Retrospective analysis of treatment, including access to breast reconstructions, of breast cancer patients - war refugees from Ukraine in Poland - the experience of a single tertiary care institution.

<b>Introduction:</b> Following the Russian invasion, more than 3600000 refugees have fled Ukraine and settled down in Poland; this group includes a growing number of breast cancer patients whose treatment had been started in Ukraine and hence required urgent therapy in Poland.</br></br> <b>Aim:</b> The aim of the study was to analyze the treatment of breast cancer patients from Ukraine, who entered Poland as war refugees - the experience of a single tertiary care institution.</br></br> <b>Material and methods:</b> The treatment of 25 consecutive breast cancer patients, war refugees from Ukraine was reviewed retrospectively.</br></br> <b>Results:</b> Patients were treated according to subtype and staging, e.g. surgery, endocrine, anti-HER2 therapy, chemotherapy, radiotherapy. 7 patients received an immediate implant, mesh-based breast reconstruction. In 2 cases, the patients refused breast reconstruction.</br></br> <b>Conclusions:</b> Nearly 5.5 million refugees across Europe who have fled the combat zones in Ukraine; of these, the vast majority sought shelter in Poland, and many of whom are women. It is expected that breast cancer mortality rates may rise and progress in oncology may slow as the war in Ukraine disrupts routine patient care, clinical trials and research. Hence, support from neighboring countries is mandatory.

Assessment of the use of the Magseed marker in the localization of non-palpable lesions in the mammary gland.

Introduction Currently, more and more cases of breast cancer are detected in the early stages of advancement. Removal of the minimum required tissue volume ensures that the proper shape of the breast is maintained. On the other hand, it is important to get negative tissue margins. Objective To present your own experience with the use of preoperative breast tumor determination using the Magseed marker. Material and methods On the eve of the procedure, a Magtrace magnetic marker was administered to determine the lymph nodes and, under ultrasound control, a Magseed magnetic marker to the tumor, and the site of the lesion was marked with a skin marker as the operated site. Before the skin incision, the lesion was located using intraoperative ultrasound and the Sentimag probe. After the tumor was excision, the presence of the marker was confirmed in the preparation using the magnetic method and the compatibility of the ultrasound image before and after the procedure. The results of the research group were 23 patients. Radicality of the procedure was achieved in 20 patients (87%). To assess the size of the preparation and tumor, a formula from the work of Angarita et al. on the volume of the ellipsoid was used. It was assessed what part of the excised preparation was a tumor marked using the Magseed marker. Cohorts of 11 patients at the beginning and end of the evaluated group were compared, showing a significant increase in this parameter. Together with the learning curve, you can identify the tumor much more precisely and save healthy breast tissues by improving the aesthetic effect in the breast range. Conclusions The method of localization of non-pallpatory lesions in the mammary gland using the Magseed marker is simple to use, and the high detection rate directly translates into a reduction in the percentage of non-radical treatments in the case of sparing treatment.

Nipple-sparing mastectomy with immediate breast reconstruction - early complications and outcomes of the treatment.

AIM OF THE STUDY: To assess the early complications and outcomes of the treatment of patients undergoing nipple-sparing mastectomy (NSM) with immediate breast reconstruction. MATERIAL AND METHODS: A retrospective study was performed on 120 patients who underwent 130 NSM (10 bilateral) procedures between 1.01.2015 and 31.12.2017 in two oncology centers in Poland. In 80 patients a breast cancer was recognized. Sixteen patients underwent operations on the basis of being carriers of the BRCA1 mutation. The follow-up period ranged from 10 to 34 months. The NSM procedures were performed with or without skin reduction and a free nipple-areola complex (NAC) transplant, with 130 prosthetic devices inserted subpectorally. Breast cancer patients followed the standard protocol for adjuvant therapy. RESULTS: The patients for risk-reducing mastectomies were younger. Prevalent histology was no special type (NST) in 60 out of 80 patients, mean tumor - NAC distance was 43.3 mm. The prevalent biological subtype was Luminal B HER2-negative. Adjuvant management consisted of chemotherapy in 61 and radiotherapy in 35 patients. We noted 14 cases of complications, 13 in the cancer group, and 1 in the non-cancer group. Skin necrosis was the most common. The mean time for the appearance of the complications was 2.8 months. No local recurrences were observed. CONCLUSIONS: NSM is a safe and effective surgical option for qualified patients with breast cancer and in risk-reducing mastectomies.

