAS (>50% stenosis or occlusion) within 7 days after onset. Participants were assessed by multiparametric magnetic resonance imaging (MRI) including diffusion-weighted imaging, three-dimension time-of-flight magnetic resonance angiography, and three-dimensional T1-weighted HRMR-VWI. The patients were recommended to receive best medical therapy and were systematically followed up for 12 months. The association between HRMR-VWI characteristics and the time to recurrent ipsilateral stroke was investigated by univariable and multivariable analysis. Two hundred and fifty-five consecutive patients were enrolled from 15 centers. The cumulative 12 month ipsilateral recurrence incidence was 4.1% (95% confidence interval (CI): 1.6-6.6%). Patients with recurrent ipsilateral stroke exhibited higher rates of intraplaque hemorrhage (IPH) (30.0% vs 6.5%) and eccentric plaque (90.0% vs 48.2%), and lower occurrence of occlusive thrombus (10.0% vs 23.7%). Plaque length (5.69 ± 2.21 mm vs 6.67 ± 4.16 mm), plaque burden (78.40 ± 7.37% vs 78.22 ± 8.32%), degree of stenosis (60.25 ± 18.95% vs 67.50% ± 22.09%) and remodeling index (1.07 ± 0.27 vs 1.03 ± 0.35) on HRMR-VWI did not differ between patients with and without recurrent ipsilateral stroke. In the multivariable Cox regression analysis, IPH (hazard ratio: 6.64, 95% CI: 1.23-35.8, p = 0.028) was significantly associated with recurrent ipsilateral stroke after adjustment.Conclusions:Our results suggest intraplaque hemorrhage (IPH) is significantly associated with recurrent ipsilateral stroke and has potential value in the selection of patients for aggressive treatment strategies. Data from this study are available and can be accessed upon request.

Abstract 36: Association Between High-Resolution Magnetic Resonance Imaging Characteristics and Recurrent Stroke in Patients With Symptomatic Intracranial Atherosclerotic Steno-Occlusive Disease: A Prospective Multicenter Study

Background and Objectives: This study aimed to investigate the association between high-resolution magnetic resonance imaging (HR-MRI) characteristics and recurrent ipsilateral stroke in patients with symptomatic intracranial atherosclerotic steno-occlusive disease (ICAS). Methods: This multicenter, observational study recruited first-ever acute ischemic stroke patients attributed to ICAS (>50% stenosis or occlusion) within 7 days after onset. Participants were assessed by multi-parametric MRI including diffusion-weighted imaging, three-dimension time-of-flight magnetic resonance angiography, and three-dimensional T1-weighted HR-MRI. The patients were recommended to receive best medical therapy and were systematically followed up for 12 months. The association between HR-MRI characteristics and the time to recurrent ipsilateral stroke was investigated by univariable and multivariable analysis. Results: Two hundred and fifty-five consecutive patients were enrolled from 15 centers. The cumulative 12-month ipsilateral recurrence incidence was 4.1% (95% confidence interval [CI]: 1.6-6.6%). The plaque length (5.69±2.21 mm vs. 6.67±4.16 mm), plaque burden (78.40±7.37% vs. 78.22±8.32%), degree of stenosis (60.25±18.95% vs. 67.50±22.09%) and remodeling index (1.07±0.27 vs. 1.03±0.35) on HR-MRI did not exhibit discernible difference between patients with and without recurrent ipsilateral stroke. Patients with recurrent ipsilateral stroke exhibited higher rates of intraplaque hemorrhage (IPH) (30.0% vs. 6.5%) and eccentric plaque (90.0% vs. 48.2%), and lower occurrence of occlusive thrombus (10.0% vs. 23.7%). In the multivariable Cox regression analysis, IPH (hazard ratio: 7.05, 95% CI: 1.53-32.41, p=0.012) was significantly associated with recurrent ipsilateral stroke after adjustment. Discussion: We found IPH is significantly associated with recurrent ipsilateral stroke. Our results suggest IPH has potential value in the selection of patients for aggressive treatment strategies.

Occult metastasis is no burden factor in oral squamous cell carcinoma patients when adhering to a standardized approach in neck dissection

ObjectivesManagement of the neck in patients with oral squamous cell carcinoma (OSCC) is pivotal to oncologic control and survival. However, there is controversy regarding necessity of neck dissection (ND) in patients with clinically node-negative neck. We aimed to assess risk factors for occult metastasis and to explore whether the presence of occult lymph node metastases (LNMs) has an impact on recurrence and survival.Material and methodsA retrospective cohort study was performed including patients with primary OSCC who underwent radical tumor resection and ND in a high-volume center adhering to the prevailing German guideline. The ND was performed according to a standardized approach.ResultsFour hundred twenty-one patients with primary surgically treated OSCC were included. The incidence of occult metastasis was 14.49%. A pathological T stage > 1 (multivariate analysis, odds ratio (OR) 3.958, p = 0.042) and the presence of extranodal extension in LNMs (multivariate analysis, OR 0.287, p = 0.020) were identified as independent risk factors for occult metastasis. When comparing patients with and without occult metastasis, there were no significant differences in terms of progression-free survival (log-rank, p = 0.297) and overall survival (log-rank, p = 0.320). There were no cases of ipsilateral neck recurrence. One patient developed contralateral neck metastasis; however, he initially presented with a unilateral pT1 pN0 tumor.ConclusionsOverall, our findings suggest that conducting a standardized approach in ND should be applied in terms of management of the neck in order to maintain survival rates and to prevent neck recurrence in OSCC patients.Clinical relevance.None of the risk factors for occult metastasis can be reliably assessed preoperatively. Although elective ND does not guarantee the complete prevention of neck recurrence, it increases the likelihood of either timely removal of micrometastases or strengthens the justification for adjuvant therapy. Consequently, this approach leads to improvements in clinical outcomes.

Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score

BackgroundPartial nephrectomy (PN) is usually recommended for T1 stage clear cell renal cell carcinoma (ccRCC) regardless of the nuclear grades. However, the question remains unresolved as to whether PN is non-inferior to RN in patients with T1-ccRCC at higher risk of recurrence. In fact, we found that patients with high nuclear grades treated with PN had poorer prognosis compared with those treated with radical nephrectomy (RN). Therefore, this study was designed to evaluate the associations of PN and RN in the four nuclear grade subsets with oncologic outcomes.MethodsA retrospective study was conducted in three Chinese urological centers that included 1,714 patients who underwent PN or RN for sporadic, unilateral, pT1, N0, and M0 ccRCC without positive surgical margins and neoadjuvant therapy between 2010 and 2019. Associations of nephrectomy type with local ipsilateral recurrence, distant metastases, and all-cause mortality (ACM) were evaluated using the Kaplan–Meier method and multivariable Cox proportional hazards regression models after overlap weighting (OW).ResultsA total of 1675 patients entered the OW cohort. After OW, in comparison to PN, RN associated with a reduced risk of local ipsilateral recurrence in the G2 subset (HR = 0.148, 95% CI 0.046–0.474; p < 0.05), G3 subset (HR = 0.097, 95% CI 0.021–0.455; p < 0.05), and G4 subset (HR = 0.091, 95% CI 0.011–0.736; p < 0.05), and resulting in increased five-year local recurrence-free survival rates of 7.0%, 17.9%, and 36.2%, respectively. An association between RN and a reduced risk of distant metastases in the G4 subset (HR = 0.071, 95% CI 0.016–0.325; p < 0.05), with the five-year distant metastases-free survival rate increasing by 33.1% was also observed. No significant difference in ACM between PN and RN was identified.ConclusionsOur findings substantiate that opting for RN, as opposed to PN, is more advantageous for local recurrence-free survival and distant metastases-free survival in patients with high nuclear grade (especially G4) pT1-ccRCC. We recommend placing a heightened emphasis on enhancing preoperative nuclear grade assessment, as it can significantly influence the choice of surgical plan.Trial registrationThis study was registered at Chinese Clinical Trial Registry (ID: ChiCTR2200063333).

Post-mastectomy reirradiation for ipsilateral T3N0M0 breast tumor relapse: apopulation-based study.

Post-mastectomy radiotherapy is commonly recommended for T3N0M0 breast cancer, particularly in the presence of adverse prognostic factors. However, for T3N0M0 ipsilateral recurrences following breast-conserving surgery and adjuvant radiotherapy, the situation is distinct. Recurrence alone signifies anegative prognostic factor. Moreover, tumor relapses within previously irradiated areas exhibit enhanced radioresistance, and reirradiation of the chest wall carries an escalated risk of radiation-induced toxicity. This study aimed to assess the impact of post-mastectomy reirradiation (PM-reRT) on patient outcomes in cases of ipsilateral T3N0M0 breast tumor recurrence, using data from the SEER database. We identified all patients who underwent treatment for primary non-metastatic breast cancer with breast-conserving surgery followed by adjuvant radiotherapy in the SEER database; among them, those who later experienced alocalized T3N0M0 breast tumor recurrence and underwent total mastectomy were included. The study's goal was to compare overall survival (OS) and cancer-specific survival (CSS) between patients who underwent only mastectomy versus those who had mastectomy followed by adjuvant PM-reRT for their ipsilateral T3N0M0 breast tumor relapse. From 2000 to 2020, the SEER database recorded 44patients with an ipsilateral T3N0M0 breast tumor recurrence after initial conservative treatment, managed with total mastectomy. No statistically significant differences in OS or CSS were observed between patients undergoing mastectomy (MT) alone versus those receiving MT combined with PM-reRT (p = 0.68 and p = 0.86, respectively). Five-year OS rates for the MT and MT + PM-reRT cohorts were 49.5% [95% CI: 29.9-81.8] and 41.7% [10.0-100.0], respectively, while 5‑year CSS rates were 51.6% [12.0-99.5] and 58.3% [15.2-100.0], respectively. For patients undergoing total mastectomy after an ipsilateral T3N0M0 breast tumor recurrence, subsequent to initial breast cancer treatment involving breast-conserving surgery and adjuvant radiotherapy, chest wall reirradiation does not enhance survival outcomes. As such, it should not be routinely performed.

