e11584 Background: Brain metastases occur late in the course of metastatic breast cancer and the median survival from time of brain metastases has historically been ~4 months. Stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) are two nonsurgical techniques used to manage brain lesions. We report our institutional experience of SRS for brain metastases in breast cancer patients to address questions regarding outcomes of treatment based on primary tumor biology and the benefit of retreatment with SRS for metachronous brain metastases. Methods: One hundred twenty-two consecutive breast cancer patients treated with SRS for brain metastases from 2001-2013 were included in this retrospective study. Forty-five patients received first SRS after WBRT (4 as planned boost, 41 as salvage) and 13 patients received WBRT as salvage after SRS. Primary tumor biologies were classified as ER+Her2- (n=41), ER+Her2+(n=31), ER-Her2+ (n=23), ER-Her2- (n=28). Median survival from time of SRS (OS) and hazard ratio (HR) by receptor status were calculated. Results: Median age at treatment was 50 and median time from primary cancer diagnosis to brain metastasis was 51 months. The median number of SRS sessions received was 1 (range 1-5), and the median number of lesions treated with the first session was 3 (1-22). For the entire cohort, OS was 15.7 months (95% CI 11.8-20.9), with poorer survival in ER-Her2-patients (Table). For patients treated with multiple SRS sessions for metachronous lesions, each additional SRS treatment was associated with HR benefit of 0.53 (p<0.001). Conclusions: In our series, SRS was associated with improved survival compared to historical outcomes achieved with WBRT. Primary tumor biology may help identify those most likely to benefit from SRS. SRS may be beneficial over a broad range of number of sessions and number of treated lesions. Survival following SRS. Median months OS (range) HR (95% CI) P value ER+ Her2+ 26(16-40) 0.75(0.42-1.33) 0.32 Her2- 16(11-29) ER- Her2- 7(4-11) 4.69(2.42-9.08) <0.0001 Her2+ 23(19-++) HER2+ ER- 23(19-++) 0.89(0.45-1.73) 0.72 ER+ 26(16-40) HER2- ER- 7(4-11) 3.09(1.78-5.38) <0.0001 ER+ 16(11-29)
506 Background: Breast cancer patients with locally advanced tumors receive preoperative chemotherapy to provide early systemic treatment and assess in-vivo tumor response. Positron emission tomography (PET) has been used to follow tumor response to therapy, as pathologic response is predictive of patient outcome. We evaluated the prognostic utility of serial quantitative PET tumor blood flow (BF) and metabolism measurements. Methods: Fifty-five women with a primary diagnosis of locally advanced breast carcinoma (LABC) underwent dynamic [18F]-FDG and [15O]-water PET scans prior to and at midpoint of neoadjuvant chemotherapy. The FDG metabolic rate (MRFDG), transport (K1), and flux (Ki) parameters were calculated, and tumor blood flow was estimated from the [15O]-water study. Associations between tumor BF and MRFDG measurements and disease-free survival (DFS) and overall survival (OS) were evaluated using the Cox proportional hazards model. Results: Patients that had an increase in BF and K1, from baseline to mid-therapy measurements, had elevated recurrence and mortality risks compared to patients that had reductions in BF and MRFDG values. In multivariate analysis, changes in BF and K1 remained independent prognostic indicators of DFS and OS survival. Conclusions: PET measurements of tumor response prior to completion of neoadjuvant chemotherapy were predictive of patient outcome. Patients that failed to have a decline in BF and K1 experienced higher risks of recurrence and mortality that was largely independent of clinical tumor characteristics assessed in this study. These results suggest that tumor perfusion, measured directly by [15O]-water or indirectly by dynamic FDG PET, is highly predictive of outcome in neoadjuvantly treated breast cancer. No significant financial relationships to disclose.
Six patients received beer preparation prior to double contrast barium enema. The beer group scored slightly better (though not statistically significantly) both in the cleanliness and in the mucosal coating of the bowel than the control group with standard preparation. The fluid balance was unaltered. The patients in the beer group felt surprisingly well, likely due to the good fluid and energy balance provided by the beer. The beer preparation could be used in cases, when the patients are ready to intake beer and want to maintain a good nutritional status.
Paclitaxel-induced myalgias and arthralgias occur in a significant fraction of patients receiving therapy with this taxane, potentially impairing physical function and quality of life. Paclitaxel-induced myalgias and arthralgias are related to individual doses; associations with the cumulative dose and infusion duration are less clear. Identification of risk factors for myalgias and arthralgias could distinguish a group of patients at greater risk, leading to minimization of myalgias and arthralgias through the use of preventive therapies. Optimal pharmacologic treatment and possibilities for the prevention of myalgias and arthralgias associated with paclitaxel are unclear, partially due to the small number of patients treated with any one medication. The effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) is the most frequently documented pharmacologic intervention, although no clear choice exists for patients who fail to respond to NSAIDs. However, the increasing use of weekly paclitaxel could necessitate daily administration of NSAIDs for myalgias and arthralgias and leave patients at risk for adverse effects. This concern may also limit the use of corticosteroids for the prevention and treatment of paclitaxel-induced myalgias and arthralgias. Data from case reports suggest that gabapentin (Neurontin), glutamine, and, potentially, antihistamines (e.g., fexofenadine [Allegra]) could be used to treat and/or prevent myalgias and arthralgias. Given the safety profile of these medications, considerable enthusiasm exists for evaluating their effectiveness in the prevention and treatment of paclitaxel myalgias and arthralgias, particularly in the setting of weekly paclitaxel administration.