ECCO Essential Requirements for Quality Cancer Care: Primary care.

BACKGROUND: ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.

Improvement in outcomes of breast cancer patient treatment in Poland in the 21st century.

Breast cancer accounts for 22%-25% of all female cancers diagnosed worldwide. The aim of study was to compare the 5-year relative survival rates for breast cancer patients treated in the years 2008-2010, 2000-2002, and 2005-2007, and to determine their relationships with the methods and costs of treatment. Data were collected from the National Cancer Registry and the Narodowy Fundusz Zdrowia (National Health Fund) data bases. An increase in the 5-year survival rate was observed. The results show the impact of some factors on the survival and treatment costs. It is necessary to create data bases being a platform for further comprehensive analyses.

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group.

BACKGROUND: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival. METHODS: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated. RESULTS: In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium. CONCLUSIONS: There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

Does the presence of sentinel lymph node macrometastases in breast cancer patients require axillary lymph node dissection?-Single-center analysis.

According to the current guidelines on treatment of breast cancer patients, identification of metastases in the sentinel lymph node (SLN (+)) is not an absolute indication for necessary axillary lymph node dissection (ALND). In our study, we present long-term outcomes of treatment among SLN(+) patients referred for conservative treatment, for example, no further ALND. A total of 3145 breast cancer patients subjected to sentinel lymph node biopsy (SLNB) between November 2008 and June 2015. SLN metastases were identified in 719 patients (22.9%). Locoregional recurrences and distant metastases as endpoints were distinquished. The mean follow-up time for patients after ALND was 36.2 months (6-74 months); 18.8 months (6-38 months) for patients with SLN macrometastases without ALND; and 34.0 months (6-74 months) for patients with micrometastases. Adjuvant ALND was performed in 626 of SLN(+) patients. Conservative treatment was applied in the remaining 93 cases. Among SLN(+) patients without adjuvant ALND, there was one case of recurrence (1.07%). In the group of patients without SLN, metastases recurrence was noted in 32 patients (1.32%). Among SLN(+) patients diagnosed with macrometastases, recurrence concerned 2.01% of analyzed cases (all subjected to ALND). Lack of radical surgical treatment in SLN(+) breast cancer patients did not lead to worsening long-term outcomes. In the occurrence of macrometastases to the sentinel lymph node, abandoning completion axillary lymph node dissection might be a reasonable option. However, it would require continuation of current research, preferably involving a clinical trial.

Dysregulation of microRNAs in triple-negative breast cancer.

OBJECTIVES: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited treatment options and poor prognosis. TNBC is usually diagnosed at a relatively young age and is characterized by high risk of developing metastases. Some epigenetic regulation of gene expression is associated with TNBC. Expression of microRNAs (miRNAs) can serve as a potential tool for identifying critical biomarkers in TNBC. The aim of our study is to examine expression of selected miRNAs in TNBC and to assess the relationship between miRNA expression and clinicopathological factors. MATERIAL AND METHODS: Expression levels of 19 selected miRNAs were compared between cancerous and normal breast tissues by use of qPCR method. We have evaluated the relationship between the expression level of miRNAs and clinicopathological factors such as: age, tumor size and lymph node status. RESULTS: We found that in TNBC tissues, when compared with normal breast tissues, the expression of miR-190a, miR- 136-5p and miR-126-5p was significantly reduced (p = 0.0041, p = 0.0007, p = 0.0007, respectively) whereas expression of miR-135b-5p and miR-182-5p was significantly increased (p = 0.0194, p = 0.0041, respectively). We found a linear trend for tumor size and expression of miR-126-5p (p = 0.0296) and miR-135b-5p (p = 0.0241). CONCLUSIONS: Our study confirms that miRNA expression profile is dysregulated in TNBC patients compared to healthy controls. MiR-190a, miR-136-5p, miR-126-5p, miR-135b-5p and miR-182-5p may be associated with development and progression of TNBC.

