SUBMIT: Systemic therapy with or without up front surgery of the primary tumor in breast cancer patients with distant metastases at initial presentation

<p>Abstract</p> <p>Background</p> <p>Five percent of all patients with breast cancer have distant metastatic disease at initial presentation. Because metastatic breast cancer is considered to be an incurable disease, it is generally treated with a palliative intent. Recent non-randomized studies have demonstrated that (complete) resection of the primary tumor is associated with a significant improvement of the survival of patients with primary metastatic breast cancer. However, other studies have suggested that the claimed survival benefit by surgery may be caused by selection bias. Therefore, a randomized controlled trial will be performed to assess whether breast surgery in patients with primary distant metastatic breast cancer will improve the prognosis.</p> <p>Design</p> <p>Randomization will take place after the diagnosis of primary distant metastatic breast cancer. Patients will either be randomized to up front surgery of the breast tumor followed by systemic therapy or to systemic therapy, followed by delayed local treatment of the breast tumor if clinically indicated.</p> <p>Patients with primary distant metastatic breast cancer, with no prior treatment of the breast cancer, who are 18 years or older and fit enough to undergo surgery and systemic therapy are eligible. Important exclusion criteria are: prior invasive breast cancer, surgical treatment or radiotherapy of this breast tumor before randomization, irresectable T4 tumor and synchronous bilateral breast cancer. The primary endpoint is 2-year survival. Quality of life and local tumor control are among the secondary endpoints.</p> <p>Based on the results of prior research it was calculated that 258 patients are needed in each treatment arm, assuming a power of 80%. Total accrual time is expected to take 60 months. An interim analysis will be performed to assess any clinically significant safety concerns and to determine whether there is evidence that up front surgery is clinically or statistically inferior to systemic therapy with respect to the primary endpoint.</p> <p>Discussion</p> <p>The SUBMIT study is a randomized controlled trial that will provide evidence on whether or not surgery of the primary tumor in breast cancer patients with metastatic disease at initial presentation results in an improved survival.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01392586">NCT01392586</a>.</p

Detection of diffuse interstellar bands in M31

We investigate the diffuse interstellar band (DIB) spectrum in the interstellar medium of M31. The DEIMOS spectrograph of the W. M. Keck observatory was used to make optical spectroscopic observations of two supergiant stars, MAG 63885 and MAG 70817, in the vicinity of the OB78 association in M31 where the metallicity is approximately equal to solar. The 5780, 5797, 6203, 6283 and 6613 DIBs are detected in both sightlines at velocities matching the M31 interstellar Na I absorption. The spectra are classified and interstellar reddenings are derived for both stars. Diffuse interstellar band (DIB) equivalent widths and radial velocities are presented. The spectrum of DIBs observed in M31 towards MAG 63885 is found to be similar to that observed in the Milky Way. Towards MAG 70817 the DIB equivalent widths per unit reddening are about three times the Galactic average. Compared to observations elsewhere in the Universe, relative to reddening the M31 ISM in the vicinity of OB78 is apparently a highly favourable environment for the formation of DIB carriers

A search for interstellar anthracene toward the Perseus anomalous microwave emission region

We report the discovery of a new broad interstellar (or circumstellar) band at 7088.8 +- 2.0 \AA coincident to within the measurement uncertainties with the strongest band of the anthracene cation (C$_{14}$H$_{10}$$^+$) as measured in gas-phase laboratory spectroscopy at low temperatures (Sukhorukov et al.2004). The band is detected in the line of sight of star Cernis 52, a likely member of the very young star cluster IC 348, and is probably associated with cold absorbing material in a intervening molecular cloud of the Perseus star forming region where various experiments have recently detected anomalous microwave emission. From the measured intensity and available oscillator strength we find a column density of N$_{an^+}$= 1.1(+-0.4) x 10$^{13}$ cm$^{-2}$ implying that ~0.008% of the carbon in the cloud could be in the form of C$_{14}$H$_{10}$$^+$. A similar abundance has been recently claimed for the naphthalene cation (Iglesias-Groth et al. 2008) in this cloud. This is the first location outside the Solar System where specific PAHs are identified. We report observations of interstellar lines of CH and CH$^+$ that support a rather high column density for these species and for molecular hydrogen. The strength ratio of the two prominent diffuse interstellar bands at 5780 and 5797 \AA suggests the presence of a ``zeta'' type cloud in the line of sight (consistent with steep far-UV extinction and high molecular content). The presence of PAH cations and other related hydrogenated carbon molecules which are likely to occur in this type of clouds reinforce the suggestion that electric dipole radiation from fast spinning PAHs is responsible of the anomalous microwave emission detected toward Perseus.Comment: Accepted for publication in Monthly Notices of the Royal Astronomical Societ

