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252 POSTER MR guided focused ultrasound surgery of breast cancer
S76
Poster session: Breast cancer
251
ORAL
Quality of life in gynecologic malignancies T. Pearman 1 , R. Weiner 2 . 1 Tulane University Medical Center, Psychiatry & Neurology, New Orleans, USA; 2 Tulane University School of Medicine, Medicine/Hematology/Oncology, New Orleans, USA Gynecologic malignancies occur in approximately 1 in 20 women in the United States. Until recently, clinical management of these cancers has focused almost exclusively on prolonging the survival of patients. A recent literature search using MEDLINE revealed relatively few research studies that reported data on quality of life (QOL) in a gynecologic cancer population. Reports in the literature have been conflicting, with some studies finding deterioration in QOL and some finding stability or improvement in QOL over time. Until recently, the impact of various treatments (surgery, radiation, chemotherapy) on QOL in this population was unknown. Recently, the QOL of women with gynecologic cancer has been compared to that of women with other types of cancer. Also, risk factors for poor adjustment in gynecologic cancer are beginning to be investigated. This presentation will attempt to 1) summarize the relevant literature on QOL in a gynecologic cancer population, 2) compare QOL in this population to other types of cancer, 3) examine risk factors for poor adjustment and 4) describe the limitations of the literature and future research directions. Overall, it appears that QOL is most negatively affected from time of diagnosis through completion of treatment. Following treatment, QOL appears to improve over the course of 6-12 months, but then appears to remain stable from that time through two years post-treatment. Compared to breast cancer patients, it appears that gynecologic cancer patients experience poorer QOL on several domains during active treatment, but that after completion of treatment, overall QOL is similar between groups. Sexual dysfunction occurs in a significant number of women, and appears to last over time. Several treatment methods have been employed, with few displaying much promise. Risk factors for maladjustment include treatment with radiotherapy or multimodality treatment, increased length of treatment, younger age, and coping using a disengaged style. Other risk factors include lower education, poor social support and lower levels of religious belief. The significance of these finding and future research directions will be discussed.
POSTER SESSION
Breast cancer 252
POSTER
MR guided focused ultrasound surgery of breast cancer H. Furusawa 1 , K. Namba 1 , C. Tanaka 1 , Y. Yasuda 1 , H. Nakahara 2 . 1 Breastopia Namba Hospital, Breast Surgical Oncology, Miyazaki, Japan; 2 Breastopia Namba Hospital, Diagnostic Radiology, Miyazaki, Japan Background: The results of prospective randomized clinical studies in Italy and USA showed that there is no difference in life expectancy between mastectomy and conservative treatment of breast cancer(BC). Under the above circumstances, BC surgery has been less invasive, and currently it continues progressing without stopping. The change of understanding for the local therapy in the background may have promoted emergence of NonSurgical Ablation. That is, Non-Surgical Ablation for cancer nest in the breast is an extension of conservative treatment of BC, in other words, ultimate conservative treatment of BC. Focused Ultrasound Surgery(FUS) is conducted under MR imaging. Materials and Methods: The first phase II clinical study of MRgFUS BC002 for BC by Gienfelice et al was conducted on 12 patients. Phase II clinical study BC003 based on the results of BC002, in our facility, phase II clinical study BC003 to conduct FUS under contrast MRI was performed on 30 patients from April of 2004.At the same time, we commercially treated 22 BC. Based on the results of BC003, multiple-facility, cooperative, international, clinical study (ACRIN study) aiming at enrollment of 600 patients is planned to be conducted in a total of 8 facilities composed of 6 USA facilities, 1 Canada facility and ours under the financial aid of American College of Radiology Imaging Network (ACRIN) from June of 2006. For reference’s sake, ACRIN examined closely all the Non-Surgical Ablation and finally selected MRgFUS. In our facility, phase III clinical
