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32. Neoadjuvant Endocrine Therapy Compared to Neoadjuvant Chemotherapy in Node‐Positive HR+, HER2− Breast Cancer (Nodal pCR and the Rate of ALND): A Systematic Review and Meta‐Analysis.

Author

Vasigh, Mahtab, Karoobi, Mohammadreza, Williams, Austin D., Abreha, Fasika Molla, Bleicher, Richard J., Yazd, Seyed Mostafa Meshkati, Shamsi, Tahereh, Omranipour, Ramesh, Elahi, Ahmad, Farhat, David, Habibi, Mehran, and Sahgal, Pranshu

Subjects
THERAPEUTIC use of antineoplastic agents, MEDICAL information storage & retrieval systems, HORMONE receptor positive breast cancer, BREAST tumors, PATHOLOGIC complete response, AXILLARY lymph node dissection, META-analysis, DESCRIPTIVE statistics, SYSTEMATIC reviews, MEDLINE, COMBINED modality therapy, ONLINE information services, DATA analysis software, SURVIVAL analysis (Biometry), COMPARATIVE studies, LUMPECTOMY
Abstract

Introduction. Patients with hormone receptor‐positive (HR+), HER2‐negative (HER2−) breast cancers have the lowest response to neoadjuvant therapy of all subtypes. The role of neoadjuvant endocrine therapy (NET) in clinically node‐positive (cN+), HR+, HER2− patients is evaluated in this meta‐analysis. Methods. This study was performed between January 2010 and August 2022. We evaluated the node pathologic complete response (pCR) and axillary lymph node dissection (ALND) rates after neoadjuvant endocrine therapy (NET). Results. 18,037 HR+, HER2−, cN+ stage II and stage III breast cancer patients within eleven studies received neoadjuvant treatments. 3,707 (20.6%) patients received NET and 14,330 (79.4%) received NAC. The average age of the NET patients was higher than that of the neoadjuvant chemotherapy (NAC) patients (64.1 versus 47.6 years old, p < 0.001). 45.0% and 26.9% of the NET and the NAC groups underwent a lumpectomy. The pooled estimates of node pCR in NET and NAC groups were 8.9% and 14.9%, and the pooled proportion of ALND was 39.1% and 58.5%, respectively. Conclusion. The rate of node pCR was lower among cN+ patients who received NET compared to the NAC group. The rate of ALND among cN+ NET patients was lower than the NAC group, revealing more patients with residual nodal disease do not get ALND in the NET group. Further prospective studies are required to compare survival outcomes as a more reliable surrogate. [ABSTRACT FROM AUTHOR]

Published
2024
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35. The Effect of Donor Nerve Subtype on Facial Nerve Grafting Outcomes in Head and Neck Cancer Patients Undergoing Facial Reanimation

Author

Simpson, Arren E., primary, Davis, Matthew J., additional, Williams, Austin D., additional, Martinez, Alexandra L., additional, Parham, Matthew J., additional, Appel, Richard, additional, Xue, Erica Y., additional, Gidley, Paul W., additional, Yu, Peirong, additional, Hanasono, Matthew M., additional, and Lee, Z-Hye, additional

Published
2024
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36. A Descriptive Analysis of Facial Nerve Grafting Outcomes in Head and Neck Cancer Patients Undergoing Free Flap Reconstruction.

Author

Davis, Matthew J., primary, Simpson, Arren E., additional, Williams, Austin D., additional, Martinez, Alexandra L., additional, Appel, Richard, additional, Xue, Erica Y., additional, Gimenez, Alejandro R., additional, Gidley, Paul W., additional, Yu, Peirong, additional, Lee, Z-Hye, additional, and Hanasono, Matthew M., additional

Published
2024
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41. Update on Hypermetabolism in Pediatric Burn Patients.

Author

Layon, Sarah A., Williams, Austin D., Parham, Matthew J., and Lee, Jong O.

Subjects
*BURN patients, *CONTINUUM of care, *PEDIATRIC therapy, *PATHOLOGICAL physiology, *CHEMICAL burns
Abstract

Despite advancements in pediatric burn care, the profound hypermetabolic response associated with severe burns remains a multifaceted challenge throughout the continuum of care. Understanding the various physiologic disturbances that constitute hypermetabolism is crucial for a thorough evaluation and for implementing appropriate surgical and nonsurgical interventions. In this article, we describe the pathophysiology and treatment of hypermetabolism in pediatric burn patients with a focus on reducing resting energy requirements, minimizing infection, and optimizing nutrition for patients undergoing frequent surgical intervention. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Should patients with hormone receptor–positive, HER2–negative breast cancer and one or two positive sentinel nodes undergo axillary dissection to determine candidacy for adjuvant abemaciclib?

Author

Williams, Austin D., Ruth, Karen, Shaikh, Saba S., Vasigh, Mahtab, Pronovost, Mary T., Aggon, Allison A., Porpiglia, Andrea S., and Bleicher, Richard J.

Subjects
*SENTINEL lymph nodes, *AXILLARY lymph node dissection, *SENTINEL lymph node biopsy, *BREAST cancer
Abstract

Background: The monarchE trial demonstrated improved outcomes with the use of adjuvant abemaciclib in patients with high‐risk hormone receptor–positive, HER2–negative (HR+/HER2–) breast cancer defined as ≥4 positive lymph nodes (+LNs) or one to three +LNs with one or more additional high‐risk features (HRFs). The proportion of patients with one or two positive sentinel lymph nodes (+SLNs) without HRFs who had ≥4 +LNs at the time of completion axillary lymph node dissection (cALND), and who therefore qualified for receipt of abemaciclib, was investigated. Methods: Females with pathologically node‐positive nonmetastatic HR+/HER2– breast cancer stratified by the number of +SLNs and +LNs and the presence of one or more HRFs were identified from the National Cancer Database (2018–2019). The proportion of patients meeting the criteria for abemaciclib both before and after ALND was assessed. Results: Of the 22,048 patients identified, 1578 patients underwent upfront surgery, had one or two +SLNs without HRFs, and went on to cALND. Only 213 (13%) of these patients had ≥4 +LNs; thus, cALND performed solely to determine abemaciclib candidacy would have constituted surgical overtreatment in 1365 patients (87%). When stratified by the number of +SLNs, only 10% of those with one +SLN and 24% of those with two +SLNs had ≥4 +LNs after cALND, which meets the criteria for abemaciclib. Conclusions: Patients with one +SLN without HRFs are unlikely to have ≥4 +LNs and should not be subjected to the morbidity of ALND in order to inform candidacy for abemaciclib. An individualized multidisciplinary discussion should be undertaken about the risk:benefit ratio of ALND and abemaciclib for those with two +SLNs. Among patients with hormone receptor–positive, HER2–negative breast cancer with no other high‐risk features, a limited sentinel node disease burden is unlikely to predict a large enough overall nodal burden to qualify for adjuvant abemaciclib. A multidisciplinary discussion weighing the morbidity of axillary dissection and the potential benefit of abemaciclib is critical. [ABSTRACT FROM AUTHOR]

Published
2024
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