Selective Avoidance of Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Human Epidermal Growth Factor 2-Positive/Triple-Negative Breast Cancer Patients With Excellent Response.

The Avoid Axillary Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy (ASLAN) trial aims to demonstrate the oncologic safety of omitting axillary surgery in patients with excellent response after neoadjuvant chemotherapy (NACT) for early human epidermal growth factor 2 (HER2)-positive (+)/triple-negative breast cancer (TNBC) who have undergone breast-conserving surgery (BCS) and adjuvant radiotherapy. The ASLAN trial will provide crucial information that could change the procedure in highly selected patients undergoing axillary surgery after NACT. ASLAN is a prospective, multicenter, and single-arm surgical trial. The recruitment will be conducted among five tertiary care hospitals in the Republic of Korea. The total number of patients to be recruited will be 178, and we plan to complete patient enrollment by December 2023. The enrollment is considered among patients with HER2+ breast cancer (BC) or TNBC at clinical stage T1-3N0-1M0 who are expected to achieve breast pathological complete response (BpCR) based on a combination of radiologic imaging and physical examination after NACT. BCS was performed on eligible patients. After BCS, patients who showed BpCR were enrolled with the omission of sentinel lymph node biopsy (SLNB). The primary study endpoint upon completion of this trial is 5-year recurrence-free survival, and the secondary endpoints include the 5-year ipsilateral breast tumor recurrence interval, 5-year ipsilateral axillary recurrence interval, 5-year distant metastasis-free survival, 5-year BC-specific survival, 5-year overall survival, 5-year contralateral BC-free survival, re-operation rate according to breast biopsy after NACT, adverse events within 5 years, and quality of life. Several clinical trials are currently underway to determine whether SLNB can be omitted after NACT in patients with HER2+ BC or TNBC that are expected to achieve pathologic complete response. The ASLAN trial is expected to provide valuable clues regarding the feasibility of omitting axillary surgery in highly selected patients. ClinicalTrials.gov Identifier: NCT04993625. Registered on August 6, 2021. Clinical Research Information Service Identifier: KCT0006371. Registered on July 22, 2021.

Incidence of Contralateral Neck Nodal Metastasis in Recurrent Oral Cavity Squamous Cell Carcinoma

Aim: The aim of the study was to evaluate the incidence of contralateral neck nodal metastasis in recurrent oral cavity squamous cell carcinoma (OCSCC) with ipsilateral neck addressed during previous surgery. Methodology: A retrospective analysis of prospectively collected data of 2870 patients treated at Kailash Cancer Hospital and Research Center, Goraj, from January 2018 to December 2022 was done. Ninety patients with ipsilateral local recurrences with lesions not crossing or reaching midline were evaluated for contralateral neck nodal metastasis. All patients had undergone ipsilateral neck dissection during the previous surgery. Results: Contralateral nodal metastasis was found in 16 patients (17.77%), of which 13 patients (14.44%) had extranodal extension (ENE) and 7 patients (7.77%) had occult metastasis. In 35 patients, ipsilateral completion neck dissection was performed, of which 5 patients (14.28%) were node positive with ENE and 8.33% had bilateral node positivity with ENE. The factors influencing contralateral nodal metastasis after surgery for recurrence were the depth of invasion and ipsilateral neck nodal positivity and factors influencing contralateral node positivity from the previous surgery were nodal status and margins. Conclusion: In patients with local recurrence of oral cavity squamous cell carcinoma, with ipsilateral neck addressed previously, the lymphatic patterns alter. Hence, the predictable echelons are modified and no longer reliable. Hence, along with the excision of the primary lesion, completion of the ipsilateral neck and addressing the contralateral neck becomes mandatory, even if the patient is clinically node negative.

Post-surgery spontaneous pneumothorax: Long-term recurrence rates and follow-up challenges revealed by a written survey.

Spontaneous pneumothorax (SP) is a frequently encountered respiratory condition. Despite advancements in treatment techniques, there is currently no standardized treatment protocol. The aim of this study was to standardize the management of SP by collecting long-term postoperative data through written surveys. Our study included 673 surgeries performed for SP at our institution between January 2011 and December 2019. We administered written surveys via mail to gather data on post-surgery recurrence rates and other related factors. The survey addressed key symptoms, medical consultations, and specific diagnoses of SP after surgery. The effective response rate was 70.7%, with significant differences observed across age groups. Among teenagers, the recurrence rate peaked three years postoperatively, with an ipsilateral recurrence rate of 4.8% and a contralateral incidence rate of 11.8%, both of which were significantly higher than those in other age groups. Additionally, age, sex, postoperative contralateral pneumothorax, and the period before the survey were identified as factors influencing the survey results. This survey highlighted the need for long-term postoperative follow-up for teenagers. While written surveys have limitations, this study provided valuable data for understanding the outcomes of SP. Moving forward, it is advisable to conduct surveys using other effective tools or to continue follow-ups in outpatient clinics.

