Phase II study of neoadjuvant anastrozole and concurrent radiotherapy for postmenopausal breast cancer patients.

BACKGROUNDS: The aim of this study was to assess the efficacy and safety of neoadjuvant anastrozole and radiation in postmenopausal breast cancer patients with hormone-receptor-positive tumors. In addition, we assessed the predictive factors for clinical and pathological response for concurrent anastrozole and radiotherapy. METHODS: Patients with tumors 3 cm or larger were treated with neoadjuvant anastrozole for 24 weeks, and concurrent radiation was administered from 12 weeks after the start of anastrozole. Core biopsies were obtained at baseline and 12 weeks after the start of anastrozole. After completing neoadjuvant treatment, patients underwent definitive surgery. The primary endpoint was the overall objective response. In addition, we assessed the predictive factors for clinical and pathological response for concurrent anastrozole and radiotherapy. This trial is registered with the UMIN Clinical Trials Registry, no. UMIN000002266. RESULTS: The overall objective response rate was 92 %. Toxicity during neoadjuvant therapy was acceptable, with no grade 3 toxicities. After surgery, grade 3 toxicities occurred in 2 of 25 patients (8 %). CONCLUSIONS: Our preliminary data suggest that neoadjuvant anastrozole and radiation therapy in postmenopausal breast cancer patients with hormone-receptor-positive tumors has a high potential for clinical response.

Risk of Ipsilateral breast tumor recurrence in patients treated with Tamoxifen or Anastrozole following breast-conserving surgery with or without radiotherapy.

BACKGROUND: It is unknown whether anastrozole (Ana) is superior to tamoxifen (Tam) with regard to local control after breast-conserving surgery without radiotherapy (RT). PATIENTS AND METHODS: Two hundred and ninety-two breast cancer patients who had undergone breast-conserving surgery and been treated with Tam or Ana, with or without RT, were retrospectively analyzed. Ipsilateral breast tumor recurrence (IBTR)-free survival rates were compared according to the treatment drug and RT. RESULTS: In the Tam group, IBTR-free survival rates did not significantly differ according to the use or absence of RT (p=0.08), whereas in the Ana group, a significant difference (5-year IBTR-free survival rate, 98.8% in the RT group vs. 65.7% in the no RT group, p<0.0001) was found. In addition, multivariate analysis showed that RT use was an independent prognostic factor for IBTR-free survival (p=0.01) among the patients treated with Ana. CONCLUSION: Caution is needed when RT is omitted for patients undergoing breast-conserving surgery and receiving Ana for adjuvant treatment.

Repeat lumpectomy for ipsilateral breast tumor recurrence after breast-conserving treatment.

OBJECTIVES: There are limited data on the outcomes of patients treated with repeat lumpectomy at the time of ipsilateral breast tumor recurrence (IBTR). METHODS: We retrospectively analyzed 78 patients who underwent repeat lumpectomy after IBTR. The risk factors for second IBTR were assessed. RESULTS: The median follow-up period was 40 months. The 5-year second IBTR-free survival rate was 78.8%. Patients with estrogen receptor (ER)-positive or unknown tumors at IBTR had a significantly better second IBTR-free survival rate than those with ER-negative tumors at IBTR (88.3 vs. 55.4%, respectively; p = 0.0022). Multivariate analysis revealed that the ER status of IBTR was a significantly independent predictive factor for second IBTR-free survival (p = 0.0177). The low-risk group for second IBTR was detected using the ER status, disease-free interval, margin status of IBTR, and age at diagnosis (5-year cumulative incidence, 7.0%). CONCLUSION: The ER status of IBTR was a significantly independent predictive factor for second IBTR-free survival. Some patients could safely undergo repeat lumpectomy for IBTR.

Breast cancer with cartilaginous and/or osseous metaplasia diagnosed by lymph nodal metastasis: a case report.

Breast cancer with cartilaginous and/or osseous metaplasia is a type of metaplastic carcinomas and is a rare disease. We report the case of a 49 year-old female who underwent right mastectomy for a large breast tumor. Histological examinations revealed a mixed tumor with both stromal and epithelial elements;the stroma showed poor differentiated spindle-shape and multiform cells with a massive osseous matrix, and atypical epithelial cells, which mainly existed on the surface of the cysts, showed nucleic atypia. The tumor was diagnosed as a malignant phyllodes tumor with osteosarcomatous differentiation;it was not identified as a metaplastic carcinoma because of the lack of proof of a cancerous component. Two years after a mastectomy, swelling of the axillary lymph nodes was found and a biopsy was performed. Histological findings for the lymph node indicated a metastasis of the invasive ductal carcinoma. The primary tumor was re-examined and was considered to be the origin of the lymph nodal metastasis. Lymph nodal metastasis of cancer proved that the primary tumor had cancerous potential, and the pathological diagnosis was altered to a breast cancer with cartilaginous and/or osseous metaplasia.

Abscess formation of the round ligament of the liver: report of a case.

Abscess formation of the round ligament of the liver is very rare. We report a case of a 70-year-old female with abscess of the round ligament after an endoscopic papillotomy for choledocholithiasis. On the 21st day following papillotomy, abscess formation of the round ligament was found by ultrasonographic examination. Surgical treatment was performed because conservative therapy was not effective. The purulent fluid and necrotic tissue at the round ligament were completely removed. Cultures obtained from the abscess grew Staphylococcus epidermidis, but the mechanism of abscess formation in this case remains unclear.