Making informed choices on incorporating chemoprevention into carE (MiCHOICE, SWOG 1904): Design and methods of a cluster randomized controlled trial

INTRODUCTION

Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy.

METHODS/DESIGN

We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation.

RESULTS/DISCUSSION

With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S.

CLINICAL SETTINGS

TRIAL REGISTRATION

NCT04496739.

Effect of Mulligan’s Mobilization Versus Muscle Energy Technique on Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction (SIJDF) is about 15% to 30% identified in a patient with low back aches. This Study aimed to determine the effect of mulligan mobilization versus muscle energy technique on sacroiliac joint dysfunction. The study was a randomized controlled trial that involved 66 participants with SIJDF, after a thorough evaluation the participants were divided into three groups. In experimental group I (Mulligan's mobilization group (MMG)), participants underwent Mulligan mobilization for 20 minutes. The experimental group II (Muscle energy group (MEG)) participants underwent the muscle energy technique for 20 minutes, and the third group underwent moist heat therapy (moist heat group (MHG)) for 20 minutes. For all three groups, 10 minutes of exercise were taught to the patients. All the participants of the groups were included based on pre-determined selection criteria, and all were willing to participate in the Study. The outcome measures of Pain, functional disability, and kinesiophobia were measured by the Numerical pain scale, Oswestry disability index, and Tampa scale respectively. The result was computed using One-way ANOVA, showing significant differences between the three groups. When significant differences were obtained on ANOVA, further analysis was done using a post hoc test. The values for the outcomes are Pain was compared with MMG vs. MEG is 8.045 and the MMG vs. MHG is 4.022 and MMG vs. MEG is 12.07, on Oswestry disability index MEG vs. MHG 9.85, MMG vs. MHG is 2.23 and MMG vs. MEG is 12.08. For kinesiophobia, MMG vs. MEG is 20.25, MMG vs. MHG is 15.35, and MMG vs. MEG is 35.60. This Study concludes that Mulligan's mobilization is more effective in reducing pain, improving function, and kinesiophobia in SI joint dysfunction than the other two groups. 

Definitive chemoradiation for oropharyngeal squamous carcinomas: Outcomes with intensity-modulated radiation therapy using simultaneous integrated boost, in a majorly p16 negative cohort

BACKGROUND

The literature on modern-era outcomes of oropharyngeal squamous carcinoma (OPSCC) in India is limited.

MATERIALS AND METHODS

We analyzed records of consecutive patients with OPSCC treated using a curative SIB IMRT regimen of 66 Gy/30#/6 weeks.

RESULTS

One hundred fifteen patients from July 2011 to December 2018 were analyzed. Twenty of 69 patients tested positive for p16. In p16 positive patients, the K-M probability of being disease free and alive at 2 years, with at least one follow-up 3 months after treatment, was 83% (median not reached) compared with 48% if p16 was unknown/negative. Patients staged as IVB p16 negative had a 2-year DFS of 25%. Patients unfit for cisplatin and consequently received other agents had 2-year DFS estimated at 20%.

CONCLUSIONS

Intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) and concurrent chemotherapy was feasible, with toxicity and disease control comparable to available literature. AJCC Stage IVB p16 negative disease had notably poor outcome.

Moderately Hypofractionated Radiotherapy and Androgen Deprivation Therapy for High-risk Localised Prostate Cancer: Predictors of Long-term Biochemical Control and Toxicity

AIMS

There is a paucity of long-term data on outcomes of high-risk prostatic adenocarcinoma after moderately hypofractionated radiotherapy with elective nodal treatment and long-term androgen deprivation therapy (ADT). We report long-term control and toxicity outcomes and analyse the predictors of failure and toxicity.

MATERIALS AND METHODS

The records of 120 consecutive high-risk prostate cancer patients treated in a single institution between February 2012 and December 2016 were retrospectively analysed. A moderately hypofractionted radiotherapy (HypoRT) regimen of 60 Gy in 20 fractions over 4 weeks with simultaneous elective pelvic irradiation to 44 Gy in 20 fractions with intensity-modulated radiotherapy was used, together with long-term ADT with either orchiectomy or medical castration for a total duration of 2-3 years. We analysed biochemical control, metastasis-free survival and late toxicities and their predictive factors using survival analysis.

RESULTS

Patients had locally advanced cancers (cT3 77.5%, median pretreatment prostate-specific antigen 30 ng/ml, Gleason score 8-10 in 45.8%). The median follow-up time was 70 months. The 3- and 5-year probability of freedom from biochemical progression was 93% and 80%, respectively. The 5-year probability of freedom from local relapse/intra-pelvic nodal relapse/distant metastases as the site of first failure was 96%/97%/86%, respectively. Gleason score 8-10 and medical ADT for 2-3 years (as opposed to orchidectomy) were independent risk factors for distant metastases. A total of 18 grade 2 and above late gastrointestinal toxicity events and a total of 23 grade 2 and above late genitourinary toxicity events were documented. Patients who underwent a transurethral resection of prostate prior to radiotherapy had worse urological toxicity.

CONCLUSIONS

HypoRT with elective nodal treatment results in excellent pelvic control. Distant metastases are the primary mode of failure. Risk of metastases is associated with Gleason score and the duration of ADT. Late urinary toxicities are more common in those with prior transurethral resection of prostate.

Immunomodulatory effects of Andrographis paniculata extract in healthy adults - An open-label study

Background

Andrographis paniculata (Burm.f.) Nees has been well-researched for its immunomodulatory effects.

Objective(s)

To investigate the immunomodulatory effects of standardized A. paniculata extract (SAPE) in healthy adults.

Materials and methods

The study was an open-label, single-centre study conducted for 30 days. Thirty participants with absolute lymphocyte counts of 1000–4000 cells/mm³ were enrolled and were instructed to ingest 200 mg of SAPE daily for 30 days. The participants visited the clinic at baseline, and days 3, 7, and 30. Immune cells such as NK cell (CD3-CD16+CD56+), T cells (CD3+), T helper cells (CD3+CD4+), T cytotoxic cells (CD3+CD8+) were measured using flow cytometry. Serum cytokines that include interferon gamma (IFN-γ), interleukin-4 (IL-4), interleukin-2 (IL-2), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-α) were measured using ELISA. The SAPE used in this study was a standardized proprietary extract (AP-Bio®/KalmCold®) developed from the leaf extracts of A. paniculata.

Results

SAPE increased T cells, T helper cells and significantly increased IFN-γ, IL-4, and decreased IL-2 at day 30. A subgroup analysis of participants with absolute lymphocyte counts of 1000–3000 cells/mm³ indicated that there is a significant increase in the T cells, T helper cells at day 7 and 30 and significant increase in IFN-γ, IL-4 and decrease in IL-2 at day 30. There was no treatment related adverse effects following SAPE intake for 30 days.

Conclusion

Supplementation of SAPE resulted in immunomodulatory effects evidenced by its effects on immune cells and cytokines and it was found to be safe and tolerable.

