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Background: Superparamagnetic iron oxide (SPIO) nanoparticles is a magnetic sentinel lymph node (SN) tracer. Since no radioisotope (technetium, Tc99) is used, there is no need for a nuclear medicine department. Compared to the use of Patent Blue V® (PB), no allergic reactions have been reported so far. However, a long lasting skin staining has been observed. We compared skin staining in women who were injected with both SPIO (MagTrace®) and PB. Methods: SPIO, Tc99 and PB were injected in all women in the SentiDose study (2017-2019), a SPIO dose optimizing trial, including six Swedish hospitals. For PB, a 1.0ml sub/intradermal, peri-areolar injection was administred. For SPIO either a 1.5ml retro-areolar (Cohort 1.5, n=163) or a 1.0ml peri-tumoral (Cohort 1.0, n=164) interstitial injection was administred. Staining was assessed by telephone interviews at 6, 12 and 24 months post surgery, and mean size calculations only included women with a stain. Mastectomy cases (n=63) were excluded from the analysis. SN detection rates will be reported elsewhere. Results: In Cohort 1.5, 27.7% (33/119) of the women had a SPIO stain and 25.2% (30/119) a PB stain at 6 months (p=0.66). The mean stain sizes were 13.4 and 9.1cm2 (p=0.16), respectively. At 12 months, 20.8% still had a SPIO stain and 17.6% a PB stain (p=0.91), with mean sizes of 4.1 and 3.7 cm2 (p=0.73), respectively. At 24 months, from the 11 women followed so far, all 3 with an earlier SPIO stain and 7 of 8 with an earlier PB stain are now stain free. In Cohort 1.0, 16.5% (25/145) had a SPIO stain and 16.9% (24/139) had a PB stain at 6 months (p=0.94). The mean stain sizes were 11.8 and 8.4 cm2 (p=0.42), respectively. Nine women were not injected with PB. After 12 months, 15.9% still had a SPIO stain and 12.4% a PB stain (p=0.42). The mean sizes were 5.1 and 2.6 cm2 (p=0.99), respectively. Comparing all women at 6 months, 22.0% had a SPIO stain and 20.5% a PB stain (p=0.12) with mean sizes 12.5 and 8.6 cm2 (p=0.83), respectively. At 12 months, 17.8% had a residual SPIO stain and 14.9% a PB stain (p=0.37) with mean sizes 4.6 and 3.3 cm2 (p=0.16), respectively. The difference in incidence of SPIO staining between Cohort 1.5 and Cohort 1.0 was statistically significant at 6 months, but not at 12 months, 27.7% vs. 16.5%, (p=0.04) and 20.8% vs 15.9% (p=0.28), respectively. The difference in SPIO stain sizes between the cohorts was neither significant at 6 months, 13.4 vs 11.8 cm2(p=0.61) nor at 12 months, 4.1 vs 5.1 cm2 (p=0.30). Conclusion: No statistically significant differences in incidence or stain size were observed between SPIO and PB. The 2-year follow up will be completed during 2021. The 1.0ml compared to 1.5ml SPIO dose, resulted in fewer but equally large stains at 6 months, but there was no difference at 1 year. Table 1. Skin staining after SPIO and Patent Blue (PB) for sentinel lymph node detectionTracerStaining/SizeStaining/Size6 months12 monthsSPIO 1.5ml, n=11927.7%/13.4cm220.8%/4.1cm2SPIO 1.0ml, n=14516.5%/11.8 cm215.9%/5.1 cm2PB, n=25820.5%/8.6 cm214.9%/3.3 cm2 Citation Format: Madeleine Warnberg, Andreas Karakatsanis, Fredrik Nilsson, Christine Obondo, Lida Pistiolis, Imad Mohammad, Carlos Dussan Luberth, Staffan Eriksson, Abdi-Fatah Hersi, Fredrik Wärnberg. A prospective comparison of skin staining after sentinel lymph node biopsy, using blue ink (PB) and superparamagnetic iron oxide nanoparticles (SPIO) tracers [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-52.