MGMT promoter methylation as a potential prognostic marker for acute leukemia.

INTRODUCTION: It has been proved that genetic and epigenetic changes play a significant role in the development and progression of acute leukemia. The aim of our study was to evaluate the frequency and prognostic implications of genetic and epigenetic alterations in p15, MGMT, DNMT3A and TP53 genes in acute leukemias. MATERIAL AND METHODS: We included in the study 59 patients with acute leukemia. Evaluation of TP53 and DNMT3A mutations was performed using sequencing analysis and PCR-RFLP, respectively. Methylation status of MGMT and p15 genes was evaluated using MSP and COBRA, respectively. For assessment of global DNA methylation ELISA-based kit was used. RESULTS: We found that overall survival was higher for ALL patients. MGMT promoter methylation was significantly associated with patients age at the time of diagnosis (p = 0.03). TP53 and DNMT3A mutations were observed only in AML patients (16.67% and 8.8%, respectively). Patients with acute leukemia and p15 promoter methylation had significantly more frequently mutated TP53 gene (p = 0.04) and AML patients with p15 promoter methylation had significantly more frequently detected global hypomethylation of DNA (p = 0.009). In the group of ALL patients we noted an opposite trend: only patients negative for p15 promoter methylation were characterized by global DNA hypomethylation. CONCLUSIONS: Our findings demonstrate that MGMT promoter methylation can have a considerable impact on the development of acute leukemia in older patients. DNMT3A and TP53 mutations may play a significant role in AML development. However, further studies conducted in a larger cohort of patients are needed to determine its clinical utility.

How Can We Improve Education of Breast Surgeons Across Europe?