Parotid sparing adaptive radiotherapy in head and neck cancer patients: A study evaluating resource intensiveness and impact on quality of life

e24037

Background: Anatomical changes during the course of parotid sparing IMRT for head and neck cancer can lead to an increase in the actual dose absorbed by the parotid glands, which may be controlled with the use of interval adaptive replanning. In this prospective assessment of adaptive replanning for parotid dose changes, we explored the feasibility of carrying out adaptive replanning based on predefined objective dosimetric criteria at specified time points. We sought to assess the impact of this measure using a clinically meaningful endpoint of patient reported quality of life outcomes. Methods: 90 patients with head and neck radiotherapy indicated for definitive management or adjuvant therapy who had at least one parotid gland receiving a mean dose (MD) of between 25-30Gy were accrued in the study. The index parotid was delineated on the images acquired on 14th and 19th day and the MD was determined by overlaying the verification image on the planned CT. If the MD had increased by 2% of the initial intended dose, an adaptive plan was attempted with an aim to reduce MD by 2% without compromising PTV coverage; this plan was then used to deliver the remaining treatment. Patients were invited to complete QoL questionnaires: EORTC-QLQC30 with HN35 module, and XeQoL score at baseline, at 3 and 9 months after completion of treatment. Results: 46 out of 90 patients met the threshold for adaptive replanning and were switched to the new plan during treatment. Adaptive replanning was triggered at D14 for 31 patients and D19 for the remaining 15. Need for adaptive replanning was associated with receipt of concurrent chemotherapy and weight loss in the first two weeks of RT. QoL was evaluable for 50 patients at 3 months post treatment. In patients who required adaptive replanning per protocol, Mean XeQoL scores at 3 months showed significantly worse scores for overall scores (1.1 vs 2.3, p 0.001) and for the component individual physical, pain, psychological, and social domains. EORTC QLQ-C30 and HN35 questionnaires at 3 months also demonstrated significantly worse mean symptom scores of the relevant domains of mouth dryness (39 vs 60), stickiness (32 vs 54) and swallowing (39 vs 60) in patients who required adaptive replanning versus those who did not. No significant QoL trends were observable in the 31 patients who were evaluable at 9 months post treatment. The average time required for each step in the planning process was comparable for both the initial planning workflow and adaptive replanning process. Conclusions: The trigger criteria for replanning identified a population of patients who have significantly worsened quality of life due to radiation induced xerostomia. The benefits of adaptive replanning strategies based on weekly evaluation, binary thresholds and standard planning procedures is doubtful Clinical trial information: CTRI/2017/11/010683.

Effects of Swiss ball exercise and Pilates exercise on core muscle strengthening in college cricketers

Introduction and Aim: Cricket is one of the most popular game in India played by men and women of all ages. Core stability is defined as the ability to control the position and movement of the trunk over the pelvis to allow optimum production, transfer and control of force and movement to the terminal segment. Major muscles involved are pelvic floor muscles, Transverse abdominis, multifidus, internal and external obliques, and rectus abdominis. Core is used to stabilize the thorax and the pelvis during dynamic movement. The study helps to compare the effectiveness of Swiss ball exercise and Pilates exercise on gaining core muscle strength. The aim of the study is to compare the effect of Swiss ball exercise and Pilates exercise on core muscle strengthening in college cricketers. Materials and Methods: The design of the study is comparative type. The study was carried out in faculty of Physiotherapy, Dr.M.G.R. Educational and Research Institute. The study sample of 30 male college cricketers between the age group of 18 to 25 years are included in the study. Individuals with associated neuromuscular conditions, any injuries to lower limbs and any spinal injuries have been excluded in the study. Swiss ball and Pilates mat are the materials used. Sphygmomanometer is the outcome measure.30 male individuals between the age group of 18 to 25 years were divided into two groups, group A and group B. Individuals in the group A (n=15) received the Swiss ball exercise and group B (n=15) received Pilates exercise for 4 session/ week for 6 weeks. Results: On comparing the mean values of group A and group B on double leg lowering test (DLLT), it shows significant decrease in the post test mean values but (group B- Pilates exercise) shows (30.60) which has the lower mean value is more effective than (group A- Swiss ball exercise) (46.80) at P ? 0.001. Hence, null hypothesis is rejected. Conclusion: The study concluded that both the group was effective but while comparing Pilates exercise showed the potential treatment option than swiss ball exercise. Hence, Pilates exercise was effective on core muscle strengthening in college cricketers. Keywords: Swiss ball; Pilates mat; core muscle; sphygmomanometer.

Tailoring the magnetic entropy change towards room temperature in Sr-site deficient La0.6Dy0.07Sr0.33MnO3 manganite

The Sr-deficient compound could be a potential candidate for room temperature magnetic refrigeration applications.

Helical Radiotherapy in Early Laryngeal Cancers Could Lead to Excess Local Recurrence: Lessons From a Phase II Prospective Study

AIMS

A prospective study was conducted to investigate the feasibility and efficacy of carotid-sparing intensity-modulated radiotherapy (CSIMRT) in early glottic cancers (EGC).

MATERIALS AND METHODS

Eighteen patients underwent CSIMRT using helical tomotherapy to a dose of 55 Gy/20 fractions/4 weeks. Carotid intimal thickness (CIT) at prespecified carotid levels was measured using B-mode ultrasound at 6, 18 and 36 months. Serial changes in CIT were also measured in a control prospective cohort of 18 patients with head and neck cancers receiving bilateral neck nodal radiation over the same time period (54-60 Gy/30 fraction/6 weeks). The outcomes of 18 patients undergoing CSIMRT were compared against a retrospective consecutive cohort of 41 patients with EGC to confirm comparable local control.

RESULTS

No significant CIT differences were identified between patients undergoing CSIMRT versus the control group. However, four patients in the CSIMRT group had a local recurrence between 8 and 39 months. In all patients the epicentre of the recurrence was noted at the anterior part of the larynx. The 5-year local recurrence-free survival was 75.1% (95% confidence interval 56.6-99.7%). By contrast, in the group of EGC patients treated without carotid sparing, local recurrence was noted only in a single patient (patient treated with helical tomotherapy) and the 5-year local recurrence-free survival was 97.1% (95% confidence interval 91.8-100%) (Log-rank P = 0.01).

CONCLUSION

We failed to show the safety of CSIMRT using helical tomotherapy in this population of EGC patients. Use of CSIMRT also did not translate into a substantial reduction in CIT until 36 months. Use of CSIMRT using rotational arc techniques such as helical tomotherapy may be associated with a greater risk of local recurrence due to intrafractional motion interplay effects.

A Phase I/II Study of Stereotactic Hypofractionated Once-weekly Radiation Therapy (SHORT) for Prostate Cancer

AIMS

Stereotactic radiation therapy has been investigated predominantly in patients with low-intermediate-risk disease. We conducted a clinical trial of stereotactic hypofractionated radiation therapy delivered in once-weekly fractions on patients with all-risk non-metastatic disease to test feasibility, acute toxicities and patient-reported outcomes.

