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Background: Locally advanced breast cancer (LABC) can be caused by a variety of breast neoplasms. The use of mammography with sonography to estimate pathological complete response (PCR) after neoadjuvant chemotherapy (NAC) has a good degree of precision. Aim of work: To evaluate the precision of breast sonomammography in determining LABC response to neoadjuvant chemotherapy. Subjects and methods: A total of 54 female patients with locally advanced breast cancer were included in the study, which was conducted prospectively from August 2019 to May 2020, they were sent to the Zagazig University Radiology Department and hospitals by the General Surgery and Oncology Departments. A thorough medical history (personal, past, present, and family) was collected, as well as a thorough physical examination. All subjects had bilateral digital mammography as well as a traditional B-mode ultrasonography examination. Before neoadjuvant treatment, a sonomammographic evaluation of the tumour size and morphometric criteria was performed. Biopsy processes were done for suspected breast masses. after finishing the NAC 1:4 weeks previous to surgery, a sonomammographic evaluation of the tumour size and morphological criteria was conducted. Results: There was significant association between post chemotherapy diameters and different breast subtypes in radiological assessment. HR-/HER2-were the most subtype to show radiological response followed by HR+/HER2-while none of HR+/HER2+ show response to NAC. Conclusion: In patients with LABC, mammography and breast ultrasonography are regarded more reliable techniques for assessing tumour size and nodal staging of breast cancer subtypes prior to or after treatment. [ABSTRACT FROM AUTHOR]

Objective: Neoadjuvant chemotherapy (NAC) is a key element of treatment for locally advanced breast cancer (LABC). Predicting the response to NAC for patients with Locally Advanced Breast Cancer (LABC) before treatment initiation could be beneficial to optimize therapy, ensuring the administration of effective treatments. The objective of the work here was to develop a predictive model to predict tumor response to NAC for LABC using deep learning networks and computed tomography (CT). Materials and methods: Several deep learning approaches were investigated including ViT transformer and VGG16, VGG19, ResNet-50, Res-Net-101, Res-Net-152, InceptionV3 and Xception transfer learning networks. These deep learning networks were applied on CT images to assess the response to NAC. Performance was evaluated based on balanced_accuracy, accuracy, sensitivity and specificity classification metrics. A ViT transformer was applied to utilize the attention mechanism in order to increase the weight of important part image which leads to better discrimination between classes. Results: Amongst the 117 LABC patients studied, 82 (70%) had clinical- pathological response and 35 (30%) had no response to NAC. The ViT transformer obtained the best performance range (accuracy = 71 ± 3% to accuracy = 77 ± 4%, specificity = 86 ± 6% to specificity = 76 ± 3%, sensitivity = 56 ± 4% to sensitivity = 52 ± 4%, and balanced_accuracy=69 ± 3% to balanced_accuracy=69 ± 3%) depending on the split ratio of train-data and test¬data. Xception network obtained the second best results (accuracy = 72 ± 4% to accuracy = 65 ± 4, specificity = 81 ± 6% to specificity = 73 ± 3%, sensitivity = 55 ± 4% to sensitivity = 52 ± 5%, and balanced_accuracy = 66 ± 5% to balanced_accuracy = 60 ± 4%). The worst results were obtained using VGG-16 transfer learning network. Conclusion: Deep learning networks in conjunction with CT imaging are able to predict the tumor response to NAC for patients with LABC prior to start. A ViT transformer could obtain the best performance, which demonstrated the importance of attention mechanism. [ABSTRACT FROM AUTHOR]

Background: Breast cancer stands as a globally significant contributor to both incidence rates and mortality among women. Approximately 10–15 % of women will face a diagnosis of an advanced yet potentially treatable stage of the disease. When individuals diagnosed with locally advanced breast cancer (LABC) exhibit resistance to preoperative chemotherapy and experience tumor progression, they unfortunately forfeit the opportunity for surgical intervention, thereby diminishing the prospects for a radical cure. Method: We conducted a prospective, single-arm cohort study aimed at evaluating the feasibility of locally modified radical resection for LABC with skin invasion. The primary endpoints encompassed overall survival (OS) and disease-free survival (DFS), whereas the secondary endpoint focused on the quality of life (QoL) among breast cancer patients. Results: Between March 2018 and December 2022, a total of 38 eligible patients were enrolled in this study. The Kaplan-Meier estimates for 1-year, 3-year, and 5-year DFS among all patients were 69.8 %, 53.3 %, and 37.5 %, respectively. Correspondingly, the OS rates were 100.0 %, 85.6 %, and 68.0 %. Both univariate and multivariate analyses revealed that patients with a history of neoadjuvant chemotherapy who exhibited stable or progressive disease had inferior DFS outcomes. Notably, patients demonstrated clinically meaningful and statistically significant enhancements in functional status and overall QoL. However, no notable improvement was observed in specific symptom domains. Conclusion: Patients with locally advanced breast cancer, specifically those presenting with T4 tumors, who undergo surgical intervention followed by postoperative adjuvant therapy, can attain favorable prognostic outcomes and experience an enhanced quality of life.

