Abstract P2-12-06: Re-excision rates in breast conserving surgery for invasive breast cancer after neoadjuvant chemotherapy with and without the use of a radiopaque tissue transfer and X-ray system

Background: Published re-excision rates after breast conserving surgery for invasive breast cancer vary between 20 and 50%. In patients after neoadjuvant chemotherapy even higher re-excision rates may result from difficulties in defining the surgical target particularly in cases with excellent treatment response. Specimen radiography is reducing re-excision rates, however, defining involved margins is often difficult using standard approaches. Devices allowing horizontal and vertical examination and an exact topographic localization of the lesion in the resected tissue could reduce re-excision rates by an intraoperative detection of involved margins.

Methods: 80 patients with invasive breast cancer receiving breast conserving surgery after neoadjuvant chemotherapy and an indication for wire marking by mammography were included in this analysis. All tumors were marked with titanium clips prior to chemotherapy. In 40 patients specimen radiography was performed in a standard approach (control group), in 40 patients a tissue transfer and X-ray system based on a non-radiopaque board with radiopaque topographic markers and a stand for cranio-caudal X-rays was used (study group). A univariate analysis was carried out to evaluate the association between the use of the radiopaque tissue transfer system and the re-excision rate using a logistic regression model. Calculations were performed using the XLSTAT Biomed Software (Version 19.03, Addinsoft, NY, USA.).

Results: 19/80 patients (23.75%) required re-excision because of involved margins; among those patients, 14/40 (35%) were in the control group and 5/40 (12.5%) in the study group. The association between the use of the radiopaque tissue transfer system and the lower re-excision rate was statistically significant (p=0.023).

Conclusion: Our analysis provides a rationale for the use of a radiopaque tissue transfer system for specimen radiography in breast conserving surgery after neoadjuvant chemotherapy for invasive breast cancer in order to reduce re-excision rates. Based on these results we are planning a study including also patients receiving primary surgery.

Citation Format: Kolberg H-C, Akpolat-Basci L, Stephanou M, Wetzig S, Cubuk Y, Gerharz J, Liedtke C. Re-excision rates in breast conserving surgery for invasive breast cancer after neoadjuvant chemotherapy with and without the use of a radiopaque tissue transfer and X-ray system [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 P2-12-06.

Abstract P2-01-35: A one-day protocol with activities lower than 20 MBq for the detection of sentinel lymph nodes - Experience after 150 cases

Introduction:

Common protocols for the detection of sentinel lymph nodes (SLN) in early breast cancer often include injection of the tracer one day before surgery. In order to detect enough activity on the day of surgery, the applied activity in many protocols is as high as several hundred MBq. Even in common one-day protocols the activity applied is often up to 50 MBq. We developed a one-day protocol with a mean activity lower than 20 MBq in order to reduce radiation exposure for patients and staff. Here we are presenting our experience after 150 cases.

Material and methods:

150 patients with clinically and sonographically negative axilla (cN0) and no multicentricity underwent a SLN biopsy using a low-dose protocol performed on the day of surgery. After ultrasound-guided injection of the tracer (Technetium99) lymphoscintigraphy was performed in all cases. 7 minutes before the first cut 5 ml blue dye was injected in the region of the areola. Fresh-frozen sections of the SLN(s) were not performed.

Results:

In 149 of 150 patients (99.3%) at least one SLN could be identified by lymphoscintigraphy. The detection rate during surgery with combined tracers Technetium99 and blue dye was 100%. The mean applied activity was 17.8 MBq (9-20). A mean number of 1.3 (0-5) SLNs were identified by lymphoscintigraphy, a mean number of 1.7 (1-5) SLNs were removed during sentinel lymph node biopsy. 36 patients received a secondary axillary dissection according to the historical standard because of involved SLNs. In 11 cases (30.6%) additional involved lymph nodes were found.

Conclusion:

One-day protocols with an activity lower than 20 MBq are a safe alternative to two-day protocols with significantly higher radiation doses. Using Technetium99 and blue dye in a dual tracer approach, detection rates of 100% are possible in clinical routine with minimal radiation exposure for patients and staff. The number of removed lymph nodes, the rate of secondary axillary dissections and the number of cases with additional involved lymph nodes is not higher than in published trials.

