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Holmes D, Iyengar G. Breast Cancer Cryoablation in the Multidisciplinary Setting: Practical Guidelines for Patients and Physicians. Life (Basel) 2023; 13:1756. [PMID: 37629613 PMCID: PMC10456083 DOI: 10.3390/life13081756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Breast cancer cryoablation has emerged as a minimally invasive alternative to lumpectomy for treating early-stage breast cancer. However, no consensus exists on what should be considered the standard of care for the multidisciplinary management of patients treated with breast cancer cryoablation. In lieu of national guidelines, this review of the literature provides a multidisciplinary framework and an evidence-based discussion of the integration of "standard of care practices" in the comprehensive management of breast cancer cryoablation patients.
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Affiliation(s)
- Dennis Holmes
- Adventist Health Glendale, 1505 Wilson Terrace, Suite 370, Glendale, CA 91206, USA
| | - Geeta Iyengar
- Medical Imaging Center of Southern California, 8727 Beverly Blvd., Beverly Hills, CA 90048, USA
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Chawla SP, Olevsky O, Iyengar G, Brigham DA, Omelchenko N, Thomas S, Suryamohan K, Foshag L, Hall FL, Gordon EM. Early-stage CCNG1+ HR+ HER2+ Invasive Breast Carcinoma in Older Women: Current Treatment and Future Perspectives for DeltaRex-G, a CCNG1 Inhibitor. Anticancer Res 2023; 43:2383-2391. [PMID: 37247916 DOI: 10.21873/anticanres.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
Women with HR+HER2+ early-stage breast cancer are disadvantaged by the lack of clinical trials focused on women ≥70 years of age. In the past years, there has been increasing controversy on the use of toxic chemotherapy as standard of care treatment for early- stage HR+ HER2+ breast carcinoma in older women. With precision medicine coming of age, molecular profiling of tumors and circulating tumor DNA has identified target oncogenes that could be used in designing an optimal treatment for this group of women. This article reviews the current treatment of early-stage triple receptor positive breast cancer, the risks of chemotherapy in older women, and CCNG1, a novel biomarker in development for the use of DeltaRex-G, a CCNG1 inhibitor. Further, future perspectives for DeltaRex-G in older women with early stage CCNG1+ HR+ HER2+ breast cancer are discussed.
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Affiliation(s)
- Sant P Chawla
- Cancer Center of Southern California, Santa Monica, CA, U.S.A
| | - Olga Olevsky
- UCLA David Geffen School of Medicine, Santa Monica, CA, U.S.A
| | - Geeta Iyengar
- Medical Imaging Center of Southern California, Santa Monica, CA, U.S.A
| | - Don A Brigham
- Cancer Center of Southern California, Santa Monica, CA, U.S.A
- Aveni Foundation, Santa Monica, CA, U.S.A
| | | | - Sonu Thomas
- Cancer Center of Southern California, Santa Monica, CA, U.S.A
| | | | - Leland Foshag
- Saint John's Cancer Institute, Santa Monica, CA, U.S.A
| | | | - Erlinda M Gordon
- Cancer Center of Southern California, Santa Monica, CA, U.S.A.;
- Aveni Foundation, Santa Monica, CA, U.S.A
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Neu E, Michailov M, Birkenbihl P, Bauer H, Gornik E, Hofstetter A, Iyengar G, Luetge C, Martin D, Schratz M, Weber G, Weissenbacher E, Welscher U, Weiss D, Zoepfl H. On neurology and policy. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Banks A, Coronado G, Zimmerman R, Iyengar G, Holmes DR. Breast conserving surgery with targeted intraoperative radiotherapy for the management of ductal carcinoma in situ. J Surg Oncol 2018; 119:409-420. [DOI: 10.1002/jso.25347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/07/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra Banks
- Department of Surgery; Helen Rey Breast Cancer Research Foundation; Los Angeles California
| | - Gerald Coronado
- Department of Surgery; Helen Rey Breast Cancer Research Foundation; Los Angeles California
| | - Robert Zimmerman
- Department of Radiation Oncology; Los Angeles Radiation Oncology Center; Los Angeles California
| | - Geeta Iyengar
- Department of Radiology; Medical Imaging Center of Southern California; Santa Monica California
| | - Dennis R. Holmes
- Department of Surgery; Helen Rey Breast Cancer Research Foundation; Los Angeles California
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Rivera R, Banks A, Casillas-Lopez A, Rashtian A, Lewinsky B, Sheth P, Hovannesian-Larsen L, Brousseau D, Iyengar G, Holmes DR. Targeted Intraoperative Radiotherapy for the Management of Ductal Carcinoma In Situ of the Breast. Breast J 2015; 22:63-74. [PMID: 26534876 DOI: 10.1111/tbj.12516] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Multiple long-term studies have demonstrated a propensity for breast cancer recurrences to develop near the site of the original breast cancer. Recognition of this local recurrence pattern laid the foundation for the development of accelerated partial breast irradiation (APBI) approaches designed to limit the radiation treatment field to the site of the malignancy. However, there is a paucity of data regarding the efficacy of APBI in general, and intraoperative radiotherapy (IORT), in particular, for the management of ductal carcinoma in situ (DCIS). As a result, use of APBI, remains