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Gamble D, Khan H, Ross J, Cheyne L, Rudd A, Horgan G, Hannah A, Urquhart G, Masannat Y, Elsberger B, Sharma R, Dawson D. Energetic and myocellular pathways in cardiac and skeletal muscle following anthracycline chemotherapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anthracycline-related cardiac dysfunction is a recognised consequence of cancer therapies. Here we assess resting cardiac and skeletal muscle energic status as an early mechanistic pathway of myocyte derangement and explore molecular targets of skeletal myocyte metabolism, protein synthesis/degradation and mitochondrial biogenesis signalling.
Methods
We conducted a prospective, mechanistic, observational, longitudinal study of chemotherapy-naive breast cancer patients undergoing anthracycline-based chemotherapy, compared to a healthy control group. 31P-Magnetic Resonance spectroscopy in cardiac and skeletal muscle (phosphocreatine/gamma adenosine triphosphate (PCr/yATP) and inorganic phosphate/phosphocreatine (Pi/PCr) ratios respectively), cardiac magnetic resonance (CMR) imaging inclusive of T1 and T2 mapping, echocardiography-derived global longitudinal strain function, serum NT-pro-BNP and skeletal muscle biopsies from the right vastus lateralis were assessed before and after 3 cycles of Flurouracil, Epirubicin and Cyclophosphamide followed by 3 cycles of Docetaxel. Statistical significance was set at p<0.05.
Results
Twenty-five female breast cancer patients (median age 53 years, range 32–74 years) receiving a mean epirubicin dose 307 mg/m2) and twenty-eight controls (median age 44 years, range 23–65) were recruited. All study assessments in breast cancer patients at pre-chemotherapy stage were comparable to the matched healthy controls. However, following chemotherapy, breast cancer patients demonstrated a small but significant reduction in cardiac function (global longitudinal strain −22.9±3.9 vs −19.1±3.3%, p=0.01 and CMR-derived ejection fraction 65±5 vs 62±4%, p=0.047), a mild increase in CMR-derived indexed left ventricular volumes (end diastolic 65±10 vs 74±11 ml/m2, p=0.014 and end systolic 23±5 vs 28±5 ml/m2, p=0.01) as well as an increase in left ventricular T1 and T2-mapping (1289±29 vs 1321±31 ms, p=0.004 and 50±4 vs 55±7 ms, p=0.027, respectively) and serum NT-Pro-BNP (49±25 vs 108±84 pg/m, p=0.008). After epirubicin, there was significant reduction in cardiac PCr/yATP ratio (2.0±0.7 vs 1.2±0.6, p=0.007) and a significant increase in skeletal muscle Pi/PCr ratio (0.13±0.04 vs 0.22±0.2, p=0.008) – Figure 1.
Following chemotherapy, there was significant upregulation of skeletal myocyte protein synthesis (mammalian target of rapamycin, 0.44±0.4 vs 0.53±0.2, p<0.001) and degradation (Calcium/calmodulin dependent protein kinase II, 1.4±0.7 vs 2.7±1.1, p<0.001), metabolism (peroxisome proliferator-activated receptor gamma, 0.35±0.2 vs 0.60±0.1, p<0.001) and muscle mass regulator myostatin-2 (0.16±0.1 vs 0.24±0.1, p<0.001).
Conclusion
Contemporary doses of epirubicin for breast cancer result in significant reduction of cardiac and skeletal muscle high energy 31P-metabolism alongside skeletal myocellular alterations of protein synthesis and metabolic regulation pathways.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Tenovus ScotlandNHS Grampian Endowment fund
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Affiliation(s)
- D Gamble
- University of Aberdeen , Aberdeen , United Kingdom
| | - H Khan
- University of Aberdeen , Aberdeen , United Kingdom
| | - J Ross
- University of Aberdeen , Aberdeen , United Kingdom
| | - L Cheyne
- University of Aberdeen , Aberdeen , United Kingdom
| | - A Rudd
- University of Aberdeen , Aberdeen , United Kingdom
| | - G Horgan
- University of Aberdeen , Aberdeen , United Kingdom
| | - A Hannah
- Aberdeen Royal Infirmary, cardiology , Aberdeen , United Kingdom
| | - G Urquhart
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - Y Masannat
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - B Elsberger
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - R Sharma
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - D Dawson
- University of Aberdeen , Aberdeen , United Kingdom
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Masannat YA, Agrawal A, Maraqa L, Fuller M, Down SK, Tang SSK, Pang D, Kontos M, Romics L, Heys SD. Multifocal and multicentric breast cancer, is it time to think again? Ann R Coll Surg Engl 2020; 102:62-66. [PMID: 31891668 PMCID: PMC6937617 DOI: 10.1308/rcsann.2019.0109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/22/2022] Open
Abstract
Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.
