Abstract P3-13-07: Is radiofrequency ablation better than lumpectomy for margin status in breast cancer? Results of a randomized clinical trial

PURPOSE: To study the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) as local treatment for breast cancer and to intraoperatively evaluate the margin status after RFA in comparison with lumpectomy.

MATERIAL and METHODS: Preliminary in vitro RF ablation experimentation with two mastectomy specimens was performed to test the electrode, practice the ultrasound technique and evaluate the macroscopic and microscopic effects of RF. Then, aprospective, randomized open-label phase II clinical trial (NCT02281812) was conducted in a single institution from 2013-2017. Forty subjects, mean age 64 (range 46-86), with ductal infiltrating carcinoma of the breast ≤2 cm were randomly assigned to RFA plus lumpectomy or lumpectomy alone. Margin status, tumor cell viability (TCV) after RFA (by nicotinamide adenine dinucleotide (NADH) and Cytokeratin 18 (CK18) staining), adverse events and local recurrences were evaluated by univariable and multivariable analyses (SPSS statistical software).

RESULTS: In the experimental design with mastectomies, the only procedural complication was a skin burn at the entrance site of the electrodes. We learned that the tip of the electrodes should cut cross the tumor by at least 10mm.

The clinical trial includes two groups: study group (n=20) and control group (n=20). NADH and CK18 staining demonstrated absence of TCV after RFA with at least one of the two techniques. The percentage of intraoperatively affected surgical margins was higher in the control group although local adverse effects after surgery was higher in the RFA treatment arm. Three study subjects presented local infection (two had partial irradiation of the breast) and none in the control group. Median follow up was 25 months (range 1–83). No recurrence or second surgery was required during the study period.

Outcomes RFA group (n = 20)Control group (n=20)p valueSpecimen weight (median, gr)42 (24-80)27 (11-60)0.004Specimen volume (median, ml)369 (259-847)201 (100-602)0.004Positive margin (intraoperative)4/20 (20%)11/20 (55%)0.022Pathological size (median, mm)11.5 (5-20)10.5 (6-16)0.07Local Adverse effect8/20 (40%)1/20 (5%)0.01Breast Inflammation5/20 (25%)1/20 (5%)0.182Breast Infection3/20 (15%)0/20 (0%)0.23RFA: radiofrequency ablation. n=number of subjects

CONCLUSION: RFA seems effective in the cases considered and could be more accurate than lumpectomy in terms of obtaining more free margins. Surgical excision associated with RFA leads to a higher amount of local adverse effects, especially if combined with partial irradiation of the breast. RFA could be considered as a less invasive treatment in tumors smaller than 20 mm; however, this warrants further investigation.

Citation Format: Garcia-Tejedor A, Guma A, Soler T, Valdivieso A, Petit A, Contreras N, Chappuis CG, Falo C, Pernas S, Anselem A, Fernandez-Montoli E, Pla MJ, Burdio F, Ponce J. Is radiofrequency ablation better than lumpectomy for margin status in breast cancer? Results of a randomized clinical trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-07.

1.15 PW-850 J compressed beam demonstration using the PETAL facility

The Petawatt Aquitaine Laser (PETAL) facility was designed and constructed by the French Commissariat à l'énergie atomique et aux énergies alternatives (CEA) as an additional PW beamline to the Laser MegaJoule (LMJ) facility. PETAL energy is limited to 1 kJ at the beginning due to the damage threshold of the final optics. In this paper, we present the commissioning of the PW PETAL beamline. The first kJ shots in the amplifier section with a large spectrum front end, the alignment of the synthetic aperture compression stage and the initial demonstration of the 1.15 PW @ 850 J operations in the compression stage are detailed. Issues encountered relating to damage to optics are also addressed.

[Autonomy and human dignity--fiction and reality]

Definition and lived-in reality of "autonomy" an "human-dignity" may differ as can be shown by means of a patient's situation: it varies whether patient, relatives, general practitioner or hospital doctor are involved. It is most important to assure these terms not only to be fiction but to become a lived reality.

