Tumor Response After Neoadjuvant Magnetic Resonance Guided Single Ablative Dose Partial Breast Irradiation

Contains fulltext : 219916.pdf (Publisher’s version ) (Closed access)PURPOSE: To assess the pathologic and radiologic response in patients with low-risk breast cancer treated with magnetic resonance (MR) guided neoadjuvant partial breast irradiation (NA-PBI) and to evaluate toxicity and patient-reported outcomes (PROs). METHODS AND MATERIALS: For this single-arm prospective trial, women with unifocal, non-lobular tumors with a maximum diameter of 20 mm (age, 50-70 years) or 30 mm (age, >/=70 years) and tumor-negative sentinel node(s) were eligible. Patients were treated with a single ablative dose of NA-PBI followed by breast-conserving surgery after an interval of 6 to 8 months. Target volumes were defined on radiation therapy planning computed tomography scan and additional magnetic resonance imaging. Prescribed doses to gross tumor volume and clinical target volume (gross tumor volume plus 20 mm margin) were 20 Gy and 15 Gy, respectively. Primary outcome was pathologic complete response (pCR). Secondary outcomes were radiologic response (on magnetic resonance imaging), toxicity (Common Terminology Criteria for Adverse Events), PROs (European Organisation for Research and Treatment of Cancer QLQ-BR23, Hospital Anxiety and Depression Scale), and cosmesis (assessed by patient, radiation oncologist, and BCCT.core software). RESULTS: Thirty-six patients were treated with NA-PBI, and pCR was reported in 15 patients (42%; 95% confidence interval, 26%-59%). Radiologic complete response was observed in 15 patients, 10 of whom had pCR (positive predictive value, 67%; 95% confidence interval, 39%-87%). After a median follow-up of 21 months (range, 12-41), all patients experienced grade 1 fibrosis in the treated breast volume. Transient grade 2 and 3 toxicity was observed in 31% and 3% of patients, respectively. Local recurrences were absent. No deterioration in PROs or cosmetic results was observed. CONCLUSIONS: NA-PBI has the potential to induce pCR in a substantial proportion of patients, with acceptable toxicity. This treatment seems a feasible alternative to standard postoperative irradiation and could even result in postponement or omission of surgery if pCR can be accurately predicted in selected low-risk patients

Heavy-metal concentrations in small mammals from a diffusely polluted floodplain : importance of species- and location-specific characteristics.

The soil of several floodplain areas along large European rivers shows increased levels of heavy metals as a relict from past sedimentation of contaminants. These levels may pose risks of accumulation in food webs and toxicologic effects on flora and fauna. However, for floodplains, data on heavy-metal concentrations in vertebrates are scarce. Moreover, these environments are characterised by periodical flooding cycles influencing ecologic processes and patterns. To investigate whether the suggested differences in accumulation risks for insectivores and carnivores, omnivores, and herbivores are reflected in the actual heavy-metal concentrations in the species, we measured the current levels of Zn, Cu, Pb, and Cd in 199 specimens of 7 small mammal species (voles, mice, and shrews) and in their habitats in a diffusely polluted floodplain. The highest metal concentrations were found in the insectivorous and carnivorous shrew, Sorex araneus. Significant differences between the other shrew species, Crocidura russula, and the vole and mouse species was only found for Cd. The Cu concentration in Clethrionomys glareolus, however, was significantly higher than in several other vole and mouse species. To explain the metal concentrations found in the specimens, we related them to environmental variables at the trapping locations and to certain characteristics of the mammals. Variables taken into account were soil total and CaCl2-extractable metal concentrations at the trapping locations; whether locations were flooded or nonflooded; the trapping season; and the life stage; sex; and fresh weight of the specimens. Correlations between body and soil concentrations and location or specimen characteristics were weak. Therefore; we assumed that exposure of small mammals to heavy-metal contamination in floodplains is significantly influenced by exposure time, which is age related, as well as by dispersal and changes in foraging and feeding patterns under influence of periodic flooding