study BC004 for BC was started in April of 2005, and is currently under way, scheduling an enrollment of 100 subjects. BC004 is the final clinical study of local treatment for BC using MRgFUS, and its endpoint is not to conduct surgical resection after the MRgFUS treatment but to follow up by only applying radiological irradiation, and confirm the local recurrence rate. Results: The results of BC003 will be published in this July.We got good enough effectiveness and adverse event. BC004 is on going. Conclusion: MRgFUS will be a option of the local treatments for BC. 253
POSTER
Serum VEGF, c-erb-B2, p53m, bcl-2 vs CEA and CA15-3 in breast cancer. Which of them can detect the recurrence earlier? R. Iosifidou 1 , G. Galaktidou 2 , F. Patakiouta 3 , A. Bousoulegas 1 . 1 Anticancer Hospital Theageneio, 3rd Surgical Clinic, Thessaloniki, Greece; 2 Anticancer Hospital Theageneio, Clinical Research, Thessaloniki, Greece; 3 Anticancer Hospital Theageneio, Pathology, Thessaloniki, Greece Purpose: The detection of breast cancer has become very interesting the last years. The most studies are about the biology of the disease and the investigation of tumor markers who can detect the recurrence earlier. The purpose of our study is to find which marker (serum VEGF, c-erb-B2, p53m, bcl-2 or CEA and CA15-3 (can detect the recurrence earlier. Patients and methods: 200 patients with breast cancer stage I and II are enrolled in our study. The mean age of the patients was 59,65±11,65 years. 102 patients had quadrectomy and axillary lymph node dissection and 98 had mastectomy. After the surgical treatment they had supplementary therapy. The size of the tumor was ≤2 cm in 105 patients and ≥2 cm in 95 patients. The histological type was ductal carcinoma in 169 patients, lobular in 10 and DCIS in 2 patients. 54 patients had ≤3 lymph node positive, 46 had ≥3 positive lymph node and 100 had negative lymph node. 14 patients had recurrence of the disease after the 18 months of the surgical treatment. The parameters were measured c-erb-B2, p53m, bcl-2 and VEGF in serum before the operation, after the operation, one year after the operation and two years afterwards (method of measurement: ELISA). CEA and CA15-3 were measured every 4 months with RIA and estrogen and progesterone receptors (ER-PR) with DCC method. The results have been analyzed with statistical methods (ROC curves). Results: In serum all the markers can detect the recurrence in some of the measurements. Bcl-2 and VEGF (before and after the operation-p=0,066, p=0,029) can detect the recurrence earlier of CEA and CA15-3 (20 and 8 months after the operation- p=0,098, p=0,045). C-erb-B2 and p53m (p=0,165- p=0,090 at 12 months) can detect the recurrence earlier of CEA and later of CA15-3. CA15-3 can detect the recurrence before the clinical appearance.(at 8 months). Conclusion: These results shows that bcl-2 and VEGF in serum can be used in the follow-up of the patients with breast cancer as they can detect the recurrence of the disease much earlier of the clinical appearance and before of CEA and CA15-3. 254
POSTER
A comparison of the surgical management of breast cancer in postmenopausal women who use hormone replacement therapy and those who do not T. Gathani, J. Green, G. Reeves, V. Beral. University of Oxford, Cancer Epidemiology Unit, Oxford, United Kingdom Introduction: Postmenopausal women who are current users of hormone replacement therapy (HRT) are at increased risk of breast cancer. The effect of HRT, if any, on the subsequent surgical management of breast cancer is essentially unknown as there is little published literature on the subject. Methods: A prospective study of postmenopausal women with breast cancer was carried out within the Million Women Study with information about HRT exposure collected at recruitment via self-reporting questionnaire. HRT users were defined as those women who were either currently using HRT or had stopped HRT use in the year previous to diagnosis. HRT non-users were defined as those women who had never used HRT or have used HRT more than one year previous to diagnosis. Surgical history data on 738 women with breast cancer were collected (by TG) from hospital record data without knowledge of HRT use. The main outcome measures