Background and objective: To assess how patients with locally advanced breast cancer respond pathologically to neoadjuvant therapy. It is uncommon to have locally advanced breast cancer (LABC), and it poses significant clinical challenges. The purpose of the study was to look into the relationship between disease-free survival and the pathological response to neoadjuvant chemotherapy. Method: An observational study was conducted at Department of General Surgery, Deccan College of Medical Sciences, Hyderabad, Telangana, India from December 2022 to November 2023. on a sample of 40 persons to assess the pathological response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. The study received ethical approval from the committee. Result: Between the ages of 50 and 60, 33% of the population fell. About half of the patients exhibited negative human epidermal growth factor receptor 2 (HER2), positive progesterone receptor (PR), and positive oestrogen receptor (ER). Sixty-seven percent of tumours tested positive for both the progesterone receptor (PR) and the oestrogen receptor (ER). Forty percent of the tumours had HER2 positive results. Merely 17% of the patient cohort exhibited a pathological reaction to neoadjuvant chemotherapy (NACT). 83% of the total did not respond. Conclusion: Finding the cancers that are most likely to respond well to specific medications and treatment strategies might significantly improve the prognosis. The most recent developments in our knowledge of cancer biology and genetic analysis can be used to enhance the therapeutic therapy of locally advanced breast cancer (LABC), producing a very effective individualised strategy. [ABSTRACT FROM AUTHOR]

ObjectiveNeoadjuvant chemotherapy (NAC) is a key element of treatment for locally advanced breast cancer (LABC). Predicting the response to NAC for patients with Locally Advanced Breast Cancer (LABC) before treatment initiation could be beneficial to optimize therapy, ensuring the administration of effective treatments. The objective of the work here was to develop a predictive model to predict tumor response to NAC for LABC using deep learning networks and computed tomography (CT).Materials and methodsSeveral deep learning approaches were investigated including ViT transformer and VGG16, VGG19, ResNet-50, Res-Net-101, Res-Net-152, InceptionV3 and Xception transfer learning networks. These deep learning networks were applied on CT images to assess the response to NAC. Performance was evaluated based on balanced_accuracy, accuracy, sensitivity and specificity classification metrics. A ViT transformer was applied to utilize the attention mechanism in order to increase the weight of important part image which leads to better discrimination between classes.ResultsAmongst the 117 LABC patients studied, 82 (70%) had clinical-pathological response and 35 (30%) had no response to NAC. The ViT transformer obtained the best performance range (accuracy = 71 ± 3% to accuracy = 77 ± 4%, specificity = 86 ± 6% to specificity = 76 ± 3%, sensitivity = 56 ± 4% to sensitivity = 52 ± 4%, and balanced_accuracy=69 ± 3% to balanced_accuracy=69 ± 3%) depending on the split ratio of train-data and test-data. Xception network obtained the second best results (accuracy = 72 ± 4% to accuracy = 65 ± 4, specificity = 81 ± 6% to specificity = 73 ± 3%, sensitivity = 55 ± 4% to sensitivity = 52 ± 5%, and balanced_accuracy = 66 ± 5% to balanced_accuracy = 60 ± 4%). The worst results were obtained using VGG-16 transfer learning network.ConclusionDeep learning networks in conjunction with CT imaging are able to predict the tumor response to NAC for patients with LABC prior to start. A ViT transformer could obtain the best performance, which demonstrated the importance of attention mechanism.