Simple Summary Superparamagnetic iron oxide (SPIO) nanoparticles have comparable performance to the combination of radioisotope and blue dye (RI + BD) for sentinel lymph node (SLN) biopsy in breast cancer. In this multicenter prospective study, lower SPIO doses (undiluted 1.5 vs. 1.0 mL) in different timeframes (perioperative vs. 1-7 days preoperative) and injection sites (subareolar vs. peritumoral) were compared to the previous standard (diluted 2.0 mL perioperatively) from the earlier Nordic trial. RI + BD were co-administered as background. In total, 534 patients were analyzed. SPIO SLN detection rates were similar (97.5% vs. 100% vs. 97.6%, p = 0.11) and respectively non-inferior to the dual technique. Significantly more SLNs were retrieved in the preoperative 1.0 mL cohort compared with 1.5 mL and the Nordic cohorts (2.18 vs. 1.85 vs. 1.83, p = 0.003). Thus, SPIO at 1.5 and 1.0 mL was non-inferior to both Sienna+(R) and the dual technique for SLN detection. Superparamagnetic iron oxide nanoparticles (SPIO) are non-inferior to radioisotope and blue dye (RI + BD) for sentinel lymph node (SLN) detection. Previously, 2 mL SPIO (Sienna+(R)) in 3 mL NaCl was used. In this dose-optimizing study, lower doses of a new refined SPIO solution (Magtrace(R)) (1.5 vs. 1.0 mL) were tested in different timeframes (0-24 h perioperative vs. 1-7 days preoperative) and injections sites (subareolar vs. peritumoral). Two consecutive breast cancer cohorts (n = 328) scheduled for SLN-biopsy were included from 2017 to 2019. All patients received isotope +/- blue dye as back-up. SLNs were identified primarily with the SentiMag(R) probe and thereafter a gamma-probe. The primary endpoint was SLN detection rate with SPIO. Analyses were performed as a one-step individual patient-level meta-analysis using patient-level data from the previously published Nordic Trial (n = 206) as a third, reference cohort. In 534 patients, the SPIO SLN detection rates were similar (97.5% vs. 100% vs. 97.6%, p = 0.11) and non-inferior to the dual technique. Significantly more SLNs were retrieved in the preoperative 1.0 mL cohort compared with 1.5 and the 2.0 mL cohorts (2.18 vs. 1.85 vs. 1.83, p = 0.003). Lower SPIO volumes injected up to 7 days before the operation have comparable efficacy to standard SPIO dose and RI + BD for SLN detection. Funding Agencies|Uppsala University; Vastmanland Cancer Foundation

Peritoneal carcinomatosis is a relatively frequent situation in the natural history of colorectal cancer and is associated with a dismal prognosis. Promising results have been shown after radical cytoreduction followed by intraperitoneal chemohyperthermic perfusion. The aim our study was to assess the outcomes after treating patients with peritoneal carcinomatosis of colonic origin by means of cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) followed by early postoperative intraperitoneal chemotherapy (EPIC).Tumour resection was performed in accordance with the guidelines for oncologic surgery. Selective peritonectomies and remnant nodule electroevaporation were performed with the aim of achieving a complete cytoreduction. Peritoneal perfusion was carried out according to the Coliseum technique at 0.5-1 L/min, and chemotherapy was administered at 42oC for 40-90 min. Mitomycin C 10-12.5 mg/m(2) or oxaliplatin 360 mg/m(2) was used. Postoperative intraperitoneally administered 5-fluorouracil (5-FU) (650 mg/m(2) per day) was given for 5 consecutive days.Twenty patients were treated from 2001 to 2008. The mean peritoneal cancer index was 11 (range 2-39). Fifteen patients had undergone complete cytoreductive surgery. The morbidity was 40%. There was one case of death due to bone marrow aplasia. Ten patients had recurrence; five of them underwent salvage surgery. Two patients were treated with a second HIPEC. Actuarial overall survival and progression-free survival were 36% and 30% at 5 years, respectively, with a median follow-up of 18 (range 8-28) months.Cytoreductive surgery combined with HIPEC is a feasible technique that might increase patient survival. It represents a potential cure for selected patients who have no other alternatives.

The aim of the study is to evaluate the limb salvage rate achieved by treating locally advanced extremity sarcoma and melanoma by hyperthermic isolated limb perfusion with melphalan and TNF-α (ILP-MT).A retrospective study was conducted on patients suffering from locally advanced soft tissue sarcoma and melanoma of the limb and treated by means of ILP-MT between November 2001 and February 2010. The response rate, toxicity, complications, disease free intervals, overall survival and limb salvage rate were evaluated.A total of 30 patients (19 females and 11 males) with a median age of 60 years (14-82) were treated by this technique. The overall response rate was 93.4% (complete, 46.7%; partial 46.7%); the mean follow-up was 23 months. The median duration of response was 5 months (0-62), The median overall survival was 13.5 months (range 1 - 62). Limb salvage rate was 86.7%. Eleven patients are currently alive (5 without disease, 2 with residual disease on treatment, 2 with local progression and 2 with systemic progression).With the use of ILP-MT we have avoided the amputation of 26 limbs affected by locally advanced sarcoma or melanoma. ILP-MT is feasible and safe in a multidisciplinary environment.