MATERIALS AND METHODS

In this phase I/II study, 30 patients with prostatic adenocarcinoma, any Gleason score, T1-4N0 and prostate-specific antigen ≤60 ng/ml were treated with volumetric intensity modulated arc radiation therapy to a dose of 35 Gy in five fractions delivered once weekly. Patients with high-risk disease also received elective nodal irradiation to a dose of 25 Gy in five fractions simultaneously. Androgen deprivation was offered to intermediate- and high-risk patients. The primary outcome was acute toxicity. Secondary outcome measures included biochemical control and late toxicity. Patient-reported outcomes were measured using the International Prostate Symptom Score and European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ).

RESULTS

All 30 patients completed treatment per-protocol. Most patients had T3 (60%) and Gleason 7 (50%) tumours. The median prostate-specific antigen was 17 ng/ml. High-risk disease was present in 20 patients (66.7%). There was a low incidence of acute toxicities (grade 2 + urinary 3.3%, grade 2 rectal 0%). Within the EORTC QLQ framework, only the urinary symptom score showed a clinically meaningful worsening from a mean of 20/100 at baseline to 34/100 at the end of treatment (P < 0.001), but reduced to 24/100 at 6 months (P = 0.08). With a median follow-up of 41.5 months, two patients each reported grade 2 late urinary and rectal toxicity. The 3- and 4-year biochemical control rates were 96.7 and 87.9%, respectively.

CONCLUSION

In a cohort of mainly high-risk cancers, stereotactic once-weekly radiation therapy was easy to implement and well tolerated, with a low incidence of acute and late toxicity and excellent biochemical control.

Optimization of 14C LSC measurement using CO2 absorption technique

Liquid Scintillation Counting (LSC) is the most commonly used technique for quantification of 14C in the environmental samples. An optimization study was carried out for the analysis of 14C with the direct carbon dioxide absorption method using LSC. The absorption capacity of CO2 in varying amounts of CO2 absorber Carbo-Sorb E to Permafluor scintillation cocktail volumes is found to be 5.33 ± 0.053 mmol/mL of Carbo-Sorb E. The optimum volume ratio of Carbo-Sorb E to Permafluor scintillation cocktail is found to be 1:1 based on the minimum detection activity (MDA) values. The effect of CO2 loading in the optimized absorption mixture shows that with an increasing CO2 amount (up to saturation) there is an increase in tSIE values which is due to an increase of Compton scattering effect in the CO2 loaded samples. The region of interest (ROI) for 14C measurement is found to be 10–96 keV based on the figure of merit values and the efficiency for detecting 14C is 83.45 % in the optimized ROI window.

Observation of enhanced magnetic entropy change near room temperature in Sr-site deficient La0.67Sr0.33MnO3 manganite

The effect of Sr-site deficiency on the structural, magnetic and magnetic entropy change of La_0.67Sr_0.33−yMnO_3−δ (y = 0.18 and 0.27) compounds was investigated. The compounds were prepared by the conventional solid-state route and powder X-ray diffraction technique along with Rietveld refinement was carried out to confirm the structure and phase purity. Lattice parameters and unit cell volumes are found to increase with the increase in Sr-deficiency due to the electrostatic repulsion from the neighbouring oxygen ions. A mixed valence state of Mn²⁺/Mn³⁺/Mn⁴⁺ was confirmed using the X-ray photoelectron spectroscopy technique and it was observed that the change of state from Mn³⁺ + Mn³⁺ pairs to Mn²⁺ + Mn⁴⁺ pairs is different for both the studied compounds. A second order ferromagnetic–paramagnetic transition with an enhancement in magnetization in comparison to the pristine compound (La_0.67Sr_0.33MnO₃) was observed due to multiple double exchange interactions. The La_0.67Sr_0.15□_0.18MnO_3−δ compound exhibits a magnetic entropy change (ΔS_M) of 4.61 J kg⁻¹ K⁻¹ at 310 K, and the La_0.67Sr_0.06□_0.27MnO_3−δ compound exhibits a ΔS_M of 4.11 J kg⁻¹ K⁻¹ at 276 K under a field of 50 kOe. In our previous work, we reported a large value of ΔS_M but at higher temperatures, around 350 K. However, in the present case, we have achieved a near room temperature (310 K) MCE with a significant ΔS_M value (4.61 J kg⁻¹ K⁻¹) which is larger than that reported for numerous perovskite manganites. Thus, the studied material could be a potential candidate for room temperature magnetic refrigeration applications.

The effect of Sr-site deficiency on the structural, magnetic and magnetic entropy change of La_0.67Sr_0.33−yMnO_3−δ (y = 0.18 and 0.27) compounds was investigated.

Visible range optical absorption, Urbach energy estimation and paramagnetic response in Cr-doped TiO2 nanocrystals derived by a sol-gel method

We have carried out a detailed study of the morphological, structural, optical and magnetic properties of Cr doped TiO₂ nanocrystals with doping concentrations varying from 3 to 12 atomic weight%. The results obtained from transmission electron microscopy analysis, size-strain plots of all the Cr-doped samples and crystallite size estimation reveal the particle size of the prepared nanocrystals to be well below 10 nm, which is observed to exhibit a decreasing trend with an increase in the Cr dopant concentration. All the samples crystallize in the anatase tetragonal phase of TiO₂, which is confirmed from the Rietveld refinement of the X-ray diffraction patterns and the different modes present in the Raman spectra. The E_g(1) mode shows a clear red shift and broadening with increase in the Cr concentration, which indicates the replacement of Ti ions with Cr ions in the TiO₂ lattice. The possibility of the presence of different functional groups present is verified by Fourier transform infra-red spectroscopy. The presence of Cr³⁺ and Ti⁴⁺ is confirmed from the X-ray photoelectron spectroscopy (XPS) results suggesting the formation of oxygen vacancies to compensate for the charge neutrality. The XPS results validate the Cr³⁺ existence in the Cr:TiO₂ system and corroborate with a slight peak shift towards lower diffraction angle and further confirm the substitutional doping in the present case. Enhanced visible range optical absorption and a clear red shift associated with the absorption edge also suggest the incorporation of Cr³⁺ ions into the host system. The estimated band-gap of Cr-doped TiO₂ nanocrystals reveals a decreasing trend with increasing Cr concentration. The Urbach energy associated with all the Cr-doped samples signifies the presence of oxygen vacancy related defects in the present system, which is further verified using photoluminescence (PL) spectra, and the deconvolution of the PL spectra provides an insight into the oxygen vacancy defects associated with the system. Paramagnetic (PM) behaviour is observed with an increase in the PM moment, suggesting the increase in isolated Cr ions with increase in the Cr concentration, which is further explained using a bound magnetic polaron (BMP) model. Isolated BMP formation could be the reason for the observed PM behavior of the present system, where the trapping of 3d electrons associated with Cr³⁺ in the vacancy sites could ultimately lead to fewer overlapped BMPs, yielding a net PM moment. The present Cr:TiO₂ system could be modified with tailored optical and magnetic properties for functional applications such as magneto-optics and optoelectronic devices.