Objective: Women with locally advanced breast cancer (LABC) or inoperable local recurrence often suffer from a significantly reduced quality of life (QOL) due to local tumor-associated pain, bleeding, exulceration, or malodorous discharge. We aimed to further investigate the benefit of radiotherapy (RT) for symptom relief while weighing the side-effects. Materials and methods: Patients who received symptom-oriented RT for palliative therapy of their LABC or local recurrence in the Department of Radiation Oncology at Heidelberg University Hospital between 2012 and 2021 were recorded. Clinical, pathological, and therapeutic data were collected and the oncological and symptomatic responses as well as therapy-associated toxicities were analyzed. Results: We retrospectively identified 26 consecutive women who received palliative RT with a median total dose of 39 Gy or single dose of 3 Gy in 13 fractions due to (impending) exulceration, pain, local hemorrhage, and/or vascular or plexus compression. With a median follow-up of 6.5 months after initiation of RT, overall survival at 6 and 12 months was 60.0% and 31.7%, and local control was 75.0% and 47.6%, respectively. Radiation had to be discontinued in 4 patients due to oncological clinical deterioration or death. When completed as initially planned, symptom improvement was achieved in 95% and WHO level reduction of analgesics in 28.6% of patients. In 36% (16%) of patients, local RT had already been indicated >3 months (>6 months) before the actual start of RT, but was delayed or not initiated among others in favor of drug alternatives or systemic therapies. RT-associated toxicities included only low-grade side-effects (CTCAE I°-II°) with predominantly skin erythema and fatigue even in the context of re-RT. Conclusion: Palliative RT in symptomatic LABC or locoregional recurrence is an effective treatment option for controlling local symptoms with only mild toxicity. It may thus improve QOL and should be considered early in palliative patient care management. [ABSTRACT FROM AUTHOR]

The literature has extensively documented how delayed access to health care services in the context of cancer can result from subjective characteristics, dysfunctional coping styles, barriers to care, or procrastination. However, limited research has investigated the psychosocial experience of women diagnosed with Locally Advanced Breast Cancer (LABC). This qualitative study aimed at understanding cognitive, emotional and relational factors associated with delayed access to care and treatment decision-making. In-depth interviews with 14 Italian women were conducted. A thematic analysis of elementary contexts using T-LAB was used to identify the association between emerging clusters and participants' coping styles as measured by the Mini-MAC. Five clusters were identified: 'relationships', 'ineluctability', 'disease', 'surgery', and 'diagnosis'. The 'relationships' cluster was characterized by elevated rates of Fighting Spirit (p < 0.01) while Anxious Preoccupation was associated with 'surgery' (p < 0.01). Findings contribute to explain individual and relational variables related to delay seeking care of LABC patients by illustrating the interplay of personal motivations and social networks' characteristics. Evidence from this work expands current understanding of the interplay of factors contributing to delays in seeking medical attention and may be utilized to inform strategies to timely identify women at greater risk. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify characteristic factors for pathological complete response (pCR) in patients with locally advanced breast cancer (LABC) undergoing surgery and neoadjuvant chemotherapy (NACT). We retrospectively collected pathological data from 237 LABC patients treated in Affiliated Fuzhou First Hospital of Fujian Medical University from January 2010 to June 2021 and divided them into a training group (n = 166) and a validation group (n = 71) in a 7:3 ratio. A predictive model for pCR was established through logistic regression analysis and evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Significant differences between the pCR and non-pCR groups were observed in tumor size (P = 0.001), T stage (P = 0.003), estrogen receptor (ER) (P = 0.031), progesterone receptor (PR) (P = 0.013), human epidermal growth factor receptor 2 (HER-2) (P = 0.001), and molecular type (P = 0.001). The pCR group also had lower levels of carbohydrate antigen 19-9 (P = 0.013), cancer antigen 125 (P = 0.011), carcinoembryonic antigen (CEA) (P = 0.001), and systemic inflammatory index (SII) (P = 0.006), but a higher prognostic nutritional index (PNI) (P = 0.001) compared to the non-pCR group. There were no statistical differences in baseline data between the training and validation groups (P>0.05). Multivariate logistic regression analysis identified tumor size (P = 0.001), HER-2 (P = 0.010), CA125 (P = 0.005), CEA (P = 0.001), SII (P = 0.010), and PNI (P = 0.001) as independent risk factors for pCR. We constructed and visualized a nomogram model that included these 6 factors and developed a dynamic prediction model using the Dynamic Nomogram (DynNom) package. In a random sample of 6 patients, the probability of non-pCR reached 98.8%. The model's AUC was 0.881 in the training group, with a clinical benefit rate of 71.68% and a concordance index (C-index) of 0.881, indicating a good fit. In the validation group, the AUC was 0.722, with a clinical benefit rate of 70.2% and a C-index of 0.722, also indicating a good fit. The Delong test showed a significant difference in AUC between the two groups (P = 0.027). In conclusion, this study constructed and validated a Nomogram model based on clinical pathological features and hematological indicators, finding that higher pCR rates were associated with smaller tumor size, HER-2 positivity, lower levels of CA125 and CEA, lower SII, and higher PNI, significantly enhancing breast cancer management and offering important clinical implications., Competing Interests: None., (AJCR Copyright © 2024.)

