Angelena Crown

Randomized, clinical trials have established the efficacy of screening mammography in improving survival from breast cancer for women through detection of

Intraoperative radiation therapy (IORT) has been shown to reduce local recurrence rates among women with early‐stage invasive ductal carcinoma, but data regarding its use among women with in situ carcinoma are limited. In this single‐institution study, 50 women with in situ carcinoma were treated with oncoplastic breast‐conserving surgery (OPS) and single‐dose IORT. All 50 patients had “no tumor on ink,” but 9 (16%) had margins < 2 mm and required additional therapy. No local recurrences were observed after a median follow‐up of 46 months. Single‐dose IORT is an efficacious treatment for well‐selected patients with DCIS.

Global disparities in breast cancer care become particularly evident when patients seek definitive care in the United States (USA) after receiving a breast cancer diagnosis and initiating care in low‐ and middle‐income countries (LMICs). We performed a retrospective review of 26 patients with breast cancer who immigrated from LMICs and received care at Bellevue Hospital. Fifteen (58%) presented with advanced disease (stage III or IV), including 7 (27%). All 26 patients required diagnostic work‐up in the USA, and all 19 (73.1%) patients with stage 0‐III disease underwent surgical excision. Patients from LMICs frequently present with advanced disease and in varying stages of breast cancer treatment. Improving communication with previous providers and fostering a collaborative approach with the international community are essential to developing efficacious treatment plans and improving oncologic outcomes.

Background Pancreatic neuroendocrine tumors (PNETs) are often indolent; however, identifying patients at risk for rapidly progressing variants is critical, particularly for those with small tumors who may be candidates for expectant management. Specific growth rate (SGR) has been predictive of survival in other malignancies but has not been examined in PNETs. Methods A retrospective cohort study of adult patients who underwent PNET resection from 2000 to 2016 was performed utilizing the multi-institutional United States Neuroendocrine Study Group database. Patients with ≥ 2 preoperative cross-sectional imaging studies at least 30 days apart were included in our analysis (N = 288). Patients were grouped as “high SGR” or “low SGR.” Demographic and clinical factors were compared between the groups. Kaplan–Meier and log-rank analysis were used for survival analysis. Cox proportional hazard analysis was used to assess the impact of various clinical factors on overall survival (OS). Results High SGR was associated with higher T stage at resection, shorter doubling time, and elevated HbA1c (all P ≤ 0.01). Patients with high SGR had significantly decreased 5-year OS (63 vs 80%, P = 0.01) and disease-specific survival (72 vs 91%, P = 0.03) compared to those with low SGR. In patients with small (≤ 2 cm) tumors (N = 106), high SGR predicted lower 5-year OS (79 vs 96%, P = 0.01). On multivariate analysis, high SGR was independently associated with worse OS (hazard ratio 2.67, 95% confidence interval 1.05–6.84, P = 0.04). Conclusion High SGR is associated with worse survival in PNET patients. Evaluating PNET SGR may enhance clinical decision-making, particularly when weighing expectant management versus surgery in patients with small tumors.

Insurance status predicts access to medical care in the USA. Previous studies have shown uninsured patients with some malignancies have worse outcomes than

Background and Objectives: Lack of high‐level evidence supporting adjuvant therapy for patients with resected gastroenteropancreatic neuroendocrine tumors (GEP NETs) warrants an evaluation of its non‐standard of care use.Methods: Patients with primary GEP NETs who underwent curative‐intent resection at eight institutions between 2000 and 2016 were identified; 91 patients received adjuvant therapy. Recurrence‐free survival (RFS) and overall survival (OS) were compared between adjuvant cytotoxic chemotherapy and somatostatin analog cohorts.Results: In resected patients, 33 received cytotoxic chemotherapy, and 58 received somatostatin analogs. Five‐year RFS/OS was 49% and 83%, respectively. Cytotoxic chemotherapy RFS/OS was 36% and 61%, respectively, lower than the no therapy cohort (P < .01). RFS with somatostatin analog therapy (compared to none) was lower (P < .01), as was OS (P = .01). On multivariable analysis, adjuvant cytotoxic therapy was negatively associated with RFS but not OS controlling for patient/tumor‐specific characteristics (RFS P < .01).Conclusions: Our data, reflecting the largest reported experience to date, demonstrate that adjuvant therapy for resected GEP NETs is negatively associated with RFS and confers no OS benefit. Selection bias enriching our treatment cohort for individuals with unmeasured high‐risk characteristics likely explains some of these results; future studies should focus on patient subsets who may benefit from adjuvant therapy.

Background: Somatostatin analog functional imaging with gallium‐68 (Ga‐68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established.Methods: Consecutive patients with NET at our institution who received an initial Ga‐68 dotatate PET/CT between July 2017 and September 2018 were included. Ga‐68 dotatate PET/CT was compared with prior imaging.Results: Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga‐68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered.Conclusions: In this series, Ga‐68 dotatate PET/CT altered diagnosis and management in one‐third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early‐stage and advanced NETs.