21-gene recurrence assay in patients receiving intraoperative radiotherapy: are "favorable" characteristics a surrogate for low recurrence?

BACKGROUND: Intraoperative radiotherapy (IORT) has gained momentum for early stage and favorable breast cancers (BC). The 21-gene recurrence assay guides treatment of hormone positive and node-negative BC. METHODS: Analysis of 82 invasive BC treated with breast conservation surgery (BCS) and IORT 2013-2015. Data collection included patient demographics, tumor characteristics, nodal status, recurrence test (RS) and adjuvant therapy. RESULTS: The mean age was 68 years. Tumors were stage Ia (86.6%), 3.6% Ib and 9.8% IIa. Of 50 patients (61.0%) with RS testing, 72% (n=36) were low risk (RS 0-17), with 28% (n=14) at intermediate risk (RS 18-30). The 39% (n=32) of patients without RS testing, were more likely to have smaller tumors (1.3 vs. 0.9 cm) and age >70 (P<0.05). CONCLUSIONS: Most patients selected for IORT based on clinical features were indeed low risk based on RS. Given the limited long-term clinical outcome and safety data of this technique, additional investigation is needed.

Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses.

BACKGROUND: Recovery from osteoporosis in anorexia nervosa (AN) is uncertain. OBJECTIVE: The purpose of this study was to understand the changes in bone mineral density (BMD) in women with AN and the mechanisms of recovery from osteopenia. DESIGN: We studied BMD and markers of bone formation and resorption, osteocalcin and N-telopeptide (NTX), in patients with AN (n=28) who were following a behavioral weight-gain protocol. RESULTS: Anorexic patients experienced significant percentage increases in BMD (4.38 +/- 7.48% for spine; 3.77 +/- 8.8% for hip; P<0.05 for both) from admission until recovery of 90% ideal body weight, achieved over 2.2 mo. NTX concentrations were higher in patients with AN at admission than in healthy control subjects (n=11; 69.0 +/- 31.09 and 48.3 +/- 14.38 nmol/mmol creatinine, respectively; P<0.05) and in reference control subjects (n=30; 69.0 +/- 31.09 and 37.0+/-6.00 nmol/mmol creatinine, respectively; P<0.001). In weight-recovered subjects with AN, osteocalcin increased (from 8.0 +/- 3.05 to 11.2 +/- 6.54 ng/mL; P<0.05), whereas NTX remained elevated (from 69.0 +/- 31.09 to 66.7 +/- 45.5 nmol/mmol creatinine; NS). A decrease in NTX (from 70.7 +/- 40.84 to 45.9 +/- 22.72 nmol/mmol creatinine; NS) occurred only in the subgroup of subjects who regained menses with weight recovery. CONCLUSIONS: Nutritional rehabilitation induces a powerful anabolic effect on bone. However, a fall of NTX and a shift from the dominant resorptive state, which we postulate involves full recovery, may involve a hormonal mechanism and require a return of menses. Nutritional rehabilitation appears to be critical to bone recovery and may explain the ineffectiveness of estrogen treatment alone on BMD in the cachectic state.

Estrogen and exercise may be related to body fat distribution and leptin in young women.

OBJECTIVE: To evaluate the effects of estrogen deficiency and exercise on body composition and leptin in young women. DESIGN: Cross-sectional clinical study. SETTING: Volunteers in an academic research environment. PATIENT(S): Three age- and body mass index-matched groups: normal-weight women with exercise-associated amenorrhea, regularly menstruating exercising control women, and regularly menstruating normally active control women. INTERVENTION(S): Collection of blood samples and measurement of body fat and regional fat distribution by dual-energy x-ray absorptiometry. MAIN OUTCOME MEASURE(S): Central fat accumulation (i.e., ratio of trunk to extremity fat) and serum concentrations of E(2) and leptin. RESULT(S): In both regularly menstruating control groups, but not in the amenorrheic women, there was a negative correlation between the serum E(2) concentrations and the trunk-to-extremity fat ratio (r = -0.4), independent of age, exercise, body fat, and serum T concentrations. In all women, E(2) concentrations were positively and exercise inversely correlated to leptin concentrations, independent of body fat. CONCLUSION(S): Estradiol level is inversely associated with central fat accumulation only in women with regular menstrual cycles. In all young premenopausal subjects, estrogen secretion influences leptin concentrations independently of body fat.