Linear/circular spectropolarimetry of diffuse interstellar bands

Context. The identification of the carriers of diffuse interstellar bands (DIBs) remains one of the long-standing mysteries in astronomy. The detection of a polarisation signal in a DIB profile can be used to distinguish between a dust or gas-phase carrier. The polarisation profile can give additional information on the grain or molecular properties of the absorber. In order to detect and measure the linear and circular polarisation of the DIBs we observed reddened lines of sight showing continuum polarisation. For this study we selected two stars HD 197770 and HD 194279. We used high-resolution (R~64.000) spectropolarimetry in the wavelength range from 3700 to 10480 Angstrom with the ESPaDOnS echelle spectrograph mounted at the CFHT. Results. High S/N and high resolution Stokes V (circular), Q and U (linear) spectra were obtained. We constrained upper limits by a factor of 10 for previously observed DIBs. Furthermore, we analysed ~30 additional DIBs for which no spectropolarimetry data has been obtained before. This included the 9577 A DIB and the 8621 A DIB. Conclusions. The lack of polarisation in 45 DIB profiles suggests that none of the absorption lines is induced by a grain-type carrier. The strict upper limits, less than ~0.01%, derived for the observed lines-of-sight imply that if DIBs are due to gas-phase molecules these carriers have polarisation efficiencies which are at least 6 times, and up to 300 times, smaller than those predicted for grain-related carriers.Comment: 6 pages + 13 pages online material, submitted to A&

Laboratory investigations of the interaction between benzene and bare silicate grain surfaces

Experimental results on the thermal desorption of benzene (C6H6) from amorphous silica (SiO2) are presented. The amorphous SiO2 substrate was imaged using atomic force microscopy (AFM), revealing a surface morphology reminiscent of that of interplanetary dust particles (IDPs). Temperature programmed desorption (TPD) experiments were conducted for a wide range of C6H6 exposures, yielding information on both C6H6-SiO2 interactions and the C6H6-C6H6 interactions present in the bulk C6H6 ice. The low coverage experiments reveal complicated desorption behaviour that results both from porosity and roughness in the SiO2 substrate, and repulsive interactions between C6H6 molecules. Kinetic parameters were obtained through a combination of direct analysis of the TPD traces and kinetic modelling, demonstrating the coverage dependence of both desorption energy and pre-exponential factor. Experiments were also performed whereby the pores were blocked by pre-exposure of the SiO2 to water vapour. C6H6 was observed to be adsorbed preferentially on the SiO2 film not covered by H2O at the temperature at which these experiments were performed. This observation means that intermolecular repulsion likely becomes important at smaller C6H6 exposures on grains with a H2O mantle. Kinetic modelling of C6H6 multilayer desorption yields kinetic parameters in good agreement with previous studies, with the SiO2 having little impact on the desorption beyond the first few layers.Comment: 23 pages, including 6 figures and 1 table ; Submitted to MNRA

A search for diffuse bands in the circumstellar envelopes of post-AGB stars

In this work we present the results of a systematic search for diffuse bands (DBs, hereafter) in the circumstellar envelopes of a carefully selected sample of post-AGB stars. We concentrated on the analysis of 9 of the DBs most commonly found in the interstellar medium. The strength of these features is determined using high resolution optical spectroscopy and the results obtained are compared with literature data on field stars affected only by interstellar reddening. Based on the weak features observed in the subsample of post-AGB stars dominated by circumstellar reddening we conclude that the carrier(s) of these DBs must not be present in the circumstellar environment of these sources, or at least not under the excitation conditions in which DBs are formed. The conclusion is applicable to all the post-AGB stars studied, irrespective of the dominant chemistry or the spectral type of the star considered. A detailed radial velocity analysis of the features observed in individual sources confirms this result, as the Doppler shifts measured are found to be consistent with an interstellar origin.Comment: Accepted for A&

A coincidence between a hydrocarbon plasma absorption spectrum and the lambda 5450 DIB

The aim of this work is to link the broad lambda 5450 diffuse interstellar band (DIB) to a laboratory spectrum recorded through an expanding acetylene plasma. Cavity ring-down direct absorption spectra and astronomical observations of HD 183143 with the HERMES spectrograph on the Mercator Telescope in La Palma and the McKellar spectrograph on the DAO 1.2 m Telescope are compared. In the 543-547 nm region a broad band is measured with a band maximum at 545 nm and FWHM of 1.03(0.1) nm coinciding with a well-known diffuse interstellar band at lambda 5450 with FWHM of 0.953 nm. A coincidence is found between the laboratory and the two independent observational studies obtained at higher spectral resolution. This result is important, as a match between a laboratory spectrum and a - potentially lifetime broadened - DIB is found. A series of additional experiments has been performed in order to unambiguously identify the laboratory carrier of this band. This has not been possible. The laboratory results, however, restrict the carrier to a molecular transient, consisting of carbon and hydrogen.Comment: 6 pages, 3 figures, accepted for publication in A&