Adjuvant therapies for special types of breast cancer

Summary Recent developments in the adjuvant treatment of breast cancer include an increasing attention to systemic therapies prescribed in homogeneous groups of patients according to the higher chance of benefit. A clear consequence of the current adjuvant treatment strategy is the importance of accurate and reliable histopathological assessment. A proper pathological evaluation may effectively support the definition of prognosis and treatment choice in niches of patients diagnosed with special types of breast cancer. Through the identification of special types of breast cancer, that account for up to 25% of all invasive breast carcinomas, it is possible to select patients with a very good prognosis often close to that of the general population (e.g. tubular and pure cribriform carcinoma). Other features, such as those related with invasive classical lobular carcinoma, might have important correlates of responsiveness to therapy other than indicators of outcome. It was in fact demonstrated that the response to primary chemotherapy is significantly lower in invasive lobular carcinoma, if compared with the ductal histotype. However, the use of available information on special types of breast cancer has been limited in tailoring adjuvant therapy, owing to the absence of standardized criteria and partial reproducibility for diagnosis. Moreover, due to the relative rarity of the disease a large number of features that identify for special types of breast carcinomas have today no particular correlation with the prognosis, and limited data are available on the biology of a large number of breast cancer subtypes. The development of more effective therapies for patients with special types of breast cancer requires tailored treatment investigations through international cooperation and should not rely on information predominantly contributed from small retrospective analyses. Examination of patterns of relapse and treatment response within subpopulations in multiple randomized trials is also mandatory to make progress and reach consensus on how to treat individual patients with special types of breast cancer

New criteria for selecting elderly patients for breast cancer adjuvant treatment studies.

Learning Objectives After completing this course, the reader will be able to: List the factors that should be considered when choosing the appropriate adjuvant treatment for an elderly women with operable breast cancer.Discuss the possible explanations that account for the underrepresentation of elderly patients in breast cancer clinical trials.Describe the clinical trials that are being specifically conducted in elderly patients with early breast cancer to evaluate different forms of adjuvant treatments. CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.co

Historical Photogrammetry and Terrestrial Laser Scanning for the 3d Virtual Reconstruction of Destroyed Structures: a Case Study in Italy

The current dramatic episodes of destruction of archaeological sites have again highlighted the problem of the safeguarding the threatened heritage and, if possible, recovering those damaged by all the armed conflicts of the past. The historical photogrammetry offers the possibility to recover a posteriori the geometrical and material properties of destroyed structures, reconstructing their 3D model to document, study and maintain their memory, until to support their real anastylosis. The presented work is about the 3D reconstruction of the civic tower of the little town of Sant'Alberto, near the city of Ravenna, Italy. The tower, as a symbol of resistance and pride of the town's population, was destroyed in December 1944 by German troops in retaliation, when they were forced to leave the area. A city committee has subsequently collected all the historical evidence concerning the tower, including a series of photographic images that can be used for the photogrammetric reconstruction; the images calibration and orientation have been solved using the geometric information derived by a terrestrial laser scanner survey realized in the area where the tower was originally located. Despite the scarcity and very poor quality of the available images, the conducted photogrammetric procedure has allowed a complete and qualitatively satisfying object reconstruction, also thanks to the use of geometric constraint tools offered by the chosen software. The integration between the obtained model of the old tower and the 3D TLS survey of the square made it possible to reconstruct the ancient situation of the area

3D comparison towards a comprehensive analysis of a building in cultural heritage

Terrestrial remote sensing techniques, including both Terrestrial Laser Scanning (TLS) and Close-Range Photogrammetry (CRP), have been recently used in multiple applications and projects with particular reference to the documentation/inspection of a wide variety of Cultural Heritage structures. The high density of TLS point cloud data allows to perform structure survey in an unprecedented level of detail, providing a direct solution for the digital three-dimensional modelling, the site restoration and the analysis of the structural conditions. Textural information provided by CRP can be used for the photorealistic representation of the surveyed structure. With respect to many studies, the combination of TLS and CRP techniques produces the best results for Cultural Heritage documentation purposes. Moreover, TLS and CRP point cloud data have been proved to be useful in the field of deformation analysis and structural health monitoring. They can be the input data for the Finite Element Method (FEM), providing some prior knowledge concerning the material and the boundary conditions such as constraints and loading. The paper investigates the capabilities and advantages of TLS and CRP data integration for the three-dimensional modelling compared to a simplified geometric reconstruction. This work presents some results concerning the Baptistery of Aquileia in Italy, characterized by an octagonal plan and walls composed by masonry stones with good texture

3D GEOMATICS TECHNIQUES FOR AN INTEGRATED APPROACH TO CULTURALHERITAGE KNOWLEDGE: THE CASE OF SAN MICHELE IN ACERBOLI'S CHURCHIN SANTARCANGELO DI ROMAGNA

The modern Geomatics techniques, such as Terrestrial Laser Scanner (TLS) and multi-view Structure from Motion (SfM), are gaining more and more interest in the Cultural Heritage field. All the data acquired with these technologies could be stored and managed together with other information in a Historical Building Information Model (HBIM). In this paper, it will be shown the case study of the San Michele in Acerboli's church, located in Santarcangelo di Romagna, Italy. This church, dated about the 6th century A.D., represents a high relevant Romanic building of the high Medieval period. The building presents an irregular square plan with a different length of the lateral brick walls and a consequential oblique one in correspondence of the apse. Nevertheless, the different lengths of the lateral brick walls are balanced thanks to the irregular spaces between the windows. Different changes occurred during the centuries, such as the closing of the seven main doors and the building of the bell tower, in the 11th century A.D., which is nowadays the main entrance of the church. An integrated survey was realized, covering the exterior and the interior. The final 3D model represents a valid support not only for documentation, but also to maintain and manage in an integrate approach the available knowledge of this Cultural Heritage site, developing a HBIM system in which all the mentioned historical, geometrical, material matters are collected

