The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

Abstract: Background: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

The Tale Of Suirrel Nutkin = Kisah Nutkin Tupai

Squirrel Nutkin bersama sekelompok tupai pergi ke Pulau Owl untuk mengumpulkan kacang. Tapi, ketika semua tupai lain sedang sibuk mengumpulkan kacang, Nutkin selalu bermain dan berbuat onar. Kejadian ini terjadi selama enam hari. Setiap mereka tiba, tupai lain mempersembahkan burung hantu penghuni pulau, Old Brown, dengan hadiah untuk mendapat persetujuannya agar diperbolehkan mengumpulkan kacang. Setiap kali itu juga, Nutkin menari dan meneriaki burung hantu itu dengan nyanyian teka-teki. Akhirnya, Nutkin sudah terlalu sering membuat Old Brown jengkel. Sang burung hantu menangkap Nutkin dan mencoba untuk mengulitinya hidup-hidup. Nutkin terlepas, tetapi dengan kehilangan hampir seluruh ekorny

The Tale Of Two Bad Mice : Kisah Dua Tikus Nakal

Buku ini berkisah tentang kehidupan hewan tikus yang nakal dengan ilustrasi buku yang indah dan digambar sendiri pengarangnya.29 hlm; 16x19,5 c

The Tale of Johnny Town-Mouse

Book 58 p. col. illus. 14 c

The tale of squirrel Nutkin.

Mode of access: Internet

The tale of Ginger & Pickles /

Ginger, a yellow tom-cat, and Pickles, a terrier, run a very popular general store but soon run into trouble because they give everyone unlimited credit.Facsim. reprint.Ginger, a yellow tom-cat, and Pickles, a terrier, run a very popular general store but soon run into trouble because they give everyone unlimited credit.Mode of access: Internet

Ginger & Pickles /

Mode of access: Internet

The tale of Benjamin Bunny /

Title vignette.Mode of access: Internet