Background: Breast cancer stands as a globally significant contributor to both incidence rates and mortality among women. Approximately 10-15 % of women will face a diagnosis of an advanced yet potentially treatable stage of the disease. When individuals diagnosed with locally advanced breast cancer (LABC) exhibit resistance to preoperative chemotherapy and experience tumor progression, they unfortunately forfeit the opportunity for surgical intervention, thereby diminishing the prospects for a radical cure., Method: We conducted a prospective, single-arm cohort study aimed at evaluating the feasibility of locally modified radical resection for LABC with skin invasion. The primary endpoints encompassed overall survival (OS) and disease-free survival (DFS), whereas the secondary endpoint focused on the quality of life (QoL) among breast cancer patients., Results: Between March 2018 and December 2022, a total of 38 eligible patients were enrolled in this study. The Kaplan-Meier estimates for 1-year, 3-year, and 5-year DFS among all patients were 69.8 %, 53.3 %, and 37.5 %, respectively. Correspondingly, the OS rates were 100.0 %, 85.6 %, and 68.0 %. Both univariate and multivariate analyses revealed that patients with a history of neoadjuvant chemotherapy who exhibited stable or progressive disease had inferior DFS outcomes. Notably, patients demonstrated clinically meaningful and statistically significant enhancements in functional status and overall QoL. However, no notable improvement was observed in specific symptom domains., Conclusion: Patients with locally advanced breast cancer, specifically those presenting with T4 tumors, who undergo surgical intervention followed by postoperative adjuvant therapy, can attain favorable prognostic outcomes and experience an enhanced quality of life., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: MicroRNAs (miRNAs) are known to play an important role in cancer cell proliferation, susceptibility of cancer cells to chemotherapy, and patient survival. Identifying miRNAs that can predict response to chemotherapy in locally advanced breast cancer (LABC), the most common variant, can help to choose appropriate drug regimens to suit the epigenetic profile of individual patients., Objective: To investigate the expression of the differentially expressed miRNAs identified by next-generation sequencing from a pilot study involving cases and controls, in peripheral blood mononuclear cells (PBMC) of patients with LABC during the course of neoadjuvant chemotherapy (NAC) and determine their role in response to chemotherapy., Methods: This study included 30 newly diagnosed LABC patients. Peripheral blood from every participant was collected before the start of chemotherapy, at the end of the third cycle, and at the end of the seventh cycle of NAC. Based on the results of a pilot study in a similar population with suitable controls, four differentially expressed miRNAs namely miR-24-2, miR-192-5p, miR-3609, and miR-664b-3p were considered to be validated in this study. The expression of these four miRNAs was examined by qRT-PCR, and their association with response to chemotherapy was analyzed., Result:  A significant change in the expression of miR-192-5p was found in responders (p = 0.001) over a period of seven cycles and the difference between the expression of miR-24-2 from baseline to the seventh cycle of NAC was higher in responders while compared to the non-responders (p < 0.05)., Conclusion: miR-192-5p and miR-24-2 were identified as predictive biomarkers for response to NAC in south Indian patients with LABC., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Tripathi et al.)

Objectives: Induction chemotherapy (ICT) is the standard of care for patients with locally advanced breast cancer. The major criticism about ICT is the delay of surgery, which may affect the local control. Survivin functions by the regulation of mitosis and inhibition of apoptosis. The miR-542-3p regulates survivin mRNA, upregulation of miR-542-3p leads to the downregulation of survivin and arrest of the cell cycle at G1 and G2/M phases resulting in tumor growth suppression. We studied whether we can use survivin mRNA and miRNA-542-3p as potential biomarkers to predict response to ICT. Methods: Fifty-one patients with locally advanced breast cancer were treated with ICT. miRNA-542-3p and survivin mRNA were determined in breast cancerous tissues and their nearby healthy breast tissues by a real-time quantitative polymerase chain reaction. Results: Our results revealed a negative correlation between miRNA and survivin. miRNA-542-3p levels were elevated in normal tissues and in patients with good prognostic features and response to ICT. On the contrary, survivin was upregulated in malignant tissues in patients with adverse prognostic features and patients with no response to neoadjuvant chemotherapy. Conclusions: ICT is a promising option for the treatment of patients with locally advanced carcinoma of the breast. The studied miRNA-542-3p and its target survivin correlate inversely with each other in both malignant and their nearby normal tissues. miRNA-542-3p and survivin can be used as possible molecular markers for the prediction of response to ICT in locally advanced carcinoma of the breast. [ABSTRACT FROM AUTHOR]

