Search

This article presents comments on various studies related to breast cancer. It includes "Evaluation of a Breast Cancer Nomogram for Prediction of Non-Sentinel Lymph Node Positivity," "Lymphatic Mapping and Sentinel Lymph Node Biopsy for Patients With Local Recurrence After Breast-Conservation Therapy" and "The Clinical Value of Parasternal Sentinel Node Biopsy in Breast Cancer."

Background.--Completion axillary lymph node dissection (ALND) remains the standard of care for patients with disease-positive sentinel lymph nodes (SLN). However, approximately two-thirds will have no additional disease-positive nodes. To identify the patient's individual risk for non-SLN metastases, the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram. Methods.--The records of 182 breast cancer patients who underwent SLN and ALND were selected. Serial hematoxylin and eosin (HE) analysis and immunohistochemistry were routinely performed on each sentinel node. For application of the nomogram, the detection method was assigned in two ways: for all metastases visible by serial HE, the method of detection was scored as "serial HE" (method 1), independent of the tumor size, and by a combination of size and staining method (method 2); so macrometastasis were scored as detected by routine HE, micrometastasis by serial HE, and isolated tumor cells by immunohistochemistry. A receiver operating characteristic curve (ROC) was drawn, and the area under the curve was calculated to assess the discriminative power of the nomogram. Results.--The area under the ROC was .71 (range, .64-.79) according to method 1 and .75 (range, .67-.88) according to method 2. Conclusions.--Because the variable "method of detection" in the MSKCC nomogram is a surrogate for SLN metastasis size, the size category of the SLN metastasis can be used in applying the nomogram to patients in whom the SLN histologic analysis is performed by a much different procedure than that used to develop the MSKCC nomogram. This results in an improved predictive accuracy. [ABSTRACT FROM AUTHOR]

The article discusses research on the factors that predict additional non-sentinel lymph node (SLN) involvement in breast cancer patients with sentinel lymph node metastasis. It references the study "Predictors to Assess Non-Sentinel Lymph Node Status in Breast Cancer Patients With Sentinel Lymph Node Metastasis," by H. Jinno and colleagues, published in a 2008 issue of "Breast Journal." Results show the link between the size of the primary tumor with non-SLN positivity. The size of the SLN metastasis is cited as a key predictor of non-SLN metastasis.

The article discusses research being done on sentinel lymph node-positive breast cancer. It references a study being done by A. Katz and colleagues published in the 2008 issue of "Journal of Clinical Oncology." It investigates the possible predictors of having four or more involved nodes for SLN positive breast cancer.

The article presents abstracts on topics related to breast cancer including "Maturation of Dendritic Cells and T-Cell Responses in Sentinel Lymph Nodes From Patients With Breast Carcinoma" and "The Significance of One Positive Axiliary Node."

The article discusses research being done on the influence of sentinel lymph node (SN) pathology protocols on surgical strategy for patients diagnosed with breast cancer. It references a study by M. J. Bolster and colleagues, published in the 2006 issue of "Annals of Surgical Oncology." The study included patients from four hospitals who underwent SN biopsy, hematoxylin and eosin examination and immunohistochemical evaluation. It found that differences in SN pathology influence surgical approach.

Background: Accelerated partial breast irradiation (APBI) has been introduced as an alternative to whole breast irradiation as part of breast conserving therapy for selected patients. The long-term outcomes remain under investigation. Previous publications have emphasized early postoperative infections with APBI with less focus on delayed infection. In the current study, we evaluated patients enrolled on a prospective registry trial for infectious complications after treatment with catheter-based APBI. Methods: Patients who underwent single-entry catheter-based APBI were identified from a single-institution prospective registry from 2009 to 2011. Data regarding treatment, patient comorbidities, complications, and outcomes were obtained from registry and retrospective chart review. Infectious complications were assessed from the date of APBI catheter insertion and were classified as early (30 days) or delayed (>30 days). All patients were maintained on oral antibiotics while the catheter was in place. Results: A total of 91 patients with 92 cases of primary breast cancer were enrolled on a prospective registry at a comprehensive cancer center between 2009 and 2011 and treated with single-entry catheter-based APBI. The median follow-up time was 76.2 weeks. A temporary catheter was placed at the time of initial operation in 40 cases (43.5%) and left in place a median of 6 days prior to definitive catheter insertion. There were 20 patients (21.7%) who required re-excision. Overall, breast infection occurred in 13 (14.1%) patients. Three (3.3%) patients had infection within 30 days of catheter placement and 10 (10.9%) occurred more than 30 days after catheter insertion (median 112.5 days, interquartile range 51-154). Eight patients were managed with oral antibiotics alone on an outpatient basis. The remainder required a combination of admission, intravenous antibiotics, and aspiration of abscess. One patient underwent operative drainage. Conclusion: We found an overall infection rate of 14.1% in patients treated with catheter-based APBI. This is consistent with other reports; however, we found that the majority of infections occurred more than 30 days after definitive catheter placement. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. Most infections following APBI can be managed on an outpatient basis without operative intervention. [ABSTRACT FROM AUTHOR]

Background: Metastatic pancreatic cancer is uniformly fatal because no effective chemotherapy is available. Mutations in the p53 tumor suppressor gene are found in up to 70% of pancreatic adenocarcinomas. We examined the efficacy of a retroviral vector containing the wild-type p53 gene on metastatic pancreatic cancer in a nude mouse model., Methods: Bxpc3 human pancreatic cancer cells were transduced with either a retroviral p53 vector or an LXSN empty vector. Cells were examined for incorporation of tritiated thymidine to determine the effect of p53 retroviral transduction on DNA synthesis, and a TACS2 assay for apoptosis was performed. The functional activity of p53 in transduced cells was assessed by Western blot analysis with an antibody to WAF1/p21. In vivo effects of intraperitoneal injections of the p53 vector were examined in a nude mouse model of peritoneal carcinomatosis., Results: Cells treated with the p53 vector exhibited a 59% to 85.5% reduction in cell number compared with the control cells (P < .05). p53-treated cells demonstrated decreased incorporation of tritiated thymidine (12.7% +/- 0.7% vs 17.5% +/- 1.4%; P = .002), increased staining for apoptosis, and increased expression of the WAF1/p21 protein. Treatment of nude mice with the retroviral p53 vector resulted in a significant inhibition of growth of the primary pancreatic tumor, as well as the peritoneal tumor deposits, compared with the LXSN control vector., Conclusions: Intraperitoneal delivery of a retroviral p53 vector may provide a novel treatment approach for peritoneal carcinomatosis from pancreatic cancer.

Systems for tracking, analyzing, and reporting variances in the length of hospital stay enable nurse case managers, nurse managers, and nurse executives to ensure desirable clinical outcomes in a cost-effective manner.