Laura Ochoa

A Prospective Longitudinal Clinical Trial Evaluating Quality of Life After Breast-Conserving Surgery and High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer

PURPOSE To prospectively examine quality of life (QOL) of patients with early stage breast cancer treated with accelerated partial breast irradiation (APBI) using high-dose-rate (HDR) interstitial brachytherapy. METHODS AND MATERIALS Between March 2004 and December 2008, 151 patients with early stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients included those with Tis-T2 tumors measuring ≤3 cm excised with negative surgical margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, version 3.0, and QLQ-BR23 questionnaires. The QLQ-C30 and QLQ-BR23 questionnaires were evaluated during pretreatment and then at 6 to 8 weeks, 3 to 4 months, 6 to 8 months, and 1 and 2 years after treatment. RESULTS The median follow-up was 55 months. Breast symptom scores remained stable in the months after treatment, and they significantly improved 6 to 8 months after treatment. Scores for emotional functioning, social functioning, and future perspective showed significant improvement 2 years after treatment. Symptomatic fat necrosis was associated with several changes in QOL, including increased pain, breast symptoms, systemic treatment side effects, dyspnea, and fatigue, as well as decreased role functioning, emotional functioning, and social functioning. CONCLUSIONS HDR multicatheter interstitial brachytherapy was well tolerated, with no significant detrimental effect on measured QOL scales/items through 2 years of follow-up. Compared to pretreatment scores, there was improvement in breast symptoms, emotional functioning, social functioning, and future perspective 2 years after treatment.

Retrieval by Other Procurement Teams Provides Favorable Lung Transplantation Outcome

BACKGROUND During the last 4 years, we have increasingly used lungs retrieved by other procurement teams. We therefore investigated whether the use of those lungs affected the outcome of lung transplantation. METHODS We analyzed the results of 159 consecutive lung transplantations performed at our institution between July 1, 1992, and December 31, 1995. The transplants were divided into three groups: distant donor lungs retrieved by our team (DB group, n = 68); distant donor lungs retrieved by other teams (DX group, n = 46); and local donor lungs retrieved by our team (LB group, n = 44). One transplantation with a local donor lung retrieved by another team was excluded from the analysis. RESULTS No significant differences were noted between the three groups in alveolar-arterial oxygen gradient immediately after transplantation (DB group, 359 +/- 18 mm Hg; DX group, 329 +/- 23 mm Hg; LB group, 327 +/- 20 mm Hg) and at 24 hours; days on ventilator; days in the intensive care unit; length of hospital stay; 30-day mortality; and actuarial 1-year survival (DB group, 81%; DX group, 87%; LB group, 89%). CONCLUSIONS The use of donor lungs retrieved by other teams achieves an equivalently satisfactory outcome after lung transplantation as lungs retrieved by our team.

Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer

Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient‐, tumor‐, and treatment‐related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence‐free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23–39 years) with a median follow‐up of 47 months (8–138 months). Breast‐conserving surgery was performed in 27%. Axillary lymph node dissection was performed in 85%. Sixty percent of patients received neoadjuvant chemotherapy with 19% achieving pathologic complete response (pCR), and 61% downstaged. Lymph node positivity was present in 91% and lymphovascular space invasion (LVSI) in 35%. Thirty‐two percent of patients had triple negative tumors (TN, ER‐/PR‐/HER2 nonamplified). Four‐year OS and RFS was 84% and 71%, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74% vs. 38%, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis.

Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry

PURPOSE Long-term outcome reports of accelerated partial-breast irradiation (APBI) are limited. Here, we report the 10-year outcomes of APBI delivered using multicatheter interstitial implant (ISI) brachytherapy. METHODS AND MATERIALS Patients with early-stage breast cancer treated with APBI via ISI brachytherapy were enrolled in a prospective registry. Selection criteria included age ≥40 years, ductal carcinoma in situ or invasive tumor ≤3 cm, negative margins (≥2 mm), and negative axillary nodes. 34 Gy in 10 twice-daily fractions was administered to 2 cm of breast tissue surrounding the surgical bed. Toxicity and cosmetic outcomes were collected prospectively. RESULTS A total of 175 patients were included. The median followup time was 10.0 years. Ten-year ipsilateral breast tumor control, regional control, freedom from distant metastasis, breast cancer-specific survival, and overall survival were 92.1%, 96.9%, 97.4%, 97.1%, and 81.2%, respectively. High-grade disease was correlated with increase in the rate of ipsilateral breast tumor recurrence. Grade 1 or 2 skin toxicity was present in 44 patients, and Grade 3 skin toxicity was present in only 1 patient. There were no Grade 4 or higher toxicities observed. Thirty-seven patients developed fat necrosis. Dose Homogeneity Index of ≤0.85 and integrated reference air-kerma of >3400 cGycm2/h correlated with higher rates of fat necrosis. There were 115 (66%), 51 (29%), 8 (5%), and 0 (0%) patients having excellent, good, fair, and poor cosmetic outcomes, respectively. CONCLUSIONS APBI using ISI brachytherapy offers excellent clinical outcomes in appropriately selected patients with excellent cosmetic outcomes and low rates of toxicities such as symptomatic fat necrosis.

A deep Boltzmann machine-driven level set method for heart motion tracking using cine MRI images

HighlightsThe DBM needs small‐sized data set to train, but imposes strong modeling ability.A three‐layer DBM can capture both local and global properties of heart contours.An efficient layer‐wise block‐Gibbs sampling is used to infer heart shape priors.The DBM‐induced heart shape priors are used as constraints of DRLSE evolution. Graphical abstract Figure. No caption available. ABSTRACT Heart motion tracking for radiation therapy treatment planning can result in effective motion management strategies to minimize radiation‐induced cardiotoxicity. However, automatic heart motion tracking is challenging due to factors that include the complex spatial relationship between the heart and its neighboring structures, dynamic changes in heart shape, and limited image contrast, resolution, and volume coverage. In this study, we developed and evaluated a deep generative shape model‐driven level set method to address these challenges. The proposed heart motion tracking method makes use of a heart shape model that characterizes the statistical variations in heart shapes present in a training data set. This heart shape model was established by training a three‐layered deep Boltzmann machine (DBM) in order to characterize both local and global heart shape variations. During the tracking phase, a distance regularized level‐set evolution (DRLSE) method was applied to delineate the heart contour on each frame of a cine MRI image sequence. The trained shape model was embedded into the DRLSE method as a shape prior term to constrain an evolutional shape to reach the desired heart boundary. Frame‐by‐frame heart motion tracking was achieved by iteratively mapping the obtained heart contour for each frame to the next frame as a reliable initialization, and performing a level‐set evolution. The performance of the proposed motion tracking method was demonstrated using thirty‐eight coronal cine MRI image sequences.