The role of unconventional lymph node metastasis in neck recurrence among patients with tongue cancer.

Statistics on the rate of unconventional lymph node metastases (ULNM) at the time of one-stage radical surgery in tongue cancer patients. To assess whether an extended neck dissection group with additional removal of ULNs has a lower rate of neck recurrence compared to the traditional neck dissection group. A total of 336 patients with TSCC who underwent radical surgery were recruited and underwent traditional or extended neck dissection. Compared to traditional neck dissection, the aim of extended neck dissection is designed to additional resect ULNs. In total, 180 patients underwent extended neck dissection, while 156 underwent traditional neck dissection. The incidence of ULNM was 11.67% (21/180) in patients treated with extended neck dissection. The incidence of ipsilateral neck recurrence was 9.49% and 0.56% in patients who underwent traditional and extended neck dissection, respectively (p = 0.0001). Extended neck dissection is effective for preventing neck recurrence in TSCC patients with ULNs. ULNM may be the main cause of neck recurrence after neck dissection in patients with tongue cancer. A better prognosis may be achieved by additional resection of ULNs on the basis of traditional neck dissection.

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Marfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients. Retrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10-June 22), with special emphasis on diagnosis, treatment, and follow-up (FU). Sixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up. Treatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.

Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study

Adjuvant breast radiotherapy as a standard component of breast-conserving treatment for early cancer can overtreat many women. Breast MRI is the most sensitive modality to assess local tumour burden. The aim of this study was to determine whether a combination of MRI and pathology findings can identify women with truly localised breast cancer who can safely avoid radiotherapy. PROSPECT is a prospective, multicentre, two-arm, non-randomised trial of radiotherapy omission in patients selected using preoperative MRI and postoperative tumour pathology. It is being conducted at four academic hospitals in Australia. Women aged 50 years or older with cT1N0 non-triple-negative breast cancer were eligible. Those with apparently unifocal cancer had breast-conserving surgery (BCS) and, if pT1N0 or N1mi, had radiotherapy omitted (group 1). Standard treatment including excision of MRI-detected additional cancers was offered to the others (group 2). All were recommended systemic therapy. The primary outcome was ipsilateral invasive recurrence rate (IIRR) at 5 years in group 1. Primary analysis occurred after the 100th group 1 patient reached 5 years follow-up. Quality-adjusted life-years (QALYs) and cost-effectiveness of the PROSPECT pathway were analysed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000810011). Between May 17, 2011, and May 6, 2019, 443 patients with breast cancer underwent MRI. Median age was 63·0 years. MRI detected 61 malignant occult lesions separate from the index cancer in 48 patients (11%). Of 201 group 1 patients who had BCS without radiotherapy, the IIRR at 5 years was 1·0% (upper 95% CI 5·4%). In group 1, one local recurrence occurred at 4·5 years and a second at 7·5 years. In group 2, nine patients had mastectomy (2% of total cohort), and the 5-year IIRR was 1·7% (upper 95% CI 6·1%). The only distant metastasis in the entire cohort was genetically distinct from the index cancer. The PROSPECT pathway increased QALYs by 0·019 (95% CI 0·008-0·029) and saved AU$1980 (95% CI 1396-2528) or £953 (672-1216) per patient. PROSPECT suggests that women with unifocal breast cancer on MRI and favourable pathology can safely omit radiotherapy. Breast Cancer Trials, National Breast Cancer Foundation, Cancer Council Victoria, the Royal Melbourne Hospital Foundation, and the Breast Cancer Research Foundation.

Longer is Better for Endoscopic Follow-up of Upper Tract Urothelial Carcinoma After Ureteroscopic Treatment: An Evaluation Spanning 10 Years of Data

BackgroundTumour recurrences are frequent among patients with upper tract urothelial carcinoma (UTUC) treated with ureteroscopy (URS). Therefore, guidelines recommend a strict follow-up regimen, but there is little evidence on how to do this. ObjectiveTo analyse outcomes during our follow-up regimen and the impact on treatment in terms of ipsilateral UTUC recurrence, treatment conversion, and tumour upgrading, and to evaluate potential prognostic factors, including second-look URS outcomes. A secondary objective was to evaluate survival outcomes. Design, setting, and participantsThe single-centre cohort included all adult patients with nonmetastatic UTUC treated with URS from January 2010 to December 2020. Follow-up involved endoscopy at 3-mo intervals in the first year, then at 6-mo intervals up to year 3, and yearly thereafter. Outcome measurements and statistical analysisDescriptive analyses were performed for the follow-up outcomes. The Andersen-Gill model for recurrent event analysis was used to analyse tumour recurrences, and multivariable Cox regression to analyse for predictors for treatment conversion in low-grade tumours. Results and limitationsWe analysed 71 patients with median follow-up of 49.5 mo. The overall 2-yr recurrence-free survival (RFS) rate was 22%. In low-grade disease, the 1-yr RFS rate was 50% and the 2-yr RFS rate was 29%. Treatment was converted to radical nephroureterectomy for 23 patients, at a median time to conversion of 9.9 mo. Upgrading was seen in 13 patients, at a median time to upgrading of 21.9 mo. No factors were prognostic for either tumour recurrence or treatment conversion. The 5-yr OS, CSS, and MFS rates were 82%, 86%, and 84%, respectively. ConclusionsOur data show that it is rational to extend endoscopic follow-up for UTUC treated with URS, as clinically relevant events (treatment conversion and tumour upgrading) occur beyond the current 6-mo guideline recommendation. Second-look URS outcomes were not prognostic for tumour recurrence or treatment conversion during follow-up. Patient summaryOur study results show that for patients with cancer of the upper urinary tract treated with kidney-sparing surgery through a small telescope called a ureteroscope (URS), most of the clinically relevant events (treatment conversion and tumour upgrading) occur outside the current recommended follow-up of 6 months. Therefore, URS follow-up should be extended for these patients.

