Intraoperative radiocolloid injection for sentinel node biopsy postneoadjuvant chemotherapy.

BACKGROUND: This study sought to determine significance of radiocolloid injection timing for sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS: A retrospective comparison of intraoperative (IRCI) and preoperative (PRCI) radiocolloid injection for SNB was performed in breast cancer patients who had completed NAC. The sentinel node identification rate (SNIDR) was tested for noninferiority by a two-proportion z-test. The differences between clinical demographics, pathologic demographics, and SNIDR were evaluated by Fisher exact test. The difference in the number of sentinel nodes removed was analyzed by two-sample t-test. RESULTS: In the 6-y study period, 120 SNB were performed after NAC: 84 received PRCI and 36 received IRCI. The two groups were similar except there were fewer clinical T2 and more clinical T3 and T4 with IRCI (P = 0.0008). The SNIDR was 92.9% with PRCI and 80.6% with IRCI. By two-proportion z-test, IRCI was not "noninferior" (P = 0.5179). By Fisher exact test, the SNIDR of the two groups did not differ. The SNIDR differs only in patients who experience T downstaging (100% versus 80%, P = 0.0173). The mean number of lymph nodes removed was higher with IRCI: 3.38 versus 2.49 nodes (P = 0.0068). There were more positive SNB with IRCI: 32.1% versus 55.2%, (P = 0.0432). The incidence of nontherapeutic axillary dissection was similar between the two groups (3.6% for PRCI versus 5.6% for IRCI). CONCLUSIONS: IRCI for SNB after NAC may be inferior to PRCI.

Intraoperative injection of radiocolloid for sentinel node biopsy in breast cancer.

UNLABELLED: Preoperative injection of radiocolloid for axillary sentinel node biopsy in breast cancer is uncomfortable for patients. This study evaluated the reliability of radiocolloid injection as determined by sentinel node identification rate and positive sentinel node biopsy rate, after the patient has been anesthetized in the operating room as compared with preoperative injection. METHODS: After institutional review board approval, a retrospective cohort of patients with breast cancer who underwent sentinel node biopsy from January 2005 through December 2010 was evaluated for analysis. Patients who received intraoperative injection of radiocolloid were compared with those who received their injection preoperatively. Patients with incomplete pathologic staging or having received neoadjuvant chemotherapy were excluded. All patients received radiocolloid injections into the retroareolar tissue; some also received intradermal injection directly over the tumor. All injections contained 37 MBq (1 mCi) in 0.5 mL of filtered (0.22-µm) (99m)Tc-sulfur colloid. RESULTS: Over the 6-y study period there were 904 sentinel node biopsy procedures, and 165 patients were excluded from analysis. Of the 739 sentinel node biopsies that were analyzed, 647 had preoperative injection of radiocolloid and 92 had intraoperative injection. The overall sentinel lymph node identification rates were similar for the 2 groups: 93.5% for the preoperative injection group and 94.6% for the intraoperative injection group (not statistically significant). The identification rates remained comparable for both groups when analyzed by T stage of the tumor. The average number of sentinel lymph nodes removed was similar between preoperative and intraoperative injection: 2.60 and 2.70 nodes, respectively. The overall rates of positive sentinel nodes were comparable for the 2 groups: 25.6% for the preoperative injection group and 26.4% for the intraoperative injection group (not statistically significant). When analyzed by T stage, the positive sentinel node rates remained similar between the 2 groups. CONCLUSION: The sentinel lymph node identification rate of 94.6% for the intraoperative injection group was similar to other published sentinel lymph node identification rates (96%-100%). The positive sentinel lymph node rate was also comparable to that of published series. Intraoperative injection of radiocolloid for axillary sentinel node biopsy appears equivalent to preoperative injection and is a less painful experience for breast cancer patients.

CC-5079: a small molecule with MKP1, antiangiogenic, and antitumor activity.

