Locoregional Recurrence In Patients Research Articles

Discovery and validation of a genomic signature to identify women with early-stage invasive breast cancer who may safely omit adjuvant radiotherapy after breast-conserving surgery.

512 Background: Adjuvant radiotherapy (RT) is currently the standard of care for women with early-stage invasive breast cancer (BC) treated with breast conserving surgery (BCS). However, some women may have very low risk of recurrence and could safely be spared RT. This study aimed to identify these women using a molecularly-based approach. Methods: We performed an analysis of the SweBCG91-RT cohort, a trial randomizing women with node-negative stage I-II invasive BC +/- RT following breast conserving surgery, with sparse use of adjuvant systemic therapy. Only patients with ER+, HER2- tumors, and not treated with adjuvant systemic therapy, were included in this analysis. Transcriptome-wide profiling of tumors was performed using the Affymetrix Human Exon 1.0 ST microarray. The SweBCG91-RT cohort was divided into a training cohort of 243 patients and a validation cohort of 354 patients. Biological gene sets and individual genes related to locoregional recurrence in patients not receiving RT of the training set were identified, and a 16-gene signature was trained using elastic net regression. The signature, named Profile for the Omission of Local Adjuvant Radiation (POLAR), was locked prior to validation. Results: In the validation cohort, POLAR was prognostic for locoregional recurrence (LRR) in patients not treated with RT (multivariable Cox model adjusting for age, grade, tumor size, and luminal A vs luminal B: HR = 1.7 [1.2,2.3], p < 0.001). Patients categorized as POLAR low-risk had a 10-year locoregional recurrence rate of 7% in the absence of RT. Notably, there was no significant benefit from RT for these POLAR low-risk patients (HR = 1.1 [0.38,3.3], p = 0.83), whereas patients categorized as POLAR high-risk had a significant decreased risk of locoregional recurrence when treated with RT (recurrence rate without RT at 10-years 19%, HR = 0.43 [0.24,0.78], p = 0.0053). Conclusions: These data suggest that the novel POLAR genomic signature based on LRR biology can not only identify patients who have a low risk of LRR without adjuvant RT after BCS but who also would not benefit from RT, thus being prime candidates for RT omission.

Recurrent disease in patients with stage III melanoma in the era of adjuvant immune and targeted therapy.

e21570 Background: Advancements in systemic therapy have reduced recurrence, and the adoption of nodal surveillance in place of dissection has reduced morbidity for patients with Stage III melanoma. The objective of this study was to describe the timing and pattern of recurrence in stage III melanoma patients and evaluate the impact of adjuvant treatment and nodal surveillance. Methods: A multicenter retrospective chart review of patients with pathologically confirmed Stage III cutaneous melanoma seen at either the Juravinski Cancer Centre or Walker Family Cancer Centre in Ontario, Canada from January 1, 2017 to December 31, 2019. Results: There were 137 patients with Stage III melanoma: 18% IIIA, 22% IIIB, 52% IIIC, and 8% Stage IIID as per the 8th American Joint Committee on Cancer (AJCC) 2018 staging system. 103 (75%) patients had sentinel lymph node biopsy (SLNB) only as part of initial surgical therapy, 6 (4%) had SLNB with completion dissection, and 25 (18%) had upfront radical nodal dissection. 67 (49%) patients received adjuvant therapy, of which 50 (74%) had immunotherapy, 17 (25%) received BRAF-targeted therapy, and 1 (1%) had interferon. 54 (39%) patients developed recurrent disease, with a median time to recurrence of 8.5 months (IQR: 4.3-14.9). The recurrence rates were 63% in patients who did not have adjuvant treatment and 37% in those who had adjuvant therapy, with a median time-to-recurrence of 7.5 and 9.0 months respectively. There were 30 (56%) loco-regional recurrences and 24 (44%) distant recurrences. Of the patients with loco-regional recurrence, 26 (87%) had SLNB only compared to 4 (13%) who had upfront or completion dissection. 12 (24%) patients recurred while on adjuvant treatment (7 distant recurrences and 5 loco-regional recurrences), and 8 (13%) patients recurred following completion of adjuvant treatment (5 distant recurrences and 3 loco-regional recurrences). Recurrences were detected by patients, clinicians, CT and nodal US surveillance in 43%, 20%, 28% and 9% of cases, respectively. The majority of loco-regional recurrence was detected clinically (67%) rather than by radiologic surveillance (33%). Of the 30 loco-regional recurrences, 24 underwent surgical resection of the recurrence, 4 had subsequent systemic therapy without surgery, 1 had intra-tumoral injections and 1 had no treatment. Conclusions: Recurrences in Stage III melanoma occur early, often within a year, with higher rates of loco-regional rather than distant disease. Recurrence rates were lower in those who received adjuvant therapy, but the majority of recurrences were detected by patients or clinicians, including loco-regional recurrences in patients who had SLNB only despite surveillance nodal US.