Abstract B083: Association of socioeconomic deprivation with breast cancer incidence, survival and ipsilateral recurrence by molecular subtype in Scotland, United Kingdom

Abstract Cancer disparities reflect the interplay of biological, environmental, and socioeconomic determinants. In the United States, disentangling racial and ethnic disparities in breast cancer (BC) including the effects of health care access and socioeconomic deprivation is challenging, given the latter highly correlated with race and ethnicity. In Scotland, United Kingdom (UK), the population is 96% White and there is a single payer National Health Service (NHS). The Scottish Index of Multiple Deprivation (SIMD) measures the extent to which a geographic area is deprived across seven domains: income, employment, education, health, access to services, crime and housing. Scotland is renowned for high-quality electronic health records including breast tumor estrogen receptor (ER) status collected since 1997 and Progesterone Receptor and HER2 since 2009, which can be linked to hospital data and mortality. To gain a better understanding of individual patients’ SIMD status (measured in quintiles) at BC diagnosis with incidence and survival, we used data on 62,378 women diagnosed with invasive BC between 2000 and 2016. For ipsilateral breast recurrence (IBR) outcomes, we used a subset of data for BC diagnosed 2007-2008 where manual case-note review was performed for 3495 patients from 10 years post-diagnosis. Screen-detected ER+ tumor incidence increased over time, particularly in the least deprived quintile [Average Annual Percentage Change = 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for non-screen-detected ER+ tumors or ER- tumors by SIMD. Most versus least deprived SIMD-quintile was associated with significantly higher mortality for luminal A and HER2-enriched tumors in multivariable Cox proportional hazard models adjusted for mode of detection and confounders (aHR = 1.46 [1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker non-significant associations for luminal B and triple negative BC tumors (aHR &amp;lt;1.20). Among 2,819 ER+ tumors, 423 patients had IBR (15%) and 438 died: SIMD was related to death (p=0.018) with the most deprived more likely to have died in the first decade of follow-up (17.7% vs 12.9%). We found no significant differences by SIMD in prognostic tumor characteristics (grade, TNM stage, treatment, screen-detection) or risk of IBR. Among 676 patients diagnosed with ER- tumors, 185 had IBR (27%) and 105 died: 50% had mastectomy and the most deprived had an increased 5-year IBR risk compared to the least deprived (aHR 3.03 [1.41-6.53]). Our analysis shows socioeconomic deprivation is associated with differential BC incidence trends for screen-detected ER+ tumors and higher mortality and IBR for selected tumor subtypes. The lack of inequities for triple negative tumors by SIMD and survival, and IBR for ER+ tumors may be due to standardized treatment protocols and healthcare access. The association with socioeconomic deprivation and survival for HER2+ and recurrence among ER- tumors requires further study on potential other factors such as co-morbidities and adherence to treatment. Citation Format: Ines Mesa-Eguiagaray, Hayley Dunlop, Sarah Wild, Sheila M. Bird, Linda Williams, Peter S. Hall, Jonine D. Figueroa. Association of socioeconomic deprivation with breast cancer incidence, survival and ipsilateral recurrence by molecular subtype in Scotland, United Kingdom [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B083.

Adhesion is a risk factor for postoperative recurrence of spontaneous pneumothorax.

