Can radical surgical treatment of the vulva be justified in the absence of a conclusive diagnosis of squamous cell carcinoma on biopsy? A retrospective 10-year cohort study

Objectives: The extent of surgical treatment for vulvar lesions is predominantly guided by the histopathologic diagnosis rendered on the pre-operative biopsy. For premalignant lesions, local excisions are performed, whereas for vulvar squamous cell carcinoma (VSCC), more radical procedures are mandatory. However, even in the absence of a conclusive diagnosis of VSCC on biopsy, the surgeon may opt for a radical excision on grounds of strong clinical suspicion, with a view to avoiding repeat surgeries. We studied a retrospective, 10-year cohort of patients who underwent vulvar excisions, in the absence of a conclusive biopsy diagnosis of VSCC. We aimed to identify the factors predictive of VSCC in these patients, and assess their treatment. Study design: All patients who underwent vulvar excision (2005–2016) at Erasmus MC, without a definitive diagnosis of VSCC on the preoperative biopsy were included. Logistic regression analysis was performed to identify the factors predictive of a final diagnosis of VSCC. Surgical treatment was categorized as definitive, incomplete, or over-treatment, based on histopathology of the excision specimen and previous surgical history. Results: In 57 % (64/113) of all included patients, the final diagnosis was VSCC. Higher patient age (

Preoperative Partial Breast Irradiation in Patients with Low-Risk Breast Cancer: A Systematic Review of Literature

Background: Preoperative instead of standard postoperative partial breast irradiation (PBI) after breast-conserving surgery (BCS) has the advantage of reducing the irradiated breast volume, toxicity, and number of radiotherapy sessions and can allow tumor downstaging. In this review, we assessed tumor response and clinical outcomes after preoperative PBI. Patients and Methods: We conducted a systematic review of studies on preoperative PBI in patients with low-risk breast cancer using the databases Ovid Medline, Embase.com, Web of Science (Core Collection), and Scopus (PROSPERO registration CRD42022301435). References of eligible manuscripts were checked for other relevant manuscripts. The primary outcome measure was pathologic complete response (pCR). Results: A total of eight prospective and one retrospective cohort study were identified (n = 359). In up to 42% of the patients, pCR was obtained and this increased after a longer interval between radiotherapy and BCS (0.5–8 months). After a maximum median follow-up of 5.0 years, three studies on external beam radiotherapy reported low local recurrence rates (0–3%) and overall survival of 97–100%. Acute toxicity consisted mainly of grade 1 skin toxicity (0–34%) and seroma (0–31%). Late toxicity was predominantly fibrosis grade 1 (46–100%) and grade 2 (10–11%). Cosmetic outcome was good to excellent in 78–100% of the patients. Conclusions: Preoperative PBI showed a higher pCR rate after a longer interval between radiotherapy and BCS. Mild late toxicity and good oncological and cosmetic outcomes were reported. In the ongoing ABLATIVE-2 trial, BCS is performed at a longer interval of 12 months after preoperative PBI aiming to achieve a higher pCR rate

Preoperative Partial Breast Irradiation in Patients with Low-Risk Breast Cancer: A Systematic Review of Literature

Background: Preoperative instead of standard postoperative partial breast irradiation (PBI) after breast-conserving surgery (BCS) has the advantage of reducing the irradiated breast volume, toxicity, and number of radiotherapy sessions and can allow tumor downstaging. In this review, we assessed tumor response and clinical outcomes after preoperative PBI. Patients and Methods: We conducted a systematic review of studies on preoperative PBI in patients with low-risk breast cancer using the databases Ovid Medline, Embase.com, Web of Science (Core Collection), and Scopus (PROSPERO registration CRD42022301435). References of eligible manuscripts were checked for other relevant manuscripts. The primary outcome measure was pathologic complete response (pCR). Results: A total of eight prospective and one retrospective cohort study were identified (n = 359). In up to 42% of the patients, pCR was obtained and this increased after a longer interval between radiotherapy and BCS (0.5–8 months). After a maximum median follow-up of 5.0 years, three studies on external beam radiotherapy reported low local recurrence rates (0–3%) and overall survival of 97–100%. Acute toxicity consisted mainly of grade 1 skin toxicity (0–34%) and seroma (0–31%). Late toxicity was predominantly fibrosis grade 1 (46–100%) and grade 2 (10–11%). Cosmetic outcome was good to excellent in 78–100% of the patients. Conclusions: Preoperative PBI showed a higher pCR rate after a longer interval between radiotherapy and BCS. Mild late toxicity and good oncological and cosmetic outcomes were reported. In the ongoing ABLATIVE-2 trial, BCS is performed at a longer interval of 12 months after preoperative PBI aiming to achieve a higher pCR rate

Divergence in timing of parental care and migration in barnacle geese

In migratory geese, the extended association of parents and offspring is thought to play a crucial role in culturally transmitting the migration strategy to the next generation. Goslings migrate with their parents and associate closely with them almost until the next breeding season. Families do not break up until spring migration, when the parent--offspring conflict intensifies during preparation for the next generation of offspring. Recently, the commencement of spring migration of the Russian population of the barnacle goose has been delayed by about 1 month. Here, we investigated whether the duration of parental care behavior changed with this alteration in migratory behavior. In contrast to our expectation, we found that parental care terminated well before the commencement of spring migration and that parent--offspring associations were nearly absent during spring migration. We argue that the mechanisms for determining the duration of parental care is different from that determining the commencement of spring migration; hence, we conclude that a divergence in timing has developed between both behaviors. A consequence of this divergence could be that the cultural transmission of migratory behavior is disrupted, possibly playing a role in the recent establishment of new populations of Barnacle geese across the Russian flyway. Copyright 2011, Oxford University Press.