[Clinical Impact of First Metastasis Sites and Subtypes in the Outcome of Brain Metastases of Breast Cancer].

Brain metastasis(BM)is the final stage of metastatic breast cancer(MBC), but its course and outcomes after the first metastasis(FM)to various sites are not fully clarified. Furthermore, the survival of patients with BM appears to be improving with the recent development in MBC control according to the subtype analysis. The present study included 35 patients with BM between 2008 and 2018, and was designed to clarify the effects of the FM sites and subtypes on the outcome of these patients. Subtypes included 8 Luminal(L), 8 L-HER2+(LH), 8 HER2(H), and 11 triple-negative(TN)types, and FM sites included 14 lungs or pleurae, 4 livers, 4 brains, 4 bones, and 9 local or lymph node(LN)metastases. The median interval between FM and BM(IFB)was 33 months(M)for overall patients; 50M for LH, 37M for L, 22M for H, and 19M for TN (p=0.0463); and 24M for the high risk(HR)FM(lung, pleura, liver)and 47M for the low risk(LR)FM group(bone, local, LN)(p=0.0385). The median overall survival(OS)after BM diagnosis was 13M for overall patients; 27M for LH, 13M for H, 10M for L, and 5M for TN(p=0.0112). There were no significant differences in the OS after BM diagnosis between HR FM and LR FM patients. Multivariate analyses for OS after BM revealed that patients with HER2(+)and estrogen receptor(+) tumors had a significantly better survival(risk ratio[RR]=0.644, p=0.0413; RR=0.290, p=0.0251, respectively). Three patients are surviving longer than 10 years after BM, including 2 with L-type and 1 with LH-type tumors, and their FM sites were 1 local, 1 brain, and 1 liver. The present study indicated that subtypes and FM site(HR or LR)had significant impact on the clinical course and prognosis of patients with BM. Focusing on the subtypes and FM site can improve the early detection and treatment results of BM.

[Radiation-Associated Angiosarcoma That Developed in the Irradiated Residual Breast after Breast-Conserving Surgery for Breast Cancer-A Case Report and Review of the Literature].

We report a radiation-associated angiosarcoma(RAAS)of the breast, which is a rare but important complication after breast-conserving surgery(BCS)and radiotherapy(RT)for breast cancer. A7 2-year-old woman had undergone BCS for invasive ductal carcinoma of the right breast(pT2pN1M0, StageⅡB), followed by RT of 50 Gy; she was treated with doxifluridine and anastrozole for 5 year. She noticed a bloody cutaneous bulla in the right breast 64 months later, and the skin lesions gradually expanded. She was brought to our clinic for the treatment of massive bleeding from the skin lesions. Ulcer biopsy revealed cutaneous AS(cells were CD31[+], CD34[+], VEGF[-], and VEGF-R[+]). She underwent mastectomy and latissimus dorsal flap surgery. She died of local recurrence and liver metastasis 13 months later. RAAS is rare, but it should be considered in patients with skin lesions, such as erosion and bloody bulla, after BCS and RT for breast cancer. To our knowledge, only 12 cases of RAAS, including the present case, have been reported in Japan, and we reviewed the Japanese RAAS cases in comparison with those reported in the Western literature.

[A Retrospective Analysis on Comparative Treatment Results for Breast Cancer between Elderly Women Aged 70 and More Than 80 Years].

This study compared the treatment results of over 80-year-old(O-80) 54 and 157 septuagenarian(70s)women with breast cancer(BC)from 1996 to 2015, to clarify the best treatment option for O-80BC patients. No differences were observed in the stages and subtypes. More than 70% of women in both groups underwent breast-conserving surgery(BCS), and 48.1% and 12.1% of O-80BC and 70sBC patients did not undergo axillary dissection, respectively. About 3.2% and 18.5% of 70sBC and O-80BC patients did not receive adjuvant therapies, respectively. Most ER-positive patients in both groups received endocrine therapy. Most patients in both groups received no intravenous chemotherapy; however, oral chemotherapy was administered in 80.3% of 70sBC and 64.8% of O-80BC patients. Approximately 75.2% of 70sBC and 11.1% of O-80BC patients received post-surgical radiotherapy(RT). No differences in both relapse-free survival and overall survival (OS)rates were observed between the 2 groups. Breast cancer-related death(57.1%)and natural death from old age (57.1%)were the most commonly observed cause of death in the 70sBC and O-80BC groups, respectively. Multivariate analyses on OS demonstrated that BCS and intravenous chemotherapy were significantly associated with poor prognosis and RT was significantly associated with better prognosis in 70sBC group, whereas BCS was significantly associated with better prognosis in O-80BC group. In conclusion, surgery, especially BCS, plays an important role in the primary treatment of O- 80BC patients; however, axillary dissection, RT, endocrine therapy, and chemotherapy cannot be performed.

