Abstract ES1-1: Accelerated partial breast irradiation: Update of an ASTRO consensus guideline

Authors

Correa CRa, Harris EEb, Leonardi MCc, Smith BDd, Taghian AGe, Thompson AMf, White Jg, Harris JRh; aDept. of Radiation Oncology, Faxton St. Luke's Healthcare, Utica, NY, bDept. of Radiation Oncology, E. Carolina Univ., Greenville, NC, cDept. of Radiation Oncology, European Inst. of Oncology, Milan, Italy, dDept. of Radiation Oncology and fDept. of Breast Surgical Oncology, The Univ. of Texas MD Anderson Cancer Center, Houston, TX, eDept. of Radiation Oncology, Massachusetts General Hosp., Boston, MA, gDept. of Radiation Oncology, Ohio State Univ. Cancer Center, Columbus, OH, hDept. of Radiation Oncology, Brigham and Women's Hosp. and Dana-Farber Cancer Inst., Boston, MA

Purpose

To update the accelerated partial breast irradiation Consensus Statement published in 2009 and provide guidance on use of intraoperative radiation therapy (IORT) for partial breast irradiation in early-stage breast cancer, based on published evidence complemented by expert opinion.

Methods

A systematic PubMed search using the same terms as the original Consensus Statement yielded 419 articles; 44 articles were selected. The authors synthesized the published evidence and, through a series of conference calls and e-mails, reached consensus regarding the recommendations.

Results

The new recommendations include lowering the age in the “suitability group” from 60 to 50 years and in the “cautionary group” to 40 years for patients who meet all other elements of suitability (Table 1). Patients with low-risk ductal carcinoma in situ, as per RTOG 9804 criteria, were categorized in the “suitable” group. The task force agreed to maintain the current criteria based on margin status. Recommendations for the use of IORT for breast cancer patients include: counseling patients regarding the higher risk of ipsilateral breast tumor recurrence with IORT compared with whole breast irradiation; the need for prospective monitoring of long-term local control and toxicity with low-energy radiograph IORT given limited follow-up; and restriction of IORT to women with invasive cancer considered “suitable.”

Conclusion

These recommendations will provide updated clinical guidance regarding use of accelerated partial breast irradiation for radiation oncologists and other specialists participating in the care of breast cancer patients.

Table 1 Comparison of patient groups in original and updated consensus statementsPatient groupRisk factorOriginalUpdateSUITABLEAge≥60 y≥50 y MarginsNegative by at least 2 mmNo change T stageT1Tis or T1 DCISNot allowedIf all: screen detected, low to intermediate nuclear grade, size ≤2.5 cm, and resected with margins negative at ≥3 mmCAUTIONARYAge50-59 y40-49 y if all other criteria for "suitable" are met; ≥50 y if patient has at least 1 of the pathologic factors[lowast] and no "unsuitable" factors MarginsClose (<2 mm)No change DCIS≤3 cm≤3 cm and does not meet "suitable" criteriaUNSUITABLEAge<50 y<40 y; 40-49 y and does not meet "cautionary" criteria MarginsPositiveNo change DCIS>3 cmNo change[lowast]Pathologic factors: size 2.1-3 cm, T2, close margins (<2 mm), limited/focal lymphovascular space invasion, ER(-), clinically unifocal with total size 2.1-3 cm, invasive lobular histology, pure DCIS ≤3 cm if "suitable" criteria not fully met, extensive intraductal component ≤3 cm

Citation Format: Correa CR. Accelerated partial breast irradiation: Update of an ASTRO consensus guideline [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 ES1-1.

Serum Vitamin A and Inflammatory Markers in Individuals with and without Chronic Obstructive Pulmonary Disease

BACKGROUND

Vitamin A is essential for the preservation and integrity of the lung epithelium and exerts anti-inflammatory effects.

OBJECTIVE

Evaluating vitamin A in the serum and sputum and testing its correlation with inflammatory markers in individuals with or without COPD. Methods. We evaluated dietary intake, serum and sputum vitamin A, tumor necrosis factor alpha, interleukin- (IL-) 6, IL-8, and C-reactive protein in 50 COPD patients (age = 64.0 ± 8.8 y; FEV1 (forced expiratory volume in the first second) (%) = 49.8 ± 16.8) and 50 controls (age = 48.5 ± 7.4 y; FEV1 (%) = 110.0 ± 15.7).

RESULTS

COPD exhibited lower serum vitamin A (1.8 (1.2-2.1) versus 2.1 (1.8-2.4) μmol/L, P < 0.001) and lower vitamin A intake (636.9 (339.6-1349.6) versus 918.0 (592.1-1654.6) RAE, P = 0.05) when compared with controls. Sputum concentration of vitamin A was not different between groups. Sputum vitamin A and neutrophils were negatively correlated (R (2) = -0.26; P = 0.03). Smoking (0.197, P = 0.042) exhibited positive association with serum vitamin A. COPD was associated with lower serum concentrations of vitamin A without relationship with the systemic inflammation.

