Ten-Year Outcomes of Stereotactic Body Radiotherapy for Oligometastatic Breast Cancer: Does Synchronous Oligometastatic Breast Cancer Benefit?

AIMS: The benefit of stereotactic body radiotherapy (SBRT) in metachronous oligometastatic breast cancer (OMBC) has previously been described and its use in current clinical practice is established. The role of SBRT in the management of synchronous OMBC remains uncertain. The aim of this study was to compare outcomes of SBRT-treated synchronous OMBC with those of SBRT-treated metachronous OMBC. MATERIALS AND METHODS: This was a retrospective analysis of consecutive extracranial OMBC patients treated with SBRT at a single institution between 2011 and 2022. Kaplan-Meier methods were used to calculate progression-free survival (PFS), overall survival, local control and distant control. Log-rank tests were used to test any differences. Cox regression was used for univariate and multivariate analyses to identify predictive factors. Toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5. RESULTS: In total, 74 OMBC patients with 113 lesions were analysed. The median follow-up was 20 months (range 0-98). Seventy per cent of patients presented metachronously and 30% synchronously. 30 Gy in three fractions was most commonly prescribed, resulting in a median biologically effective dose (BED at α/ß = 10) of 60 Gy (range 35.7-112.5 Gy). Forty-nine per cent of patients switched systemic therapy post-SBRT (median time to switch: 14 months, range 0-79). Two patients (2%) experienced grade 3 acute toxicities with no grade ≥4 toxicities. At 2 years overall survival was 92.4% and PFS 39.0%, local control 85.9% and distant control 37.0%. For metachronous and synchronous disease, respectively, 2-year local control rates were 86.5% and 85.8% and PFS rates were 35.3% and 48.3%. The median PFS of metachronous and synchronous disease were 18 months and 17 months, respectively (P = 0.86). Predictive factors on multivariate analysis were treated site for overall survival, change in systemic therapy post-SBRT for PFS and BED for local control. CONCLUSION: Our data confirm SBRT as a well-tolerated treatment for OMBC with excellent local control rates regardless of metachronous or synchronous presentation. There is no suggestion that survival outcomes are inferior for synchronous disease. Further prospective studies are required to validate this finding.

Spontaneous aortic atherosclerosis in sheep.

Aortas of 334 sheep 6 months to 6 years old were stained with Sudan IV. Sudanophilic lesions resembling early fatty streaks of man were detected in 50% of these aortas. Metastatic calcification was seen in eight (2.3%) aortas.

Gross, histomorphological and histochemical changes in thyroid gland of goat with age. II. Occurrence of ultimobranchial follicles.

Occurrence and histomorphology of ultimobranchial follicles in the thyroid glands of 26 goats of six different age groups (ranging from 20 days to above five years) was studied. The occurrence of ultimobranchial follicles was 38.46%. In 15.38% of the cases, it was found with and in 23.08% without any association of the thymic tissue. Its association with parathyroid tissue has also been recorded in one of the goats aged 7 months 11 days. Their size and shape varied greatly and were narrow and wide tubular, epithelial pear like, long follicle with colloid, sheet of stratified squamous cells attached to follicle, bilobed, evaginated and a group of follicles. The latter three forms of follicles were due to the branching of main stem UB follicle, present at different levels. They were located in perivascular connective tissue in the deeper zone of the thyroid gland but their presence in periphery of thyroid gland within the capsule was not uncommon. The epithelial lining of these follicles was highly variable from simple squamous to columnar with or without cilia which may be stratified. Light cells were seen among epithelial lining. The lumen of the follicles was filled with nucleated, non-nucleated and colloid debris which was PAS-positive. In older animal colloid contained acid mucopolysaccharides.

Gross, histomorphological and histochemical changes in thyroid gland of goat with age. IV. Histomorphological study.

Histomorphological changes on the thyroid gland of 26 goats of different ages ranging from 20 days to over 5 years and of both the sexes were studied. The main fibroarchitecture was of collagen and reticular fibres, the latter fibres being gradually replaced by former with advancing age. The presence of thyroid lobule was observed in all age groups. The interfollicular connective tissue was constantly found around the follicle and increase with age. The follicles became irregular in outline and their diameter increased in the older subjects. The follicular epithelium comprised of two types of cells--Follicular cell and light cell and had tendency to become squamous with ageing. The mitotic division was occasional in younger and rare in older age groups. The mode of secretion was of merocrine and apocrine type. The solid form of colloid was observed in oldest goat. Accessory thyroid tissue and isthmus had similar histomorphology, however, the glandular sthmus was replaced by fibrous tissue with ageing.

Histomorphological and morphometric changes in the spleen of ageing goats.

The spleens of twenty four goats of both the sex and the females at various phases of estrus cycle aged from 20 days to over five years have been studied for their varying histomorphology with age. The morphometric studies included the computation of percent white pulp, percent red pulp, percent trabecular tissue, size of white pulp follicles and number of white pulp follicles per cm2 area. Agewise and sexual and cyclic changes in these parameters have been presented with the help of statistically analysed data by applying multiple range test and computing the correlation coefficients and regression equations. The interrelationship between different parameters have also been considered. The results have been discussed in light of above with graphic presentation including the scatter diagrams and the regression lines.

Regional and age associated changes in the umbilical artery of goat.

The umbilical arteries from 42 goate ranging between 1 day to over 6 years of age have been studied serially throughout their length. The histomorphology at the point of its origin and the progressive changes in the artery during its course towards its termination as well as with age have been discussed.

Histomorphology and histochemistry of renal, colliac and anterior mesenteric arteries of ageing goat.

Renal, coeliac and anterior mesenteric arteries from 33 goats of 20 days to over five years of age have been studied. A detailed description of the structure of renal artery of goat, the general histomorphological and histochemical differences in coeliac and anterior mesenteric arteries and the relative extent of age associated changes in them have been discussed.

Gross, histomorphological and histochemical changes in the thyroid gland of goat with age. III. Occurrence of thymic tissue.

The observations on the thyroid glands from 26 goats aged between 20 days and about 5 years revealed the presence of thymic tissue embedded within or in close vicinity of thyroid in 26.9% of the animals, generally occurring in association with parathyroid tissue (23.08%) and only occasionaly (3.84%) alone. Different forms of the thymic tissue associated to thyroid and variations in their histomorphology and PAS reaction in relation to age has been observed and discussed.

Histomorphological and histochemical studies on systemic and pulmonary arteries of goat with advancing age. III. Calcium deposition in different arteries of ageing goat.

Thirty three goats, ranging from twenty days to over five years, were included in present investigation which revealed calcification of the different layers of seventeen different collateral arterial branches as well as various aortic segments. The initial appearance of calcium deposition and its progression with advancing age in goats was noted. The calcium deposition in the elastic elements, smooth muscle cells of tunica media, and constituents of tunica adventitia was observed and discussed in light of the available literature in domestic animals.