The proposed global curriculum developed by the American Society of Surgical Oncology (SSO) and the European Society of Surgical Oncology (ESSO) and the textbook: provides a state-of- the- art of breast cancer surgery, complements the syllabus and curriculum of the Union Europeenne des Medecins Specialistes (UEMS) examination in breast surgery/ European Board of Surgery Qualification in Breast Surgery (EBSQinBS) administered by ESSO (1) Knowledge and understanding of the principles of breast cancer incidence, aetiology, risk factors, genetics, premalignant and high-risk lesions, pathology, prognostic and predictive factors, risk prediction models, screening, diagnosis and imaging, breast cancer, oncoplastic, reconstructive breast surgery, axillary surgery and future perspective for this, radiation therapy, neoadjuvant and adjuvant systemic treatment- endocrine-, immuno- and chemotherapy, side effects and toxicities of treatment, locoregional recurrence, follow-up, locally advanced breast cancer, metastatic breast cancer, breast cancer in young and elderly patients, survivor issues, lymphedema, palliative care, chroni pain, body image and sexuality, fertility issues, cognitive functions, etc.) (1) ESSO fellowships: for instance BSSO (Brazilian Society of Surgical Oncology)-ESSO fellowship, ESSO members are being offered the opportunity by the BSSO to apply for a visiting observership in Brazil; ESSO fellowship in Breast Surgery- the fellowship provides further specialised training in the multi-modality clinical care specific to the breast cancer patient and a deeper training in breast cancer research; training fellowships- to allow young surgeons to visit a specialist breast unit in Europe, to help them to expand their experience and learn new techniques; congress fellowships- for each ESSO congress the ESSO Scientific Committee awards a number of fellowship grantsto participants from low-income countries to attend the congress; EYSAC (ESSO Young Surgeons and Alumni Club) research fellowship; SSO/ ESSO fellowshipthrough its partnership with ESSO, SSO provides a grant to attend the SSO Annual Symposium; Reciprocal International Exchange Programmes with Japan, Latin America and North America (2). ESSO courses and masterclasses: expanded portfolio of courses, in- and outside Europe, basic and advanced, international faculty, multidisciplinary approach, learning methods: hands-on with human cadavers, workshops in small groups, live and case demonstrations, interactive sessions, 3D videos (for instance in 2017 ESSO course on ultrasound of breast in Barcelona, advanced course on oncoplastic surgery in Barcelona, advanced course on breast cancer surgery in Naples) (2). Trials: Interantional Nipple- Sparing Mastectomy Registry (INSPIRE), EURECCA (European Cancer Audit) project. The aim of INSPIRE is to provide pooled evidence derived from a prospective collaborative high-quality registry between international centers, oncological safety, patient- reported outcome measures, launched in March, 2016, European Breast Cancer Conference EBCC 10, Amsterdam (2). EXAMINATION: European Board of Surgery Qualification in Breast Surgery (EBSQ in BS): phase 1-eligibility assessment (CV, logbook, references); phase 2- test; phase 3- oral examination with 2 clinical cases and 1 critical review of academic paper. The applicant must hold a current license to practice as a surgeon (general or plastic or gynaecologist), demonstrate work for one year in a breast surgery unit with at least 150 new primary breast cancer cases per year, attended at least one national/ international training course in breast surgery and has attended at least one well recognized international congress. The applicant should present a signed log book for breast surgery with application; published either one paper or book chapter on breast disease Conclusions 1. The need for certified breast units: Standardised techniques by specialist breast surgeons across Europe should be the aim. 2. No man'™s land. Across Europe oncoplastic reconstruction is performed by specialist breast, general or plastic surgeons, sometimes in collaboration with each other. There may be dispute as who should or should not be involved. This needs to be addressed. 3. Oncoplastic reconstruction technique expansion. Significant expansion in number, variety and complexity of available techniques is a fact. A good example would be a 6-fold increase together with a low rate of complications in some Eastern European countries over the last decade 4. CME. European breast surgeons want to improve their skills, as evidenced by fully or overbooked ESSO-endorsed breast surgery courses and other high quality workshops. Applications for the European Examination in Breast Surgery (EBSQBS) continue to increase.

Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: First multicenter European report on 100 cases.

We report the outcomes of the European prospective study on prepectoral breast reconstruction using preshaped acellular dermal matrix for complete breast implant coverage. Seventy-nine patients were enrolled between April 2014 and August 2015 all over Europe using a single protocol for patient selection and surgical procedure, according to the Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons joint guidelines for the use of acellular dermal matrix in breast surgery. The preshaped matrix completely wraps the breast implant, which is placed above the pectoralis major, without detaching the muscle. A total of 100 prepectoral breast reconstructions with complete implant coverage were performed. This series, with mean follow-up of 17.9 months, had two cases of implant loss (2.0%) including one necrosis of the nipple and one wound breakdown (1.0% respectively). No implant rotations were observed. Good cosmetic outcomes were obtained with natural movement of the breasts and softness to the touch; none of the patients reported experiencing pain or reduction in the movements of the pectoralis major muscle postoperatively. The use of preshaped acellular dermal matrix for a complete breast implant coverage in selected patients is safe and gives satisfactory results, both from the aesthetic view point and the low postoperative complication rates. Further studies reporting long-term outcomes are planned.

Landscape of oncoplastic breast surgery across Poland.

Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast-conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two-stage expander followed by implant-based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement.

Immune checkpoints: Cytotoxic T-lymphocyte antigen 4 and programmed cell death protein 1 in breast cancer surgery.

