Abstract OT3-04-04: 21-gene recurrence score® in patients with primary metastatic ER+ HER2- breast cancer

Background and Purpose

Results from the 21-gene Recurrence Score (RS) are prognostic and predictive for recurrence in early breast cancer independent of clinical-pathological parameters. Prognostic information and distribution of RS in primary metastatic breast cancer (PMBC) was reported in a previous study by King et al but remains ultimately unclear in ER+ HER2- patients. We hypothesize that there is a prognostic correlation between RS and TTP/OS in PMBCindependent of clinical-pathological parameters, and the objective of the study is to evaluate the test for that cohort.

Patients and Trial Design

Between 2004 and 2014, 150 patients with first diagnosis of ER+/HER2- PMBC were enrolled in a multicenter, prospectively collected database. Pretreatment breast tumor samples will be analyzed by using 21-gene RS. Minimum follow-up will be 24 months.

Methods and Statistical Analysis

Patient characteristics, time to first progression (TTP), overall survival (OS) and treatment modalities will be described. The association between RS risk groups and both TTP and OS will be assessed by Kaplan-Meier estimates and compared with the log-rank test. Multivariate Cox regression models will be utilized to adjust for covariates. Additionally, assessing correlation of RS results using RS cut offs of 18 and 30 and additionally of 11 and 25 as well as analysis of quantitative ER from Oncotype DX assay for patients treated first-line with endocrine therapy are planned.

First results are expected to be presented in 2017.

Contact information for people with a specific interest in the trial:

Dr. Jana Barinoff

barinoff.jana@googlemail.com.

Citation Format: Barinoff J, Anastasiadou L, Brandi C, Junker-Stein A, Silbermann J, Langenfeld M, Fortmann C, Thill M. 21-gene recurrence score® in patients with primary metastatic ER+ HER2- breast cancer [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 OT3-04-04.

A less invasive posterior approach for the management of extended secondary epidural abscess technical note

Spondylodiscitis is considered to be the main cause of epidural abscess. In this report, the authors present their concept for the management of the extended epidural abscess that occurs in combination with spondylodiscitis. It consists of debridement and fusion for spondylodiscitis together with epidural abscess drainage using a microscopically assisted percutaneous technique. In the period from April 2000 to April 2004, 5 patients with spondylodiscitis and an accompanying extended epidural abscess were operated on. The mean age of the patients was 66 years. There were 4 males and one female. The follow-up period ranged from 3-12 months. To manage the extended epidural abscess, the authors created one or two drainage sites along the extension of epidural abscess. These drainage sites were made using a microscopically assisted percutaneous approach. In all presented cases, the offending organism was Staphylococcus aureus. The postoperative infection markers showed marked regression. The postoperative control MRI demonstrated effective drainage of the extended epidural abscess. Regarding the neurological deficits, 3 patients previously classified as Frankel C showed an improvement to Frankel E within 3 months postoperatively. From these results, it seems that our technique (ventro-dorsal abscess drainage combined with a microscopically assisted percutaneous approach) could be a successful method for the management of the extended epidural abscess associated with spondylodiscitis.

Traumatic subdural hematoma of the thoraco-lumbar junction of spinal cord

BACKGROUND

Spinal subdural hematoma (SSDH) is an exceedingly uncommon and potentially neurologically devastating condition. Recognition of blood products in magnetic resonance imaging is a very important clue for the diagnosis of SSDH. It is generally agreed that prompt surgical evacuation should be performed before irreversible damage to the spinal cord occurs. However, conservative treatment still plays a role in the management of SSDH.

OBJECTIVES

To describe the clinical presentation, characteristic MRI findings, and treatment of traumatic SSDH.

METHODS

A case of traumatic SSDH at the thoraco-lumbar junction.

RESULTS

Magnetic resonance imaging findings of high signal intensity lesion in both T1 and T2 sequences suggest the possibility of subdural hematoma although it may be mistaken for tumorlike cystic lesion of the cord. Although there is a place for conservative treatment of subdural hematoma, we believe that rapid surgical drainage of the subdural hematoma will be associated with the best prognosis especially in the cervical, thoracic, and thoraco-lumbar junctions of the spinal cord.

CONCLUSIONS

Rapid surgical drainage of traumatic SSDH affecting the thoraco-lumbar junction of the cord will be associated in most of the cases with rapid neurologic recovery.

Neuronavigation in surgery of intracranial and spinal tumors

PURPOSE

To demonstrate the new possibilities and advantages of neuronavigation in the surgery of intracranial and spinal tumors, based on patient populations treated in our hospital.

MATERIALS AND METHODS

An infrared navigation system with integrated microscope guidance was used for frameless intracranial neuronavigation. The biopsies of intracranial tumors were carried out using a frame-based stereotactic technique. Intracranial navigation was, in part, combined with the use of an intraoperative CT scanner and a three-dimensional ultrasound system for data acquisition, correction of brain shifts, and intraoperative quality control. The navigation was also supported by presurgical brain mapping with magnetic source imaging. Navigation in spinal surgery was exclusively performed using an infrared navigation system in combination with an intraoperative CT scanner.

RESULTS

The stereotactic tumor biopsies (n = 57) were carried out with an accuracy of 91.4% as compared with the histological diagnosis. The work flow of stereotactic procedures could be increased by using the intraoperative CT scanner. Fifty-seven patients with intracranial tumors were treated with the aid of neuronavigation between July 1997 and December 1999. These patients showed an improvement from 80% to 86% on the Karnofsky index 8 weeks postoperatively. The majority of intracranial cases were primary brain tumors (n = 30) and metastases (n = 13) in functionally important areas of the brain. In four patients, a significant brain shift was observed during neuronavigation, and could be corrected by an image update using either the intraoperative CT scanner (n = 2) or the three-dimensional ultrasound system (n = 2). The presurgical brain mapping with magnetoencephalography was shown to be reliable in the sensory cortex (n = 25). Eleven patients with a thoracic or lumbar tumor were treated by open surgery or stabilization, using a combination of spinal neuronavigation and the intraoperative CT scanner. Two patients with spinal tumors underwent navigated biopsies. Neither of them showed a reduction in the clinical stage, but the Karnofsky index improved from 63% up to 72% 8 weeks postoperatively.

CONCLUSION

Neuronavigation allows very precise intracranial and spinal surgery. The problem of brain shift during the navigation procedures has been solved by intraoperative image acquisition. The use of neuronavigation was shown to improve the postoperative quality of life of patients suffering from brain and spinal tumors.