Locoregional recurrence via mucus-mediated extension following lung resection for mucinous tumors

BackgroundClinically, locoregional recurrences following mucinous tumor resection are often experienced. However, it remains unclear whether mucinous tumors directly affect local recurrence or not, and if so, the mechanism is not known. Therefore, we investigated whether mucinous tumors are associated with locoregional recurrence after pulmonary resection and whether mucus extension is a risk factor for locoregional recurrence.MethodsThe data of 152 patients who underwent pulmonary resection for metastases were reviewed. When mucus was partially or wholly present in the tumor based on macro- or microscopic identification, we assigned the tumor as mucinous. In mucinous tumors, when mucus was identified within the air spaces in the normal lung parenchyma, beyond the edge of the tumor, we assigned the tumor as positive for “mucus extension.”ResultsThe 5-year cumulative incidence of locoregional recurrence in patients with mucinous tumors was 48.1%, which was significantly higher than that observed in those with non-mucinous tumors (14.9%). Within the mucinous tumor, the presence of mucus extension beyond the tumor edge was an independent risk factor for locoregional recurrence after pulmonary resection (hazard ratio, 5.52; P = 0.019).ConclusionsDuring the resection of mucinous cancer, surgeons should maintain sufficient distance from the tumor edge to prevent locoregional recurrences.

Abstract PS13-42: Locoregional recurrence in patients with early-stage triple-negative breast cancer receiving neoadjuvant systemic therapy: Patient characteristics and clinical outcomes

Abstract Background: Recurrence is common among patients with early-stage triple-negative breast cancer (ESTNBC). There is minimal real-world evidence describing the patient characteristics and clinical outcomes following recurrence among patients receiving neoadjuvant chemotherapy for ESTNBC. Methods: This retrospective, observational study aimed to describe the demographic and clinical characteristics and clinical outcomes in ESTNBC patients experiencing locoregional recurrence in the US community oncology setting in the Concerto HealthAI Definitive Oncology Dataset. Eligibility criteria included female sex, age 18+ years, diagnosis of stage II, IIIA or IIIB ESTNBC between 3/2008 and 3/2016, and receipt of definitive surgical resection following neoadjuvant systemic therapy. Descriptive methods were used to evaluate patient characteristics and treatment patterns in this population. Locoregional recurrence was defined as recurrence in the same breast and/or regional nodal recurrence as documented by the provider in the medical record. Results: Of 308 patients who received neoadjuvant treatment for ESTNBC, 27.3% patients (n=84) observed recurrence, within which 25.0% (n=21) were locoregional and 75.0% (n=63) were metastatic. All 21 patients with locoregional recurrence were 65 or younger, with mean age of 50.6 (SD 8.7) at initial diagnosis. They were primarily White (47.6%, n=10) or African American (42.9%, n=9). Over half of patients were stage II at initial diagnosis (61.9%, n=13), while 38.1% (n=8) were stage III. The majority had ductal histology (90.5%, n=19) and had Grade 3 tumors (90.5%, n=19). Of the 21 patients with locoregional recurrence, less than one-tenth (9.5%, n=2) had achieved pathologic complete response (pCR) prior to their recurrence, compared to 41.2% (n=127) of the 308 patients receiving neoadjuvant treatment. In terms of treatment following locoregional recurrence, two-thirds of patients received radiation therapy (66.6%, n=14) with median duration of 47.5 days. Over half of patients (57.1%, n=12) had mastectomy following recurrence, while 14.3% (n=3) had partial mastectomy (breast conserving surgery). Most patients (85.7%, n=18) received systemic chemotherapy after recurrence. Median duration of systemic therapy following locoregional recurrence was 108 days. Nearly one-half (47.6%, n=10) had a subsequent metastatic diagnosis and nearly one-third (28.6%, n=6) had a record of death. Median time from locoregional recurrence to metastatic diagnosis was 36.6 months, but median time from locoregional recurrence to death was not reached. Conclusions: Among patients who received neoadjuvant therapy for ESTNBC in the real-world setting, nearly 7% (n=21) experienced locoregional recurrence. Nearly one-fourth of those patients had a prior pCR which potentially suggests a higher risk of recurrence associated with ESTNBC patients. Chemotherapy was the mainstay of treatment following recurrence. Most patients also received radiation therapy and surgery, but despite those nearly one-half of the patients went on to have a subsequent metastatic diagnosis. This probably reflects the limitations of existing treatment modalities for ESTNBC patients. Future studies with a bigger sample size could confirm our findings. Our study provides some benchmark perspective to such future studies. Citation Format: Amin Haiderali, Whitney C. Rhodes, Santosh Gautam, Min Huang, Jan Sieluk, Karen E. Skinner, Lee S. Schwartzberg. Locoregional recurrence in patients with early-stage triple-negative breast cancer receiving neoadjuvant systemic therapy: Patient characteristics and clinical outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-42.