Immune checkpoints refer to a plethora of inhibitory pathways built into the immune system, and recent studies have emphasized the role of these checkpoints in carcinogenesis. The aim of the present study was to evaluate two major immune checkpoints, the cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1), in the serum of 35 patients with stage I and II breast cancer. Serum concentrations of CTLA-4 and PD-1 were measured at three time points: i) Preoperatively; ii) during anesthesia following the harvesting of sentinel nodes (SNs); and iii) 24 h postoperatively. Control samples were obtained from 25 healthy, age-matched females. Assessment of CTLA-4 and PD-1 expression levels was conducted using flow cytometry. A statistically significant difference in PD-1 expression was identified between breast cancer patients preoperatively and healthy controls (26.31±11.87 vs. 12.72±8.15; P<0.0001). In addition, a statistically significant association was found between CTLA-4 and PD-1 levels prior to surgery (P=0.0084). In addition, CTLA-4 expression was associated with age (P=0.0453), with elevated levels of CTLA-4 detected in older breast cancer patients. Higher PD-1 expression levels were observed in T2 tumors compared with T1 tumors prior to surgery and intraoperatively; however, the differences were not statistically significant. Furthermore, a decrease in PD-1 levels was observed subsequent to harvesting SNs with metastasis, but not in SN-negative patients (P=0.05). A negative correlation was also observed between PD-1 expression and progesterone receptor (PR) status following surgery (P=0.024). These results provided a basis for further investigation of immune checkpoints in breast cancer. Breast cancer patients exhibit an altered profile of immune checkpoint markers, with higher concentrations of PD-1 observed in larger, PR-negative tumors.

Association of microRNA-93, 190, 200b and receptor status in core biopsies from stage III breast cancer patients.

Oncologists now favor more personalized treatment strategies in breast cancer patients. Gene expression analysis has been widely used, but less is known about epigenetic factors, for example, microRNAs (miRNAs). The aim of this study was to determine the relationship between selected miRNAs and receptor status in core biopsies sampled before preoperative chemotherapy in stage III locally advanced breast cancer (LABC) patients. In 37 LABC core biopsies, three miRNAs per sample were analyzed: hsa-miR-93-5p, hsa-miR-190a, and hsa-miR-200b-3p, and hsa-miR-103a-3p as an endogenous control (TaqMan(®) RT-PCR; Applied Biosystems). Receptor status was determined by a dedicated pathologist. The Mann-Whitney U, Shapiro-Wilk, and Levene's tests were used to compare related samples. Levels of miRNA-93 differed significantly in core biopsies of LABC patients with different expressions of ER (estrogen receptor) and PR (progesterone receptor). Higher levels of miRNA-93 were found in ER-negative (p=0.0027) and PR-negative patients (p=0.0185). Levels of miRNA-190 and 200b did not differ significantly in core biopsies of LABC patients who expressed ER and PR differently (p=0.7727, p=0.9434, p=0.6213, and p=0.1717). Levels of miRNA-93, 190, and 200b were not significantly different in core biopsies of LABC patients with different HER2 (human epidermal growth factor 2) expressions (p=0.8013, p=0.2609, and p=0.3222). The assessment of core biopsy miRNA profiles and receptor-based subtypes may identify new signaling pathways for improved breast cancer classification.

Retrospective analysis of local recurrence rate in breast cancer patients treated at the department of surgical oncology in Lódz between 2009 and 2013.

UNLABELLED: The aim of the study was to analyze clinicopathological features in breast cancer patients with local recurrence (LR). MATERIAL AND METHODS: A retrospective analysis of database of breast cancer patients operated on in the Department of Surgical Oncology in Lódz from 2 January 2009 to 30 June 2013, identified 1080 women with primary breast cancer and 11 patients with LR. RESULTS: LR rate was 0.23% per year. True recurrence (TR) occurred more frequently in patients with luminal B molecular subtype, in HER-2 positive and in triple-negative subgroups. In one patient with luminal -A subtype new primary (triple negative) occurred. TR were noted predominantly in patients with axillary lymph nodes metastases and with luminal B subtype who did not receive adjuvant chemotherapy but were given only endocrine therapy. LR were observed more frequently in patients who did not receive adjuvant radiotherapy or this treatment was delayed. Minimal surgical margins in postoperative specimens measured by pathologist were 4-25 mm, mean 9.5 mm. CONCLUSIONS: The LR rate in patients operated on breast cancer in the Department of Surgical Oncology between 2009 and 2013 was low. TR was diagnosed in patients with non- luminal A breast cancer despite wide surgical margins, especially if the patients did not receive optimal adjuvant systemic treatment or radiotherapy was delayed or omitted. Complete cancer excision followed by an immediate implementation of optimal adjuvant treatment seems to be crucial especially in patients with poor tumor biology.