The TNM classification of breast cancer: need for change

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Integration of geomatics techniques for digitizing highly relevant geological and cultural heritage sites: The case of san Leo (Italy)

The research activities described in this contribution were carried out at San Leo (Italy). The town is located on the top of a quadrangular rock slab affected by a complex system of fractures and has a wealth of cultural heritage, as evidenced by the UNESCO's nomination. The management of this fragile set requires a comprehensive system of geometrical information to analyse and preserve all the geological and cultural features. In this perspective, the latest Geomatics techniques were used to perform some detailed surveys and to manage the great amount of acquired geometrical knowledge of both natural (the cliff) and historical heritage. All the data were also georeferenced in a unique reference system. In particular, high accurate terrestrial laser scanner surveys were performed for the whole cliff, in order to obtain a dense point cloud useful for a large number of geological studies, among others the analyses of the last rockslide by comparing pre-And post-event data. Moreover, the geometrical representation of the historical centre was performed using different approaches, in order to generate an accurate DTM and DSM of the site. For these purposes, a large scale numerical map was used, integrating the data with GNSS and laser surveys of the area. Finally, many surveys were performed with different approaches on some of the most relevant monuments of the town. In fact, these surveys were performed by terrestrial laser scanner, light structured scanner and photogrammetry, the last mainly applied with the Structure from Motion approach. \ua9 Authors 2017. CC BY 4.0 License

Expression of apoptosis-related markers and clinical outcome in patients with advanced colorectal cancer

The clinical relevance of bax and bcl-2 protein expression has been investigated in 84 patients with recurrent or metastatic colorectal cancer submitted to a chemotherapy regimen including methotrexate and fluorouracil/leucovorin. Cytoplasmic immunostaining of bax and bcl-2 was present in 65.5% and 38%, respectively, of the tumours. No association was found between bax and bcl-2 or between p53 and bax or bcl-2 protein expression. Moreover, the biomarkers were unrelated to patient and tumour characteristics known to affect the clinical outcome of colorectal cancer patients. In general, the apoptosis-related markers did not appear indicative of short- and long-term clinical response nor of prognosis. Bcl-2-negative lesions were more frequent among patients who reached an objective clinical response, which is in agreement with previously reported data regarding other tumour types. When the interrelationship between p53 and bax expression was examined, a better response rate (40%) was found for patients whose tumours did not express p53 and bax, and a better prognosis (2-year probability of overall survival 75%) for patients with p53-positive and bax-negative tumours. In the present series of patients with advanced colorectal cancer submitted to systemic chemotherapy we did not find a clear association between expression of apoptosis-related markers and clinical outcome, even in the subset of patients in which the apoptotic index as determined by the TUNEL approach was investigated. © 2001 Cancer Research Campaign http://www.bjcancer.co

neoadjuvant pegylated liposomal doxorubicin in combination with cisplatin and infusional fluoruracil ccf with and without endocrine therapy in locally advanced primary or recurrent breast cancer

Abstract Purpose To explore the activity of pegylated liposomal doxorubicin (PLD) as neoadjuvant therapy of breast cancer. Methods The combination of PLD with cisplatin and infusional fluorouracil (CCF) for 8 courses was investigated in patients with primary or recurrent T2-T4a-d N0-3 M0 breast cancer. Patients with ER and/or PgR ≥10% tumors also received letrozole (±triptorelin). Results Forty patients entered the study. Four patients had recurrent tumors and 13 had cT4d tumors. Overall, clinical response rate was 77.5% whereas a pathological complete response (pCR) was obtained in 3 patients (7.7%), 4 when considering bilateral tumors. Noticeably 3 pCR were observed among the 10 patients with T4d ER positive tumors (33%). Eleven patients discontinued treatment before completion of the 8 planned courses. Conclusions Our results indicated that CCF yielded an appreciable rate of clinical responses in a series of very locally advanced tumors and an unusually high rate of pCR in T4d ER positive tumors, suggesting an enhanced cutaneous activity of PLD

HIGH RESOLUTION 3D ACQUISITION AND MODELLING IN CULTURAL HERITAGE KNOWLEDGE AND RESTORATION PROJECTS: THE SURVEY OF THE FOUNTAIN OF NEPTUNE IN BOLOGNA

In 2016, the Municipality of Bologna (Italy) has undertaken the restoration of one of the symbols of the entire city, the Fountain of Neptune, in evident state of degradation. The works have touched upon all the aspects of this complex object and the project has seen involved the Municipality and the University of Bologna, the Istituto Superiore per la Conservazione e il Restauro (ISCR) (Rome) and the Visual Computing Lab of the CNR – ISTI (Pisa), in a modern and highly multi-disciplinary approach.One of the key elements of the project was made up by the creation of an information system ad hoc developed to permit, in an innovative, efficient and user-friendly way, the collection, sharing, management and analysis of all the information and data related to diagnostics and restoration actions. The base of the information system is a very detailed 3D model of the monument, realized by means of the most modern techniques for objects 3D modelling (laser scanning, digital photogrammetry and 3D scanning) integrated together with the aim to obtain a photo-textured 3D model characterized by a sub-millimetre precision level in the geometric description and a high perceptive fidelity of colour reproduction.The surveying activities and data processing, performed by the DICAM Geomatics group of the University of Bologna (with the collaboration of the MCM Company of Rome), are described in the paper, with considerations on the problems encountered and the procedures and solutions adopted. The information system has been developed by CNR-ISTI.</p