Dynamic compression of the lateral antebrachial cutaneous nerve (LABCN) occurs with forearm pronation when the LABCN becomes compressed by the lateral margin of the biceps tendon. LABCN compression is a rare occurrence and is often overlooked as an etiology for forearm pain. While this entity has been described in several case reports in the orthopedic literature, it has not yet been described in radiology literature. We present a case of LABCN compression by the biceps tendon which was suggested by high-resolution magnetic resonance neurography in combination with the clinical findings and was subsequently confirmed and corrected surgically. [ABSTRACT FROM AUTHOR]

Breast carcinoma is a cancer in women with the highest frequency in the world and is the leading cause of death. Patients with breast carcinoma experience periods of stress both physical and emotional which encourages them to produce proteins such as interleukin-6 (IL-6). Interleukin-6 plays an important role in tumorigenesis via activation of janus activated kinase (JAK). This study measured the levels of serum IL-6 which plays an important role in the molecular pathogenesis of metastasis in locally advanced breast cancer (LABC) compared to metastatic breast cancer (MBC). The study design was cross-sectional, comparative analytics by comparing the mean levels of IL-6 in both groups: LABC and MBC. The study was conducted at the Dr. Hasan Sadikin Hospital Bandung (RSHS) from June–November 2012. Subjects were 35 women consisting of 18 LABC and 17 MBC. Levels of serum IL-6 were measured by enzyme-linked immunosorbent assay (ELISA) technique. The results of this study show that the mean levels of serum IL-6 on LABC 4.99 pg/mL and the mean levels of serum IL-6 on MBC 32.73 pg/mL. There was a significant difference between the levels of serum IL-6 on LABC and MBC, p9.85 pg/mL had 37,5 times higher risk for incidence of metastasis. In conclusion, the levels of serum IL-6 on MBCare higher than LABC.

Introduction Delay between clinical presentation and treatment of breast cancer (BC) can significantly impact mortality. We aimed at drawing a picture of women with locally advanced breast cancer (LABC) treated at our Breast Unit and at investigating factors associated with treatment delay. Material and methods A retrospective descriptive analysis, using a specific 28-item semi-structured questionnaire, was conducted in 67 patients diagnosed with T4 BC. Results Nearly a third of our patients had at least one known predisposing factor for LABC. 42% of patients did not perform routine medical breast checks, 49% reported indifference as the first feeling and 47% waited at least 3 months before seeking medical attention. The reasons for diagnostic delay were different in the various age groups. Doctor's delay in making the right diagnosis occurred in 60% of younger patients (≤40 years, n = 5), whereas among women aged 41–69years (n = 34) 50% suffered from psychiatric comorbidities. In patients ≥70 years (n = 28) social factors such as isolation, being widowed and living in a retirement home were present in most of the cases. Delay in seeking medical care was also associated with increasing age. Across all age groups, coping factors such as denial and indifference were also associated with an increase in the odds of delayed presentation, as opposed to fear. Conclusions Factors possibly explaining late medical consultation seem to differ according to age. Psychological factors are crucial in patients' delay whereas age and social factors are relevant in doctors' and system's delay. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a leading cause of death and disability between women, particularly young women, in low- and average -income countries (Porter, 2018). Neoadjuvant chemotherapy (NAC) is increasingly used in management patients with locally advanced breast cancer (LABC) (Mougalian et al., 2015). Mammography and breast ultrasound are the most widest diagnostic techniques used to evaluate primary tumor size and character at the time of diagnosis and monitoring the response to NAC (Kald et al., 2015) Aim of the work: The purpose of this study is to assess and evaluate the role and the accuracy of Mammography and breast ultrasound modalities in monitoring the response of the breast cancer to the neoadjuvant chemotherapy. Patients and methods: Twenty three patients presenting with pathologically proven malignant mass and conducted for neoadjuvant chemotherapy with age above 40 years-old. They were referred to the radiology department (mammography unit, Ultrasound unit and MRI unit) at El Salam oncology center, during the period between December 2018 to June 2019. Once a patient satisfied the inclusion and exclusion criteria for this study, an elaborate history was taken from all the patients which was followed by a thorough clinical evaluation, in which duration of symptoms, affected side, affected breast and family history. Patients were subjected to evaluation before starting neoadjunant chemotherapy by mammography, ultrasound and MRI as well as after finishing the neoadjuvant cycles which usually was ranging 3-4 cycles. Results: Total of 23 patients with breast cancer were enrolled in this study. The patients were in the age group of 41-70 years with mean age of 54 years. Majority of patients had infiltrative ductal carcinoma IDC (16 cases -69.56% and the rest of cases were infiltrative lobular carcinoma (9 cases -39.13 %). After monitoring the response of the cases to neoadjuvant chemotherapy the results showed significant regressive course to the majority of cases ( 17 cases ) (73.91%) with the rest non respondent cases divided to cases with stationary ( 3 cases ) (13.04% ) and cases with progressive course ( 3 cases ) (13.04% ). The comparison between the results of Sonomammographic assessment of the breast lesions before and after the neoadjuvant chemotherapy cycles and also to MRI show close results. There were 5 cases that showed non-respondent (including stationary course and progressive course) in both Sonomammography and MRI and only one case that was respondent according to Sonomammography and non-respondent according to MRI breast (false +). On the other hand there were 16 cases that had showed respondent fashion in both Sonomammography and MRI. Also there was one case that had showed non respondent course according to Sonomammography and was respondent according to MRI results (false -). Sonomammography sensitivity was 94.12 % and specificity was 83.33% compared to MRI results, with high accuracy value reaching to 91.30 %. Conclusion: The ability of mammography and breast ultrasound to accurately measure residual tumor size following neoadjuvant chemotherapy compared to Breast MRI measurement of the residual tumor demonstrated sensitivity of 94.12 % and specificity of 83.33% with high accuracy value reaching to 91.30 %. Even that the MRI is proved to be of high accuracy in detecting residual tumor, sonomammographic imaging is a cost-effective imaging modality than the MRI with sensitivity and specificity near to that of MRI. [ABSTRACT FROM AUTHOR]