CONCLUSIONS

Serum concentration of vitamin A is negatively associated with the presence of COPD and positively associated with smoking status. Sputum retinol is quantifiable and is negatively influenced by neutrophils. Although COPD patients exhibited increased inflammation it was not associated with serum retinol.

Oxidative stress on cardiotoxicity after treatment with single and multiple doses of doxorubicin

The mechanism of doxorubicin (DOX)-induced cardiotoxicity remains controversial. Wistar rats ( n = 66) received DOX injections intraperitoneally and were randomly assigned to 2 experimental protocols: (1) rats were killed before (−24 h, n = 8) and 24 h after (+24 h, n = 8) a single dose of DOX (4 mg/kg body weight) to determine the DOX acute effect and (2) rats ( n = 58) received 4 injections of DOX (4 mg/kg body weight/week) and were killed before the first injection (M0) and 1 week after each injection (M1, M2, M3, and M4) to determine the chronological effects. Animals used at M0 ( n = 8) were also used at moment −24 h of acute study. Cardiac total antioxidant performance (TAP), DNA damage, and morphology analyses were carried out at each time point. Single dose of DOX was associated with increased cardiac disarrangement, necrosis, and DNA damage (strand breaks (SBs) and oxidized pyrimidines) and decreased TAP. The chronological study showed an effect of a cumulative dose on body weight ( R = −0.99, p = 0.011), necrosis ( R = 1.00, p = 0.004), TAP ( R = 0.95, p = 0.049), and DNA SBs ( R = −0.95, p = 0.049). DNA SBs damage was negatively associated with TAP ( R = −0.98, p = 0.018), and necrosis ( R = −0.97, p = 0.027). Our results suggest that oxidative damage is associated with acute cardiotoxicity induced by a single dose of DOX only. Increased resistance to the oxidative stress is plausible for the multiple dose of DOX. Thus, different mechanisms may be involved in acute toxicity versus chronic toxicity.

Comparison of oxidative stress in ASA physical status I patients scheduled for minimally invasive surgery under balanced or intravenous anesthesia

BACKGROUND

The effects of anesthetics on inflammation and oxidative parameters, evaluated in patients without comorbidities undergoing minor surgery, remain unknown. The present study aimed to investigate the inflammatory and oxidative stress status in adult patients undergoing elective minimally invasive surgery, using different anesthetic techniques.

METHODS

Thirty patients classified as ASA physical status I, who were scheduled for minor surgeries (tympanoplasty or septoplasty), were randomly allocated into two groups: balanced (BAL) anesthesia maintained with isoflurane or total intravenous anesthesia (TIVA) with propofol. Blood samples were drawn prior to the induction of anesthesia (baseline), 120 min after the beginning of anesthesia and one day after surgery. The proinflammatory cytokine IL-6 was determined by flow cytometry; DNA oxidation was evaluated by the single cell gel electrophoresis assay, and plasma malondialdehyde (lipid peroxidation biomarker) and antioxidant status were determined through fluorometry.

RESULTS

Increased IL-6 was observed one day after surgery in both groups (P=0.0001). Malondialdehyde levels did not change among the time points assessed or between the groups (P>0.05). Whereas BAL anesthesia had no effect on acid nucleic and antioxidant status, TIVA decreased oxidized/alkylated purines (P=0.03) and increased antioxidant status (P=0.002) during anesthesia. The two groups did not differ significantly in DNA oxidation or antioxidant status (P>0.05).

CONCLUSION

BAL anesthesia maintained with isoflurane and TIVA maintained with propofol are safe by virtue of not causing oxidative stress status in ASA physical status I patients undergoing minimally invasive surgeries. Moreover, even in minor surgeries, TIVA with propofol produces an antioxidant effect in patients.

Glyceraldehyde-3-phosphate dehydrogenase as a surface associated antigen on human breast cancer cell lines MACL-1 and MGSO-3

Breast cancer is a major health burden, responsible for >10% of all cases of cancer worldwide. Advances in breast cancer diagnosis and treatment have contributed to an improved rate of survival, although mortality rates remains significantly high. The establishment of breast cancer cell lines is an important model for understanding biological processes involved in this disease and for identifying potential therapeutic targets. The novel human breast cancer cell lines, MACL-1 and MGSO-3, were used in this study to identify possible surface antigens by antibodies directed against two commercial breast cancer cell lines MCF-7 and MDA-MB-231. We purified a 37 kDa antigen by affinity chromatography from MDA-MB-231, and its N-terminal amino acid sequence was homologous to glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Therefore, immunohistochemical experiments, using specific monoclonal antibodies, evidenced a co-localization of GAPDH and Na+/K+-ATPase on the surface of commercially available and recently established breast cancer cell lines. It is of note that Na+/K+-ATPase was used as a plasma membrane marker. This finding opens new perspectives for breast cancer diagnosis and treatment since GAPDH could be used as a biomarker or as a potential therapeutic target in breast cancer.

