Adjuvant treatment of early colon cancer with micrometastases: results of a national survey.

BACKGROUND AND OBJECTIVES: Optimal adjuvant treatment for patients with Stage I/II colon cancer with micrometastases (MM) is unknown. Because there is no known adjuvant treatment-related benefit, we evaluated whether MM influenced treatment decisions. METHOD: Review of a national survey from members of the SSO and ASCO. RESULTS: Of 602 survey responses, 305 (51%) stated that MM had significant prognostic value, 250 (42%) were unsure, and 47 (7%) did not believe that MM held prognostic value. Three hundred seventy-four (63%) would offer adjuvant therapy in the setting of MM, while 222 (37%) would not. Only 15% routinely performed IHC on lymph nodes. Medical oncologists were more likely to recommend adjuvant therapy compared to surgical oncologists (68% vs. 51%, P = 0.001). CONCLUSIONS: MM in colon cancer apparently influenced adjuvant treatment decisions absent known prognostic benefit. Prospective trials are needed to improve the selection of patients for systemic chemotherapy in early, node-negative colon cancer.

Neoadjuvant therapy for breast cancer.

The past few decades have seen an increase in both the role and the complexity of neoadjuvant therapy for breast cancer. Neoadjuvant therapy was initially described as systemic chemotherapy for inflammatory or locally advanced breast cancer but now entails a combination of chemotherapy, endocrine therapy, and targeted therapy. Neoadjuvant systemic therapy is employed for inoperable inflammatory and locally advanced breast cancer, and also for patients with operable breast cancers who desire breast-conserving therapy (BCT) but are not candidates based on the initial size of the tumor in relation to the size of the breast. Neoadjuvant therapy in this subset of patients may impact the surgical options. This review will summarize the benefits of neoadjuvant systemic therapy and implications for BCT, the timing of sentinel node biopsy, and the utility of magnetic resonance imaging (MRI) to predict response to therapy.

Assessing breast cancer risk and providing treatment recommendations: immediate impact of an educational session.

The widespread availability of information regarding advancements in breast cancer care has heightened public awareness about risk and prevention, but there is limited knowledge as to the translation of these evolving advancements into physician practice patterns. The purpose of this study was to: (a) determine current practice patterns/treatment recommendations for evaluating patients at high-risk for breast cancer and (b) measure the immediate effect of an educational session on new knowledge acquired for high-risk patients. Five thousand and one health care provider surveys were sent to physicians in the greater Chicago area. The survey inquired about practice patterns and offered an opportunity to attend an educational session utilizing our "Spectrum of Care Options" framework. To evaluate session effectiveness, pre and post-tests were administered to participants. Of 767 survey respondents, 78 attended an educational session, 64 completed a pre and post-test, and 65 completed program evaluations. Pretest scores averaged 67.1% correct (range = 29-100%, SD = 15.8%) while post-test scores averaged 80.3% correct (range = 59-100%, SD = 11.0%), p < 0.0001. Participants rated the following on a 1-5 (poor to excellent) Likert scale (average scores): presentations 4.74, instructional materials 4.58, usefulness to practice 4.60, new knowledge gained 4.71, and likelihood of changing practice 4.49. Primary care physicians and surgeons are interested in identifying and treating high-risk patients, but may lack sufficient state-of-the art knowledge to do so. An educational session providing information on this subject, based on Spectrum of Care Options, significantly improved their knowledge and may influence their future practices.

Weight of normal parathyroid glands in patients with parathyroid adenomas.

Although the size and weight of a parathyroid gland are frequently the only intraoperative determinants of abnormality, these parameters have not been examined in living patients with primary hyperparathyroidism (PHP). The records of 240 patients who underwent parathyroidectomy according to standard surgical practice by a single surgeon were reviewed to identify those who were euparathyroid after in toto removal of a histologically confirmed normal gland and a histologically confirmed adenoma. The 25 (86%) females and 4 (14%) males who met the study criteria had a mean age of 60 yr (range, 33-82 yr). The mean PTH level was 130.1 pg/ml (range, 58-278) before parathyroidectomy and 32.4 pg/ml (range, 1-68) after parathyroidectomy. The mean calcium level was 11.1 mg/dl (range, 10-14) before and 8.7 mg/dl (range, 8-10) after parathyroidectomy. Thirty-four intact normal glands were removed and available for analysis. Their mean weight was 62.4 +/- 31.6 mg (range, 18-161 mg), and 15 (44%) weighed 60 mg or more. The mean weight of the adenomas was 553.7 +/- 520.5 mg (range, 66-2536). Adenomas were clearly distinguished from normal glands by cellularity, stromal fat, and intracellular fat in chief cells. The weight of normal parathyroid glands removed at surgery in patients with PHP may be greater than that reported in autopsy studies. Therefore, certain histological features are a better measure than weight in determining whether a gland is normal, and intraoperative identification of slightly enlarged glands should not lead to immediate subtotal parathyroidectomy.