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Rita S Mehta,
William E Barlow,
Kathy S Albain,
Ted A Vandenberg,
Shaker R Dakhil,
Nagendra R Tirumali,
Danika L Lew,
Daniel F Hayes,
Julie R Gralow,
Robert B Livingston,
Gabriel N Hortobagyi
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ABSTRACT: The aromatase inhibitor anastrozole inhibits estrogen synthesis. Fulvestrant binds and accelerates degradation of estrogen receptors. We hypothesized that these two agents in combination might be more effective than anastrozole alone in patients with hormone-receptor (HR)-positive metastatic breast cancer.
Postmenopausal women with previously untreated metastatic disease were randomly assigned, in a 1:1 ratio, to receive either 1 mg of anastrozole orally every day (group 1), with crossover to fulvestrant alone strongly encouraged if the disease progressed, or anastrozole and fulvestrant in combination (group 2). Patients were stratified according to prior or no prior receipt of adjuvant tamoxifen therapy. Fulvestrant was administered intramuscularly at a dose of 500 mg on day 1 and 250 mg on days 14 and 28 and monthly thereafter. The primary end point was progression-free survival, with overall survival designated as a prespecified secondary outcome.
The median progression-free survival was 13.5 months in group 1 and 15.0 months in group 2 (hazard ratio for progression or death with combination therapy, 0.80; 95% confidence interval [CI], 0.68 to 0.94; P=0.007 by the log-rank test). The combination therapy was generally more effective than anastrozole alone in all subgroups, with no significant interactions. Overall survival was also longer with combination therapy (median, 41.3 months in group 1 and 47.7 months in group 2; hazard ratio for death, 0.81; 95% CI, 0.65 to 1.00; P=0.05 by the log-rank test), despite the fact that 41% of the patients in group 1 crossed over to fulvestrant after progression. Three deaths that were possibly associated with treatment occurred in group 2. The rates of grade 3 to 5 toxic effects did not differ significantly between the two groups.
The combination of anastrozole and fulvestrant was superior to anastrozole alone or sequential anastrozole and fulvestrant for the treatment of HR-positive metastatic breast cancer, despite the use of a dose of fulvestrant that was below the current standard. (Funded by the National Cancer Institute and AstraZeneca; SWOG ClinicalTrials.gov number, NCT00075764.).
New England Journal of Medicine 08/2012; 367(5):435-44. · 53.30 Impact Factor
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Aida Kuzucan,
Jeon-Hor Chen,
Shadfar Bahri, Rita S Mehta,
Philip M Carpenter,
Peter T Fwu,
Hon J Yu,
David J B Hsiang,
Karen T Lane,
John A Butler,
Stephen A Feig,
Min-Ying Su
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ABSTRACT: This study aimed to evaluate the influence of hormone receptor (HR) and Ki-67 proliferation markers in predicting the accuracy of magnetic resonance imaging (MRI) for measuring residual tumor size in patients with HER2-negative (HER2(-)) breast cancer receiving neoadjuvant chemotherapy (NAC).
Fifty-four women were studied. Patients received AC (doxorubicin (Adriamycin)/cyclophosphamide) and/or taxane-based regimens. The accuracy of MR-determined clinical complete response (CCR) was compared to pathological complete response (pCR). The size of detectable residual tumor on MRI was correlated with pathologically diagnosed tumor size using the Pearson correlation.
MRI correctly diagnosed 16 of the 17 cases of pCR. There were 8 false-negative diagnoses: 7 HR(+) and 1 HR(-). The overall sensitivity, specificity, and accuracy of MRI were 78%, 94%, and 83%, respectively. The positive predictive value was 97% and the negative predictive value was 67%. For MRI vs. pathologically determined tumor size correlation, HR(-) cancers showed a higher correlation (R = 0.79) than did HR(+) cancers (R = 0.58). A worse MRI/pathology size discrepancy was found in HR(+) cancer than in HR(-)cancer (1.6 ± 2.8 cm vs. 0.56 ± 0.9 cm; P = .05). Tumors with low Ki-67 proliferation (< 40%) showed a larger size discrepancy than did those with high Ki-67 proliferation (≥ 40%) (1.2 ± 2.0 cm vs. 0.4 ± 0.8 cm; P = .05).
