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PurposeSince the publication of the Z0011 trial, practice-changing clinical guidelines for breast surgery have been developed. Although recent studies confirmed the feasibility of the Z0011 strategy in Asian populations, there has been no study on the trends of axillary surgery in Asian cohort. This study aimed to investigate the time trend of axillary surgery for breast cancer in Korea and compare it with that in Dutch cohort to understand the impact of the Z0011 trial.MethodsWe collected prospectively constructed data from the nationwide Korean Breast Cancer Registry (KBCR). We identified patients who underwent sentinel node biopsy followed by breast-conserving surgery from 2011 to 2018 and were found to have pathological stage T1-2N1-3M0 disease. Regression analyses were performed to compare the downward trend of axillary lymph node dissection (ALND) in our cohort with that previously reported in a Dutch cohort.Results From KBCR data, 7,478 patients met the inclusion criteria. The proportion of ALND significantly decreased from 2011 (76.6%) to 2018 (47.5%). Multivariate analysis revealed that earlier year at diagnosis, larger tumor size, and lymphatic invasion were associated with a higher odds ratio of performing ALND. Compared to Dutch cohort, the downward trend of ALND in Korea was significantly more gradual (annual percent change: 30.1% vs. 5.8%, P < 0.001).ConclusionsThis study demonstrated a downward trend of ALND in Korean patients with breast cancer. However, the rate of decrease was significantly slower than that in Dutch cohort, indicating the need to spread the Z0011 strategy in Asia.

Turbulence measurements are made in a novel gas tur- bine rig facility recently used to study combustor-turbine in- Teractions in jet engines [1]. The rig is capable of numer- ous area traverses surrounding engine turbine nozzle guide vanes (NGVs). The rig is unique in that complete engine hardware of the annular combustion subsystem is used to simulate the upstream flow entering the turbine. The rig operates at cold, near-atmospheric conditions. The tur- bulence measurements include both the turbulence intensi- Ties and lengthscales and span an area over a single com- bustor sector. Axial measurement planes include locations both upstream and downstream of the real engine hardware NGVs. The upstream plane corresponds to a conventional combustor-turbine interface plane. In [1], pressure, ve- locity, and passive scalar mixing measurements were pre- sented along with RANS CFD predictions. Here, in addi- Tion to the newly measured turbulence quantities, large-eddy simulations (LES) are performed for the complete, coupled combustor-turbine system. Good agreement between rig data and CFD is seen at the combustor-turbine interface, with LES yielding improved predictions over RANS. For the flow through the NGV pas- sages, vortex visualizations of the simulated flow fields show significant differences to the classic, commonly accepted pic- Ture of Langston [2] and others [3]. The difference is at- Tributed to the high turbulence levels created by the combus- Tor. The impact of the limitations of the combustor-turbine rig on these findings is discussed. Copyright © 2012 by ASME.

Combined risk profiles are helpful in assessing the likelihood of prostate-specific antigen relapse-free survival (PSA-RFS) for patients with localized prostate cancer. This retrospective analysis reports the 5-year biochemical outcome of a large cohort of patients according to prognostic factors and risk profiles for patients undergoing ultrasound-guided transperineal interstitial permanent prostate brachytherapy (TIPPB).Seven hundred seventeen consecutive patients with clinically localized prostate cancer treated between June 1992 and November 1997 underwent TIPPB. Palladium-103 (103Pd) (n = 539) or iodine-125 (125I) (n = 178) sources were utilized to a prescribed dose of 120 Gy and 144 Gy, respectively. One hundred eleven patients received combined external-beam irradiation (41.4 or 45 Gy) and TIPPB (103Pd, 90 Gy, and 125I, 108 Gy). One hundred twelve patients received androgen ablation therapy in advance of TIPPB. Patients were grouped into risk profiles based on pretreatment factors that consisted of PSAor = 10 and Gleason scoreor = 6. Patients meeting both criteria were classified as favorable (n = 334). Those not fulfilling one criteria were classified as intermediate risk (n = 261), and those not fulfilling two criteria were classified as unfavorable risk (n = 261). PSA-RFS was calculated based on the American Society of Therapeutic Radiology and Oncology consensus conference definition of PSA failure. The median follow-up was 41 months (range, 14-82 months).The actuarial PSA-RFS survival at 5 years was 82%. Multivariate Cox regression analysis identified PSA and Gleason score as highly significant factors predicting for biochemical outcome. Hazard risk ratios using a nadir definition of the PSA asor = 1.0 ng/mL andor = 0.5 ng/mL were each significant predictors of outcome with the 0.5 ng/mL nadir level only slightly better (risk ratio for nadiror = 1.0 = 2.78; risk ratio for nadiror = 0.5 = 3.57). Favorable-risk patients had a 5-year actuarial PSA-RFS of 93%, whereas intermediate-risk and unfavorable-risk groups had 5-year PSA-RFSs of 77% and 62%, respectively. Four hundred ninety-three patients underwent brachytherapy without external-beam irradiation or androgen ablation. From this group, the 5-year PSA-RFSs for the favorable-risk, intermediate-risk, and unfavorable-risk patients were 92%, 74%, and 55%, respectively.This retrospective study examining TIPPB demonstrated excellent 5-year actuarial PSA-RFS rates. The assignment of risk profiles based on the results of multivariate analysis of prognostic factors identifies the expected PSA-RFS for patients undergoing TIPPB.