Radical radiotherapy or chemoradiotherapy for inoperable, locally advanced, non-small cell lung cancer: Analysis of patient profile, treatment approaches, and outcomes for 213 patients at a tertiary cancer center

INTRODUCTION

Radical radiotherapy (RT) with curative intent, with or without chemotherapy, is the standard treatment for inoperable, locally advanced nonsmall cell lung cancer (NSCLC).

MATERIALS AND METHODS

We retrospectively reviewed the data for all 288 patients who presented with inoperable, locally advanced NSCLC at our institution, between May 2011 and December 2016.

RESULTS

RT alone or sequential chemoradiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) was used for 213 patients. Median age was 64 years (range: 27-88 years). Stage-III was the biggest stage group with 189 (88.7%) patients. Most patients with performance status (PS) 0 or 1 received CCRT, whereas most patients with PS 2 received RT alone (P < 0.001). CCRT, SCRT, and RT alone were used for 120 (56.3%), 24 (11.3%), and 69 (32.4%) patients, respectively. A third of all patients (32.4%) required either volumetric-modulated arc radiotherapy (VMAT) or tomotherapy. Median follow-up was 16 months. The median progression-free survival and median overall survival (OS) were 11 and 20 months, respectively. One-year OS and 2-year OS were 67.9% and 40.7%, respectively. Patients treated using CCRT lived significantly longer with a median survival of 28 months, compared with 13 months using SCRT and RT alone (P < 0.001). On multivariate analysis, OS was significantly affected by age, stage group, treatment approach, and response to treatment.

CONCLUSION

RT including CCRT is feasible, safe, and well tolerated in our patient population and results in survival benefits comparable with published literature. CCRT should be considered for all patients with inoperable, locally advanced NSCLC, who are fit and have good PS.

Impact of Mn-dopant concentration in observing narrowing of band-gap, urbach tail and paramagnetism in anatase TiO2 nanocrystals

In addition to the numerous applications of Mn-doped TiO₂, it could be a potential candidate as a dilute magnetic semiconductor.

Significant reduction in the optical band-gap and defect assisted magnetic response in Fe-doped anatase TiO2 nanocrystals as dilute magnetic semiconductors

The nature of BMPs, whether overlapped or isolated, determines the magnetic behavior of Fe-doped TiO₂.

Structural, optical and magnetic behavior of sol–gel derived Ni-doped dilute magnetic semiconductor TiO2 nanocrystals for advanced functional applications

Defect engineering of Ni-doped TiO₂ could tailor the magnetic properties through BMP interactions, which is advantageous for spintronics applications.

Defect mediated mechanism in undoped, Cu and Zn-doped TiO2 nanocrystals for tailoring the band gap and magnetic properties

Oxide based dilute magnetic semiconductor materials have been of great interest over the years due to their potential use in spintronic devices. However, the variations in the magnetic behavior of the materials have raised concerns regarding the origin of ferromagnetic properties which still needs to be explored. Manipulation of magnetic behavior in oxide based dilute magnetic semiconductors has become a challenge due to the interplay of intrinsic defects present in the material. TiO2 nanocrystals have been studied largely due to their challenging optical and magnetic properties. The present investigation studies in detail the structural, morphological, optical and magnetic behavior of non-magnetic element (Cu and Zn) doped TiO2, synthesized via a simple sol-gel technique. X-ray diffraction patterns and Raman spectra confirm the anatase phase and high resolution transmission electron microscopic results clearly indicate the formation of highly crystalline nanocrystals in all the samples with particle size ranging from 5-15 nm. Energy dispersive X-ray fluorescence spectroscopic studies reveal the compositional homogeneity of all the investigated samples. The presence of functional groups and molecular interactions were identified by Fourier transform infrared spectroscopy. Optical properties were studied through UV-visible and photoluminescence spectroscopy from which a significant reduction in band gap in Cu-doped TiO2 nanocrystals was found. X-ray photoelectron spectra confirm the presence of Ti3+, Cu2+, Cu+ and Zn2+ in Cu and Zn-doped TiO2 samples. The concept of bound magnetic polarons associated with the vacancy defects at both Ti, Cu, Zn and oxygen sites is used to explain the induced weak ferromagnetic behavior in undoped, Cu and Zn-doped TiO2 at room temperature. The overlapping of bound magnetic polarons could be the source of ferromagnetism irrespective of the non-magnetic nature of the dopant ion. The concentration of bound magnetic polarons is estimated using a Langevin fit and a detailed understanding of the variation of defect mediated magnetic properties is established with the help of PL analysis. A significant reduction in bandgap along with enhanced magnetization observed in the Cu-doped TiO2 material makes it suitable as a potential candidate for spintronics and magneto-optics applications. Room temperature magnetic properties of the Zn doped sample show a diamagnetic tail which is explained based on the defect centers and oxidation states of dopant ions present in the sample which is further verified with the help of XPS results.

Impact of modern radiotherapy techniques on survival outcomes for unselected patients with large volume non-small cell lung cancer

OBJECTIVE:

Intensity modulated radiotherapy (IMRT) is used, where necessary, for bulky or complex-shaped, locally advanced, non-small cell lung cancer (NSCLC). We evaluate our real-world experience with radical radiotherapy including concurrent chemoradiation (CCRT), and analyse the impact of IMRT on survival outcomes in patients with larger volume disease.

METHODS:

All patients treated between May 2011 and December 2017 were included. Analyses were conducted for factors affecting survival, including large volume disease that was defined as planning target volume (PTV) > 500 cc.

RESULTS:

In 184 patients with large volume disease, the median overall survival was 19.2 months, compared to 22 months seen with the overall cohort of 251 patients who received radical radiotherapy. PTV and using CCRT were significant predictors for survival. IMRT was used in 93 (50.5%) of 184 patients with large PTV. The patients treated using IMRT had significantly larger disease volume (median PTV = 859 vs 716 cc; p-value = 0.009) and more advanced stage (proportion of Stage IIIB: 56 vs 29%; p-value = 0.003) compared to patients treated with three-dimensional conformal radiotherapy. Yet, the outcomes with IMRT were non-inferior to those treated with 3DCRT. CCRT was used in 103 (56%) patients with large volume disease and resulted in a significantly better median survival of 24.9 months. The proportional benefit from CCRT was also greater than in the overall cohort.

CONCLUSION:

Despite being used for larger volume and more advanced NSCLC, inverse-planned IMRT resulted in non-inferior survival.

ADVANCES IN KNOWLEDGE:

IMRT enables the safe use of curative CCRT for large-volume, locally-advanced NSCLC.