Questions 1. In female patients with locally advanced breast cancer (LABC) and good response to neoadjuvant chemotherapy (NACT), including endocrine therapy, what is the role of breast-conserving surgery (BCS) compared with mastectomy? 2. In female patients with LABC, a. is radiotherapy (RT) indicated for those who have undergone mastectomy? b. does locoregional RT, compared with breast or chest wall RT alone, result in a higher survival rate and lower recurrence rates? c. is RT indicated for those achieving a pathologic complete response (PCR) to NCAT? 3. In female patients with LABC who receive NACT, is the most appropriate axillary staging procedure sentinel lymph node biopsy (SLNB) or axillary dissection? Is SLNB indicated before NACT rather than at the time of surgery? 4. How should female patients with LABC that does not respond to initial NACT be treated? Methods This guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care (PEBC) and the Breast Cancer Disease Site Group (DSG). A systematic review was prepared based on literature searches conducted using the medline and embase databases for the period 1996 to December 11, 2013. Guidelines were located from that search and from the Web sites of major guideline organizations. The working group drafted recommendations based on the systemic review. The systematic review and recommendations were then circulated to the Breast Cancer DSG and the PEBC Report Approval Panel for internal review; the revised document underwent external review. The full three-part evidence series can be found on the Cancer Care Ontario Web site. Recommendations • For most patients with LABC, modified radical mastectomy should be considered the standard of care. For some patients with noninflammatory LABC, BCS can be considered on a case-by-case basis when the surgeon deems that the disease can be fully resected and the patient expresses a strong preference for breast preservation. • For patients with LABC, RT after mastectomy is recommended. • It is recommended that, after BGS or mastectomy, patients with LABC receive locoregional RT encompassing the breast or chest wall and local node-bearing areas. • It is recommended that postoperative RT remain the standard of care for patients with labc who achieve pCR to nact. • It is recommended that axillary dissection remain the standard of care for axillary staging in LABC, with the judicious use of SLNB in patients who are advised of the limitations of the current data. • Although SLNB either before or after NACT is technically feasible, the data are insufficient to make any recommendation about the optimal timing of SLNB with respect to NACT. Limited data suggest higher sentinel lymph node identification rates and lower false negative identification rates when SLNB is conducted before NACT; however, those data must be balanced against the requirement for two operations if SLNB is not performed at the time of resection of the main tumour. • It is recommended that patients receiving neoadjuvant an thracycline-tax an e-based therapy (or other sequential regimens) whose tumours do not respond to the initial agent or agents, or who experience disease progression, be expedited to the next agent or agents of the regimen. • For patients who, in the opinion of the treating physician, fail to respond or progress on firstline NACT, several therapeutic options can be considered, including second-line chemotherapy, hormonal therapy (if appropriate), RT, or immediate surgery (if technically feasible). Treatment should be individualized through discussion at a multidisciplinary case conference, considering tumour characteristics, patient factors and preferences, and risk of adverse effects. • It is recommended that prospective randomized clinical trials be designed for patients with LABC who fail to respond to nact so that more definitive treatment recommendations can be developed. [ABSTRACT FROM AUTHOR]