Association of microRNAs and pathologic response to preoperative chemotherapy in triple negative breast cancer: preliminary report.

Triple negative breast cancer (TNBC) has caught the attention of oncologists worldwide because of poor prognosis and paucity of targeted therapies. Gene pathways have been widely studied, but less is known about epigenetic factors such as microRNAs (miRNAs) and their role in tailoring an individual systemic and surgical approach for breast cancer patients. The aim of the study was to examine selected miRNAs in TNBC core biopsies sampled before preoperative chemotherapy and the subsequent pathologic response in mastectomy or breast conservation specimens. Prior to treatment, core needle biopsies were collected from 11 female patients with inoperable locally advanced TNBC or large resectable tumors suitable for down-staging. In all 11 TNBC core biopsies we analyzed 19 miRNAs per sample: 512, 190, 200, 346, 148, 449, 203, 577, 93, 126, 423, 129, 193, 182, 136, 135, 191, 122 and 222 (miRCURY LNA™ Universal RT microRNA polymerase chain reaction Custom Pick & Mixpanels). The Wilcoxon signed-rank test was used to compare related samples. Ingenuity pathway analysis was used to evaluate potential functional significance of differentially expressed miRNAs. Statistical analysis showed that 3 of 19 miRNAs differed in relation to pathologic response i.e. good versus poor. These differences failed to reach statistical significance, although a trend was observed (p=0.06). Among these miRNAs, we identified-miR-200b-3p, miR-190a and miR-512-5p. In summary, our results indicate that higher miR-200b-3p, higher miR-190a and lower miR-512-5p expression levels in core biopsies sampled from TNBC patients may be associated with better pathologic response to chemotherapy and the increased feasibility of breast conserving surgery in these patients. Although these results were from a small cohort, they provide an important basis for larger, prospective, multicenter studies to investigate the potential role of miRNAs in neoadjuvant setting.

Pathological complete response in younger and older breast cancer patients.

INTRODUCTION: Pathologic complete response (pCR) after neoadjuvant systemic treatment for inoperable locally advanced breast cancer is defined as complete microscopic disappearance of invasive cancer in both the breast and axilla in the postoperative specimen. The aim of the study was to characterize the groups of younger (≤ 40 years old) and older (≥ 70 years old) breast cancer patients who achieved a pCR. MATERIAL AND METHODS: One hundred thirty-eight consecutive patients aged between 30 and 78 years with locally advanced breast cancer, operated on after neoadjuvant systemic treatment between November 2007 and June 2010, were analyzed. In this group 9 women (6.5%) were 40 years of age or younger, and 12 patients (8.7%) were 70 years of age or older. RESULTS: In the younger group, pCR was achieved in 1 patient with triple negative, invasive ductal breast cancer, G3, BRCA 1 mutation, treated with cisplatin. A near pCR was achieved in 2 other patients, with triple negative, invasive ductal breast cancer, G3, treated with AT. The pCR in the breast was found in a HER2 positive patient. In older patients, pCR was achieved in 2 patients with triple negative, invasive ductal breast cancer, G3, treated with AT or FEC. Pathologic complete response in the axilla was achieved in 1 patient with triple negative, ductal carcinoma. The pCR rates were significantly higher in triple negative breast cancer in both groups (p = 0.047 and p = 0.018, respectively). CONCLUSIONS: Pathologic complete response was significantly associated with receptor- based subtypes in both young and old women.