Abstract PS1-59: Skin and nipple sparing mastectomies - oncologic outcomes from an oncologic center

Abstract Introduction: Skin and Nipple Sparing mastectomies are an alternative for patients not eligible for conservative breast surgery, allowing for better aesthetic results than classical mastectomies. We aimed to evaluate oncological safety outcomes and identify risk factors for locoregional recurrence in patients submetided to sparing mastectomies. Methods: A retrospective analysis was conducted on all consecutive cases of skin sparing mastectomy (SSM) or nipple sparing mastectomy (NSM) for a primary diagnosis of invasive or in situ breast carcinoma, treated at an oncologic center, from january 2013 to may 2019. Primary outcome was locoregional recurrence. Secondary outcomes included overall survival and disease-free survival, median time to recurrence and median follow-up time. Risk factors for locoregional recurrence were analysed using chi-square test and t test where suitable, followed by a logistic regression model. Survival analysis was performed using Kaplan-Meier curve. Results: We included 461 cases; 59 cases (13%) presented with carcinoma in situ and 402 (87%) with invasive carcinoma. Median age was 46 (24-78) years. Seventy-one (15%) patients had locally advanced disease. SSM were performed in 226 (49%) cases and NSM in 235 (51%). Neoadjuvant chemotherapy was administered in 141 (31%) cases and adjuvant radiotherapy in 203 (44%). Locoregional recurrence rate was 3,4% with no nipple-areolar complex (NAC) recurrence. Median time to recurrence was 22 (1-54) months. Overall survival was 91,7% and disease-free survival was 80,4% at a median follow-up time of 39 (1-86) months.Factors associated with locoregional recurrence in univariate analysis were tumor size over 4cm, high histological grade, negative endocrine receptors, neoadjuvant chemotherapy and absence of endocrine therapy (p<0,05), however none of these factors were independently associated with recurrence as ascertained by logistic regression model. There was no association of recurrence with familial risk mutation. Conclusions: SSM and NSM present as a safe surgical approach to breast cancer requiring mastectomy, with a locoregional recurrence rate comparable to classical mastectomy. It was not identified a group of patients who are at risk of recurrence. Nonetheless, risk factors such as tumor size, histological grade, absence of endocrine receptors, neoadjuvant chemotherapy and absence of endocrine therapy may correlate with less favorable outcomes. Citation Format: Beatriz Costeira, Francisca Brito da Silva, Rodrigo Oom, Cristina Costa, João Vargas Moniz, Rui Serra Alves, Nuno Abecasis, Catarina Rodrigues Santos. Skin and nipple sparing mastectomies - oncologic outcomes from an oncologic center [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-59.

Lateral pelvic lymphadenectomy for low rectal cancer: a META-analysis of recurrence rates.

Locoregional recurrence (LR) remains a problem for patients with lower rectal cancer despite standardized surgery and improved neoadjuvant treatment regimens. Lateral pelvic lymph node dissection (LPLND) has been routine practice for some time in the Orient/East, but other regions have concerns about morbidity. As perioperative care and surgical approaches are refined, this has been revisited for selected patients. The question as to whether LPLND improves oncological outcomes was explored here. A systematic review of patients who underwent TME with or without LPLND from 2000 to 2020 was performed. The primary endpoint was the rate of LR between the two groups. Seven papers met the predefined search criteria in which 2000 patients underwent TME alone, while 1563 patients had TME and LPLND. The rate of LR was marginally higher with TME alone when compared with TME plus LPLND, but this result was not statistically significant (9.8 vs 9.4%, odds ratio 0.75, 95% CI 0.41-1.38, *p =0.35). In addition, four studies reported on distant recurrence rates, with TME and LPLND showing a slight reduction in overall rates (27.3 vs 29.9%, respectively, OR 0.65, 95% CI 0.45-0.92, *p =0.02). The addition of LPLND to TME is not associated with a significantly lower risk of LR in patients who undergo surgery for lower rectal cancer.

Risk stratification for prediction of locoregional recurrence in patients with pathologic T1\u20132N0 breast cancer after mastectomy