controversial. A prospective nonrandomized trial was designed to determine if patients with pure DCIS considered eligible for concurrent IORT based on preoperative mammography and contrast-enhanced magnetic resonance imaging (CE-MRI) could be successfully treated using IORT with minimal need for additional therapy due to inadequate surgical margins or excessive tumor size. Between November 2007 and June 2014, 35 women underwent bilateral digital mammography and bilateral breast CE-MRI prior to selection for IORT. Patients were deemed eligible for IORT if their lesion was ≤4 cm in maximal diameter on both digital mammography and CE-MRI, pure DCIS on minimally invasive breast biopsy or wide local excision, and considered resectable with clear surgical margins using breast-conserving surgery (BCS). Postoperatively, the DCIS lesion size determined by imaging was compared with lesion size and surgical margin status obtained from the surgical pathology specimen. Thirty-five patients completed IORT. Median patient age was 57 years (range 42-79 years) and median histologic lesion size was 15.6 mm (2-40 mm). No invasive cancer was identified. In more than half of the patients in our study (57.1%), MRI failed to detect a corresponding lesion. Nonetheless, 30 patients met criteria for negative margins (i.e., margins ≥2 mm) whereas five patients had positive margins (<2 mm). Two of the five patients with positive margins underwent mastectomy due to extensive imaging-occult DCIS. Three of the five patients with positive margins underwent successful re-excision at a subsequent operation prior to subsequent whole breast irradiation. A total of 14.3% (5/35) of patients required some form of additional therapy. At 36 months median follow-up (range of 2-83 months, average 42 months), only two patients experienced local recurrences of cancer (DCIS only), yielding a 5.7% local recurrence rate. No deaths or distant recurrences were observed. Imaging-occult DCIS is a challenge for IORT, as it is for all forms of breast-conserving therapy. Nonetheless, 91.4% of patients with DCIS were successfully managed with BCS and IORT alone, with relatively few patients requiring additional therapy.
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Affiliation(s)
- Ronald Rivera
- University of California, Los Angeles - David Geffen School of Medicine, Los Angeles, California
| | - Alexandra Banks
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
| | - America Casillas-Lopez
- University of Southern California - Norris Comprehensive Cancer Center, Los Angeles, California
| | - Afshin Rashtian
- Cancer Center Riverside Community Hospital, Los Angeles, California
| | - Bernie Lewinsky
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
| | - Pulin Sheth
- University of Southern California - Norris Comprehensive Cancer Center, Los Angeles, California
| | | | - David Brousseau
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
| | - Geeta Iyengar
- Medical Imaging Center of Southern California, Los Angeles, California
| | - Dennis R Holmes
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
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Gilbert FJ, Astley SM, Boggis CR, McGee MA, Griffiths PM, Duffy SW, Agbaje OF, Gillan MG, Wilson M, Jain AK, Barr N, Beetles UM, Griffiths MA, Johnson J, Roberts RM, Deans HE, Duncan KA, Iyengar G. Variable size computer-aided detection prompts and mammography film reader decisions. Breast Cancer Res 2008; 10:R72. [PMID: 18724867 PMCID: PMC2575546 DOI: 10.1186/bcr2137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/21/2008] [Accepted: 08/25/2008] [Indexed: 11/12/2022] Open
Abstract
Introduction The purpose of the present study was to investigate the effect of computer-aided detection (CAD) prompts on reader behaviour in a large sample of breast screening mammograms by analysing the relationship of the presence and size of prompts to the recall decision. Methods Local research ethics committee approval was obtained; informed consent was not required. Mammograms were obtained from women attending routine mammography at two breast screening centres in 1996. Films, previously double read, were re-read by a different reader using CAD. The study material included 315 cancer cases comprising all screen-detected cancer cases, all subsequent interval cancers and 861 normal cases randomly selected from 10,267 cases. Ground truth data were used to assess the efficacy of CAD prompting. Associations between prompt attributes and tumour features or reader recall decisions were assessed by chi-squared tests. Results There was a highly significant relationship between prompting and a decision to recall for cancer cases and for a random sample of normal cases (P < 0.001). Sixty-four per cent of all cases contained at least one CAD prompt. In cancer cases, larger prompts were more likely to be recalled (P = 0.02) for masses but there was no such association for calcifications (P = 0.9). In a random sample of 861 normal cases, larger prompts were more likely to be recalled (P = 0.02) for both mass and calcification prompts. Significant associations were observed with prompting and breast density (p = 0.009) for cancer cases but not for normal cases (P = 0.05). Conclusions For both normal cases and cancer cases, prompted mammograms were more likely to be recalled and the prompt size was also associated with a recall decision.