[Prevention of accidental falls in the elderly]

A variety of effective methods to prevent falls of the elderly are presented for everyday practice.

[Rehabilitation of hemiplegia patients]

The indications for a specific rehabilitation training programme for elderly stroke patients are discussed. Special symptomatology, such as hemi-anesthesia as a result of a damaged perceptual process, apraxia including apraxia of dressing, communication disorders and affective disorders are presented. The measures to be taken for effective rehabilitation in hospital, in an institution for the elderly or in the home care situation are indicated. In addition, the physician has to have marked ability for empathic comportment.

[Malnutrition in old age: the importance of multi-dimensional evaluation]

Protein-energy malnutrition is a frequent, but often overlooked problem in geriatric patients. To prevent malnutrition and its severe complications, a systematic strategy for identifying signs, symptoms and risk factors of malnutrition is required. In this review we present a plan for a multidimensional nutritional workup, including functional nutritional assessment. Special aspects of malnutrition management in geriatric patients are discussed (e.g. dementia, tube-feeding, environmental aspects). Use of available diagnostic and therapeutic measures for preventing malnutrition may lead to improved quality of life in many geriatric patients.

Adenocarcinoma of the stomach: a review of 35 years and 1,710 cases

The records of 1,710 patients with adenocarcinoma of the stomach treated at Charity Hospital over a 35-year period were reviewed to note any trends which might help in understanding the decreasing incidence and poor prognosis of the disease. The yearly number of gastric cancer patients has dropped from 234/100,000 in the 1950's to 195/100,000 in the 1960's to 108/100,000 patients in the last decade. The percentage of affected white males is decreasing at a rate equal to the increasing frequency of black female patients, while the ratios for black males and white females remain constant. The median age rose from 61.5 years to 66 years over the study period. The operability rate decreased from 82.4% to 72.8% and the resectability rate was 49%. Subtotal gastrectomy was the most common procedure, but radical subtotal gastrectomy gave the best 5-year survival. There are fewer lesions of the antrum today, but the highest number of 5-year survivors had antral lesions. Long-term survival of patients with lesions of the cardia improved from zero in the first 25 years to 14% in the last decade. For the last 2 decades, patients with stage III and IV lesions comprised one-half of the 5-year survivors. Our overall 5-year survival was 7.9%, but in the last decade it was 8.9%. Our 5-year survival for all patients who underwent a resection was 17.9%, but increased to 24.8% for the last decade. These improvements, in combination with a decrease in incidence, have dropped the overall mortality from gastric cancer.

Hepatic low density lipoprotein receptors, HMG-CoA reductase, and plasma lipids and apolipoproteins in high- and low-responding rhesus monkeys: effect of cholestyramine treatment

Plasma lipids and apolipoproteins, and hepatic LDL receptor and HMG-CoA reductase activities in biopsy samples were measured in high- and low-responding rhesus monkeys maintained on a cholesterol-rich and regular diets. The effect of a 30-day cholestyramine treatment on the above parameters under both dietary conditions was also determined. On the cholesterol-rich diet the high-responders, when compared to the low-responders, had several-fold increased plasma cholesterol and apoB concentrations and significantly lower HDL apoA-I and cholesterol concentrations. Hepatic LDL receptor and HMG-CoA reductase activities were not detectable in the high-responders, while the low-responders expressed a reduced number of LDL receptors of normal affinity. Administration of cholestyramine resulted in a rapid induction of the hepatic LDL receptors in the high-responders and a small additional increase in the low-responders. Cholestyramine treatment also stimulated the expression of the hepatic HMG-CoA reductase in both groups of monkeys. These changes were accompanied by a dramatic drop in plasma cholesterol and apoB concentrations in the high-responders and, to a lesser extent, in the low-responders. Plasma HDL concentrations in the high-responders rose to levels higher than those seen in the low-responders. The affinity and receptor number were similar in both groups of monkeys on the control diet, but the low-responders had significantly higher HMG-CoA reductase activities. Administration of cholestyramine during the control diet had a small but significant additional effect on the hepatic LDL receptors of the low-responders but not of the high-responders.(ABSTRACT TRUNCATED AT 250 WORDS)