BackgroundPrevious studies have revealed that nearly 15–20% of selected high-risk T1–2N0 breast cancers developed LRR after mastectomy. This study is aim to indentify the risk factors of locoregional recurrence (LRR) in patients with pathologic T1–2N0 breast cancer after mastectomy in a real-world and distinguish individuals who warrant postmastectomy radiotherapy (PMRT).MethodsFemale patients treated from 1999 to 2014 in National Cancer Center of China were retrospectively reviewed. A competing risk model was developed to estimate the cumulative incidence of LRR with death treated as a competing event.ResultsA total of 4841 patients were eligible. All underwent mastectomy plus axillary nodes dissection or sentinel node biopsy without PMRT. With a median follow-up of 56.4 months (range, 1–222 months), the 5-year LRR rate was 3.9%.Besides treatment era, age ≤ 40 years old (p < 0.001, hazard ratio [HR] = 2.262), tumor located in inner quadrant (p < 0.001, HR = 2.236), T2 stage (p = 0.020, HR = 1.419), and negative expressions of estrogen receptor (ER) and progesterone receptor (PR) (p = 0.032, HR = 1.485), were patients-related independent risk factors for LRR. The 5-year LRR rates were 1.7, 3.5, and 15.0% for patients with zero, 1–2, and 3–4 risk factors (p < 0.001).ConclusionsRisk Stratification based on age, T stage, ER/PR status and tumor location can stratify patients with pT1–2 N0 breast cancer into subgroups with different risk of LRR. PMRT might be suggested for patients with 3–4 risk factors.

The Future of Personalized Medicine: One Step Melanoma Surgery

Abstract The divergent, personalized approach in the surgical treatment of cutaneous melanoma is the one in which the treatment of the neoplasm differs from that proposed within the generally accepted standards or guidelines. According to their presumption, guidelines are not obligatory for the treatment of a certain type of disease and cannot replace the judgment of the clinician. Which to a large extent determines the freedom (or possible one) of the clinician‘s action regarding the „personalization“ in the choice of a new, divergent therapy. It is interesting, for example, that the occurrence of locoregional recurrences in patients with melanoma after guideline therapy insures clinicians against both criticism of treatment choice and the end results. However, the lack of recurrences after innovative/personalized surgical treatment of cutaneous melanoma is accompanied for unknown reasons by a serious dose of unwarranted criticism. The fact is that a personalized surgical approach in the treatment of skin melanomas and the recommended by AJCC guidelines approach lead to exactly the same end results and that should not be ignored. The difference lies in the fact that this end result can be achieved by one step melanoma surgery (OSMS), for example, which is carried out in a single surgical session. Several advantages of OSMS can be noted: 1) it provides high efficiency in a short time, even in the initial stage of the disease, 2) it is cost-effective, and 3) according to initial clinical observations we have a much lower to no propensity for locoregional relapses.

Predicting Locoregional Failure After Definitive Radiation Using Machine Learning

Clinical staging has been used to predict locoregional recurrence (LR) rates in cohorts of patients undergoing definitive head and neck (HandN) radiation therapy. However, this gross categorization is unable to reliably predict the likelihood of recurrence in an individual patient. High-throughput quantitative imaging features for gross tumor volume derived from pre-treatment multimodality images may provide information that can predict recurrence rates in a given patient, creating a framework towards personalized treatment. We aimed to build a custom machine learning model that can reliably predict the rate of LR prior to the definitive radiation therapy. We retrospectively pooled a large cohort of patients with head and neck cancer treated with definitive radiation from 2008 to 2018 at a single institution. 59 patients were available for analysis (15 patients with LR). Each patient underwent a planning CT scan, an FDG PET scan, and an attenuation corrected (AC) diagnostic CT scan prior to radiotherapy. The gross tumor volume (GTV) was manually drawn on the planning CT. The AC CT scan was diffeomorphically warped to the planning CT using Advanced Normalization Tools (ANTs: http://stnava.github.io/ANTs/), and the transform was applied to the FDG PET scan. 6321 radiomic features (2077 from each of the three scans) from within the GTV mask were extracted using Pyradiomics package. The extracted radiomics features included first order spatial statistics, shape-based volumetrics, and gray level matrix operations on the original image as well as derived images using a variety of spatial filters. Dimensionality reduction was performed using a logistic regression model, reducing the feature dimensions from 6321 to 2754. The remaining features were then fed into a variety of machine learning models to train (N = 35) and validate (N = 24) the predictive model with a balanced number of recurrences in the training and validation sets. The model performance was evaluated using receiver operating characteristic (ROC) curve. We further identified the most important features that may affect prognosis. The machine learning models were able to significantly predict locoregional recurrence in our cohort of 59 patients. The classifier performance of the random forests model revealed an area under the curve (AUC) of 0.81 +/- 0.13. The top feature weights used a combination of features from all three scans, indicating the need for the multi-modal approach of all three scans. We built machine learning models that can be used to predict locoregional recurrence in patients underwent head and neck radiation using pre-treatment PET and CT scans. This model can be applied to better stratify patients based on pre-treatment images towards personalized treatment. We used automated advanced non-linear registrations and neural networks to improve performance from prior models. The approach can be tailored to optimize medical management using data-driven models.

Determining whether postoperative chemoradiotherapy is required in patients with pathologic T3N0 rectal cancer with negative resection margin.