INTRODUCTION: CC-5079, a small molecule inhibitor of tubulin polymerization and phosphodiesterase-4 activity, was evaluated for antiangiogenic and antitumor activities. MATERIALS AND METHODS: First, CC-5079 in vitro activity on human umbilical vein endothelial cells (HUVECs), fibroblasts, and MC38 were evaluated by proliferation, migration, and invasion assays. Second, CC-5079 effect on microvessel formation was evaluated ex vivo by chick chorioallantoic membrane (CAM), rat aortic rings assays, and with directed in vivo angiogenesis assay (DIVAA). Third, CC-5079 antitumor effect was determined in treatment of C57BL/6 mice with MC38 tumors. Finally, CC-5079 modulation of MKP1 in HUVECs, human fibroblast, and MC38 were determined by RNA isolation for qRT-PCR. RESULTS: At the 0.1 µM concentration CC-5079 significantly inhibited HUVEC, fibroblast, and MC38 proliferation and migration (all P < 0.001). At the 0.1 µM concentration, CC-5079 also inhibited HUVEC invasion (P < 0.05) but not fibroblast. In the CAM and rat aortic ring assays, CC-5079 at 0.1 µM inhibited microvessel formation (P < 0.05). By DIVAA, CC-5079 at 1 mg/kg/d continuous delivered inhibited microvessel formation (P < 0.05). Intraperitoneal CC-5079 was well tolerated and inhibited the growth of subcutaneous MC38 at 100 mg/kg/d (P < 0.01). By qRT-PCR, CC-5079 stimulated MKP1 expression in HUVEC and fibroblast. CONCLUSION: CC-5079 demonstrated stimulation of MKP1, antiangiogenic, and antitumor properties.

Effects of surgical excision on survival of patients with stage IV breast cancer.

BACKGROUND: Non-palliative resection of the primary tumor in stage IV breast cancer is controversial. Our aim was to determine whether surgery improves survival in stage IV patients. METHODS: We reviewed records of all stage IV breast cancer patients (1990-2000) at our institution. Data collection included demographics, metastasis sites, treatment, and survival. Survival was compared between metastasis type, hormonal therapy versus no hormonal therapy, chemotherapy versus no chemotherapy, radiation versus no radiation, and surgery versus no surgery. To ascertain local therapy effects while accounting for chemotherapy, we analyzed survival among chemotherapy alone versus chemotherapy with radiation versus chemotherapy with surgery. We also performed multivariate analysis by multiple linear regression. RESULTS: Of 157 patients, 58 (37%) had bone-only metastases, 99 (63%) had visceral metastases. Both groups had a 17-mo median survival. Eighty (51%) received hormonal therapy while 77 (49%) did not. Both groups had a 15-mo median survival. Eighty-four (54%) received chemotherapy with a 25-mo median survival versus 8 mo for 73 (46%) not receiving chemotherapy, Wilcoxon (P < 0.0001), and log-rank (P = 0.02). Fifty-eight (37%) received radiation and 99 (63%) did not, with both groups having a 17-mo median survival. Fifty-two (33%) with surgery to the breast primary had a 25-mo median survival, while 105 (67%) without surgery had a 13-mo median survival, Wilcoxon (P = 0.004) and log-rank (P = 0.06). Among patients receiving chemotherapy, 37 with chemotherapy alone had a 21-mo median survival versus 40 mo for the 14 with chemotherapy and radiation and 22 mo for the 33 with chemotherapy and surgery. These differences were not significant by Wilcoxon (P = 0.41) or log-rank (P = 0.36). Multivariate analysis determined chemotherapy as the only factor associated with improved survival (P = 0.02). CONCLUSION: Our data, when standardized for chemotherapy, suggests loco-regional therapy does not improve survival.

Predictors of length of stay following colorectal resection for neoplasms in 183 Veterans Affairs patients.

BACKGROUND: There is increasing pressure to reduce the length of stay in hospital (LOS) after colorectal surgery. The aim of this study was to identify factors that prolong LOS after colorectal surgery in a population of veterans. METHODS: Retrospective analysis was performed of all patients undergoing colorectal resection for a neoplasm at a single Veterans Affairs (VA) hospital (2002-2007). Data collected included demographics, co-morbidities, operative management, postoperative morbidity and mortality, nutritional status, and LOS. Statistical analysis included descriptive statistics, univariate analysis, and multivariate analysis. RESULTS: A total of 186 patients were identified. Three patients had an LOS of more than 100 days and were omitted from the analysis. The median LOS was 8 days. Multivariate analysis showed only two variables: coronary artery disease (CAD) and postoperative complications were predictive of prolonged LOS. Chronic obstructive pulmonary disease (COPD) was the only preoperative morbidity predictive of complications. CONCLUSIONS: The aim of this study was to identify factors that prolong LOS after colorectal surgery in a VA population. We found that CAD and postoperative complications were the only variables predictive of prolonged LOS after colorectal resection, and COPD was the only factor predictive of postoperative complications.