Multifocal and multicentric breast cancer is associated with increased local recurrence regardless of surgery type.

Multifocal and multicentric breast cancers have been correlated with poor prognostic factors and worse outcomes versus unifocal disease. We evaluated the impact of multifocal and multicentric disease versus case controls with unifocal disease, matching for age, grade, T-, and N-stage. A total of 110 patients with multifocal (n = 93) or multicentric (n = 17) disease and 263 matched case controls were identified with a median follow-up of 53 months and 64 months, respectively. The actuarial local control rates for the multifocal/multicentric and unifocal group were 88% and 97%, respectively at both 5 and 10 years (p < 0.001). On multivariate analysis, multifocal/multicentric disease remained associated with higher local recurrence after controlling for other covariates including surgery type. The disease-free survival rates in the multifocal/multicentric group at 5 and 10 years were 75% and 71%, respectively, versus 87% and 78% at 10 years (p = 0.01). On multivariate analysis, multifocal/multicentric disease was no longer associated with worse disease-free survival. There was no difference in the cohorts in terms of regional control, overall survival, or cancer specific survival. Our findings suggest that multifocal/multicentric disease may be associated with worse outcomes versus unifocal disease regardless of type of surgery. This suggests a more biologically aggressive cancer and may be an important consideration when managing these patients. Further studies are needed to better understand the impact of multifocal/multicentric breast cancers on outcomes.

Endoscopic brachytherapy for obstructive colorectal cancer.

PURPOSE: Palliation of obstructive colon cancer is often challenging. Treatment options include Yttrium aluminum garnet (YAG) laser, stent placement, and surgical intervention. High-dose-rate intraluminal brachytherapy (HDRILBT) has been used to relieve obstructive symptoms due to rectal, bronchial, and esophageal cancers. In this case report, we document the combined use of YAG laser and HDRILBT for the palliation of obstructive colon cancer at the hepatic flexure, not previously reported in the literature. METHODS AND MATERIALS: The patient in this case report had a large colonic tumor at the hepatic flexure causing near complete obstruction. Stent insertion and surgery were not feasible. YAG laser was used once and 11 days later, two fractions of HDRILBT were given 1 week apart. Under endoscopic vision and fluoroscopic guidance, a 150-cm Teflon catheter was passed through the lumen of the partially obstructed bowel for purposes of HDRILBT. A total dose of 10Gy was delivered at 1cm from the center of the source axis using a high-dose-rate afterloader. RESULTS: After treatment with the first fraction of HDRILBT, the tumor size decreased and the colonic lumen was significantly more patent. The patient's symptoms were significantly relieved after two fractions. Her weight increased and she was medically fit enough to undergo further chemotherapy. Further HDRILBT was not indicated. The calculated biological effective dose for the total HDRILBT treatments was well below the dose tolerances for acute effects for normal colonic tissue. CONCLUSION: HDRILBT should be considered as a possible treatment option for obstructive colon cancers when stent placement or surgery is not possible.