This study aimed to identify the risk factors for locoregional recurrence (LR) and determine possible candidates for postoperative concurrent chemoradiotherapy (CCRT) in pathologic T3N0 (pT3N0) rectal cancer patients with a negative resection margin after total mesorectal excision (TME). Data from 365 patients who had pT3N0 rectal cancer between 2003 and 2012 in the Samsung Medical Center were reviewed. All patients underwent upfront surgery without preoperative treatment. Postoperative management involved either no adjuvant therapy (n = 122), chemotherapy alone (n = 100), or CCRT (n = 143). The median follow-up duration was 71 months. The 5-year overall survival, disease-free survival, and LR-free survival (LRFS) rates were 95.9%, 86.9%, and 96.3%, respectively. When comparing the three groups (surgery alone [n = 122], chemotherapy alone [n = 100], and CCRT [n = 143]), there was no significant difference in LRFS among them (94.0%, 93.4%, and 99.2%, respectively; p = 0.20). However, when patients were stratified by risk factors (distance from anal verge ≤ 5 cm and distal resection margin [DRM] ≤ 2 cm), the 5-year LRFS improved by more than 10% by adding CCRT (98.9% with CCRT vs. 87.4% without CCRT, p = 0.006) in those with more than one risk factor. Postoperative CCRT did not affect the 5-year LRFS (100% with CCRT vs. 99.0% without CCRT, p = 0.66) in patients with no risk factors. Postoperative CCRT significantly decreased LR in patients with pT3N0 rectal cancer with a negative resection margin but having a distance from the anal verge ≤ 5 cm or DRM ≤ 2 cm.

The use of artificial intelligence, machine learning and deep learning in oncologic histopathology.

Recently, there has been a momentous drive to apply advanced artificial intelligence (AI) technologies to diagnostic medicine. The introduction of AI has provided vast new opportunities to improve health care and has introduced a new wave of heightened precision in oncologic pathology. The impact of AI on oncologic pathology has now become apparent, and its use with respect to oral oncology is still in the nascent stage. A foundational overview of AI classification systems used in medicine and a review of common terminology used in machine learning and computational pathology will be presented. This paper provides a focused review on the recent advances in AI and deep learning in oncologic histopathology and oral oncology. In addition, specific emphasis on recent studies that have applied these technologies to oral cancer prognostication will also be discussed. Machine and deep learning methods designed to enhance prognostication of oral cancer have been proposed with much of the work focused on prediction models on patient survival and locoregional recurrences in patients with oral squamous cell carcinomas (OSCC). Few studies have explored machine learning methods on OSCC digital histopathologic images. It is evident that further research at the whole slide image level is needed and future collaborations with computer scientists may progress the field of oral oncology.

Multidisciplinary Management of Locoregional Recurrent Breast Cancer.

Locoregional recurrence (LRR) from breast cancer represents a heterogeneous class of disease that has significant variation in its prognosis and preferred treatments. Therefore, the optimal management of LRR disease requires multidisciplinary assessment and integration of input from all disciplines involved in breast cancer management. In this review, we identify prognostic variables associated with the treatment outcome of LRR disease; discuss the roles of surgery, radiation, and systemic treatments; and define reasonable treatment algorithms to aid in the evaluation and management of patients. Unfortunately, there are few prospective clinical trials to provide high-level evidence regarding the optimal therapeutic strategy for patients with LRR disease. Such trials are difficult to design and execute because of the heterogeneity of prognostic factors and previous treatments of patients. In addition, LRR is becoming much less common with improvements in diagnostic and therapeutic management of primary disease. For example, the risk of development of LRR in patients with early-stage disease treated with breast-conserving surgery, whole-breast radiation, and appropriate systemic treatments is approximately 0.5% per year.1 This rate is almost half that seen in the first generation of breast-conserving therapy (BCT) trials conducted several decades ago, which averaged LRR rates of approximately 1% per year.2 A number of reasons have contributed to these improved outcomes, including better diagnostic imaging and tumor localization, improved pathologic techniques and attention to surgical margins, more optimal localization of radiation to intended targets, and increased use of effective systemic therapies. These therapeutic advances have also significantly decreased the rates of LRR in patients treated with mastectomy. In one study that focused on LRR for patients with 1-3 positive lymph nodes treated with mastectomy, the LRR rate in a more contemporary cohort who did not receive postmastectomy radiation was 2.8% compared with a rate of 9.5% in a similar staged cohort that was treated approximately 15 years earlier.3 In this study, the era in which the patient was treated was the most significant predictor of the risk of LRR for the cohort of patients who did not receive initial radiation, with an adjusted hazard ratio (HR) of 0.35 for the more recent era (P < .001). Table ​Table11 highlights many of the important prognostic factors for patients with LRR. One of the first considerations for patients with isolated LRR is to determine whether the disease represents a true recurrence versus a new primary, particularly for those with an in-breast recurrence. The following factors suggest a new primary: change in the biomarker profile and/or histopathology of the disease, recurrence is in a different quadrant of the breast compared with the primary tumor, and changes in gene-expression profiles. Investigators from MD Anderson Cancer Center evaluated 397 patients with an in-breast recurrence and classified approximately half as having a new primary and half as having a true recurrence (based on tumor location, histologic subtype, and biomarker profile). The new primary cohort had a better 10-year survival and developed metastatic disease less commonly than patients classified as true recurrence but were more likely to develop contralateral breast carcinoma.4 A similar study from Yale University compared 70 patients classified as having a new primary, with 60 patients classified as having a true recurrence. Again, those with a new primary had a better overall 10-year overall survival (75% v 55%; P < .0001) and distant disease-free survival (DFS; 85% v 41%; P < .0001).5 TABLE 1. Prognostic Factors for Patients With LRR Disease