Observation of enhanced magnetocaloric properties with A-site deficiency in La0.67Sr0.33MnO3 manganite

In this paper, we have studied the effect on the structural, magnetic and magnetocaloric properties of La and Sr-deficiencies in the La_0.67Sr_0.33MnO₃ compound. Rietveld refinement of the X-ray powder diffraction patterns confirms that all of the compounds have crystallized into a rhombohedral crystal symmetry with an R3[combining macron]c space group. X-ray photoelectron spectroscopy measurements revealed that the parent compound has a mixed valance of Mn³⁺/Mn⁴⁺, whereas Mn²⁺/Mn³⁺/Mn⁴⁺ mixed valency is found in the case of both La and Sr-deficient compounds. The La_0.67Sr_0.33MnO₃ compound shows a magnetic transition temperature of 365 K, while the La and Sr-deficient compounds exhibit transition temperatures of 367 K and 355 K, respectively. Among the studied compounds, the Sr-deficient compound shows the highest magnetic entropy change (ΔS_M) of 5.08 J kg^-1 K^-1 at 352 K for a 50 kOe field with a relative cooling power (RCP) of 142 J kg^-1 and an adiabatic temperature change of 3.48 K, while the parent and La-deficient compounds exhibit a -ΔS_M of 4.78 J kg^-1 K^-1 at 364 K and of 4.12 J kg^-1 K^-1 at 364 K, respectively. The temperature dependence of the electrical resistivity with and without applied magnetic fields reveals that the La-deficient compound has one order and the Sr-deficient compound has two orders of suppression in the electrical resistivity. Thus, the Sr-deficient compound shows promising behaviour for reduction of the magnetic transition temperature towards room temperature, along with an increase in the ΔS_M values, and enhancement in the electrical conductivity. Therefore, it could be possible to tune the transition temperature towards room temperature without compromising the magnetic entropy change in order to develop materials for magnetic refrigeration applications.

Development and validation of a decision support tool to select IMRT as radiotherapy treatment planning modality for patients with locoregionally advanced non-small cell lung cancers (NSCLC)

OBJECTIVE:

Radiation planning for locally-advanced non-small cell lung cancer (NSCLC) can be time-consuming and iterative. Many cases cannot be planned satisfactorily using multisegment three-dimensional conformal radiotherapy (3DCRT). We sought to develop and validate a predictive model which could estimate the probability that acceptable target volume coverage would need intensity modulated radiotherapy (IMRT).

METHODS:

Variables related to the planning target volume (PTV) and topography were identified heuristically. These included the PTV, it's craniocaudal extent, the ratio of PTV to total lung volume, distance of the centroid of the PTV from the spinal canal, and the extent PTV crossed the midline. Metrics were chosen such that they could be measured objectively, quickly and reproducibly. A logistic regression model was trained and validated on 202 patients with NSCLC. A group of patients who had both complex 3DCRT and IMRT planned was then used to derive the utility of the use of such a model in the clinic based on the time taken for planning such complex 3DCRT.

RESULTS:

Of the 202 patients, 93 received IMRT, as they had larger volumes crossing midline. The final model showed a good rank discrimination (Harrell's C-index 0.84) and low calibration error (mean absolute error of 0.014). Predictive accuracy in an external dataset was 92%. The final model was presented as a nomogram. Using this model, the dosimetrist can save a median planning time of 168 min per case.

CONCLUSION:

We developed and validated a data-driven, decision aid which can reproducibly determine the best planning technique for locally-advanced NSCLC.

ADVANCES IN KNOWLEDGE:

Our validated, data-driven decision aid can help the planner to determine the need for IMRT in locally advanced NSCLC saving significant planning time in the process.

Actual gains in dosimetry and treatment delivery efficiency from volumetric modulated arc radiotherapy for inoperable, locally advanced lung cancer over five-field forward-planned intensity-modulated radiotherapy

AIMS

Volumetric modulated arc radiotherapy (VMAT) is used for inoperable, locally advanced nonsmall cell lung cancer, where three-dimensional conformal radiotherapy (3D-CRT) cannot yield an acceptable plan.

METHODS

The planning and treatment data were prospectively collected on the first 18 patients treated using VMAT plans. We analyzed the actual dosimetric gain and impact on treatment, compared with complex multisegment 3D-CRT (five-field forward-planned intensity-modulated radiotherapy [IMRT]) that were generated for treatment. Proportion of planning target volume (PTV) receiving 95% dose (PTV-V95%) conformity index (CI), conformity number (CN), dose homogeneity index (DHI), monitor units (MUs), and treatment time were also analyzed.

RESULTS

The PTV coverage (PTV-V95%) was improved from a median of 91.41% for 5-F forward-IMRT to 98.25% for VMAT (P < 0.001). The CI improved with a mean of 1.12 for VMAT and 1.31 for 5-F forward-IMRT (P < 0.001). The mean DHI improved from 1.15 for forward-IMRT to 1.08 for VMAT (P < 0.001). The mean CN improved from 0.62 for forward-IMRT to 0.87 for VMAT (P < 0.001). No significant increase in the low-dose bath (V5, V10 and mean lung dose) to the lung was seen. Significantly higher number of MUs (P < 0.001) and shorter treatment delivery times (P = 0.03) were seen with VMAT.

CONCLUSION

VMAT resulted in improvement in target volume coverage, demonstrated by PTV-V95%, CI, CN, and DHI, without any increase in the low-dose bath to the lung. For conventional fractionation, VMAT requires more MUs (P < 0.001) but has a shorter treatment delivery time (P = 0.03) per fraction.

Abstract P3-04-11: Implications of somatic TP53 and PIK3CA mutations in patients with metastatic breast cancer who underwent germline BRCA testing

Background: TP53 and PIK3CA are the most frequently mutated genes in breast cancer. However, there is limited data evaluating the impact of somatic mutations in TP53 and/or PIK3CA patients (pts) with metastatic breast cancer (MBC) who have undergone germline testing for BRCA mutations. Here, we report the frequency of somatic TP53 and PIK3CA mutations in MBC pts who previously underwent germline BRCA (gBRCA) testing and evaluate their impact on long-term outcomes.

Methods: We identified pts with MBC from our prospectively maintained high risk genetics database who underwent gBRCA testing and had somatic mutation testing performed for TP53 and/or PIK3CA through hotspot sequencing of single genes or as part of a next generation sequencing panel. Univariable logistic regression was used to evaluate associations between clinicopathological characteristics, including gBRCA status, and the presence of somatic TP53 and PIK3CA mutations. Overall survival (OS) was defined as the time from diagnosis to death from any cause. Multivariable cox regression analysis was used to identify independent predictors of OS.

Results: 104 pts met all inclusion criteria. Somatic mutations in TP53 and PIK3CA were found in 46% (39/84) and 23% (24/104) of tested pts, respectively. Associations between clinicopathological characteristics and somatic TP53 and PIK3CA mutation status are summarized in Table 1. Pts with hormone receptor positive (HR+) disease were less likely to have TP53 mutations (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11-0.70, p=0.007) but more likely to harbor PIK3CA mutations (OR: 3.27, 95% CI: 1.11-9.62, p=0.031). There were no significant associations between gBRCA mutation status and somatic TP53 or PIK3CA mutations. On multivariable analysis, somatic TP53 mutations (adjusted hazard ratio [aHR]: 1.98, 95% CI: 1.10-3.58, p=0.023) and de novo metastatic disease (aHR=2.88, 95% CI: 1.26-6.58, p=0.012) independently predicted poorer OS, while HR+ disease (aHR: 0.40, 95% CI: 0.21-0.74, p=0.004) and HER2+ disease (aHR: 0.33, 95% CI: 0.13-0.83, p=0.019) were significantly associated with improved OS. PIK3CA mutations (aHR: 1.20, 95% CI: 0.59-2.44, p=0.62) and gBRCA mutations (aHR: 0.78, 95% CI: 0.33-1.83, p=0.57) did not significantly impact OS in this study.