[General medicine criteria for the determination of dental care needs of geriatric patients]

Recently it has been shown that there is a high prevalence of treatable dental conditions in elderly subjects in Switzerland. The purpose of the present prospective study was to assess the value of an oral screening examination intended to help the primary care physician to determine which patients should be referred to a dental service for specialized treatment. Of 219 patients aged over 65 referred consecutively to a geriatric hospital, 58.4% were objectively in need of dental treatment according to the data obtained by a dentist. In a multiple logistic analysis, 4 oral screening criteria (presence of residual teeth of the patient's own, no prosthetic replacement of an edentulous arch, subjective dental treatment requirement, subjective chewing impairment) were found to predict the objectively assessed dental need with a sensitivity of 93.0% and a specificity of 82.4%. Among the patients with objective dental treatment requirement not predicted by the screening examination, 3 had ulcerations of the oral mucosa. An intraoral soft-tissue examination should therefore be included in the screening examination. In conclusion, simple oral screening may serve to identify patients needing dental care with a high degree of diagnostic accuracy. This enables the primary care physicians to screen for oral and dental problems and to refer patients in the same way as for other special treatment problems.

Dental treatment needs in an elderly population referred to a geriatric hospital in Switzerland

Of 219 elderly patients admitted consecutively to a geriatric hospital in Switzerland, 59.4% were edentulous. A high proportion of the dentate patients exhibited tooth loss patterns requiring free-end partial dentures in the maxilla (36.0%) or the mandible (69.7%). Of the remaining teeth, 29.3% were decayed, and 45.1% had severe periodontitis. Virtually all (97.8%) dentate and 31.5% of the edentulous subjects were judged to need some kind of dental treatment. In contrast, the subjective need for dental treatment was low in dentate (30.4%) and edentulous (13.1%) subjects. Prosthesis hygiene was poor in 73.8% of the 191 denture wearers whether they needed assistance with oral hygiene or not. The objectively-assessed need for a new prosthesis in edentulous patients was determined by income, marital status, and patient mobility, whereas the need for a prosthesis alteration was related to cognitive function. These findings should help to plan future dental prophylactic and therapeutic services in geriatric hospitals.

[The relation of hospital and outpatient care: an important factor in geriatric practice]

An example of a way to establish contact between hospital and outpatient care was demonstrated by the method of working at a clinic for geriatrics and rehabilitation. The basis for evaluation of the working method concerning the patient is optimal information about his situation at the time of hospitalisation. An objective for the hospitalisation can be determined together with the patient. The progress achieved during hospitalisation is judged at regular intervals by the patient and the staff taking care of him. This makes an estimation of the length of required hospitalisation possible. About 40% of the patients returning to family practitioner care require outpatient care. The division between the different services involved is demonstrated. The working method was judged, based on an inquiry at the family practitioners.

Non-mutagenicity of urine from coffee drinkers compared with that from cigarette smokers

The urine of human coffee drinkers who ingested 12 g of instant coffee per day, during 4 days in a first experiment or 12 g within 2 h in a second experiment, was fractionated by XAD-2 column chromatography. The non-polar urine fractions so obtained were not mutagenic in the Ames Salmonella tester strains TA98 or TA100 in either experiment, either with or without beta-glucuronidase treatment of the urine. The non-polar urine fraction of smokers, who smoked 20--30 cigarettes per day during 4 days in the first experiment or 7--18 cigarettes during 7 h in the second experiment, was mutagenic when metabolically activated.