High Ki67 as negative predictor for response to concurrent radiotherapy plus Capecitabine in chemo-resistant advanced breast cancer.

PURPOSE: The purpose of this study was to evaluate Ki67 as a biomarker for response to concurrent chemo-radiotherapy in previously treated patients with standard chemotherapy protocols in the neoadjuvant setting (NACT). METHODS: Evaluated were 33 patients treated concurrently with radiotherapy and capecitabine. All patients had residual disease after anthracycline-docetaxel based NACT, verified with imaging techniques and clinical exams. Response rate (RR) was evaluated 3 months after completion of the concurrent treatment, and was correlated to tumor immune-histochemical characteristics. Binary logical regression was used for model testing and correlation of Ki67 and RR. An Omnibus test showed the model to be statistically significant and that a set of depending variables can be used as predictors for treatment response with p=0.021. Model -2 log likelihood with Nagelkerke R Square were used to define significance of other tumor characteristics besides Ki67. RESULTS: Only Ki67 showed statistically significant correlation with RR, as high Ki67 predicts that there will be no response to concurrent capecitabine - radiotherapy treatment in chemo-resistant advanced breast cancer. Other characteristics such as histological grade, estrogen or progesterone receptors, HER2 overexpression or lymphovascular or perineural invasion showed no significance. CONCLUSION: High value of Ki67 is a negative predictor for response in concurrent capecitabine-radiotherapy treatment in chemo-resistant advanced breast cancer.

Evaluation of thoracic surface motion during the free breathing and deep inspiration breath hold methods.

The aim of this study was to evaluate thoracic surface motion from chest wall expansion during free breathing (FB) and deep inspiration breath hold (DIBH) methods, measured with and without 4-dimensional computed tomography (4D-CT) simulation, using equipment developed in-house. The respiratory amplitude and chest wall expansion were evaluated at 5 levels of the thorax, (the sterno-clavicular joint (SCJ), the second level, the intermammary line (IML), the fourth level and the caudal end of the xiphoid process (XP)) using radiopaque wires and potentiometers, with a CT scan simultaneously. This study included 25 examinees (10 volunteers performed FB, 10 volunteers performed DIBH and 5 patients performed FB). For low and irregular respiration, coaching was used, and its impact was evaluated for both breathing methods, FB and DIBH. The breathing amplitude performed with FB between volunteers and patients was not detectable at the SCJ; increasing to the abdomen, 3 mm vs 2 mm (p = 0.326) at the second level; 6 mm vs 4 mm (p = 0.042) at the IML; 10 mm vs 8 mm (p < 0.01) at the fourth level; and 23 mm vs 19 mm (p < 0.001) at the XP. Contrary to the DIBH, where breathing amplitude was greater at 2 first levels 18 mm (SCJ) and 20 mm (second level), decreasing to the abdomen, 14 mm (IML); 11 mm (fourth level); and 10 mm (XP). Chest wall expansion was not detected at the SCJ, while at other levels measured from 1 to 7 mm. Coaching was improve breathing amplitude, for both methods, FB (3 mm) and DIBH (5 mm). The location of amplification is different depending on the breathing method and the in-house phantom was useful to check the amplification level.

2020 consensus guideline for optimal approach to the diagnosis and treatment of HER2-positive breast cancer in Bosnia and Herzegovina.

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.