Several risk factors for postoperative recurrence of spontaneous pneumothorax have been reported, but the identified risk factors differed among studies. A total of 183 primary spontaneous pneumothorax patients were enrolled in this retrospective study, and the risk factors for postoperative recurrence were evaluated. Among the patients, more than 80% with ipsilateral postoperative recurrence (IPR) relapsed within 3 years and more than 80% with contralateral postoperative recurrence relapsed within 4 years. Compared with patients without IPR, patients with IPR had significantly more cases with history of pneumothorax (P<0.10), more cases without preoperative drainage (P=0.02), more cases with intraoperative adhesion (P<0.01), greater upward lung volume (P=0.04), more numbers of automatic sutures (P=0.04), and more cases with contralateral recurrence (P<0.01). Furthermore, compared with patients without adhesion, patients with adhesion had significantly older age (P<0.01), and more cases with adhesion on CT images (P<0.01). Patients with adhesion also had significantly greater upward lung volume (P<0.01), more cases that received covering with polyglycolic acid (PGA) sheet covering with fibrin glue (P=0.01), and more cases that received re-do surgery (P=0.04). IPR was significantly more common in the adhesion group (P<0.01), while contralateral postoperative recurrence did not differ significantly between the groups with and without adhesion (P=0.06). Univariate analyses showed that body mass index (BMI) <15.6 kg/m2 (P<0.01), history of pneumothorax (P=0.01), intraoperative adhesion (P<0.01), upward lung volume >80% (P=0.02), lateral lung volume >80% (P=0.02), 3 fire or more of automatic sutures (P=0.03), and contralateral recurrence (P=0.01) were significant risk factors for IPR. BMI <15.6 kg/m2 (odds ratio: 20.89; 95% confidence interval: 1.55-280.70; P=0.02) and intraoperative adhesion (odds ratio: 25.58; 95% confidence interval: 1.91-342.39; P=0.01) were identified as risk factors for IPR in a multivariate analysis. The present findings suggest that low BMI and intraoperative adhesion are risk factors for postoperative recurrence of spontaneous pneumothorax. For such patients, additional intraoperative procedures, such as covering with PGA sheet absorbable oxidized cellulose may be required to reduce postoperative recurrence.

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

IntroductionThis study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy in terms of comorbidities, complication rates, and recurrences in the largest study cohort published to date.MethodsWe conducted a retrospective analysis of patients, both adults and children, who were treated for peritonsillar abscess between 2007 and 2019. Patient charts were analyzed to assess surgical treatment, infection and inflammation rates, risk of bleeding, recurrence rates, duration of illness, and sick certificates. Additionally, patient imaging and blood levels were compared. Postal questionnaires were sent to all patients to evaluate subjective success rates, complications, and long-term benefits of the different treatment regimens. General practitioners and ENT doctors in private practices were contacted to gather missing data on the long-term course of the disease.ResultsA total of 821 patients with peritonsillar abscess were included in this study. Two patients had to be excluded due to incidental pathological findings. Of the remaining 819 patients, 180 were successfully treated with needle aspiration or incision. Among these patients, 37.7% required tonsillectomy during the same inpatient stay. Laboratory parameters such as leukocyte count or C-reactive protein levels were not indicative of the need for tonsillectomy. Furthermore, computed tomography was only necessary in cases of suspected parapharyngeal abscess, not in clear cases of peritonsillar abscess. Among the 641 patients who underwent tonsillectomy, 11.4% experienced postoperative bleeding requiring treatment. Only patients who underwent bilateral tonsillectomy reported recurrent episodes of sore throat and pharyngitis resulting in absence from work. The ipsilateral recurrence rate for peritonsillar abscess after needle aspiration or incision was 2.8%. There were no contralateral recurrences during the observation period.ConclusionDue to the lower risk of postoperative bleeding, shorter absence from work, and shorter inpatient stay, incision and drainage are the preferable treatment for peritonsillar abscess. Additionally, patients who underwent bilateral tonsillectomy reported higher rates of work incapacity due to sore throat caused by pharyngitis. No patient met the clear indication for bilateral tonsillectomy due to recurrent acute tonsillitis. The recurrence rate after drainage without tonsillectomy was very low (2.8% ipsilaterally, no recurrence contralaterally).

Endovascular Recanalization for Nonacute Carotid Artery Occlusion: A Nationwide Registry‐Based Cohort Study

Background The management of nonacute symptomatic internal carotid artery occlusion remains unsatisfactory. Endovascular recanalization has been reported to be feasible but associated with a noteworthy risk of postprocedural complications in patients with symptomatic internal carotid artery occlusion. The present study aimed to investigate whether successful recanalization exerts clinical benefits over procedural risks. Methods We analyzed consecutive patients who underwent endovascular treatment of nonacute symptomatic internal carotid artery occlusion in a nationwide prospective registry. The primary outcome was the ipsilateral ischemic stroke recurrence. Other outcomes of interest included all strokes and death during follow‐up, and 30‐day symptomatic intracranial hemorrhage, and all strokes after intervention. Results The final analysis included 511 patients. Endovascular revascularization was successful in 300 patients (58.7%) but failed in 211 patients (41.3%). Patients with successful recanalization had less time from the last ischemic event to the endovascular treatment as compared with patients with failed recanalization (median [interquartile range] days, 18 [12–33] versus 22 [14–50]; P =0.003). Successful recanalization was associated with a higher rate of symptomatic intracranial hemorrhage within 30 days after intervention (odds ratio [OR], 7.99 [95% CI, 1.02–62.39]; P =0.047). Thirty‐day all strokes (OR, 1.91 [95% CI, 0.83–4.40]; P =0.128) and ischemic stroke (OR, 0.90 [95% CI, 0.33–2.46]; P =0.839) did not differ significantly. During a median follow‐up of 37 months, patients with successful recanalization demonstrated a reduced risk of ipsilateral ischemic stroke (adjusted hazard ratio, 0.28 [95% CI, 0.13–0.59]; P &lt;0.001). The 5‐year risk of all strokes and death was likewise lower in patients with successful recanalization (restricted mean survival time difference, 3.77 months [95% CI, 0.16–7.38]; P =0.041). Conclusion Despite an increase in the 30‐day symptomatic intracranial hemorrhage, successful recanalization was associated with reduced long‐term risk of ipsilateral ischemic stroke in patients with symptomatic internal carotid artery occlusion.