Magseed localisation for loco-regional breast and lymph node recurrences: Placement prior to chemotherapy to allow focused removal of the initially diseased tissue.

e12610 Background: Multi-disciplinary meeting decisions may suggest chemotherapy prior to surgery. Prior to chemotherapy, localisation of the diseased tissue is important to ensure accurate retrieval. Magseed is induced to become a magnet when used in conjunction with a detector. The aim of this study was to assess the accuracy of placement, retrieval, and localisation of a Magseed into a radiologically suspicious loco-regional recurrence in patients requiring chemotherapy. Methods: Patients with loco-regional recurrence that had been assessed in the multidisciplinary meeting as requiring chemotherapy, as well as being potential candidates for surgery post-chemotherapy, were referred for placement of a Magseed prior to commencing chemotherapy or during treatment. The seed was placed by a senior radiologist in the unit. Ten patients have currently completed chemotherapy and surgery. Two patients had more than one Magseed placed. Giving a total seed placement number of 14 seeds. Results: Seed localisation with the Sentimag probe was successful in all cases at 100% localisation, however the retrieval rate was less at 93% due to a case where a lymph node underwent fibrosis. The maximum number of days between the seed placement and surgery was 249 days. Conclusions: Magseed is successful and accurate in localising and retrieving loco-regional recurrences in patients requiring surgery post chemotherapy. Retrieval is possible due to high recordings on the sensor in all cases. Magseed thus provides the treating clinician with an alternative to conventional radiological markers with the added benefit of a single placement to retrieval methodology.

Surgical extent and role of adjuvant radiotherapy of surgically resectable, low-grade parotid cancer.

Due to the rarity of low-grade parotid gland cancer and the diversity of histologic subtype, its optimal treatment modalities and prognostic factors have not been established yet. In this study, we aimed to identify the prognostic factors and adequate treatment modalities for patients with low-grade parotid gland cancer. We retrospectively analyzed clinico-pathologic data from 287 patients with low-grade parotid gland cancer from 1999 to 2018. Recurrence-free survival, disease-specific survival, and overall survival rates at 10years were 80.6%, 93.9%, and 84.4%, respectively. Among all patients, 56.1% received surgery alone, and the remaining 43.9% received surgery with adjuvant radiotherapy. Resection margin status and TNM stage were significant unfavorable prognostic factors. In patients with T1-2 tumor, surgical extent (total vs. less-than-total) did not show any significant effect on disease recurrence and patients' survival, and the disease was controlled well if a negative surgical margin was obtained after surgery, even with microscopic clear margin of<1mm. In patients with adverse pathologic features (positive margin, lymphovascular invasion, perineural invasion, extracapsular nodal spread, T3-4, and N1-3), adjuvant radiotherapy significantly decreased loco-regional recurrence. Oncological outcomes were good in patients with low-grade parotid gland cancer with surgery and radiotherapy. In patients with T1-2 low-grade parotid gland cancer, surgery alone showed good local control rate regardless of the extent of surgery, if a negative surgical margin was obtained after surgery. Adjuvant radiotherapy played a significant role in controlling loco-regional recurrence in patients with adverse pathologic features.

Evaluation of locoregional recurrence in patients with early breast carcinoma post-breast-conserving surgery with and without the use of preoperative chemotherapy

The effects of neoadjuvant chemotherapy in increasing the rate of conservative breast therapy and associated with reducing morbidity and better cosmetic has been fully acknowledged. Now, there are commonly used neoadjuvant chemotherapy for operable early breast carcinomas patients. Currently, neoadjuvant chemotherapy is used for locally advanced breast carcinoma, inflammatory breast cancer, and down staging of the large tumor to allow for breast conservative therapy. A prospective study performed in the department of surgery in Al-Sadder Medical City/Najaf city/Iraq, from the …….. of October 2015 to the 1st of October 2018, where 48 patients presented with a breast cancer diagnosis by clinical examination, Mammography, breast ultrasound, chest x-ray, bone scan, serum CEA, CA15_3 level, the initial diagnosis of breast cancer made by core needle biopsy. Breast saving surgery consisted of wide local excision with a safe margin with standard level I, II lymph node of axilla dissection. The resected specimen and lymph node was sent for histopathological examination; the size, width, length &amp;height dimension were recorded and the resection margin was recorded positive if close to 2mm and negative if &gt;2mm tumor-free margin. The 48 patients enrolled in this study with a mean age at diagnosis of 44.6 ± 8.4 years. 34 patients received neoadjuvant chemotherapy, Locoregional recurrence reported in 4 patients (28.6%) not received neoadjuvant chemotherapy (P. value &lt; 0.001), the higher relapse rate was reported significantly in the cases aged more than 50 years compared to those aged 50 years or below (P. value = 0.05, significant). Neoadjuvant chemotherapy decreases the incidence of locoregional recurrence of early breast carcinoma after breast-conserving surgery.