Poster session: Breast cancer
251
ORAL
Quality of life in gynecologic malignancies T. Pearman 1 , R. Weiner 2 . 1 Tulane University Medical Center, Psychiatry & Neurology, New Orleans, USA; 2 Tulane University School of Medicine, Medicine/Hematology/Oncology, New Orleans, USA Gynecologic malignancies occur in approximately 1 in 20 women in the United States. Until recently, clinical management of these cancers has focused almost exclusively on prolonging the survival of patients. A recent literature search using MEDLINE revealed relatively few research studies that reported data on quality of life (QOL) in a gynecologic cancer population. Reports in the literature have been conflicting, with some studies finding deterioration in QOL and some finding stability or improvement in QOL over time. Until recently, the impact of various treatments (surgery, radiation, chemotherapy) on QOL in this population was unknown. Recently, the QOL of women with gynecologic cancer has been compared to that of women with other types of cancer. Also, risk factors for poor adjustment in gynecologic cancer are beginning to be investigated. This presentation will attempt to 1) summarize the relevant literature on QOL in a gynecologic cancer population, 2) compare QOL in this population to other types of cancer, 3) examine risk factors for poor adjustment and 4) describe the limitations of the literature and future research directions. Overall, it appears that QOL is most negatively affected from time of diagnosis through completion of treatment. Following treatment, QOL appears to improve over the course of 6-12 months, but then appears to remain stable from that time through two years post-treatment. Compared to breast cancer patients, it appears that gynecologic cancer patients experience poorer QOL on several domains during active treatment, but that after completion of treatment, overall QOL is similar between groups. Sexual dysfunction occurs in a significant number of women, and appears to last over time. Several treatment methods have been employed, with few displaying much promise. Risk factors for maladjustment include treatment with radiotherapy or multimodality treatment, increased length of treatment, younger age, and coping using a disengaged style. Other risk factors include lower education, poor social support and lower levels of religious belief. The significance of these finding and future research directions will be discussed.
POSTER SESSION
Breast cancer 252
POSTER
MR guided focused ultrasound surgery of breast cancer H. Furusawa 1 , K. Namba 1 , C. Tanaka 1 , Y. Yasuda 1 , H. Nakahara 2 . 1 Breastopia Namba Hospital, Breast Surgical Oncology, Miyazaki, Japan; 2 Breastopia Namba Hospital, Diagnostic Radiology, Miyazaki, Japan Background: The results of prospective randomized clinical studies in Italy and USA showed that there is no difference in life expectancy between mastectomy and conservative treatment of breast cancer(BC). Under the above circumstances, BC surgery has been less invasive, and currently it continues progressing without stopping. The change of understanding for the local therapy in the background may have promoted emergence of NonSurgical Ablation. That is, Non-Surgical Ablation for cancer nest in the breast is an extension of conservative treatment of BC, in other words, ultimate conservative treatment of BC. Focused Ultrasound Surgery(FUS) is conducted under MR imaging. Materials and Methods: The first phase II clinical study of MRgFUS BC002 for BC by Gienfelice et al was conducted on 12 patients. Phase II clinical study BC003 based on the results of BC002, in our facility, phase II clinical study BC003 to conduct FUS under contrast MRI was performed on 30 patients from April of 2004.At the same time, we commercially treated 22 BC. Based on the results of BC003, multiple-facility, cooperative, international, clinical study (ACRIN study) aiming at enrollment of 600 patients is planned to be conducted in a total of 8 facilities composed of 6 USA facilities, 1 Canada facility and ours under the financial aid of American College of Radiology Imaging Network (ACRIN) from June of 2006. For reference’s sake, ACRIN examined closely all the Non-Surgical Ablation and finally selected MRgFUS. In our facility, phase III clinical