Early and Intermediate Treatment Outcome After Postoperative External Beam Accelerated Partial Breast Irradiation in Patients With Early-Stage Breast Cancer

Purpose/ObjectivesTo prospectively evaluate early and intermediate outcome after APBI in early-stage breast cancer patients. Materials/MethodsInclusion criteria were defined according to the APBI ASTRO CONSENSUS STATEMENT. The prescribed dose was 26-28 Gy in 5 fractions on 5 consecutive days. Regular follow-up visits with objective and subjective evaluation of treatment tolerance were performed after 0 and 2 weeks, 6 months and at annual intervals. ResultsBetween 02/2017-01/2020, 175 patients with breast conserving surgery met the inclusion criteria for APBI. Mean age was 65.7 years (range 46-88). 13% of patients were diagnosed with DCIS/Tis, 5/35/37% with T1a/b/c, and 10% with T2 stages, respectively. The mean volume of PTV was 119 cc (range 45-465), the ratio of mean PTV: whole breast volume ratio was 21% (7-53%). Mean follow-up was 42 months (median 45, range 0 – 67). Acute toxicity after 2 weeks was low with 69/26/5% grade 0/1/2.1, 2, 3, 4 and 5-year follow-up data was available from 146/134/107/73/25 patients. Patient-reported cosmetic outcomes were assessed excellent or good in 97.9/98.5/98.1/98.6/100%.Regarding grade 2 toxicities, as by now 3/2/2/0/0% G2 fibrosis, 1/1/0/0/0% G2 atrophy, no G2 skin telangiectasia or breast edema occurred. So far, none of the patients have experienced G3 toxicity or higher. The remaining patients had grade 0 or 1 toxicity only.Five ipsilateral breast recurrences (one marginally to PTV, four out-of-field) and five distant recurrences were recorded by now (03/2023). The 4-year in-breast recurrence rate was 2.5%. Eight patients died, two of them from disease. For all patients, the 4-year overall, cancer specific and disease-free survival rates were 97.1%, 99.4%, and 95.3%, respectively. ConclusionsHerewith we showed high early and intermediate term treatment tolerance and disease control of APBI using 26-28Gy in 5f/1w in carefully selected early breast cancer patients. APBI is highly appreciated by patients and efficient, as an additional advantage for busy centers.

Evaluation of the association of area-level socioeconomic deprivation and breast cancer recurrence by oestrogen receptor subtypes in Scotland

BackgroundWomen from socioeconomically deprived areas have lower breast cancer (BC) incidence rates for screen-detected oestrogen receptor (ER) + tumours and higher mortality for select tumour subtypes. We aimed to determine if ipsilateral breast cancer recurrence (IBR) differs by Scottish Index of Multiple Deprivation (SIMD) quintile and tumour subtype in Scotland.MethodsPatient data for primary invasive BC diagnosed in 2007–2008 in Scotland was analysed. Manual case-note review for 3495 patients from 10 years post-diagnosis was used. To determine the probability of IBR while accounting for the competing risk of death from any cause, cumulative incidence functions stratified by ER subtype and surgery were plotted. Multivariable Cox Proportional Hazards models were used to estimate the association of SIMD accounting for other predictors of IBR.ResultsAmong 2819 ER + tumours, 423 patients had a recurrence and 438 died. SIMD was related to death (p = 0.018) with the most deprived more likely to have died in the 10-year period (17.7% vs. 12.9%). We found no significant differences by SIMD in prognostic tumour characteristics (grade, TNM stage, treatment, screen-detection) or risk of IBR. Among 676 patients diagnosed with ER- tumours, 105 died and 185 had a recurrence. We found no significant differences in prognostic tumour characteristics by SIMD except screen detection with the most deprived more likely than the least to have their tumours detected from screening (46.9% vs. 28%, p = 0.03). Among patients with ER- tumours, 50% had mastectomy and the most deprived had increased 5-year IBR risk compared to the least deprived (HR 3.03 [1.41–6.53]).ConclusionsIBR is not a major contributor to mortality differences by SIMD for the majority of BC patients in our study. The lack of inequities in IBR are likely due to standardised treatment protocols and access to healthcare. The association with socioeconomic deprivation and recurrence for ER- tumours requires further study.