Gene expression and pathologic response to neoadjuvant chemotherapy in breast cancer.

Pathologic complete response after neoadjuvant systemic treatment appears to be a valid surrogate for better overall survival in breast cancer patients. Currently, together with standard clinicopathologic assessment, novel molecular biomarkers are being exhaustively tested in order to look into the heterogeneity of breast cancer. The aim of our study was to examine an association between 23-gene real-time-PCR expression assay including ABCB1, ABCC1, BAX, BBC3, BCL2, CASP3, CYP2D6, ERCC1, FOXC1, GAPDH, IGF1R, IRF1, MAP2, MAPK 8, MAPK9, MKI67, MMP9, NCOA3, PARP1, PIK3CA, TGFB3, TOP2A, and YWHAZ receptor status of breast cancer core biopsies sampled before neoadjuvant chemotherapy (anthracycline and taxanes) and pathologic response. Core-needle biopsies were collected from 42 female patients with inoperable locally advanced breast cancer or resectable tumors suitable for downstaging, before any treatment. Expressions of 23 genes were determined by means of TagMan low density arrays. Analysis of variance was used to select genes with discriminatory potential between receptor subtypes. We introduced a correction for false discovery rates (presented as q values) due to multiple hypothesis testing. Statistical analysis showed that seven genes out of a 23-gene real-time-PCR expression assay differed significantly in relation to pathologic response regardless of breast cancer subtypes. Among these genes, we identified: BAX (p = 0.0146), CYP2D6 (p = 0.0063), ERCC1 (p = 0.0231), FOXC1 (p = 0.0048), IRF1 (p = 0.0022), MAP2 (p = 0.0011), and MKI67 (p = 0.0332). The assessment of core biopsy gene profiles and receptor-based subtypes, before neoadjuvant therapy seems to predict response or resistance and to define new signaling pathways to provide more powerful classifiers in breast cancer, hence the need for further research.

Local antibiotic therapy in rectal cancer surgery.

UNLABELLED: Infectious complications and their consequences are still key issues in rectal cancer surgery. Currently, intravenous antibiotic administration is a recognized method for lowering the rate of these complications. The aim of the study was to assess the efficacy of complementary application of a gentamicin-impregnated sponge in the perineal wound or in the vicinity of intestinal anastomosis after abdominoperineal resection or low anterior resection. MATERIAL AND METHODS: 112 patients with primary rectal cancer were enrolled in this study. 42 patients were treated with a gentamicin sponge and drainage (group A) and 70 individuals were treated with drainage alone (group B). In the aforementioned groups a routine short-term regimen of antibiotic prophylaxis was used. We applied gentamicin-impregnated sponges in 27 patients in whom anterior resection was performed and in 15 patients from the abdominoperineal resection group (64% and 36%, respectively). In the control group, 44 anterior resections and 26 abdominoperineal resections were carried out (63% and 37%, respectively). RESULTS: We did not observe statistically significant differences in the incidence of suppurative complications (intraabdominal abscess, perineal wound infection): 4 cases (9.52%) in group A and 9 (12.58%) in group B and anastomotic leakage with clinical manifestation after low anterior resection: 1 case (3.7%) in group A and 2 (4.5%) in group B. Postoperative fever of unknown origin was noted more often in group B: 23 patients (32.8%) versus 10 patients (23.8%) in group A and this difference was statistically significant (p<0.05). Hospitalization after surgery was also significantly longer in group B (9-37 days, median 11 days) as compared with group A (8-26 days, median 13 days) (p<0.05). CONCLUSIONS: Local antibiotic therapy in rectal cancer surgery lowered the incidence of postoperative fever of unknown origin and permitted shorter hospitalization after surgery. Local gentamicin application in rectal cancer surgery did not change significantly the rate of infectious complications.