Failure patterns of cervical lymph nodes in metastases of unknown origin according to target volume.

PurposeThis study was aim to evaluate the patterns of failure according to radiotherapy (RT) target volume for cervical lymph nodes in metastases of unknown primary origin in head and neck region (HNMUO).Materials and MethodsSixty-two patients with HNMUO between 1998 and 2016 were retrospectively reviewed. We analyzed the clinical outcomes and primary site failure depending on the radiation target volume. The target volume was classified according to whether the potential head and neck mucosal sites were included and whether the neck node was treated involved side only or bilaterally.ResultsPotential mucosal site RT (mucosal RT) was done to 23 patients and 39 patients did not receive mucosal RT. Mucosal RT showed no significant effect on overall survival (OS) and locoregional recurrence (LRR). The location of primary site failure encountered during follow-up period was found to be unpredictable and 75% of patients with recurrence received successful salvage therapies. No significant differences in OS and LRR were found between patients treated to unilateral (n = 35) and bilateral neck irradiation (n = 21). Treatment of both necks resulted in significantly higher mucositis. conclusionsWe found no advantages in OS and LRR of patients with HNMUO when mucosal sites and bilateral neck node were included in the radiation target volume.

The Effect of Prophylactic Central Neck Dissection During Hemithyroidectomy on Locoregional Recurrence in Patients With Papillary Thyroid Carcinoma: A Meta-Analysis.

Objectives.Hemithyroidectomy is commonly performed in patients with low- to intermediate-risk papillary thyroid carcinoma. The purpose of this meta-analysis was to evaluate the effect of prophylactic central neck dissection on locoregional recurrence in patients undergoing hemithyroidectomy.Methods.A meta-analysis was performed of full-text publications published in English retrieved from the Embase database.Results.The rate of regional recurrence in the central compartment after hemithyroidectomy, with or without prophylactic central neck dissection, was 0.17% and 1.78%, respectively. This difference was statistically significant. Recurrence in the lateral compartment or contralateral thyroid was not affected by prophylactic central neck dissection; the overall rate of recurrence was 1.3% and 5.4%, respectively.Conclusion.Prophylactic central neck dissection significantly reduced the risk of recurrence in the central compartment in patients undergoing hemithyroidectomy.

The Effect of Prophylactic Central Neck Dissection During Hemithyroidectomy on Locoregional Recurrence in Patients With Papillary Thyroid Carcinoma: A Meta-Analysis.

Hemithyroidectomy is commonly performed in patients with low- to intermediate-risk papillary thyroid carcinoma. The purpose of this meta-analysis was to evaluate the effect of prophylactic central neck dissection on locoregional recurrence in patients undergoing hemithyroidectomy. A meta-analysis was performed of full-text publications published in English retrieved from the Embase database. The rate of regional recurrence in the central compartment after hemithyroidectomy, with or without prophylactic central neck dissection, was 0.17% and 1.78%, respectively. This difference was statistically significant. Recurrence in the lateral compartment or contralateral thyroid was not affected by prophylactic central neck dissection; the overall rate of recurrence was 1.3% and 5.4%, respectively. Prophylactic central neck dissection significantly reduced the risk of recurrence in the central compartment in patients undergoing hemithyroidectomy.

