Long-Term Impact of Regional Nodal Irradiation in Patients With Node-Positive Breast Cancer Treated With Neoadjuvant Systemic Therapy.

PURPOSE: The impact of regional nodal irradiation (RNI) on locoregional recurrence (LRR) and any disease recurrence (DR) in women with node-positive breast cancer who receive neoadjuvant systemic therapy (NAT) is unknown. METHODS AND MATERIALS: The impact of RNI on LRR and DR was estimated with the cumulative incidence method in 1289 women with stage II to III breast cancer with cytologically confirmed axillary metastases who received NAT between 1989 and 2007. Multicovariate Cox regression analysis was performed to examine the effect of RNI after accounting for other predictive and prognostic variables. RESULTS: The median follow-up after definitive surgery was 10.2 years. Axillary pathologic complete response (pCR) was observed in 368 of 1289 patients (28.5%). On univariate analysis, axillary pCR reduced 10-year LRR risk from 9.7% to 4.8% (P = .006) and DR risk from 43.0% to 17.0% (P < .001). RNI was administered to 1080 of 1289 patients (83.8%). On univariate analysis, RNI did not affect 10-year LRR risk (no RNI, 9.4%; RNI, 8.1%; P = .62) or DR risk (no RNI, 31.3%; RNI, 36.5%; P = .16). On multicovariate analysis, RNI significantly reduced the risk of LRR (hazard ratio, 0.497; 95% confidence interval [CI], 0.279-0.884; P = .02) and DR (hazard ratio, 0.731; 95% CI, 0.541-0.988; P = .04) and showed a particularly strong reduction in risk of DR in patients with HER2+ disease who received trastuzumab (hazard ratio, 0.237; 95% CI, 0.109-0.517; P = .0003). A nomogram to predict 10-year LRR risk with and without RNI has been generated to assist clinicians in individualizing treatment decisions based on patient and disease characteristics and response to NAT. CONCLUSIONS: Adjuvant RNI reduces risk of LRR and DR in patients with breast cancer with axillary metastases who receive NAT across subtypes and particularly decreases the risk of DR in HER2+ breast cancer treated with trastuzumab. Enrollment on the National Surgical Adjuvant Breast and Bowel Project B-51/Radiation Therapy Oncology Group 1304 protocol is encouraged to help determine whether RNI can be omitted in patients with axillary pCR to NAT.

Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention.

Answer questions and earn CME/CNE Recent decades have seen an unprecedented rise in obesity, and the health impact thereof is increasingly evident. In 2014, worldwide, more than 1.9 billion adults were overweight (body mass index [BMI], 25-29.9 kg/m2 ), and of these, over 600 million were obese (BMI ≥30 kg/m2 ). Although the association between obesity and the risk of diabetes and coronary artery disease is widely known, the impact of obesity on cancer incidence, morbidity, and mortality is not fully appreciated. Obesity is associated both with a higher risk of developing breast cancer, particularly in postmenopausal women, and with worse disease outcome for women of all ages. The first part of this review summarizes the relationships between obesity and breast cancer development and outcomes in premenopausal and postmenopausal women and in those with hormone receptor-positive and -negative disease. The second part of this review addresses hypothesized molecular mechanistic insights that may underlie the effects of obesity to increase local and circulating proinflammatory cytokines, promote tumor angiogenesis and stimulate the most malignant cancer stem cell population to drive cancer growth, invasion, and metastasis. Finally, a review of observational studies demonstrates that increased physical activity is associated with lower breast cancer risk and better outcomes. The effects of recent lifestyle interventions to decrease sex steroids, insulin/insulin-like growth factor-1 pathway activation, and inflammatory biomarkers associated with worse breast cancer outcomes in obesity also are discussed. Although many observational studies indicate that exercise with weight loss is associated with improved breast cancer outcome, further prospective studies are needed to determine whether weight reduction will lead to improved patient outcomes. It is hoped that several ongoing lifestyle intervention trials, which are reviewed herein, will support the systematic incorporation of weight loss intervention strategies into care for patients with breast cancer. CA Cancer J Clin 2017;67:378-397. © 2017 American Cancer Society.