Conclusion: In this study, somatic TP53 mutations independently predicted worse OS in pts with MBC after adjusting for significant covariates, including gBRCA mutation status. These findings should be validated in a larger cohort of pts.

Table 1: Association between patient characteristics and somatic TP53 and PIK3CA mutation status TP53  PIK3CA   TP53 mutant (n=39)TP53 wild type (n=45)p valuePIK3CA mutant (n=24)PIK3CA wild type (n=80)p valueMedian Age – years (Interquartile Range)37 (33-47)39 (36-44)0.93739 (34-46)38 (34-43)0.494gBRCA mutant – n(%)3 (8)11 (24)0.0511 (4)15 (19)0.116ER/PR positive - n(%)17 (44)33 (73)0.00719 (79)43 (54)0.031HER2 positive - n(%)8 (21)6 (13)0.3827 (29)10 (13)0.060De Novo Metastatic – n(%)6 (15)8 (18)0.7693 (13)16 (20)0.409Visceral Disease – n(%)23 (59)26 (58)0.91215 (63)47 (59)0.743

Citation Format: Yam C, Gutierrez Barrera A, Huang D, Lin X, Litton JK, Arun B. Implications of somatic TP53 and PIK3CA mutations in patients with metastatic breast cancer who underwent germline BRCA testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-11.

Phase I/II study on stereotactic hypofractionated once-weekly radiation therapy (SHORT) for localized prostate cancer

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Background: The low α/β ratio of prostate cancer (PrCa) is well established. However, stereotactic hypofractionated radiotherapy (SRT) has been investigated primarily in highly selected patient populations with low-intermediate risk disease. We performed a clinical trial of SRT delivered in once-weekly fractions on an unselected cohort of patients with non-metastatic PrCa. Methods: In this Phase I/II study 30 patients with non-metastatic PrCa (multiparametric MRI cT1-4N0, M0, Gleason 6-10, PSA < = 60 ng/ml) were treated with SRT to a prescription dose of 35Gy in 5 fractions delivered once a week (overall treatment time 29 days). Elective nodal RT at 25Gy/5Fr was delivered in patients high-risk by NCCN criteria, and androgen deprivation therapy given to intermediate and high-risk patients. SRT was planned using volumetric intensity modulated arc therapy (VMAT) or Helical Tomotherapy (HT) with pre-defined dose-criteria. The primary endpoint was acute toxicity NCI CTC v4, and secondary endpoints were biochemical control and late toxicity. Results: Thirty patients completed treatment per-protocol. Stage T3, Gleason 8-10, and PSA > 10 was seen in 18 (60%), 7 (23%) and 24 (80%) respectively. Overall 20 (66.7%) were high-risk. Median of Mean PTV dose was 36Gy, and normal tissue constraints could be met in all patients (Table). Acute urinary toxicities (Gr 0: 1; Gr 1: 27; Gr 2: 1; Gr 3-4: 0) and acute rectal toxicities (Gr 0: 20; Gr 1: 10; Gr 2: 0; Gr 3-4: 0) were very modest. The mean IPSS scores at baseline, end of treatment and 3 months after treatment were 8.8, 14.7, and 9.9. With a median follow up of 23.7 months, the 2 year biochemical control was 96%. Late grade 2 rectal bleeding developed in 1 patient. Conclusions: Carefully planned stereotactic VMAT/HT based once-weekly SRT to a predominantly high-risk non-metastatic PrCa cohort was very well tolerated and found to be safe for clinical use. Preliminary biochemical control and late toxicity profiles are encouraging. Clinical trial information: CTRI/2016/02/006671. [Table: see text]

High-dose Neural Stem Cell Radiation May Not Improve Survival in Glioblastoma

AIMS

To evaluate the effect of radiotherapy dose-volume parameters of neural stem cell (NSC) compartment on progression-free survival (PFS) and overall survival after post-resection chemoradiation in newly diagnosed glioblastoma.

MATERIALS AND METHODS

Sixty-one patients with unifocal glioblastoma were included. Ipsilateral (NSC_Ipsi), contralateral (NSC_Contra) and combined NSC (NSC_Combined) were contoured on radiotherapy planning computerised tomography datasets. NSC dose-volume parameters were correlated with PFS and overall survival. Serial magnetic resonance imaging scans were assessed to understand the frequency of pre- and post-treatment involvement of the NSC by contrast enhancing lesions (CELs).

RESULTS

Baseline involvement of NSC with CELs was seen in 67.2% and 95.9% had CELs and FLAIR abnormalities at progression. With a median follow-up of 14.1 months (interquartile range 9.4-20.6 months), median PFS and overall survival were 14.5 (95% confidence interval 11.6-17.5) and 16.2 (95% confidence interval 13.3-19.2) months, respectively. Poor Eastern Cooperative Oncology Group performance score, advanced recursive partitioning analysis class, unmethylated O6-methylguanine methyltransferase (MGMT) status, higher than median of mean NSC_Ipsi dose were associated with significantly inferior PFS and overall survival on univariate analysis. On multivariate analysis, unmethylated MGMT status, higher than median of mean doses to NSC_Ipsi and poor compliance to adjuvant temozolomide were independent predictors of inferior survival.

CONCLUSIONS

In this cohort, 67.2% of newly diagnosed glioblastoma patients had NSC involved with CELs at presentation and 95.9% at progression. This might be an imaging surrogate of the current notion of gliomagenesis and progression from NSC rests. A high radiation dose to NSC_Ipsi was significantly associated with inferior survival. This could be a function of larger tumours and planning target volumes in those with pre-treatment NSC involvement. Methylated MGMT and good compliance to adjuvant temozolomide were independent predictors of better survival. Until further evidence brings hope for glioblastoma, elective, partial NSC irradiation remains experimental.

Effectiveness of Myofascial Release Therapy with Shoulder Taping on Subacromial Impingement Syndrome in Collegiate Basket Ball Players -A Quasi experimental Pilot study

Background: Shoulder complex dysfunction can arise when any of its components goes for malfunction. Overhead athletes cause impingement in the shoulder due to subacromial impingement or anterior instability. Myofascial tightness is found to be the common causative mechanism for the shoulder pain, though the literatures were not detailed in considering the myofascial tightness and the management.Aims & Objective: The aim of the study was to find out the effect of myofascial release therapy with shoulder taping on subacromial impingement syndrome in collegiate basketball players. Quasi experimental pilot study with 38 collegiate basketball players who participated in the university tournaments were selected for the study. 19 players in control group were under myofascial therapy whereas 19 players in experimental group underwent shoulder taping and myofascial release therapy.Result: The outcome measures were pain and functional ability. Pain was assessed using numerical pain rating scale, and functional ability was assessed using SPADI. Unrelated ‘t’ test was done to evaluate the effect of the treatment for pain value between groups is 13.9 with the p value <0.05% and SPADI scale was 13.8 with the p value <0.05%. The result shows that the myofascial release therapy with shoulder taping had more significant improvement than myofascial release therapy only.Conclusion: Study concludes that shoulder taping and myofascial release therapy helps in reducing pain and improvement of functional disability.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.347-351

Incidental germline variants in 1000 advanced cancers on a prospective somatic genomic profiling protocol

BACKGROUND

Next-generation sequencing in cancer research may reveal germline variants of clinical significance. We report patient preferences for return of results and the prevalence of incidental pathogenic germline variants (PGVs).