Citation Format: Kolberg H-C, Afsah S, Winzer U, Akpolat-Basci L, Stephanou M, Liedtke C. A one-day protocol with activities lower than 20 MBq for the detection of sentinel lymph nodes - Experience after 150 cases [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-35.

Abstract P4-14-06: Neoadjuvant chemotherapy with docetaxel, carboplatin and weekly trastuzumab (TCH) is active in HER2-positive early breast cancer: Results after a median follow-up of over 4 years

Background:

HER2-positive breast cancer is known to carry an adverse prognosis compared to HER2-negative disease, which may however be compensated by the use of HER2-targeted agents. Therefore, most patients with HER2-positive disease larger than 5 mm receive chemotherapy and trastuzumab. Data from adjuvant trials have shown that the combination of docetaxel, carboplatin and weekly trastuzumab (TCH) is well tolerated and as effective as anthracycline containing regimes. Previous investigations on neoadjuvant treatment with TCH showed pCR-rates in the range of 40%, however, survival data have not yet been presented. Here we present 4-year follow-up data for a cohort of 51 patients treated with neoadjuvant TCH.

Methods:

We treated 51 patients with operable HER2-positive breast cancer with a neoadjuvant schedule of docetaxel (75 mg/m2) and carboplatin (AUC 6) q3w and trastuzumab (2(4)mg/kg) q1w. Lymph node involvement was verified by SLNB or core-cut-biopsy. Patients were diagnosed at a mean age of 55 years, 68.6% had ER positive tumors, 39.2% presented with grade 3 disease and 49% of patients were node-positive. Patients were monitored every two cycles by ultrasound. After 6 cycles of chemotherapy all patients had surgery. Axillary dissection was performed in case of positive lymph node status prior to TCH. After surgery trastuzumab was continued q3w up to one year.

Results:

In 50 patients TCH could be administered as planned without dose reductions or delays. One patient suffered from an allergic reaction on taxane after the second cycle, resulting in replacement by gemcitabine. Side effects were mild, no grade III/IV toxicities occurred and no case of cardiomyopathia was observed. 21 (41.18%) patients achieved a pCR, 18 (72.0%) patients converted from cN+ to ypN0. Outcome data at a median follow-up of 51.6 months are as follows.

 All patients (n=51)pCR (n=21)N+ (n=25)cN+ → ypN0 (n=18)ER positive (n=35)G3 (n=20)DFS (n/%)42/82.3517/80.9517/68.016/88.8931/88.5716/80.0DDFS (n/%)46/90.219/90.4820/80.017/94.4433/94.2918/90.0OS (n/%)48/94.1821/100.022/88.018/100.034/97.1419/95.0

Conclusion:

Outcome following neoadjuvant TCH as observed in our analysis compares well to outcome data observed in adjuvant trastuzumab trials such as HERA (4-year follow-up; DFS 78.6% and OS 89.3%) or BCIRG006 (36-month follow-up; DFS 82% and OS 91% in the TCH-arm). Particularly among patients with ER positive disease and those experiencing axillary conversion we obseverd an excellent outcome. Importantly, TCH was well tolerated in our cohort. Therefore our data support the use of TCH as neoadjuvant therapy regimen for patients with HER-positive breast cancer. They also strongly encourage the use of docetaxel and carboplatin as chemotherapy backbone in studies investigating the dual blockade with trastuzumab and pertuzumab in the neoadjuvant setting.

Citation Format: Kolberg H-C, Akpolat-Basci L, Stephanou M, Hannig CV, Liedtke C. Neoadjuvant chemotherapy with docetaxel, carboplatin and weekly trastuzumab (TCH) is active in HER2-positive early breast cancer: Results after a median follow-up of over 4 years. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-06.

Seasonal variations in UV-B absorbing capacity and allelopathic potential of Dittrichia viscosa leaf rinsates

The seasonal variations in the amount and the allelopathic potential of the water-soluble, leaf epicuticular exudates in the Mediterranean ruderal Dittrichia viscosa were investigated. Both parameters peaked during the dry, hot, and sunny summer, confirming the prediction that the seasonal fluctuations should be commensurate with the ascribed antitranspirant and phytotoxic functions. In particular, the drainage of the material to the soil with the heavy autumn rains provides excellent timing for exerting its strong allelopathic interference on seed germination, affording D. viscosa a considerable competitive advantage. Key words: allelopathy, Dittrichia viscosa, leaf rinsates, seasonal variations.