Limitations in the Application of Clinicopathologic Factors Alone in Predicting Radiation Benefit for Women with Low-Risk DCIS after Breast Conserving Surgery: The Impact of a 7-Gene Biosignature Based on 10-Year Ipsilateral Breast Recurrence (IBR) Rates

Most women diagnosed with ductal carcinoma in situ (DCIS) receive radiotherapy (RT) after breast conserving surgery (BCS); however, clinical trials show that over 70% of women with BCS alone will not have a recurrence and therefore not benefit from RT. Traditionally, clinicopathologic (CP) factors have been used to select for whom to de-escalate treatment, but prospective trials have failed to identify a low risk CP group that did not benefit from RT with respect to local control. This study assessed the re-classification of patients with low-risk CP into Risk groups defined by the 7-gene biosignature and compared to 10-yr IBR rates. Women (n = 926) from four international DCIS cohorts treated with BCS had formalin-fixed paraffin embedded tissue samples analyzed at a CLIA lab (Laguna Hills, CA). CP low-risk patients were identified using a) RTOG-9804-like criteria [Nuclear Grade 1 or 2 & Size ≤2.5 cm & non-Palpable & Screen Detected & margin negative (no-ink on tumor)] and b) MSKCC-like criteria [low-risk score<220, determined using nomogram weighted factors (excluding: number of re-excisions and RT treatment), and using no-ink-on-tumor instead of close margin]. The 7-gene DCIS biosignature combined biomarkers with CP factors (age, size, palpability, and margin status) using an algorithm reporting a Decision Score (DS) and Residual Risk subtype (RRt). Women with low-risk CP were classified into biosignature Low Risk (DS≤2.8, no RRt) or High Risk (DS>2.8 +/- RRt) groups. 10yr in-breast event (IBR) rates with and without RT were assessed by Kaplan-Meier rates and Cox proportional hazard analyses. Overall, 37% of all women were classified into the biosignature Low Risk group, while 51% and 34% were classified into CP low-risk groups (RTOG-9804-like, MSKCC-like, respectively). The biosignature Low Risk group (n = 338) had a 10-yr IBR risk of 5.6% after BCS and no significant RT benefit (absolute RT benefit = 0.8%, p = 0.70), 99% negative predictive value (NPV) for RT benefit. CP low-risk groups had 10-yr IBR rates of 12% and 8% after BCS without RT with absolute 6% (p = 0.04) and 4% (p = 0.1) IBR rate reductions with RT. The biosignature reclassified 51% and 63% of CP low-risk patients into the biosignature High Risk group. Importantly, these patients had higher IBR rates without RT (20% and 12%) and significant 13% (p = 0.005) and 8% (p = 0.01) absolute IBR rate reductions from RT. CP low-risk patients with concordant biosignature Low Risk demonstrated no significant RT benefit. The 7-gene predictive biosignature more reliably identified patients with low 10-yr IBR rates and no significant RT benefit than the traditional CP low-risk criteria (RTOG-9804-like, MSKCC-like). Importantly, those CP low-risk patients who were re-classified as biosignature High Risk had increased 10-year IBR rates and significant RT benefit.

Disease Control and Toxicity Outcomes after Intraoperative HDR Brachytherapy for Neck Recurrences in Patients Previously Irradiated Head and Neck Cancer

Despite recent advances in local and systemic therapies for head and neck squamous cell carcinomas (HNSCC), the most common types of treatment failure remain local and regional. Patients with HNSCC also have a higher risk of developing secondary head and neck tumors due to a field cancerization phenomenon. Treatment of these recurrences poses a challenge, particularly in patients having previously received full dose external beam radiotherapy (EBRT) to the head and neck region. This study evaluates the clinical outcomes of intraoperative Harrison-Anderson-Mick applicator (HAM) HDR brachytherapy (BT) after salvage neck dissection for neck recurrences in patients previously irradiated for HNSCC. All patients having received HAM BT for HNSCC neck recurrences at a single institution were identified. Demographic, treatment, disease control and toxicity data were collected retrospectively. Toxicity was graded as per Common Terminology Criteria for Adverse events version 5. The Kaplan Meier method was used to assess overall survival (OS) and ipsilateral regional control (IRC) from the time of HAM BT. Nineteen patients with regional recurrence of HNSCC were treated with HAM BT Ir-192 between July 2006 and June 2022, with a median follow-up for survival of 51.4 months (range: 2.5-186.7). The median BT dose was 12.5 Gy delivered intraoperatively at 5 mm tissue depth/1 cm from source. Fifteen patients (78.9%) also received postoperative EBRT to a median dose of 46 Gy in 23 fractions and 13 (68.4%) received systemic therapy. Six patients (31.6%) developed ipsilateral neck recurrences (4 who had adjuvant EBRT and 2 who did not), 2 patients had primary site recurrences and 5 patients developed distant metastases. In terms of acute toxicity, 4 patients had grade 3 dysphagia requiring feeding tube (FT) placement and one patient required surgical intervention for wound necrosis. In terms of late toxicity, 2 additional patients required FT placement and 1 was able to have it removed. No grade 4+ late toxicities were noted. The IRC at the site of HAM BT at 1 year was 71.5% and 63.6% at 5 years. The 1-year OS was 81.3% and 5-year OS was 40.9%. Intraoperative HAM BT resulted in favorable rates of IRC with acceptable toxicity in the reirradiation setting for HNSCC.