Establishment and characterization of MACL-1 and MGSO-3 cell lines derived from human primary breast cancer

Breast cancer is a major health burden worldwide. It is responsible for over 1 million of 10 million cases of cancer in the world. Advances in breast cancer detection and treatment have contributed to improve the rate of survival, although mortality rates remains significantly high. Despite all these advances, more efficient diagnostic methods and effective treatments are necessary. The establishment of breast cancer cell lines is an important tool to understand biological processes involved in this disease, as well as the identification of potential therapeutic targets. In the present work, two cell lines, MACL-1 and MGSO-3, were established from human primary breast cancer based on differential centrifugation, followed by growth in culture for over 70 passages. Characterization of the cell lines included morphology analysis, determination of doubling time, telomerase expression, tumor antigen expression, colony formation in soft agar, and xenograft implantation into nude mice. Morphological examination demonstrated a typical epithelial morphology and PCR analyses showed that both cell lines were telomerase positives. Moreover, MACL-1 and MGSO-3 were capable of growing in soft agar culture, which suggests its metastatic potential, and both demonstrated a positive tumorigenic potential in nude mice. These experimental models open new perspectives on the investigation of breast cancer pathobiology.

Parametric sensibility study of the sinoatrial node math model

The results of the parametric sensibility study to the sinoatrial node math model was presented. The model was proposed by H. Zhang, A. V. Holden and M.R. Boyett. The sensitivity analysis indicates that the sodium and potassium ionic concentrations need to be controlled in order to maintain the normal behavior of the node. The calcium concentrations changes simulated don't produce significant effects over the operation of the node. One response surface model was developed as a simplification of original model. The diastolic depolarization rate was redefined in order to allow its measure in potential waves for peripheral node cells.

Whole-body protein turnover in malnourished patients with child class B and C cirrhosis on diets low to high in protein energy

The purpose of this study was to determine the rate of whole-body protein turnover in moderately and severely alcoholic, malnourished, cirrhotic patients fed with different amounts of protein or energy. Six male patients (Child classes B and C) and four age- and sex-matched healthy control subjects were studied for 18 d in fasting and feeding states; a single oral dose of [(15)N]glycine was used as a tracer and urinary ammonia was the end product. The kinetic study showed that patients had higher protein catabolism while fasting (patients: 3.14 +/- 1.2 g of lean body mass/9 h; controls: 1.8 +/- 0.3 g of lean body mass/9 h; P < 0.02). Although not statistically significant, protein catabolism (grams of lean body mass/9 h) was lower with the hyperproteic/hyperenergetic diet when compared with fasting. Nitrogen retention was consistent with the lower protein-catabolism rate; a statistically significant increase in nitrogen balance was observed when patients were fed with the hyperproteic/hyperenergetic diet compared with fasting (4.3 +/- 3.2 g of nitrogen/d and -2.2 +/- 1.9 g of nitrogen/d, respectively; P < 0.01). These data indicate that Child class B and C cirrhotic patients are hypercatabolic and that long-term nutritional intervention with a hyperproteic/hyperenergetic diet is likely needed to improve their clinical and nutritional status.

Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis

Fish oil omega-3 fatty acids exert antiinflammatory effects on patients with ulcerative colitis. However, a comparative study in patients with mild to moderate ulcerative colitis receiving only sulfasalazine or omega-3 fatty acids has not been performed. We sought to detect changes in the inflammatory disease activity with the use of either fish oil omega-3 fatty acids or sulfasalazine in patients with ulcerative colitis. Ten patients (five male, five female; mean age = 48 +/- 12 y) with mild to moderate active ulcerative colitis were investigated in a randomized cross-over design. They received either sulfasalazine (2 g/d) or omega-3 fatty acids (5.4 g/d) for 2 m.o. Disease activity was assessed by clinical and laboratory indicators, sigmoidoscopy, histology, and whole-body protein turnover (with 15N-glycine). Treatment with omega-3 fatty acids resulted in greater disease activity as detected by a significant increase in platelet count, erythrocyte sedimentation rate, C-reactive protein, and total fecal nitrogen excretion. No major changes in protein synthesis and breakdown were observed during either treatment. In conclusion, treatment with sulfasalazine is superior to treatment with omega-3 fatty acids in patients with mild to moderate active ulcerative colitis.

[Use of proteic metabolism (15N-glycine) in the early detection of disease exacerbation in patients with non-specific ulcerative colitis]

Disease activity was assessed in 10 (five males and five females) ulcerative colitis patients through the following parameters: clinical, laboratory, sigmoidoscopic and histological. Protein metabolism was also assessed with 15N-glycine and urinary ammonia as end product. Only one patient had exacerbation of the disease two months after the study started. This patient presented in the beginning of the study protein synthesis and breakdown of 4.51 and 3.47 g protein/kg/day, respectively, values higher than all other patients, showing an hypermetabolic state, suggesting an increase of the disease activity. However, this increase was not detected by others indicators and indexes utilized. These data allow to suggest the hypothesis that protein metabolism predicts precociously the exacerbation of disease activity in ulcerative colitis patients.