The results showed that the diagnostic performance of MRI for patients with breast cancer undergoing NAC is associated with a molecular biomarker profile. Among HER2(-)tumors, the accuracy of MRI was worse in HR(+)cancers than in HR(-)cancers and was also worse in low-proliferation tumors than in high-proliferation tumors. These findings may help in surgical planning.
Clinical Breast Cancer 04/2012; 12(2):110-8. · 2.38 Impact Factor
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ABSTRACT: Research on suction-feeding performance has mostly focused on measuring individual underlying components such as suction pressure, flow velocity, ram or the effects of suction-induced forces on prey movement during feeding. Although this body of work has advanced our understanding of aquatic feeding, no consensus has yet emerged on how to combine all of these variables to predict prey-capture performance. Here, we treated the aquatic predator-prey encounter as a hydrodynamic interaction between a solid particle (representing the prey) and the unsteady suction flows around it, to integrate the effects of morphology, physiology, skull kinematics, ram and fluid mechanics on suction-feeding performance. We developed the suction-induced force-field (SIFF) model to study suction-feeding performance in 18 species of centrarchid fishes, and asked what morphological and functional traits underlie the evolution of feeding performance on three types of prey. Performance gradients obtained using SIFF revealed that different trait combinations contribute to the ability to feed on attached, evasive and (strain-sensitive) zooplanktonic prey because these prey types impose different challenges on the predator. The low overlap in the importance of different traits in determining performance also indicated that the evolution of suction-feeding ability along different ecological axes is largely unconstrained. SIFF also yielded estimates of feeding ability that performed better than kinematic traits in explaining natural patterns of prey use. When compared with principal components describing variation in the kinematics of suction-feeding events, SIFF output explained significantly more variation in centrarchid diets, suggesting that the inclusion of more mechanistic hydrodynamic models holds promise for gaining insight into the evolution of aquatic feeding performance.
Journal of Experimental Biology 01/2012; 215(Pt 1):1-13. · 3.00 Impact Factor
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ABSTRACT: Diffuse optical spectroscopic imaging (DOSI) non-invasively and quantitatively measures tissue haemoglobin, water and lipid. Pilot studies in small groups of patients demonstrate that DOSI may be useful for longitudinal monitoring and predicting breast cancer neoadjuvant chemotherapy pathological response. This study evaluates the performance of a bedside DOSI platform in 34 breast cancer patients followed for several months. DOSI optical endpoints obtained at multiple timepoints are compared with final pathological response. Thirty-six stage II/III breast cancers (34 patients) were measured in vivo with DOSI prior to, in the middle of and after the completion of pre-surgical neoadjuvant chemotherapy. Cancer therapies ranged from standard anthracyclines to targeted therapies. Changes in DOSI-measured parameters at each timepoint were compared against final surgical pathology. Absolute changes in the tumour-to-normal (T/N) ratio of tissue deoxyhaemoglobin concentration (ctHHb) and relative changes in the T/N ratio of a tissue optical index (TOI) were most sensitive and correlate to pathological response. Changes in ctHHb and TOI were significantly different between tumours that achieved pathological complete response (pCR) versus non-pCR. By therapy midpoint, mean TOI-T/N changes were 47±8 versus 20±5 per cent for pCR versus non-pCR subjects, respectively (Z=0.011). Changes in ctHHb and TOI scaled significantly with the degree of pathological response (non-, partial and complete). DOSI measurements of TOI separated pCR from non-pCR by therapy midpoint regardless of drug or dosing strategy. This approach is well suited to monitoring breast tumour response and may provide feedback for optimizing therapeutic outcomes and minimizing side-effects.
Philosophical Transactions of The Royal Society A Mathematical Physical and Engineering Sciences 11/2011; 369(1955):4512-30. · 2.77 Impact Factor
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ABSTRACT: To investigate the difference of MR percent breast density measured from fat-suppressed versus nonfat-suppressed imaging sequences.
Breast magnetic resonance imaging (MRI) with and without fat suppression was acquired from 38 subjects. Breasts were divided into subgroups of different morphological patterns ("central" and "intermingled" types). Breast volume, fibroglandular tissue volume, and percent density were measured. The results were compared using nonparametric statistical tests and regarded as significant at p < 0.05.
Breast volume, fibroglandular volume, and percent density between fat-suppressed and nonfat-suppressed sequences were highly correlated. Breast volumes measured on these two sequences were almost identical. Fibroglandular tissue volume and percent density, however, had small (<5%) yet significant differences between the two sequences-they were both higher on the fat-suppressed sequence. Intraobserver variability was within 4% for both sequences and different morphological types. The fibroglandular tissue volume measured on downsampled images showed a small (<5%) yet significant difference.
The measurement of breast density made on MRI acquired using fat-suppressed and nonfat-suppressed T1W images was about 5% difference, only slightly higher than the intraobserver variability of 3%-4%. When the density data from multiple centers were to be combined, evaluating the degree of difference is needed to take this difference into account.
Medical Physics 11/2011; 38(11):5961-8. · 2.83 Impact Factor
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Jeon-Hor Chen,
Shadfar Bahri, Rita S Mehta,
Aida Kuzucan,
Hon J Yu,
Philip M Carpenter,
Stephen A Feig,
Muqing Lin,
David J B Hsiang,
Karen T Lane,
John A Butler,
Orhan Nalcioglu,
Min-Ying Su
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ABSTRACT: To assess how the molecular biomarker status of a breast cancer, including human epidermal growth factor receptor 2 (HER2), hormone receptors, and the proliferation marker Ki-67 status, affects the diagnosis at 3.0-T magnetic resonance (MR) imaging.
This study was approved by the institutional review board and was HIPAA compliant. Fifty patients (age range, 28-82 years; mean age, 49 years) receiving neoadjuvant chemotherapy were monitored with 3.0-T MR imaging. The longest dimension of the residual cancer was measured at MR imaging and correlated with pathologic findings. Patients were further divided into subgroups on the basis of HER2, hormone receptor, and Ki-67 status. Pathologic complete response (pCR) was defined as when there were no residual invasive cancer cells. The Pearson correlation was used to correlate MR imaging-determined and pathologic tumor size, and the unpaired t test was used to compare MR imaging-pathologic size discrepancies.
Of the 50 women, 14 achieved pCR. There were seven false-negative diagnoses at MR imaging. The overall sensitivity, specificity, and accuracy for diagnosing invasive residual disease at MR imaging were 81%, 93%, and 84%, respectively. The mean MR imaging-pathologic size discrepancy was 0.5 cm ± 0.9 (standard deviation) for HER2-positive cancer and 2.3 cm ± 3.5 for HER2-negative cancer (P = .009). In the HER2-negative group, the size discrepancy was smaller for hormone receptor-negative than for hormone receptor-positive cancers (1.0 cm ± 1.1 vs 3.0 cm ± 4.0, P = .04). The size discrepancy was smaller in patients with 40% or greater Ki-67 expression (0.8 cm ± 1.1) than in patients with 10% or less Ki-67 expression (3.9 cm ± 5.1, P = .06).
The diagnostic accuracy of breast MR imaging is better in more aggressive than in less aggressive cancers. When MR imaging is used for surgical planning, caution should be taken with HER2-negative hormone receptor-positive cancers.
Radiology 08/2011; 261(3):735-43. · 5.73 Impact Factor
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ABSTRACT: Breast MRI acquires many images from the breast, and computer-aided algorithms and display tools are often used to assist the radiologist's interpretation. Women with lifetime risk greater than 20% of developing breast cancer are recommended to receive annual screening MRI, but the current breast MRI computer-aided-diagnosis systems do not provide the necessary function for comparison of images acquired at different times. The purpose of this work was to develop registration methods for evaluating the spatial change pattern of fibroglandular tissue between two breast MRI scans of the same woman taken at different times. The registration method is based on rigid alignment followed by a non-rigid Demons algorithm. The method was tested on three different subjects who had different degrees of changes in the fibroglandular tissue, including two patients who showed different spatial shrinkage patterns after receiving neoadjuvant chemotherapy before surgery, and one control case from a normal volunteer. Based on the transformation matrix, the collapse of multiple voxels on the baseline images to one voxel on the follow-up images is used to calculate the shrinkage factor. Conversely, based on the reverse transformation matrix the expansion factor can be calculated. The shrinkage/expansion factor, the deformation magnitude and direction, as well as the Jacobian determinate at each location can be displayed in a 3D rendering view to show the spatial changes between two MRI scans. These different parameters show consistent results and can be used for quantitative evaluation of the spatial change patterns. The presented registration method can be further developed into a clinical tool for evaluating therapy-induced changes and for early diagnosis of breast cancer in screening MRI.
Physics in Medicine and Biology 08/2011; 56(18):5865-75. · 2.83 Impact Factor
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ABSTRACT: Hormone-receptor (HR) and HER2/neu-receptor (HER2) status of breast tumors are important indicators for targeted therapies. We examine the association of receptor status and risk for a second breast cancer.
We analyzed data on 106,331 women in the California Cancer Registry whose first cancer is locoregional invasive breast disease, diagnosed from 1999 through 2005, yielding 1,613 second primary breast cancers. Standardized incidence ratios (SIR) with 95% confidence intervals (CIs) were used to evaluate risk of second tumors, accounting for age at first diagnosis, duration at risk, and race/ethnicity.
Among non-Hispanic whites, HR-positive first tumors signal a reduction in risk for second breast cancers (SIR = 0.83, 95% CI: 0.77-0.89) whereas HR-negative status signals elevated risk (SIR = 1.48, 95% CI: 1.29-1.70). Asian/Pacific Islanders, African Americans, and Hispanics are at elevated risk of second breast cancers regardless of HR status of the first tumor. Hispanics with HR-negative first tumors are at greater risk than those with HR-positive disease (HR(-): SIR = 3.76, 95% CI: 2.97-4.71; HR(+): SIR = 1.86, 95% CI: 1.56-2.20). HER2 status does not differentiate risk for second tumors in any group examined.
HR status of a first breast cancer is a marker for risk of a second breast cancer. HER2 status does not seem to be a marker of risk for a second breast cancer. Risk differences across race/ethnic groups by HR status suggest heterogeneity of breast cancers across race/ethnicity.
These data suggest that HR status may be helpful in shaping strategies to reduce risk of a second breast cancer, while HER2 status seems uninformative for this purpose.
Cancer Epidemiology Biomarkers & Prevention 03/2011; 20(2):389-96. · 4.12 Impact Factor
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ABSTRACT: Trade-offs are believed to impose major constraints on adaptive evolution, and they arise when modification of a trait improves one aspect of performance but incurs a cost in another. Here we show that performance costs that result from competing demands on one trait can be mitigated by compensatory changes in other traits, so long as performance has a complex basis. Numerical simulations indicate that increases in the number of traits that determine performance decrease the strength of performance trade-offs. In centrarchid fishes, multiple traits underlie suction feeding performance, and experimental data and hydrodynamic modeling show that combinations of traits evolve to increase the ability to feed on attached prey while mitigating costs to performance on evasive prey. Diet data for centrarchid species reveal a weak trade-off between these prey types, corroborating the results based on hydrodynamic modeling and suggesting that complexity in the functional basis of suction feeding performance enhances trophic diversification. Complexity may thus permit the evolution of combinations of high-performance behaviors that appear to violate underlying trade-offs, such as the ability to exert high suction forces with large gape. This phenomenon may promote morphological, functional, and ecological diversification in the face of the myriad selective demands organisms encounter.
The American Naturalist 03/2011; 177(3):E69-83. · 4.72 Impact Factor
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ABSTRACT: One of the most notable features in looking across fishes is their diversity of body shape and size. Extant actinopterygian fishes range in shape from nearly spheroidal in pufferfishes to extremely elongate in snipe eels with nearly every shape in-between. One extreme along the body-shape continuum is a highly elongate form, which has evolved multiple times independently in Actinopterygii. Thus, comparison of these separate (independent) radiations provides a unique opportunity for examining the anatomical traits underlying elongation as well as the similarities and differences in the evolutionary pathways followed. Body elongation generally evolves via an increase in region-specific vertebral number, although certain lineages elongate via an increase in vertebral length. In this study, we describe how anatomical characters related to feeding and locomotion are correlated with elongation of the body across Actinopterygii. In addition to modifications of the postcranial axial skeleton, elongation in fishes is often accompanied by an increase in head length, loss of the pelvic fins, reduction of the pectoral fins, and expansion of the median fins. Based on anatomical studies and on recent studies of developmental control of the body axis in different species, we hypothesize how an axial trait might change at the genetic level. Overall, we discuss the evolution of body elongation in fishes in light of an understanding of the underlying anatomical modifications, developmental control, ecology, and locomotion.
Integrative and Comparative Biology 12/2010; 50(6):1106-19. · 2.45 Impact Factor
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ABSTRACT: The shape of the body affects how organisms move, where they live, and how they feed. One body plan that has long engaged the interest of both evolutionary biologists and functional morphologists is axial elongation. There is a growing interest in the correlates and evolution of elongation within different terrestrial and aquatic vertebrate clades. At first glance, Anguilliformes may appear to exhibit a single cylindrical form but there is considerable diversity underlying this seemingly simplified body plan. Here, we explore evolution of the axial skeleton in 54 anguilliform taxa and some close relatives. We describe the diversity of axial elongation as well as investigate how characters such as head length, branchial-arch length, and shape of the pectoral fins correlate with vertebral number to possibly facilitate changes in absolute diameter of the body. Overall, we find that precaudal vertebral numbers and caudal vertebral numbers are evolving independently across elopomorph fishes. We also find that precaudal and caudal vertebral aspect ratios are evolving together across elopomorph fishes. When focusing within Anguilliformes we find striking diversity in the mechanisms of elongation of the body, including almost every trend for axial elongation known within actinopterygian fishes. The three major clades of eels we examined have slightly different mechanisms of elongation. We also find a suite of morphological characters associated with elongation in anguilliform fishes that appears to coincide with a more fossorial lifestyle such as high elongation ratios, a more posteriorly extended-branchial region, and a reduction in the size of the pectoral fins. Lastly, we point out that a diverse range of derived behaviors such as head- and tail-first burrowing, rotational feeding, and knotting around prey are only found in long cylindrical vertebrates.
Integrative and Comparative Biology 12/2010; 50(6):1091-105. · 2.45 Impact Factor
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ABSTRACT: Imaging tumor response to neoadjuvant chemotherapy in vivo offers unique opportunities for patient care and clinical decision-making. Detailed imaging studies may allow oncologists to optimize therapeutic drug type and dose based on individual patient response. Most radiologic methods are used sparingly because of cost; thus, important functional information about tumor response dynamics may be missed. In addition, current clinical standards are based on determining tumor size changes; thus, standard anatomic imaging may be insensitive to early or frequent biochemical responses. Because optical methods provide functional imaging end points, our objective is to develop a low-barrier-to-access bedside approach that can be used for frequent, functional assessment of dynamic tumor physiology in individual patients.
Diffuse Optical Spectroscopic Imaging (DOSI) is a noninvasive, bedside functional imaging technique that quantifies the concentration and molecular state of tissue hemoglobin, water, and lipid. Pilot clinical studies have shown that DOSI may be a useful tool for quantifying neoadjuvant chemotherapy response, typically by comparing the degree of change in tumor water and deoxy-hemoglobin concentration before and after therapy. Patient responses at 1 week and mid-therapy have been used to predict clinical outcome. In this report, we assess the potential value of frequent DOSI monitoring by performing measurements on 19 different days in a 51-year-old subject with infiltrating ductal carcinoma (initial tumor size 60 x 27 mm) who received neoadjuvant chemotherapy (anthracyclines and bevacizumab) over an 18-week period.
A composite index, the Tissue Optical Index (TOI), showed a significant ( approximately 50%) decrease over the nearly 18 weeks of chemotherapy. Tumor response was sensitive to the type of chemotherapy agent, and functional indices fluctuated in a manner consistent with dynamic tumor physiology. Final pathology revealed 4 mm of residual disease, which was detectible by DOSI at the conclusion of chemotherapy before surgery.
This case study suggests that DOSI may be a bedside-capable tool for frequent longitudinal monitoring of therapeutic functional response to neoadjuvant chemotherapy.
Academic radiology 08/2010; 17(8):1031-9. · 2.09 Impact Factor
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Annals of Surgical Oncology 06/2010; · 4.17 Impact Factor
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Annals of Surgical Oncology 02/2010; 17(7):1964-5. · 4.17 Impact Factor
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ABSTRACT: We examined the effects of variation in swimming speed, or 'ram speed', on the feeding kinematics of juvenile Indo-Pacific tarpon, Megalops cyprinoides. Tarpon were filmed feeding on non-elusive prey at 500 images s(-1). Prey items were offered at one end of the filming tank, the opposite end where tarpon grouped, to encourage them to use a ram strategy to capture their prey. We describe tarpon as ram-suction feeders. Ram speed varied among strikes from 0.19 to 1.38 m/s and each individual produced speeds that spanned at least 0.9 m/s across trials. Although suction distances were much less variable, prey movement towards the predator was present in all feeding trials. There was a strong positive relationship between initial predator - prey distance and ram speed (r(2)=0.72, P<0.001). When tarpon initiated their strike from further away, they achieved higher ram speeds, but also took longer to capture their prey. All other timing variables were unaffected by ram speed whereas at higher ram speeds tarpon exhibited greater expansion of the mouth and buccal cavity. Greater buccal expansion accomplished in the same period of time implies that both the total volume of water captured and the water flow rate entering the mouth was greater in strikes at higher ram speeds. Our results demonstrate how feeding kinematics may vary as a function of ram speed, and how fish predators that lack jaw protrusion and have a large gape capacity can maximize their feeding success by altering their swimming speed.
Zoology 02/2010; 113(2):75-84. · 1.50 Impact Factor
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ABSTRACT: To characterize imaging features of pure DCIS on dynamic contrast-enhanced MR imaging (DCE-MRI), 31 consecutive patients (37-81 years old, mean 56), including 2 Grade I, 16 Grade II, and 13 Grade III, were studied. MR images were reviewed retrospectively and the morphological appearances and kinetic features of breast lesions were categorized according to the ACR BI-RADS breast MRI lexicon. DCE-MRI was a sensitive imaging modality in detecting pure DCIS. MR imaging showed enhancing lesions in 29/31 (94%) cases. Pure DCIS appeared as mass type or non-mass lesions on MRI with nearly equal frequency. The 29 MR detected lesions include 15 mass lesions (52%), and 14 lesions showing non-mass-like lesions (48%). For the mass lesions, the most frequent presentations were irregular shape (50%), irregular margin (50%) and heterogeneous enhancement (67%). For the non-mass-like lesions, the clumped internal enhancement pattern was the dominate feature, seen in 9/14 cases (64%). Regarding enhancement kinetic curve, 21/29 (78%) lesions showed suspicious malignant type kinetics. No significant difference was found in morphology (P > .05), tumor size (P = 0.21), and kinetic characteristics (P = .38) between non-high grade (I+II) and high-grade (III) pure DCIS.
Journal of Oncology 01/2010; 2010.
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Journal of Clinical Oncology 06/2009; 27(18):3067-8; author reply 3068-9. · 18.37 Impact Factor
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ABSTRACT: To compare changes in the concentration of choline-containing compounds (tCho) and in tumor size at follow-up after neoadjuvant chemotherapy (NAC) between patients who achieved pathologic complete response (pCR) and those who did not (non-pCR).
This study was approved by the institutional review board and was compliant with HIPAA; each patient gave informed consent. Thirty-five patients (mean age, 48 years +/- 11 [standard deviation]; range, 29-75 years) with breast cancer were included. Treatment included doxorubicin and cyclophosphamide followed by a taxane-based regimen. Changes in tCho and tumor size in pCR versus non-pCR groups were compared by using the two-way Mann-Whitney nonparametric test. Receiver operating characteristic (ROC) analysis was performed to differentiate between them and the area under the ROC curve (AUC) was compared.
In the pCR group, the tCho level change was greater compared with change in tumor size (P = .003 at first follow-up, P = .01 at second follow-up), but they were not significantly different in the non-pCR group. Changes in tumor size and tCho level at the first follow-up study were not significantly different between the pCR and non-pCR groups but reached significance at the second follow-up. In ROC analysis, the magnetic resonance (MR) imaging and MR spectroscopic parameters had AUCs of 0.65-0.68 at first follow-up; at second follow-up, AUC for change in tumor size was 0.9, AUC for change in tCho was 0.73.
Patients who show greater reduction in tCho compared with changes in tumor size are more likely to achieve pCR. The change in tumor size halfway through therapy was the most accurate predictor of pCR.
Radiology 04/2009; 251(3):653-62. · 5.73 Impact Factor
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ABSTRACT: We demonstrate successful treatment of recurrent chondroid-metaplastic breast cancer. Breast cancer recurrence was diagnosed when a patient with a history of metaplastic breast cancer presented with recurrent acute strokes. A diagnosis of tumor embolism was suspected when a chest radiograph performed as part of a work-up for stroke demonstrated several lung nodules, with 1 lung nodule invading the pulmonary vein and extending into the left atrium-the source of tumor emboli. This was followed by timely surgery to remove the embolizing metastatic lesion and local radiation to prevent growth and recurrent embolization. Subsequently, the patient received carboplatin and albumin-bound paclitaxel and experienced complete remission.
Clinical Breast Cancer 03/2009; 9(1):56-9. · 2.38 Impact Factor
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Rita S Mehta
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ABSTRACT: The pharyngeal jaws of moray eels function exclusively to transport prey from the oral jaws into the esophagus. This functional innovation in the moray pharyngeal jaw system occurred through the loss of some ancestral functions that presumably included prey processing. Therefore, the oral jaws of morays are used to capture and process prey. Dietary accounts suggest that morays can be categorized as either piscivorous or durophagous in feeding habits. These extreme feeding specializations that select for conflicting biomechanical demands on the oral jaws should result in two discrete clusters of cranial form and diet in morphospace. When functional characters underlying the oral jaws were examined for 10 muraenid species, piscivorous and durophagous morays occupied distinct areas of morphospace. Piscivores exhibited longer jaws, narrower heads, and long recurved teeth, while durophagous morays exhibited shorter jaws, greater dentary depths, and short blunt teeth. Durophagous morays process prey in their oral jaws, and their jaw-opening and jaw-closing ratios, along with their enlarged adductors, revealed jaws modified for force transmission. Pharyngeal jaw characters also separated moray species into different areas of morphospace. For example, Gymnomuraena zebra, a molluscivore, had more teeth on its pharyngobranchials than all other morays, and these teeth were long and thin compared with those of piscivores. The overall patterns of morphological variation corresponded well with moray dietary breadth. In addition, the range of jaw-opening and jaw-closing ratios revealed that for a clade of obligate carnivores, morays exhibit diverse biting behaviors.
Physiological and Biochemical Zoology 01/2009; 82(1):90-103. · 2.20 Impact Factor
