Prospective evaluation of weekly concomitant tumor bed boost with three-week hypofractionated whole breast irradiation in early breast cancer

Objectives: A prospective study was conducted to assess the acute and late toxicity of hypofractionated whole breast irradiation with a weekly concomitant boost for women with early breast cancer (EBC). Methods: Women with EBC who underwent breast-conserving surgery were eligible. A dose of 40Gy in 15 fractions over 3 weeks was delivered to the whole breast with a concomitant weekly boost to the post-operative cavity of 3Gy in three fractions. Toxicity was graded using the Radiation Therapy Oncology Group (RTOG) acute toxicity and RTOG/EORTC late toxicity scales. Results: A total of 67 women were enrolled with a median age of 49 years (range 31–69). Median follow-up was 25 months (range 11–34). Acute skin reactions included grade (G) 1 (n = 47, 70%), G2 (n = 10, 13%), and G3 (n = 1, 1.5%). Late skin toxicity was observed in 13 patients (19%), all of whom experienced G1 toxicity only. On multivariable analysis, diabetes mellitus was predictive of acute skin toxicity (p = 0.003), while age less than 50 years (p = 0.029) and diabetes mellitus (p = 0.013) were predictive of late skin toxicity. Conclusions: Whole breast irradiation with concomitant weekly boost appears feasible and safe. Further investigation is required to fully evaluate this schedule as an alternative to conventional whole breast irradiation with a sequential boost

Improving the quality and efficiency of follow-up after curative treatment for breast cancer – rationale and study design of the MaCare trial

BACKGROUND: After curative treatment for breast cancer women frequently attend scheduled follow-up examinations. Usually the follow-up is most frequent in the first 2–3 years (2–4 times a year); thereafter the frequency is reduced to once a year in most countries. Its main aim is to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. However, the cost-effectiveness of these frequent visits is under much debate, leading to a search for less intensive and more cost-effective follow-up strategies. In this paper the design of the MaCare trial is described. This trial compares the cost-effectiveness of four follow-up strategies for curatively treated breast cancer patients. We investigate the costs and effects of nurse-led telephone follow-up and a short educational group programme. METHODS/DESIGN: The MaCare trial is a multi centre randomised clinical trial in which 320 breast cancer patients are randomised into four follow-up strategies, focussed on the first 18 months after treatment: 1) standard follow-up; 2) nurse-led telephone follow-up; 3) arm 1 with the educational group programme; 4) arm 2 with the educational group programme. Data is collected at baseline and 3, 6, 12 and 18 months after treatment. The primary endpoint of the trial is cancer-specific quality of life as measured by the global health/QoL scale of the EORTC QLQ-C30. Secondary outcomes are perceived feelings of control, anxiety, patients' satisfaction with follow-up and costs. A cost-effectiveness analysis will be performed from a societal perspective. DISCUSSION: Reduced follow-up strategies for breast cancer have not yet been widely applied in clinical practice. Improvement of psychosocial support and information to patients could lead to a better acceptance of reduced follow-up. The MaCare trial combines a reduced follow-up strategy with additional psychosocial support. Less frequent follow-up can reduce the burden on medical specialists and costs. The educational group programme can improve QoL of patients, but also less frequent follow-up can improve QoL by reducing the anxiety experienced for each follow-up visit. Results of the trial will provide knowledge on both costs and psychosocial aspects regarding follow-up and are expected in 2009

Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography

INTRODUCTION: The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid ((99m)Tc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile ((99m)Tc-Sestamibi [(99m)Tc-MIBI]) distribution in ductal breast carcinoma in situ and lobular breast carcinoma in situ (DCIS/LCIS), in relation to mammographic, histological and immunohistochemical parameters. MATERIALS AND METHODS: One hundred and two patients with suspicious palpation or mammographic findings were submitted preoperatively to scintimammography (a total of 72 patients with (99m)Tc-(V)DMSA and a total of 75 patients with (99m)Tc-Sestamibi, 45 patients receiving both radiotracers). Images were acquired at 10 min and 60 min, and were evaluated for a pattern of diffuse radiotracer accumulation. The tumor-to-background ratios were correlated (T-pair test) with mammographic, histological and immunohistochemical characteristics. RESULTS: Histology confirmed malignancy in 46/102 patients: 20/46 patients had DCIS/LCIS, with or without coexistent invasive lesions, and 26/46 patients had isolated invasive carcinomas. Diffuse (99m)Tc-(V)DMSA accumulation was noticed in 18/19 cases and (99m)Tc-Sestamibi in 6/13 DCIS/LCIS cases. Epithelial hyperplasia demonstrated a similar accumulation pattern. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for each tracer were calculated. Solely for (99m)Tc-(V)DMSA, the tumor-to-background ratio was significantly higher at 60 min than at 10 min and the diffuse uptake was significantly associated with suspicious microcalcifications, with the cell proliferation index ≥ 40% and with c-erbB-2 ≥ 10%. CONCLUSION: (99m)Tc-(V)DMSA showed high sensitivity and (99m)Tc-Sestamibi showed high specificity in detecting in situ breast carcinoma ((99m)Tc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography

New Radiocarbon Dates from CA-CCO-138 (Hotchkiss Mound) and CA-CCO-139 (Simone Mound) and Insights into Mounds, Settlement Patterns, and Culture History in the California Delta

We report 91 new AMS radiocarbon dates on human bone collagen from two important central California sites: CA-CCO-138 (Hotchkiss Mound; n = 46) and CA-CCO-139 (Simone Mound; n = 45). The sites lie within 500 m of one another in the California Delta and have figured prominently in the formulation of culture historical sequences in central California. The new AMS dates show that the two sites are nearly separate in their occupation sequences, with CA-CCO-139 interments dating between 1,190 and 790 cal BP and CA-CCO-138 between 810 and 150 cal BP (median date ranges). We compare the new dates to previous age assignments based on associated artifacts and depth, and discuss implications for understanding ancient settlement patterns, mound occupation sequences, and culture history in the region

Brackish water foraging: Isotopic landscapes and dietary reconstruction in Suisun Marsh, Central California

While bone stable isotope signatures of humans foraging in open coastal and fully terrestrial environments have been relatively well documented, the signature of foraging near brackish-water estuaries is less well known. This study examines the Central California isotopic landscape, or isoscape, showing how foods in different ecosystems have distinctive isotopic compositions. We present new bone collagen and apatite stable isotope data from two Late Holocene sites (CA-SOL-11 and CA-SOL-69) near Suisun Marsh, a low salinity brackish water estuary upstream from San Francisco Bay. Faunal remains at the sites include significant numbers of aquatic resources including fish and shellfish, in addition to terrestrial mammals, while paleobotanical remains suggest mainly terrestrial nuts and seeds. Stable isotope data at the population level corroborate this finding and show consumption of significant levels of brackish water nutrients, including both dietary protein and dietary carbohydrates and fats, paired with terrestrial foods. This dietary focus generates a unique brackish-water isotopic signature that is distinct from others in Central California. The documentation of an isoscape with strong regional gradients can be of tremendous help in reconstructing ancient patterns in subsistence, migration, and trade. © 2013 Elsevier Ltd

Brackish water foraging: Isotopic landscapes and dietary reconstruction in Suisun Marsh, Central California

While bone stable isotope signatures of humans foraging in open coastal and fully terrestrial environments have been relatively well documented, the signature of foraging near brackish-water estuaries is less well known. This study examines the Central California isotopic landscape, or isoscape, showing how foods in different ecosystems have distinctive isotopic compositions. We present new bone collagen and apatite stable isotope data from two Late Holocene sites (CA-SOL-11 and CA-SOL-69) near Suisun Marsh, a low salinity brackish water estuary upstream from San Francisco Bay. Faunal remains at the sites include significant numbers of aquatic resources including fish and shellfish, in addition to terrestrial mammals, while paleobotanical remains suggest mainly terrestrial nuts and seeds. Stable isotope data at the population level corroborate this finding and show consumption of significant levels of brackish water nutrients, including both dietary protein and dietary carbohydrates and fats, paired with terrestrial foods. This dietary focus generates a unique brackish-water isotopic signature that is distinct from others in Central California. The documentation of an isoscape with strong regional gradients can be of tremendous help in reconstructing ancient patterns in subsistence, migration, and trade. © 2013 Elsevier Ltd

Stable isotope evidence of juvenile foraging in prehistoric Central California

Ethnographic evidence demonstrates that hunter-gatherer children may forage effectively enough to supplement an adult provisioned diet, where ecology, subsistence strategies, and social organization are conducive to juvenile participation. We use stable isotope measures (δ15N and δ13C) from bone collagen and serial-samples of dentinal collagen extracted from first molars to examine childhood dietary patterns among 24 individuals from the Late Holocene Central California site CA-ALA-554. We identify weaning age and early childhood dietary patterns, and find evidence for independent child foraging among 25% of the sample population (n = 6), the majority of whom lived during the high-stress Medieval Climatic Anomaly (1100-700 BP)