Intraoperative radiation therapy for early-stage breast cancer: a single-institution experience

Background: To assess outcomes and toxicity after low-energy intraoperative radiotherapy (IORT) for early-stage breast cancer (ESBC).  Materials and methods: We reviewed patients with unilateral ESBC treated with breast-conserving surgery and 50-kV IORT at our institution. Patients were prescribed 20 Gy to the surface of the spherical applicator, fitted to the surgical cavity during surgery. Patients who did not meet institutional guidelines for IORT alone on final pathology were recommended adjuvant treatment, including additional surgery and/or external-beam radiation therapy (EBRT). We analyzed ipsilateral breast tumor recurrence, overall survival, recurrence-free survival and toxicity. Results: Among 201 patients (median follow-up, 5.1 years; median age, 67 years), 88% were Her2 negative and ER positive and/or PR positive, 98% had invasive ductal carcinoma, 87% had grade 1 or 2, and 95% had clinical T1 disease. Most had pathological stage T1 (93%) N0 (95%) disease. Mean IORT applicator dose at 1-cm depth was 6.3 Gy. Post-IORT treatment included additional surgery, 10%; EBRT, 11%; adjuvant chemotherapy, 9%; and adjuvant hormonal therapy, 74%. Median total EBRT dose was 42.4 (range, 40.05-63) Gy and median dose per fraction was 2.65 Gy. At 5 years, the cumulative incidence of ipsilateral breast tumor recurrence was 2.7%, the overall survival rate was 95% with no breast cancer-related deaths, and the recurrence-free survival rate was 96%. For patients who were deemed unsuitable for postoperative IORT alone and did not receive recommended risk-adapted EBRT, the IBTR rate was 4.7% versus 1.7% (p = 0.23) for patients who were either suitable for IORT alone or unsuitable and received adjuvant EBRT. Cosmetic toxicity data was available for 83%, with 7% experiencing grade 3 breast toxicity and no grade 4–5 toxicity. Conclusions: IORT for select patients with ESBC results in acceptable outcomes in regard to ipsilateral breast tumor recurrence and toxicity

Effects of probiotic fermented milk on biofilms, oral microbiota, and enamel

The aim of this study was to evaluate in vitro and in vivo the effects of 2 brands of probiotic fermented milk on biofilms, oral microbiota, and enamel. For the in situ experiment, ten volunteers wore palatine devices containing four blocks of bovine dental enamel over 3 phases, during which 20% sucrose solution, Yakult® (Treatment A), and Batavito® (Treatment B) were dropped on the enamel blocks. Salivary microbial counts were obtained and biofilm samples were analyzed after each phase. For the in vivo experiment, the same ten volunteers drunk Yakult® (Treatment C) and Batavito® (Treatment D) in two phases. Saliva samples were collected for microbial analysis after each phase. The in situ study showed that in comparison with Treatment A, Treatment B resulted in fewer total cultivable anaerobes and facultative microorganisms in biofilms, higher final microhardness, lower percentage change in surface hardness, and smaller integrated subsurface enamel hardness. In the in vivo study, Treatment D resulted in a reduction in the counts of all microorganisms. The results suggested that the probiotic fermented milk Batavito®, but not Yakult®, reduced the amount of oral microorganisms and mineral loss in bovine enamel.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Estadual Paulista Faculdade de Odontologia de Araçatuba Department of Pediatric and Social DentistryUniversidade Estadual Paulista Faculdade de Odontologia de Araraquara Department of Orthodontics and Pediatric DentistryUniversidade Estadual Paulista Faculdade de Odontologia de Araçatuba Department of Pediatric and Social DentistryUniversidade Estadual Paulista Faculdade de Odontologia de Araraquara Department of Orthodontics and Pediatric Dentistr

Comment on A Letter to the Editor Regarding "evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (S-LYMPHA) for the Prevention of Breast Cancer-Related Clinical Lymphedema after Axillary Lymph Node Dissection"

none6simixedJohnson A.R.; Feldman S.M.; James T.A.; Spiguel L.; Boccardo F.; Singhal D.Johnson, A. R.; Feldman, S. M.; James, T. A.; Spiguel, L.; Boccardo, F.; Singhal, D

Abstract P1-01-02: Sentinel Node Biopsy Alone for Node Positive Breast Cancer, a Twelve Year Experience at a Single Institution

Abstract Background: The decision to perform complete node dissection for a tumor positive sentinel node is becoming more controversial. Five year data from the American College of Surgeon's Z011 trial recently demonstrated no difference in regional control in patients undergoing sentinel node biopsy alone for node positive disease. We report our institution's 12 year experience with sentinel node biopsy alone for tumor positive sentinel node and clinicopathologic factors that are associated with sentinel node biopsy alone. Patients and Methods: From 1998 to 2009, a retrospective review was performed on 2,139 patients who underwent sentinel node biopsy alone for breast cancer. Of these 2,139 patients, 1,997 were tumor negative, 123 tumor positive and 19 cases were undocumented. Sentinel nodes were staged node positive according to AJCC criteria. Patient and tumor factors associated with sentinel node biopsy alone and locoregional recurrence, distant recurrence and overall survival were examined. Results: One hundred twenty three node positive patients underwent sentinel node biopsy alone with no completion axillary dissection for invasive breast cancer. Eighty two (66.7%) patient's sentinel nodes had macrometastases and 41 (33.3%) had micrometastases. Median follow-up was 8 years (range0.7 to 12yrs). Mean age was 57 years (range 32-92) and stage distribution was as follows: Stage IIA: 76 (62%) patients, Stage IIB: 40 (33%) patients, Stage III: 4 patients (3%), and Stage IV: 1 patient (0.8%). The mean size of the tumors was 1.9cm (range 0.1-9), 79 patients (64%) had grade I/II tumors and 36 (29%) had grade III tumors. Eighty nine (72%) underwent lumpectomy and 34 (28%) underwent mastectomy. When we examined patient and treatment factors that might explain omission of axillary dissection we saw that 95 (77%) patients had no comorbidities, 8 (6.5%) had one comorbidity and 20 (16%) had two or more comorbidities listed. Seventy seven patients (67%) received breast radiation in combination with adjuvant chemotherapy or hormonal therapy. Ninety (73%) patients had three or less sentinel nodes removed and 33 (27%) had four or more sentinel nodes removed. One hundred twenty patients had recurrence data, of which one (0.8%) had an axillary recurrence and 13 (11%) have expired. Of the 13 patients who died, four died of metastatic breast cancer and 9 of other causes. All patients with recurrence had macrometastasis to the lymph nodes. Conclusions: Favorable tumor and patient characteristics and high prevalence of adjuvant therapy may explain why completion axillary dissection was omitted in this group of tumor positive sentinel node patients. This study represents one of the longer follow-up periods in the literature and demonstrates that recurrent regional disease is rare with extended follow-up in patients undergoing sentinel node biopsy alone for node positive disease, even macrometastatic disease. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-02.</jats:p