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Affiliation(s)
- Fiona J Gilbert
- Division of Applied Medicine, School of Medicine & Dentistry, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Duffy SW, Nagtegaal ID, Astley SM, Gillan MGC, McGee MA, Boggis CRM, Wilson M, Beetles UM, Griffiths MA, Jain AK, Johnson J, Roberts R, Deans H, Duncan KA, Iyengar G, Griffiths PM, Warwick J, Cuzick J, Gilbert FJ. Visually assessed breast density, breast cancer risk and the importance of the craniocaudal view. Breast Cancer Res 2008; 10:R64. [PMID: 18651965 PMCID: PMC2575537 DOI: 10.1186/bcr2123] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 06/20/2008] [Accepted: 07/23/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mammographic density is known to be a strong risk factor for breast cancer. A particularly strong association with risk has been observed when density is measured using interactive threshold software. This, however, is a labour-intensive process for large-scale studies. METHODS Our aim was to determine the performance of visually assessed percent breast density as an indicator of breast cancer risk. We compared the effect on risk of density as measured with the mediolateral oblique view only versus that estimated as the average density from the mediolateral oblique view and the craniocaudal view. Density was assessed using a visual analogue scale in 10,048 screening mammograms, including 311 breast cancer cases diagnosed at that screening episode or within the following 6 years. RESULTS Where only the mediolateral oblique view was available, there was a modest effect of breast density on risk with an odds ratio for the 76% to 100% density relative to 0% to 25% of 1.51 (95% confidence interval 0.71 to 3.18). When two views were available, there was a considerably stronger association, with the corresponding odds ratio being 6.77 (95% confidence interval 2.75 to 16.67). CONCLUSION This indicates that a substantial amount of information on risk from percentage breast density is contained in the second view. It also suggests that visually assessed breast density has predictive potential for breast cancer risk comparable to that of density measured using the interactive threshold software when two views are available. This observation needs to be confirmed by studies applying the different measurement methods to the same individuals.
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Affiliation(s)
- Stephen W Duffy
- Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK.
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Sanchetee P, Venkataraman S, Mohan C, Shetty DD, Iyengar G. Basal ganglia calcification. J Assoc Physicians India 1999; 47:507-9. [PMID: 10778562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Basal ganglia calcification (BGC) is now being diagnosed with increasing frequency with widespread application of computed tomography (CT) in clinical practice and is no more considered a rarity. During the period 1987 to 1995, 42 patients were noted to have BGC and it constituted 0.93% of all CT scan of brain carried out during the relevant period. These patients presented with diverse neurological and endocrine disorders i.e., epilepsy (22 patients), mental retardation (five patients), extra-pyramidal syndromes (five patients), abnormal behaviour (three patients), stroke (two patients), raised intracranial tension without localizing signs (one patient), following radiotherapy (one patient), and with hypoparathyroidism (three patients). These patients were noted to have variable degree of calcification in different parts of brain i.e., basal ganglia (42 cases), cerebellum (12 cases) and cerebral cortex (nine cases). Family history of a neurological disorder was available in five patients. This study highlights the fact that calcification of basal ganglia and other parts of the brain is often a nonspecific finding on CT scan and it may not be possible to establish a clinicopathological correlation.
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Affiliation(s)
- P Sanchetee
- Department of Medicine, Neurology, Radiology, Armed Forces Medical College, Pune
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