Diffuse large B-cell lymphoma of the breast: prognostic factors and treatment outcomes.

BACKGROUND: The breast is a rare site of extranodal involvement of diffuse large B-cell lymphoma (DLBCL). We aimed to assess the clinical characteristics, prognostic factors, and treatment outcomes of breast DLBCL. PATIENTS AND METHODS: We retrospectively analyzed 113 patients (from our institution and the literature) between 1973 and 2014. The primary end point was overall survival (OS). Kaplan-Meier OS curves were compared with the log-rank test. Cox regression analysis was applied to determine the prognostic factors for OS, progression-free survival (PFS), local control (LC), and cause-specific survival (CSS). RESULTS: A total of 113 patients were included in the study: 42 cases from our hospital and 71 cases from 12 publications. The median age at diagnosis was 58 years. With a median follow-up time of 39.2 months, the estimated 5-year OS, PFS, LC, and CSS were 71.4%, 58.8%, 75.6%, and 74.9%, respectively. In multivariate analysis, more than four cycles of chemotherapy, having localized cancer, lumpectomy with or without axillary lymph node (ALN) dissection, and low to low-to-intermediate International Prognostic Index were favorable factors for OS. For PFS, significant prognostic factors were rituximab use, B symptoms, and tumor size. As for the local group, lumpectomy with or without ALN dissection and more than four cycles of chemotherapy were favorable factors for OS. Tumor size >4 cm and nonuse of rituximab were adverse factors for PFS. Twenty-one patients (18.6%) developed local relapse and 33 (29.2%) developed systemic relapse. Eight patients had central nervous system relapse (7.3%). CONCLUSION: Our results reveal that local and extended staging criteria can reflect the different prognosis and treatment outcomes of breast DLBCL. Rituximab use, lumpectomy, and more than four cycles of chemotherapy are recommended as a treatment regimen. However, further study is warranted to validate our data.

Similar Outcomes of Standard Radiotherapy and Hypofractionated Radiotherapy Following Breast-Conserving Surgery.

BACKGROUND: Adjuvant radiation therapy is commonly administered to breast cancer patients who received breast-conserving surgery. However, lengthy treatment times of standard radiotherapy pose certain challenges. Here, we performed a prospective controlled study comparing standard radiation to hypofractionated radiotherapy in terms of efficacy and outcome. MATERIAL AND METHODS: Eighty breast cancer patients (tumor stage pT1-2N0-1M0) who had undergone breast-conservation surgery were randomly divided into 2 groups (40 patients/group). The experimental group received 43.2 Gy to the whole breast in 18 fractions for 24 days with a concomitant boost (50.4 Gy) to the tumor bed. The control group received 45 Gy to the whole breast in 25 fractions for 44 days with a boost to the tumor bed of 59 Gy. Survival, locoregional recurrence, adverse effects, and aesthetic results were all considered for analysis. RESULTS: The following criteria were included as part of study follow-up: local control, survival, adverse skin reactions, cosmetic outcome, and hematological toxicity. At a median follow-up of 27 months (follow-up rate 100%), there were no statistical differences in any of the categories between the 2 groups. The 2-year survival rate of both groups was 100% without any locoregional recurrence. Although there was some skin toxicity, these instances were not severe and they cleared on their own within 6 weeks. The most common problems encountered by patients were breast fibrosis and altered pigmentation. CONCLUSIONS: A shortened whole-breast hypofractionated irradiation schedule with a concomitant boost is as effective as standard radiation and may be a reasonable alternative following breast conservation surgery.

Brain metastasis treated with Cyberknife.

BACKGROUND: Cyberknife can greatly raise the fractional dose of stereotactic radiosurgery, thus improving its clinical efficacy. We retrospectively analyzed clinical outcomes of brain metastasis treated with Cyberknife. METHODS: We analyzed 40 cases of brain metastases treated with Cyberknife in the Tianjin Cancer Hospital from August 1, 2006 to August 1, 2007, for a total of 68 lesions with maximal diameter of 0.4 - 7.5 cm (average 1.88 cm). Total hypofractional radiated dosage was 18 - 36 Gy (5 - 25 Gy/F, 1 - 5 F) by Cyberknife. We evaluated the remission rate of clinical symptoms, correlation factors to new foci, 3-month local control rates, and 3-month and 1-year survival rates. All patients were followed up for more than 14 months. RESULTS: After 1 week, clinical remission was 90.0% (36/40). After 3 months, the local control rate and therapeutic effective rate were 77.9% (53/68) and 94.1% (64/68), respectively, as observed by cranium augmentation CT or MRI. The three-month, six-month and 1-year survival rates were 97.5% (39/40), 82.5% (33/40) and 67.5% (27/40), respectively. Fourteen patients had neopathy outside the original lesion after 3 months. Neopathy was not correlated with age, whole-brain radiotherapy, number of original lesions, maximum diameter of the original lesion, therapeutic dose per fraction, therapeutic frequency or total therapeutic dose. CONCLUSIONS: Cyberknife got perfect clinical outcomes by higher dosage per fraction. It is an appropriate and valid treatment shortcut for brain metastasis.

[Protein expression of p53, bcl-2, and bax in adenoid cystic carcinoma of lacrimal gland].

OBJECTIVE: To investigate the expression of p53, bcl-2, and hax, apoptosis regulating genes, in adenoid cystic carcinoma of larcrimal gland and the roles thereof in clinical prognosis. METHODS: 56 patients of adenoid cystic carcinoma of larcrimal gland were divided into two groups according to the prognosis: poor prognosis group with recurrence or metastasis within 5 years (n=32) and better prognosis group (n=24) surviving tumor free within 5 years. The protein expression levels of p53, tumor suppressor gene, bax, apoptosis promoting gene, and bcl-2, anti-apoptosis gene, were analyzed by strepavidin peroxidase method. 8 cases of normal lacrimal gland tissues were used as controls. RESULTS: (1) The overall positive rate of p53 of the patients with adenoid cystic carcinoma of larcrimal gland was 73.2%, significantly higher than that of the normal controls (0, P < 0.05). The p53 positive rate of better prognosis group was 62.5%, significantly higher than that of the poor prognosis group (81.3%, P < 0.05). The protein expression of p53 in adenoid cystic carcinoma of larcrimal gland was negatively correlated with clinical prognosis. (2) The overall expression rate of bcl-2 of the patients with adenoid cystic carcinoma of larcrimal gland was 69.6%, significantly lower than that of the control group (P < 0.05). The expression bcl-2 protein was correlated with better clinical prognosis. (3) The bax positive rate of the patients with adenoid cystic carcinoma of larcrimal gland group was 60.7%, not significantly lower than the control group. The bar positive rate of the better prognosis group was 91.7%, significantly higher than that of the poor prognosis group (65.6%, P < 0.05). CONCLUSION: Some apoptosis regulating genes, such as mutation-type (mt) p53 play an important role in the gene ration and development of adenoid cystic carcinoma of larcrimal gland. p53, bax, and bcl-2 proteins may act as valuable signals for clinical prognosis. The patients with over expression of bcl-2 and bax and low expression of p53 may have better prognosis than the contrary ones.