PATIENTS AND METHODS

Targeted exome sequencing of 202 genes was carried out in 1000 advanced cancers using tumor and normal DNA in a research laboratory. Pathogenic variants in 18 genes, recommended for return by The American College of Medical Genetics and Genomics, as well as PALB2, were considered actionable. Patient preferences of return of incidental germline results were collected. Return of results was initiated with genetic counseling and repeat CLIA testing.

RESULTS

Of the 1000 patients who underwent sequencing, 43 had likely PGVs: APC (1), BRCA1 (11), BRCA2 (10), TP53 (10), MSH2 (1), MSH6 (4), PALB2 (2), PTEN (2), TSC2 (1), and RB1 (1). Twenty (47%) of 43 variants were previously known based on clinical genetic testing. Of the 1167 patients who consented for a germline testing protocol, 1157 (99%) desired to be informed of incidental results. Twenty-three previously unrecognized mutations identified in the research environment were confirmed with an orthogonal CLIA platform. All patients approached decided to proceed with formal genetic counseling; in all cases where formal genetic testing was carried out, the germline variant of concern validated with clinical genetic testing.

CONCLUSIONS

In this series, 2.3% patients had previously unrecognized pathogenic germline mutations in 19 cancer-related genes. Thus, genomic sequencing must be accompanied by a plan for return of germline results, in partnership with genetic counseling.

Prediction of background in low-energy spectrum of Phoswich detector

In vivo monitoring of actinides in occupational workers is done using Phoswich detector by measuring the low-energy X ray and gamma rays. Quantification of actinides like plutonium and americium in the lungs is extremely difficult due to higher background in the low-energy regions, which is from ambient background as well as from the subject. In the latter case, it is mainly due to the Compton scattering of body potassium, which varies person-to-person. Hence, an accurate prediction of subject-specific background counts in the lower-energy regions is an essential element in the in vivo measurement of plutonium and americium. Empirical equations are established for the prediction of background count rate in (239)Pu and (241)Am lower-energy regions, called 'target regions', as a function of count rate in the monitoring region (97-130 keV)/(40)K region in the high-energy spectrum, weight-to-height ratio of the subject (scattering parameter) and the gender.

Effects of a green tea extract, Polyphenon E, on systemic biomarkers of growth factor signalling in women with hormone receptor-negative breast cancer

BACKGROUND

Observational and experimental data support a potential breast cancer chemopreventive effect of green tea.

METHODS

We conducted an ancillary study using archived blood/urine from a phase IB randomised, placebo-controlled dose escalation trial of an oral green tea extract, Polyphenon E (Poly E), in breast cancer patients. Using an adaptive trial design, women with stage I-III breast cancer who completed adjuvant treatment were randomised to Poly E 400 mg (n = 16), 600 mg (n = 11) and 800 mg (n = 3) twice daily or matching placebo (n = 10) for 6 months. Blood and urine collection occurred at baseline, and at 2, 4 and 6 months. Biological endpoints included growth factor [serum hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF)], lipid (serum cholesterol, triglycerides), oxidative damage and inflammatory biomarkers.

RESULTS

From July 2007-August 2009, 40 women were enrolled and 34 (26 Poly E, eight placebo) were evaluable for biomarker endpoints. At 2 months, the Poly E group (all dose levels combined) compared to placebo had a significant decrease in mean serum HGF levels (-12.7% versus +6.3%, P = 0.04). This trend persisted at 4 and 6 months but was no longer statistically significant. For the Poly E group, serum VEGF decreased by 11.5% at 2 months (P = 0.02) and 13.9% at 4 months (P = 0.05) but did not differ compared to placebo. At 2 months, there was a trend toward a decrease in serum cholesterol with Poly E (P = 0.08). No significant differences were observed for other biomarkers.

CONCLUSIONS

Our findings suggest potential mechanistic actions of tea polyphenols in growth factor signalling, angiogenesis and lipid metabolism.

Abstract P2-16-05: Efficacy of ABT-888 (veliparib) in patients with BRCA-associated breast cancer

Background: The potential for exploiting BRCA deficiencies with DNA repair inhibitors has both pre-clinical and clinical support. ABT-888 (veliparib), a DNA repair inhibitor initially thought to target Poly(ADP-Ribose) Polymerases (PARP), has demonstrated in vitro inhibition of BRCA1 and BRCA2 deficient mouse embryonic stell cells, with a larger effect on BRCA1 cells. We report on the pre-planned interim analysis of the efficacy of single agent veliparib in patients with either BRCA1 or BRCA2-associated stage IV breast cancer. Methods: BRCA 1 or 2 carrier patients with stage IV breast cancer, with measurable disease, without prior exposure to a PARP inhibitor or a platinum compound in the metastatic setting, were eligible. Velapirib was administered orally, at doses of 400 mg twice daily. Dose adjustments based on toxicity were permitted. Patients progressing on velapirib alone received carboplatin at an AUC of 5, IV, given Q 21 days, and velapirib 150 mg twice daily (the maximum tolerated dose [MTD] of the combination from our completed Phase I study: J Clin Oncol 30, 2012 [suppl; abstr 1024]). Patients were to be accrued from 7 NCI NO1- supported consortia. Initially 10 patients were to be accrued to each stratum (BRCA1 and BRCA2) to provide evidence of single agent activity. If there was sufficient activity to warrant consideration of velapirib as single agent therapy (defined as 2 or more confirmed partial [PR] or better responses out of 10 per stratum), an additional 12 patients would be accrued per stratum. Results: 20 evaluable patients (11 BRCA1 and 9 BRCA2 [1 in screening]) have been accrued, the majority with lung or liver as visceral metastatic sites of disease. Median age (range) is 46 (29-68) years. Tumors from 9 patients were hormone receptor positive. BRCA1 cohort: 4 of 11 patients are off treatment at a median of 2 months (1-4); 1 patient stopped velapirib due to toxicity (grade 2 rash/pruritus, grade 2 vomiting), 3 stopped for progressive disease (one with an unconfirmed PR). Seven patients are still on single agent veliparib with 1 unconfirmed PR, and 1 patient with two evaluations showing stable disease. BRCA2 cohort: 2 patients are off treatment at 2 months for progressive disease, 7 are still on treatment with 1 confirmed PR, and 3 unconfirmed PRs. Data on patients receiving combination of velapirib and carboplatin after progression is too early. Treatment-related toxicity is being updated and has so far been reported from 14 patients: 1 patient had grade 3 fatigue, 1 patient with liver metastasis had both grade 3 alanine aminotransferase elevation and grade 3 abdominal pain. Grade 2 toxicities occurring in more than 1 patient included nausea/vomiting (6 patients), chills (2 patients), and fatigue (2 patients). Conclusion: Velapirib has single agent activity in both BRCA1 and BRCA2-associated stage IV breast cancer patients, and is well-tolerated. Mature response, treatment, and toxicity data will be presented.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-05.