[Third- and Fourth-Line Chemotherapies including Paclitaxel and Bevacizumab for Metastatic Breast Cancer].

The present study was designed to estimate the clinical efficacy of bevacizumab(BV)combined with paclitaxel(PTX)(BVPTX) as third- and fourth-line therapies in 31 patients with metastatic breast cancer(MBC). Most patients were previously treated with docetaxel and/or epirubicin. Patients were intravenously treated with BV at 5-10mg/kg and PTX at 3-5mg/kg at 2-3week intervals, and when the effect of BV-PTX was low, other chemotherapeutic agents(CTAs)and/or trastuzumab (Tr)were additionally administered. Twelve MBC patients were treated with BV-PTX alone and 19 MBC patients were treat- ed with other CTAs and/or Tr in addition to BV-PTX. No serious adverse events were observed in any regimen. Three complete responses(9.7%), 4 partial responses(12.9%), 8 stable diseases(25.8%), and 16 progressive diseases(51.6%)were observed; the response rate was 22.6%, and the clinical benefit rate was 48.4%. The median progression-free survival(PFS) and median overall survival(OS)after the initiation of BV-PTX were 7.0 and 16.0 months, respectively. All 13 HER2-positive MBC patients were treated with Tr in addition to BV-PTX, and the OS and PFS were significantly higher in the BV-PTX+Tr+ CTAs group than in the BV-PTX+Tr group. In 18 HER2-negative MBC patients, PFS and OS were better in the BV-PTX+CTAs group than in the BV-PTX alone group, though this difference was not significant. Multivariate analyses demonstrated that an additional CTAs was a variable for significantly better PFS, and additional CTAs, Tr, and endocrine therapy were significant variables for better OS. These results indicated that additional CTAs and Tr should be combined with BV-PTX for third- and fourth-line chemotherapies.

[A Multivariate Analysis of the Efficacy of Adjuvant Chemotherapy in Triple-Negative Breast Cancer].

Triple-negative breast cancers(TNBCs)are associated with early recurrence after surgery and unfavorable prognoses. To date, no effective therapies for TNBCs have been established. The present study was designed to evaluate the efficacy of adjuvant chemotherapy(ACT)for 111 TNBCs using a retrospective multivariate analysis(MVA). The intravenous(iv)ACTs included docetaxel, epirubicin, gemcitabine, and vinorelbine. The oral ACTs included UFT, doxifluridine, and cyclophosphamide. The 10-year disease-free survival(DFS)and overall survival(OS)rates were 77.5% and 86.0%, respectively. Recurrences were observed in 17 patients, and the first recurrence was most frequently located in the lung. MVA revealed that pT was a significant independent variable for poor DFS and OS. UFT was the only significant independent variable for improved DFS. The survival analysis also demonstrated that UFT alone may be an effective option for Stage I TNBCs. Furthermore, it suggested that the addition of further iv ACTs to UFT could improve the outcome in patients with Stage II-III TNBCs.

[Three patients with local recurrence of ER-positive breast cancer for whom anastrozole was clinically effective].

We treated three postmenopausal female patients with unresectable local recurrence from breast cancer. All pathological diagnoses of the local recurrence lesions were ER-positive breast cancer. For treatment, we administered anastrozole to these three patients. One has been stable disease for 25 months after taking anastrozole. Another has also showed stable disease for 18 months, and the last patient has been a partial response. We performed a biopsy from a recurring lesion on these three patients, and made a diagnosis of ER-positive breast cancer. This strategy of unresectable local recurrence revealed that these three patients could have had a stable condition for a long duration by taking anastrozole.