A two-step selection of breast cancer patients candidates for exclusive IORT with electrons: a mono-institutional experience

AIM

To assess the impact of a two-step multiparameter selection on the actual enrollment of women with breast cancer into a prospective intraoperative radiotherapy (IORT) trial.

PATIENTS AND METHODS

From September 2009, a prospective clinical trial was started in order to deliver adjuvant exclusive single -fraction IORT to patients with early breast cancer. To select patients meeting suitable eligibility criteria for the clinical trial, a two-step decision process was developed: at pre-surgical examination (first step) and during surgery (second step).

RESULTS

A series of 464 patients with breast cancer was analysed: at the first step, out of 464 patients, 333 (71%) were considered eligible for the IORT protocol; at the second step, out of 333 patients, 199 (60%) met the eligibility criteria and received the IORT fraction according to the criteria of the controlled trial.

CONCLUSION

In our experience, the ultimate rate of patients who enrolled in the IORT clinical trial after the two-step decision process was 43%.

Unilateral headache associated with a pontine infarction

Brain stem structures are implicated in the generation of migraine and other types of headache. The patient described herein had chronic left hemicranial headaches associated with a left pontine infarction.

Clinical and molecular predictors of disease severity and survival in chronic lymphocytic leukemia

Several parameters may predict disease severity and overall survival in chronic lymphocytic leukemia (CLL). The purpose of our study of 190 CLL patients was to compare immunoglobulin heavy chain variable region (IgV(H)) mutation status, cytogenetic abnormalities, and leukemia cell CD38 and Zap-70 to older, traditional parameters. We also wanted to construct a simple, inexpensive prognosis score that would significantly predict TTT and survival in patients at the time of diagnosis and help practicing clinicians. In univariate analyses, patients with higher clinical stage, higher leukocyte count at diagnosis, shorter leukocyte doubling time, elevated serum lactate dehydrogenase (LDH), unmutated immunoglobulin heavy chain variable region (IgV(H)) genes, and higher CD38 had a shorter overall survival and time-to-treatment (TTT). CLL cell Zap-70 expression was higher in patients with unmutated IgV(H), and those with higher Zap-70 tended to have shorter survival. IgV(H)4-34 or IgV(H)1-69 was the most common IgV(H) genes used (16 and 12%, respectively). Of those with IgV(H)1-69, 86% had unmutated IgV(H) and had a significantly shorter TTT. A cytogenetic abnormality was noted in 71% of the patients tested. Patients with 11q22 del and 17p13 del or complex abnormalities were significantly more likely to have unmutated IgV(H). We found that a prognostic score constructed using modified Rai stage, cellular CD38, and serum LDH (parameters easily obtained clinically) significantly predicted TTT and survival in patients at the time of diagnosis and performed as well or better than models using the newer markers.

Exercise intervention for pediatric cancer survivors: Feasibility and preliminary efficacy

20013

Background: Obesity and diminished physical activity are known sequelae of cancer and its treatment. In medical oncology, data support the efficacy of exercise interventions. We therefore evaluated such an intervention for overweight/inactive adolescent cancer survivors. Methods: Participants were randomized to an exercise or control condition. The intervention group attended exercise sessions for 12-weeks with an exercise physiologist, during which they developed an individualized program emphasizing cardiovascular fitness. Controls received written exercise and nutrition materials. Outcome measures included self-reported health-related quality of life (HRQOL), physical activity, and fatigue; and lab measures of body mass index (BMI) and VO2max. Results: Among the 36 participants (mean age = 18.0 yrs, mean = 12.0 yrs post-diagnosis), at baseline both groups had diminished HRQOL, elevated BMIs, low physical activity, decreased V02max and high levels of fatigue. Post-treatment, there was little change in BMI, while physical activity and fatigue slightly increased in both groups. Study participation among survivors was limited due to the commute and time commitment for center-based sessions. Table 1 . a7-Day Physical Activity Recall; minutes/week of moderate-intense physical activity bMultidimensional Fatigue Questionnaire; lower scores = increased fatigue Conclusions: Survivors of childhood cancer are at risk for impaired HRQOL, high BMI, decreased physical activity, and fatigue, even 10+ years after diagnosis. Preliminary data are discouraging with respect to the immediate benefits of intervention, but analyses are ongoing to assess other outcomes as well as the impact 3 months following study completion. Feasibility issues of conducting such a study in a tertiary cancer center served by a broad catchment area have been identified. Continued research is required, which includes novel approaches to overcome concerns of time commitment, which limited study participation.

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No significant financial relationships to disclose.