Abstract P6-12-02: Survival differences between patients with metastatic inflammatory and non-inflammatory breast cancer

Background: Very little is known about the survival of patients with inflammatory breast cancer (IBC) and distant metastasis. Furthermore, the American Joint Committee on Cancer classification of breast cancer does not recognize metastatic IBC as a distinct entity within stage IV. We hypothesized that the survival of patients with IBC and distant metastasis is worse than the survival of patients with stage-matched non-IBC.

Patients and Methods: We retrospectively reviewed 5314 consecutive patients with stage III or IV breast cancer (IBC or non-IBC) who were treated at our institution between 1986 and 2012. A total of 1079 patients presented with IBC (stage III: 861; stage IV: 218) and 4235 non-IBC (stage III: 2781; stage IV: 1454). We compared the time to distant metastasis from initial diagnosis, distant metastasis–free survival (DMFS), and overall survival (OS) in stage-matched patients with IBC or non-IBC.

Results: The median follow-up periods were 3.3 years for patients with stage III disease (range, 0-32.2 years) and 1.8 years for patients with stage IV disease (range, 0-19.9 years). The total number of recorded events (metastasis/death) was 1657 for stage III, while the numbers of deaths for stage III and IV were 1337 and 973, respectively. In patients with stage III, the time to distant metastasis was shorter in IBC than in non-IBC (median 1.3 vs. 1.7 years, P &lt; .001). DMFS and OS were shorter in patients with stage III IBC than in those with stage III non-IBC (2.5 vs. 6.9 years, P &lt; .001; and 4.7 vs. 8.9 years, P &lt; .001; respectively). However, there was no significant difference in OS after development of distant metastasis between stage III IBC and non-IBC (median for both 1.3 years, P = .83). In multivariate analysis, the diagnosis of IBC remained significantly associated with mortality after adjusting for potential confounders. De novo stage IV IBC presented more frequently with multiple sites of metastasis than de novo stage IV non-IBC (P = .02). In patients with de novo stage IV disease, OS was shorter in IBC than in non-IBC (2.3 vs. 3.4 years, P = .004). In the multicovariate Cox model, while ethnicity, tumor grade, hormone receptor status and HER2 status, site of metastasis, number of sites of metastasis, and definitive breast surgery by 1 year were all significant factors in OS for stage IV breast cancer, the diagnosis of IBC conferred a hazard ratio of 1.33 (95% confidence interval: 1.05 - 1.69) in multivariate analysis.

Conclusion: Our findings suggest that IBC patients with metastasis at diagnosis have worse outcomes than stage-matched non-IBC patients. IBC patients presenting with de novo stage IV disease should be considered as a separate subcategory of stage IV in the tumor-node-metastasis classification because their clinical course and prognosis are different from those of patients with stage IV non-IBC.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-12-02.

Abstract P5-13-03: Factors associated with prophylactic mastectomy among BRCA-positive patients with no personal history of breast cancer

Background: The rate of prophylactic mastectomy (PM) has recently increased1. A deleterious mutation in the BRCA1 or BRCA 2 genes is among the major reasons why patients pursue PM 2, 3. Women with BRCA1 or BRCA2 gene mutations have up to an 87% risk to develop an invasive breast cancer (BC), and up to 45% risk for ovarian cancer (OC)2, 3. Most studies evaluating predictors of PM in BRCA mutation carriers are performed among women with breast cancer; however, accurate predictors for PM among unaffected BRCA mutation carriers are less defined. In a single institution study we aimed to evaluate predictors of PM among BRCA carriers with no personal history of breast cancer.

Method: One hundred seventy seven women with no personal history of BC, who tested positive for a BRCA1 or BRCA 2 germline mutation, were included in the study. Patients’ characteristics were obtained from a prospectively maintained research database under an IRB approved protocol at UT MD Anderson Cancer Center. Univariate analyses using chi-square and logistic regression analysis were used to determine predictive factors associated with PM. The patient characteristics examined included age, martial and educational status, bilateral salphingo-oophorectomy (BSO), family history of 1st and 2nd degree relatives with breast (BC) and ovarian cancer (OC), race, and BRCA genetic test result.

Results: Out of the 177 BRCA1 and BRCA 2 positive patients, 51 (29%) elected for PM. The average age for the cohort was 44 years (range 23-91). The majority were Caucasian (81%), and married (72%) with a college degree (64%). One hundred sixty-four (92%) patients had 1st and 2nd degree relatives with BC, 93 (53%) had 1st and 2nd degree relatives with OC, and 85 (48%) had undergone BSO. A logistic regression model was run to identify factors associated with undergoing PM, including family history of OC, family history of BC, BSO and age. Patients with a family history of OC were 2.5 times more likely than those without to have had a PM (p = 0.0125), and patients who had a BSO were 0.137 times less likely to have had a PM (p &lt;.0001). Only 12 patients did not have a family history of BC and none of those patients had a PM, so an Odds Ratio could not be calculated. However, it was determined through the Fisher's exact test that patients with a family history of BC were more likely to undergo a PM (p = 0.0198).

Conclusion: The rate of PM in our cohort was slightly lower than expected. Factors associated with PM included a family history of BC and OC. Interestingly, having had a BSO was associated with lower likelihood of undergoing PM (menopausal status will be further evaluated); possibly due to the knowledge that BSO reduces breast cancer risk.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-03.

Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial

OBJECTIVE

Although chemotherapy-induced cognitive impairment is common among breast cancer patients, evidence for effective interventions addressing cognitive deficits is limited. This randomized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation (TSM) program to improve cognitive function and quality of life in breast cancer patients.

METHODS

Forty-seven breast cancer patients (mean age 56.3 years), who were staged I-III at diagnosis, 6-60 months post-chemotherapy, and reported cognitive impairment at study entry were recruited. Participants were randomized to either two weekly TSM sessions for 6 weeks or a wait list control group. Neuropsychological assessments were completed at baseline and 1 month post-treatment. Self-report measures of cognitive function (Functional Assessment of Cancer Therapy (FACT)-Cog), quality of life (SF-36), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep disturbance (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and spirituality (FACT-Sp) were completed at baseline, the end of treatment, and 1 month later.

RESULTS

Relative to the control group, women in the TSM group performed better on the verbal memory test (Rey Auditory Verbal Learning Test trial 1) (p = 0.06) and the short-term memory and processing speed task (Digit Symbol) (p = 0.09) and reported improved cognitive function (p = 0.06), cognitive abilities (p = 0.08), mental health (p = 0.04), and spirituality (p = 0.05) at the end of treatment but not 1 month later.

CONCLUSIONS

This randomized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short-term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients.