W. L. Barrett

Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast.

PURPOSE To determine the 15-year outcome for women with ductal carcinoma in situ (DCIS, intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. PATIENTS AND METHODS An analysis was performed of 270 intraductal breast carcinomas in 268 women from 10 institutions in Europe and the United States. In all patients, breast-conserving surgery included complete gross excision of the primary tumor followed by definitive breast irradiation. When performed, pathologic axillary lymph node staging was node-negative (n=86). The median follow-up time was 10.3 years (range, 0.9 to 26.8). RESULTS The 15-year actuarial overall survival rate was 87%, and the 15-year actuarial cause-specific survival rate was 96%. The 15-year actuarial rate of freedom from distant metastases was 96%. There were 45 local recurrences in the treated breast, and the 15-year actuarial rate of local failure was 19%. The median time to local failure was 5.2 years (range, 1.4 to 16.8). A number of clinical and pathologic parameters were evaluated for correlation with local failure, and none were predictive for local failure (all P > or = .15). CONCLUSION The results from the present study demonstrate high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of DCIS of the breast using breast-conserving surgery and definitive breast irradiation. These results support the use of breast-conserving surgery and definitive breast irradiation for the treatment of DCIS of the breast.

The Atmospheric Neutrino Flavor Ratio from a 3.9 Fiducial Kiloton-Year Exposure of Soudan 2

Abstract We report a measurement of the atmospheric neutrino flavor ratio, R, using a sample of quasi-elastic neutrino interactions occurring in an iron medium. The flavor ratio (tracks/showers) of atmospheric neutrinos in a 3.9 fiducial kiloton-year exposure of Soudan 2 is 0.64±0.11(stat.)±0.06(syst.) of that expected. Important aspects of our main analysis have been checked by carrying out two independent, alternative analyses; one is based upon automated scanning, the other uses a multivariate approach for background subtraction. Similar results are found by all three approaches.

Measurement of the atmospheric neutrino flavour composition in Soudan 2

Abstract The atmospheric neutrino flavour ratio measured using a 1.52 kton-year exposure of Soudan 2 is found to be 0.72 ± 0.19−0.07+0.05 relative to the expected value from a Monte Carlo calculation. The possible background of interactions of neutrons and photons produced in muon interactions in the rock surrounding the detector has been investigated and is shown not to produce low values of the ratio.

Measurement of the L/E distributions of atmospheric neutrinos in Soudan 2 and their interpretation as neutrino oscillations

The effects of oscillations of atmospheric muon neutrinos are observed in the 5.90 fiducial kiloton-year exposure of the Soudan 2 detector. An unbinned maximum likelihood analysis of the neutrino L/E distribution has been carried out using the Feldman-Cousins prescription. The probability of the no oscillation hypothesis is 5.8x10-4. The 90% confidence allowed region in the sin**(2theta), Delta m**2 plane is presented.

Salvage treatment for local recurrence following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (Intraductal Carcinoma) of the breast

PURPOSE The purpose of the present study is to evaluate the outcome of salvage treatment for local recurrence in the breast following the initial treatment of ductal carcinoma in situ (intraductal carcinoma) with breast-conserving surgery and definitive breast irradiation. METHODS AND MATERIALS An analysis was performed of 42 local failures in the breast that occurred following the initial treatment of ductal carcinoma in situ (intraductal carcinoma) with breast-conserving surgery and definitive breast irradiation. At the time of the local recurrence, 23 cases (55%) showed invasive ductal carcinoma, and 19 cases (45%) showed intraductal carcinoma, one with associated Pagets disease. The surgical treatment at the time of local recurrence included mastectomy (n = 39), excision (n = 2), or other (n = 1). Adjuvant systemic therapy at the time of local recurrence included chemotherapy (n = 2), hormonal treatment (n = 7), both (n = 1), or none (n = 32). The median follow-up after salvage treatment was 3.7 years (mean = 4.0 years; range = 0.1-9.5 years). RESULTS The 5-year actuarial outcome following salvage treatment for the 42 local recurrences showed an overall survival rate of 78% and a cause-specific survival rate of 84%. The 5-year actuarial rate of freedom from distant metastases was 86%. None of the patients with histology of the local recurrence of intraductal carcinoma or with detection of the local recurrence with mammographic findings only developed distant metastatic disease after salvage treatment. The 5-year actuarial rate of freedom from chest wall recurrence following salvage mastectomy was 92%. All three of the patients who developed chest wall recurrence following salvage mastectomy also developed distant metastatic disease. CONCLUSIONS These results demonstrate that local recurrences following the initial treatment of ductal carcinoma in situ with breast-conserving surgery and definitive breast irradiation can be salvaged with high rates of survival, freedom from distant metastases, and freedom from chest wall recurrence. The results of salvage treatment support the use of breast-conserving surgery and definitive breast irradiation for the initial management of ductal carcinoma in situ of the breast.

The use of complementary and alternative medicine by cancer patients undergoing radiation therapy

Objective:Use of complementary alternative medicine (CAM) is widespread among patients with chronic diseases including cancer. The purpose of our study was to examine the pattern of alternative medicine use in patients undergoing radiation treatment of cancer. Methods and Materials:A cross-sectional study was conducted among cancer patients treated with radiation therapy from July 2003 through July 2005 at the University of Cincinnati. We defined CAM as the use of dietary supplements, massage therapy, prayer, acupuncture, chiropractic, and other novel therapies undertaken after their diagnosis with cancer. Results:There were 152 patients that participated in the study. Their median age was 59 (range, 21–85), 82 (54%) were males, 108 (69%) were Caucasian. Out of 152 patients, 104 (68%) patients were users of CAM. The most common CAM modality reported was prayer 85 (82%) and use of dietary supplements 84 (80%). The majority of users were female and well-educated. Among CAM users 60 (58%) had discussed its use with their physician. Level of education, employment status and income showed a significant correlation with the use of CAM. Conclusion:This study demonstrates that the use of complementary alternative medicine among cancer patients receiving radiation therapy is frequent. Given the potential risks with some CAM therapies, physicians should actively ask patients whether they use CAM and provide appropriate counseling.

Base-of-Tongue Cancer: Survival, Function, and Quality of Life After External-Beam Irradiation and Brachytherapy†

Objective Base‐of‐tongue cancer has traditionally been treated by surgical resection followed by radiation therapy. Primary radiation therapy with brachytherapy has recently been proposed as an alternative. In a prior analysis, we found that patients with advanced tongue‐base cancer treated by total glossectomy and postoperative radiation therapy can be cured while potentially maintaining good quality of life. Therefore, we designed the current study to assess survival, function, and quality of life in our patients with tongue‐base cancer who were treated with primary radiation therapy and brachytherapy with neck dissection as indicated.

Observation of atmospheric neutrino oscillations in Soudan 2.

The effects of oscillations of atmospheric �µ are observed in the 5.90 fiducial kiloton-year exposure of the Soudan 2 detector. An unbinned maximum likelihood analysis of the neutrino L/E distribution has been carried out using the Feldman-Cousins prescription. The probability of the no oscillation hypothesis is 5.8×10 4 . The 90% confidence allowed region in the sin 2 2�,�m 2 plane is presented.

Neutrino oscillation effects in Soudan-2 upward-stopping muons

Upward-going stopping muons initiated by atmospheric {nu}{sub {mu}} and {nu}{sub {mu}} interactions in the rock below the Soudan 2 detector have been isolated, together with a companion sample of neutrino-induced single muons, created within the detector, which travel downwards and exit. The downward-going sample is consistent with the atmospheric-neutrino flux prediction, but the upward-going sample exhibits a sizable depletion. Both are consistent with previously reported Soudan 2 neutrino-oscillation results. Inclusion of the two samples in an all-event likelihood analysis, using recent 3D-atmospheric-neutrino-flux calculations, reduces both the allowed oscillation parameter region and the probability of the no-oscillation hypothesis.

Treatment of Refractory Radiation-induced Hemorrhagic Proctitis With Hyperbaric Oxygen Therapy

Objective:To evaluate the efficacy of hyperbaric oxygen therapy in treatment of severe refractory radiation-induced hemorrhagic proctitis. Methods:Nine patients with median age 75 (range, 66–83) treated with hyperbaric oxygen (HBO) at University of Cincinnati were reviewed. Pre- and post-therapy bleeding was graded on a 5-point scale. Five patients had previous hospitalizations for anemia and required transfusions. Three patients had undergone electrocautery or argon plasma coagulation before hyperbaric oxygen therapy (HBOT). The remainder had medical therapy before HBO. No patients experienced resolution of symptoms before HBO. The median follow-up after HBO was 17 months (range, 1–77). Results:Seven patients had complete resolution of rectal bleeding. Two patients exhibited a partial response, but continued to experience intermittent bleeding. The Wilcoxon signed rank test determined that HBOT significantly reduced rectal bleeding. Conclusions:HBOT is a very effective treatment of hemorrhagic radiation-induced proctitis.