Background: Response evaluation following neo-adjuvant chemotherapy in breast cancer is usually done without taking in to account the axillary response and the available tools like 'response evaluation criteria in solid tumors' (RECIST) have this limitation. These criteria rely solely on the response observed in the primary tumour. Neoadjuvant response index is one such attempt to have a comprehensive assessment of response both in the primary tumour and the axilla. Methods: 30 cases of locally advanced breast cancer (LABC) were assessed for response using 'Neo-adjuvant Response Index'. The index always gives score between '0' (no response or progressive disease) and '1' (pathological complete response i.e. no invasive tumor in breast as well as axilla). This index includes axillary response as well and provides a spectrum of response rather than dividing patients into simply responders and non-responders . Results: Mean reading of index was found to be 0.2925 in this study. Three patients achieved an index of 1. This index correlates significantly with the existing scales for assessing response. Hormone negative tumors were found to be more chemo responsive with higher rates of pathological complete response (pCR) while ER/PR + Her2- tumors showed a very poor response to NACT. Conclusions: Based on the observations of the present study it may be submitted that Neoadjuvant Response Index (NRI) is a reliable and simple tool that can serve as a comprehensive and accurate method of assessing response to neo-adjuvant chemotherapy as it takes in to consideration both the tumor and axillary response unlike the existing RECIST, binary system (responders are those with greater than 50 % reduction), RCB method and the available biomarkers. This study being first of it's kind in Indian population, in spite of it's limitations, could prove to be a launching ground for further reasearch and contribute substantially to the evidence base. [ABSTRACT FROM AUTHOR]

In patients undergoing breast reconstruction after partial and total mastectomy, selecting the appropriate timing as well as the best method of reconstruction are essential to optimize the outcome. At M.D. Anderson Cancer Center, the timing of oncoplastic repair after partial mastectomy defects and breast reconstruction after mastectomy tends to dictate the technique for reconstruction. In patients undergoing repair of a partial mastectomy defect, immediate or delayed repair before radiation therapy allows for the use of the remaining breast tissue to perform the repair. Delayed repair after radiation therapy is usually performed with autologous fat grafting or a flap. Immediate breast reconstruction after mastectomy is preferable for patients with a low risk of requiring postmastectomy radiation therapy (XRT) (stage I breast cancer, some stage II). In patients who are deemed preoperatively to be at an increased risk of requiring XRT (stage II breast cancer), delayed-immediate breast reconstruction may provide an additional option. Delayed-delayed reconstruction may be a consideration in patients known preoperatively to require XRT (stage III breast cancer), to allow for a skin-preserving delayed reconstruction after XRT. Newer techniques for breast reconstruction after mastectomy include one-stage implant, implant-based reconstruction plus acellular dermal matrix, autologous fat grafting after negative suction applied to chest wall, and perforator-based autologous tissue flaps. Often, the decision to perform a partial or total mastectomy depends upon reconstructive issues, not oncology-related considerations. Whether to repair a partial mastectomy defect or perform a total breast reconstruction after mastectomy is one of the most critical decisions in breast reconstruction. [ABSTRACT FROM AUTHOR]

Breast cancer is the second leading cause of cancer death in women. Treatment options for advanced-stage disease, although numerous, remain suboptimal. Lapatinib and ixabepilone are two new agents approved by the United States Food and Drug Administration (FDA) in 2007 for the treatment of locally advanced breast cancer (LABC) or metastatic breast cancer (MBC). When added to the existing endocrine therapies--single-agent cytotoxic therapies and combination chemotherapy regimens--lapatinib and ixabepilone offer potential treatment strategies for disease that has become resistant to trastuzumab and the taxanes, respectively. Lapatinib is an oral dual tyrosine kinase inhibitor against members of the human epidermal growth factor receptor (HER) family (HER1 or epidermal growth factor receptor [EGFR], and HER2). It is indicated for combination therapy with capecitabine for the treatment of patients with HER2-overexpressing LABC or MBC whose disease has progressed after receiving previous treatment with an anthracycline, a taxane, and trastuzumab. Of note, lapatinib is the first FDA-approved tyrosine kinase inhibitor indicated for use in MBC. Ixabepilone, the first FDA-approved analog of the antimicrotubule agent epothilone B, is indicated as monotherapy for the treatment of LABC or MBC in patients whose tumors are refractory or resistant to anthracyclines, taxanes, and capecitabine. It is also indicated in combination with capecitabine for treatment of LABC or MBC that is resistant to anthracycline and taxane. Both lapatinib and ixabepilone are fairly well tolerated. The most common toxicities with lapatinib are diarrhea (65%) and hand-and-foot syndrome (53%), whereas peripheral neuropathy (62%), fatigue (56%), and neutropenia (54%) are most common with ixabepilone. Though the conventional standard end point of overall survival has not yet been assessed in clinical trials, these agents have been shown to improve surrogate markers of clinical benefit: progression-free survival and the related time to progression. Future clinical trials should focus on elucidation of optimal combination or sequential therapies, as well as patient-specific therapies based on tumor characteristics, such as biomarkers and tumor subtypes. [ABSTRACT FROM AUTHOR]