study BC004 for BC was started in April of 2005, and is currently under way, scheduling an enrollment of 100 subjects. BC004 is the final clinical study of local treatment for BC using MRgFUS, and its endpoint is not to conduct surgical resection after the MRgFUS treatment but to follow up by only applying radiological irradiation, and confirm the local recurrence rate. Results: The results of BC003 will be published in this July.We got good enough effectiveness and adverse event. BC004 is on going. Conclusion: MRgFUS will be a option of the local treatments for BC. 253
POSTER
Serum VEGF, c-erb-B2, p53m, bcl-2 vs CEA and CA15-3 in breast cancer. Which of them can detect the recurrence earlier? R. Iosifidou 1 , G. Galaktidou 2 , F. Patakiouta 3 , A. Bousoulegas 1 . 1 Anticancer Hospital Theageneio, 3rd Surgical Clinic, Thessaloniki, Greece; 2 Anticancer Hospital Theageneio, Clinical Research, Thessaloniki, Greece; 3 Anticancer Hospital Theageneio, Pathology, Thessaloniki, Greece Purpose: The detection of breast cancer has become very interesting the last years. The most studies are about the biology of the disease and the investigation of tumor markers who can detect the recurrence earlier. The purpose of our study is to find which marker (serum VEGF, c-erb-B2, p53m, bcl-2 or CEA and CA15-3 (can detect the recurrence earlier. Patients and methods: 200 patients with breast cancer stage I and II are enrolled in our study. The mean age of the patients was 59,65±11,65 years. 102 patients had quadrectomy and axillary lymph node dissection and 98 had mastectomy. After the surgical treatment they had supplementary therapy. The size of the tumor was ≤2 cm in 105 patients and ≥2 cm in 95 patients. The histological type was ductal carcinoma in 169 patients, lobular in 10 and DCIS in 2 patients. 54 patients had ≤3 lymph node positive, 46 had ≥3 positive lymph node and 100 had negative lymph node. 14 patients had recurrence of the disease after the 18 months of the surgical treatment. The parameters were measured c-erb-B2, p53m, bcl-2 and VEGF in serum before the operation, after the operation, one year after the operation and two years afterwards (method of measurement: ELISA). CEA and CA15-3 were measured every 4 months with RIA and estrogen and progesterone receptors (ER-PR) with DCC method. The results have been analyzed with statistical methods (ROC curves). Results: In serum all the markers can detect the recurrence in some of the measurements. Bcl-2 and VEGF (before and after the operation-p=0,066, p=0,029) can detect the recurrence earlier of CEA and CA15-3 (20 and 8 months after the operation- p=0,098, p=0,045). C-erb-B2 and p53m (p=0,165- p=0,090 at 12 months) can detect the recurrence earlier of CEA and later of CA15-3. CA15-3 can detect the recurrence before the clinical appearance.(at 8 months). Conclusion: These results shows that bcl-2 and VEGF in serum can be used in the follow-up of the patients with breast cancer as they can detect the recurrence of the disease much earlier of the clinical appearance and before of CEA and CA15-3. 254
POSTER
A comparison of the surgical management of breast cancer in postmenopausal women who use hormone replacement therapy and those who do not T. Gathani, J. Green, G. Reeves, V. Beral. University of Oxford, Cancer Epidemiology Unit, Oxford, United Kingdom Introduction: Postmenopausal women who are current users of hormone replacement therapy (HRT) are at increased risk of breast cancer. The effect of HRT, if any, on the subsequent surgical management of breast cancer is essentially unknown as there is little published literature on the subject. Methods: A prospective study of postmenopausal women with breast cancer was carried out within the Million Women Study with information about HRT exposure collected at recruitment via self-reporting questionnaire. HRT users were defined as those women who were either currently using HRT or had stopped HRT use in the year previous to diagnosis. HRT non-users were defined as those women who had never used HRT or have used HRT more than one year previous to diagnosis. Surgical history data on 738 women with breast cancer were collected (by TG) from hospital record data without knowledge of HRT use. The main outcome measures