Integrated monitoring of South Portugal water bodies: a methodology towards WFD.

The challenge on implementation of the EU Water Framework Directive (WFD) (2000/60/EC) fosters the development of new monitoring approaches. The directive promotes the use of modelling techniques to assist all phases of the process, from characterization and establishment of reference conditions to identification of pressures and assessment of impact. This work is based on the above principles. A classical monitoring of the water status of the main transitional water bodies of Algarve (South of Portugal) is combined with advanced in situ water profiling and hydrodynamic, water quality and ecological modelling to build a complete description of the system. The aim is to demonstrate a methodology where traditional monitoring and modelling tools can be joined together to draw a holistic picture. The results show that globally the water bodies present a good trophic status. Eutrophication symptoms are not generalized. Due to physical transport and dispersion, nutrient enrichment is not the only factor limiting growth; residence time is also an important factor. Some confined regions with high residence times are at present endangered by point and diffuse sources of pollution. The microbiologic impact of waste water treatment plants (WWTP) is confined to regions between 500 m and 1 km from the discharges.

Treatment of chronic ulcers in the lower extremities with topical becaplermin gel .01%: a multicenter open-label study.

This prospective, multicenter, open-label study assessed the efficacy and tolerability of recombinant human platelet-derived growth factor BB (becaplermin) in the treatment of chronic ulcers of the lower extremities in 73 patients with and without type 2 diabetes mellitus. Becaplermin gel .01% was applied once daily for 12 weeks. Efficacy was assessed in terms of progression to healing (100% epithelialization); the secondary efficacy endpoint was time to complete healing. Safety was assessed in terms of incidence of adverse events. Ninety-five percent of all ulcers were completely healed at week 9; only 5% remained incompletely healed at week 12 and were considered treatment failures. Healing time did not differ between diabetic and nondiabetic patients. The major adverse events were pain, burning sensation, and pruritus at the ulcer site, with an overall incidence of 10%. No patients dropped out because of adverse events. Becaplermin gel .01% was safe and well tolerated. Further studies are necessary to assess the durability of healing with this treatment.

[Comparative study of laparoscopic appendectomy vs open appendectomy]. / Estudio comparativo de apendicectomía laparoscópica con endoasas preatadas vs apendicectomía abierta.

UNLABELLED: Laparoscopy reduces the risk of performing unnecessary appendectomies and offers the advantages of minimal invasive surgery when appendectomy is needed. We report our experience comparing open (Group A) with laparoscopic (Group B) appendectomy. PATIENTS AND METHODS: There were 20 patients in each group. Age, sex, signs, symptoms, evolution, laboratory, stage of disease, drains, duration of surgery, antibiotics, oral intake restart, postoperative pain at 24, 48 and 72 hours, complications, hospital stay, return to normal activities and cosmesis were reviewed. Statistical differences were determined using Student's t test (two tailed) or chi-square with Yates correction. Surgical technique is described. RESULTS: In both groups most variables were similar (p = ns). Group B presented earlier oral intake restart (p < 0.001), and less postoperative pain at 24 (p < 0.001), 48 (p < 0.01) and 72 hours (p < 0.001). Hospitalization stay was shorter (p < 0.001) and return to normal activities was earlier (p < 0.001) in group B. Better cosmetical appearance was observed in Group B (16 vs. 0 "excellent" -p < 0.001). CONCLUSIONS: Laparoscopic approach may reduce unnecessary appendectomies and it allows to perform appendectomy in a safe and effective way. In this study, laparoscopic was better than open appendectomy regarding early restart of oral intake, less postoperative pain, shorter hospitalization stay, earlier return to normal activities and better cosmetic appearance.