The present study aimed at evaluating whether a weekly cisplatin, epirubicin, and paclitaxel (PET) regimen could increase the pathological complete response (pCR) rate in comparison with a tri-weekly epirubicin and paclitaxel administration in locally advanced breast cancer (LABC) patients. Patients with stage IIIB disease were randomised to receive either 12 weekly cycles of cisplatin 30 mg m(-2), epirubicin 50 mg m(-2), and paclitaxel 120 mg m(-2) (PET) plus granulocyte-colony stimulating factor support, or four cycles of epirubicin 90 mg m(-2)+paclitaxel 175 mg m(-2) (ET) every 3 weeks. Overall, 200 patients (PET/ET=100/100) were included in this study. A pCR in both breast and axilla occurred in 16 (16%) PET patients and in six (6%) ET patients (P=0.02). The higher activity of PET was evident only in ER negative (27.5 vs 5.4%; P=0.026), and in HER/neu positive (31 vs 5%; P=0.037) tumours. The two arms yielded similar pCR rate in ER positive (PET/ET=7.5/7.1%) and HER/neu negative (PET/ET=10/6%) patients. At a 39 months median follow-up, 70 patients showed a progression or relapses (PET, 32 vs ET, 38). Anaemia, mucositis, peripheral neuropathy, and gastrointestinal toxicity were substantially more frequent in the PET arm. The PET weekly regimen is superior to ET in terms of pCR rate in LABC patients with ER negative and/or HER2 positive tumours Mature data in terms of disease-free and overall survival are needed to ascertain whether this approach could improve the prognosis of these subsets of LABC patients. [ABSTRACT FROM AUTHOR]

The Advanced Breast Cancer Second International Consensus Conference (ABC2) on diagnosis and treatment of advanced breast cancer took place in Lisbon, Portugal, on November 7-9, 2013. The focus of the conference was inoperable, locally advanced breast cancer. The diagnosis and treatment of metastatic breast cancer had already been discussed 2 years before at the ABC1 Consensus and were only updated regarding special issues as part of this year's ABC2 Consensus. Like 2 years ago, a working group of German breast cancer experts commented on the voting results of the ABC panelists, with special consideration of the German guidelines for the diagnosis and treatment of breast cancer (German Gynecological Oncology Working Group (AGO) recommendations, S3 Guideline) in order to adapt them for daily clinical practice in Germany. The goal of both the ABC Consensus and the German comments is to facilitate evidence-based therapy decisions.

Aim: To assess the prevalence and prognostic power of disseminated tumor cells (DTC) in patients with locally advanced breast cancer (LABC) before primary systemic therapy (PST)., Materials and Methods: LABC patients attending our Breast Unit were studied between 2002 and 2012, all of them being considered for PST. To determine the presence of DTC, posterior iliac crest aspirates were obtained and marrow samples were processed by gradient separation with Ficoll (Lymphoprep(®)) and immunohistochemical staining using the antiCK A45-B/B3 (EPIMET) antibody. Clinicopathologic variables were recorded before and after PST to assess response. Disease-free survival (DFS) and overall survival (OS) were determined after follow-up. The presence of DTC as a predictor of response to PST and as a prognostic tool for OS and DSF was evaluated., Results: DTC were observed in 26% of 47 patients included in the study. PST consisted of chemotherapy in 94% and hormone therapy in 6%. Breast-conserving therapy was attained in 33%. Mean follow-up was 68 months. Complete clinical response (CR) after PST was seen in 26%, disease recurrence in 38%, and cancer-related death in 8%; tumor size and negative estrogen receptors were significant predictors of CR and mastectomy was associated with DFS. Persistent axillary disease after PST and previous recurrence were predictive of OS. DTC were detected more often in patients who did not achieve CR and those who presented recurrence. DTC detection was a significant prognostic factor for a worse OS (OR = 7.62; CI95%: 1.46-39.61; p = 0.009) and a decreased survival time (62 versus 82 months, p = 0.004)., Conclusion: Presence of DTC before PST was found in a significant number of patients with LABC. DTC were found to be a significant prognostic factor for cancer-related death. DTC could be a surrogate predictor of response to PST and also of disease recurrence in LABC patients., (Copyright © 2013 Elsevier Ltd. All rights reserved.)