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Affiliation(s)
- YA Masannat
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - A Agrawal
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - L Maraqa
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Fuller
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - SK Down
- James Paget University Hospitals NHS Foundation Trust, Great, UK
- University of East Anglia, Norwich Medical School, Athens, Greece
| | - SSK Tang
- St George’s University Hospitals NHS Foundation Trust, London, UK
| | - D Pang
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - M Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | - L Romics
- New Victoria Hospital and Queen Elizabeth University Hospital, Glasgow, UK
| | - SD Heys
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
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Romics L, Macaskill J, Fernandez T, Morrow E, Simpson L, Pitsinis V, Barber M, Tovey S, Masannat Y, Young O, Mansell J, Stallard S, Doughty J, Dixon M. Abstract P4-13-01: Oncoplastic breast conservations – The Scottish Audit: Surgical techniques, oncological outcomes, complication rates and variations in practice across the country based on the analysis of 589 patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-13-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. We studied the outcomes of OBC practice in Scotland and compare individual breast units.
Methods: a predefined database of patients treated with OBC was completed retrospectively in 11 breast units in Scotland. Patients were treated with OBC from 2005 onwards were included. For statistical calculations Chi-test, ANOVA and Pearson correlation analysis were used.
Results: Altogether 589 patients were included. Median age was 56 years [21-86]. Patients were diagnosed between September 2005 and March 2017. Number of patients treated with OBC per unit ranged between 4 and 145. High volume units were doing a mean of 19.3 OBCs per year [17.3 – 26.5] vs. low volume units doing 11.1 OBCs per year [7 .7– 14.4] (p=0.012).
23 different oncoplastic surgical techniques were applied. Range of oncoplastic techniques used was associated with case-loads: high volume units used a wider range (8 – 14 different techniques) compared to low volume units (3 – 6) (p=0.004). Volume displacement was done in 515 patients (91.3%), volume replacement in 49 patients (8.7%). OBC was carried out as a joint operation between a breast and a plastic surgeon in 66.3% (389 patients). Immediate contralateral symmetrisation rate was significantly higher when the procedure was carried out as a joint operation (70.7% vs. not joint operations: 29.8%; p<0.001).
Incomplete excision rate was 10.4% (60 of 578). Incomplete excision was significantly higher after invasive lobular carcinoma (18.9%; 10 of 43; p=0.0292). After neoadjuvant chemotherapy incomplete excision rate was significantly lower (3%; 2 of 66 vs. no neoadjuvant chemotherapy: 11%; 35 of 319; p=0.031).
Neodjuvant systemic treatment rate was 28.6% (142 of 496 patients). Of those 68 patients received neoadjuvant chemotherapy (13.7%) and 74 patients had neoadjuvant hormonal treatment (14.9%). Neoadjuvant systemic treatment rate varied amongst the units from 9.7% to 57.2% for patients with invasive carcinoma.
259 patients diagnosed with (non)invasive carcinoma had a median follow-up time of 5 years [35-124]. Of these 7 patients (2.7%) developed isolated local recurrence. 5-year local recurrence rate after DCIS was higher than after pure invasive ductal carcinoma (DCIS: 8.3%; 3 of 36 vs. ductal: 1.6%; 3 of 181; p=0.02567). 5-year disease-free survival of these patients was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%.
145 of 510 patients developed complications, which is 28.4% overall complication rate. 71 patients had major complications (13.9%) and 74 patients had minor complications (14.5%). Overall complication rate was significantly lower after neoadjuvant chemotherapy (15.9%; 11 of 69) compared to patients who did not receive neoadjuvant chemotherapy (27.9%; 127 of 455 patients) (p=0.035).
Conclusion: this national audit demonstrated similar outcomes overall compared to relevant published data. Units should be urged to build stronger collaboration in order to reduce variability in OBC practices.
None of the authors have conflict of interest to declare.
Citation Format: Romics L, Macaskill J, Fernandez T, Morrow E, Simpson L, Pitsinis V, Barber M, Tovey S, Masannat Y, Young O, Mansell J, Stallard S, Doughty J, Dixon M. Oncoplastic breast conservations – The Scottish Audit: Surgical techniques, oncological outcomes, complication rates and variations in practice across the country based on the analysis of 589 patients [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 P4-13-01.
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Affiliation(s)
- L Romics
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - J Macaskill
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - T Fernandez
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - E Morrow
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - L Simpson
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - V Pitsinis
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - M Barber
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - S Tovey
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - Y Masannat
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - O Young
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - J Mansell
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - S Stallard
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - J Doughty
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - M Dixon
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
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