Abstract P4-02-14: Impact of ACOSOG Z0011 trial at University Hospital in Brazil

Abstract Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trialwas a milestone in the surgical treatment of the axilla. Its results have made significant contributions in reducing the extent of breast surgery. In Brazil, this new approach was questioned, since the survival of the disease remains lower in the developing countries due to the difficulty in the early diagnosis, delay in the treatment and diagnosis in more advanced stages. Objective: To evaluate the overall survival and locoregional recurrence in patients with sentinel lymph node (SLN) metastatic from breast cancer with or without complete axillary lymph node dissection (ALND) treated at our institution. Methods: This retrospective cohort study evaluated patients with primary invasive breast cancer and clinically negative axilla who underwent lumpectomy and sentinel lymph node dissection (SLND) at the São Paulo Hospital, from February 2008 to December 2018. Patients with metastatic SLN were treated with SLND (group 1) or ALND (group 2). Group 1 was composed by the patients who met the inclusion criteria of ACOSOG Z0011 trial. Group 2 was composed by patients treated previous to the publication or by patients that had exclusion criteria according ACOSOG Z0011 trial. Overall survival was defined as the time relapsed from the date of surgery to death from any cause. Locoregional recurrence was determined by the presence of disease in the breast or ipsilateral lymph nodes in the axilla, supraclavicular, infraclavicular or internal mammary. Survival was analyzed with Kaplan-Meier method and comparison among groups with log-rank. Cox proportional-hazards model were applied. Statistical analysis was performed in SPSS version 20.0 and STATA12, with p value &amp;lt;0.05 considered significant. Results: A total of 415 patients were included in this study, 23.3% (97 patients) were identified as metastatic SLN, 56 patients were treated with SLND only (group 1) and 41 patients with ALND (group 2). The groups were homogeneous in relation to the variables: age group (50 years versus 51 years and over) (p = 0.279), race (p = 0.120), level of education (p = 0.142), pathological diagnosis (p = 0.210), histological grade (p = 0.983), hormonal receptors (p = 0.708), HER2 status (p = 0.695), pT (p = 0.334). Average age was 58.3 years (group 1) and 56.3 years (group 2), p = 0.456; and average tumor size was 1.8 cm (group 1) and 2.2 cm (group 2), p = 0.048. In group 1, the average number of resected lymph nodes was 2.7 and 91% of the cases only 1 lymph node was positive. In group 2, the average number of positive lymph nodes was 3.5 and only 17% had additional axillary disease. The SLND presented 35.7% micrometastasis compared to 2.4% in ALND (p &amp;lt;0.001) and a lower number of capsular extravasation (8.9%), in contrast to 41.5% in the ALND group (p &amp;lt;0.001). In addition, ALND group also had greater axillary involvement as evidenced by axillary pathological staging, with N1 (73.2%), N2 (19.5%), N3 (4.9%) and SLND group with N1 (62.5%) and no cases N2 or N3 (p &amp;lt;0.001). The average survival time, estimated using the Kaplan-Meier model, was 9.18 years (95% CI: 8.47-9.90). There was no difference in overall survival between patients who underwent SLND alone or ALND. The 5-year survival was 80.1% in the SLND and 87.5% in the ALND (p = 0.376). The locoregional recurrence was a rare event, average time of 5 years was 1.8% SLND and 7.7% ALND (p = 0.196). Only 4 locoregional recurrences were described and all occurred within 18 months of follow-up. Conclusions: Overall survival and locoregional recurrence in patients with metastatic axillary sentinel lymph node treated with SLND alone did not differ from those who underwent ALND, corroborating ACOSOG Z0011 data. The omission of axillary lymph node dissection and the implementation of this practice in our service benefits the patients treated with less aggressive surgeries and, potentially, produces lower morbidity. Citation Format: Afonso CelsoPinto Nazário, Simone Elias, Gil Facina, Vanessa Monteiro Sanvido. Impact of ACOSOG Z0011 trial at University Hospital in Brazil [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-14.

Современная концепция использования лучевой терапии при раке полости рта и орофарингеальной зоны

In the world, there is a rise of cancer incidence, including cancer of the head and neck. The incidence cancer of the head and neck is 4.8 cases per 100 000 population. Oral and oropharyngeal cancers are the most frequently forms cancer of the head and neck – 4,8–27 % of all cancer with this location. Among the causes of oral and oropharyngeal cancer noted alcohol abuse, tobacco and infection with human papilloma virus (HPV-16). Mortality from oral and oropharyngeal cancer is on 8 rank among patients with all tumors. Now when deciding about treatment of oral and oropharyngeal cancer is applied a new classification АJCC8th, the main differences from the previous version are the inclusion of data on the depth of tumor invasion and the presence of extranodal growth of lymphogenic metastasis.&#x0D; The chemoradiotherapy to a total dose 60–74 Gy is the most common treatment used in oral and oropharyngeal cancer. When planning irradiation, both the tumor itself (or its residual component) and lymphogenic metastases or lymph nodes with a high risk of metastatic lesions are included in the target volume. The most commonly used chemotherapy drug is cisplatin. The duration of life of patients is significantly influenced by the stage of the tumor process. So 5-year relapse-free survival among patients with oral cancer is 91 % at T1–2, 83 % – at T3 and 12 % – at T4. During the first 5 years after completion of treatment, the probability of locoregional recurrence in patients with oropharyngeal cancer is much shorter in infected HPV-16 – 28.9 % and 54.9 %, respectively. &#x0D; The effective multimodal treatment of oral and oropharyngeal cancer can be only if the evaluation of the tumor process under the current classification, comply with the requirements of treatment standards and clinical guidelines as well as take into account the latest achievements of the relevant field of medical science.