Neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with systemic chemotherapy in patients with breast cancer

BACKGROUND AND PURPOSE: This is the first study investigating neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with chemotherapy in patients with breast cancer. The goal was to evaluate the type of surgical treatment, histopathologic response, side effects, local control, and survival. PATIENTS AND METHODS: 53 patients, who could not be treated with breast-conserving surgery due to initial tumor size (36/53) or due to an unfavorable breast-tumor ratio (17/53), were analyzed retrospectively. All but one were in an intermediate/high-risk group (St. Gallen criteria). The patients received a neoadjuvant protocol consisting of systemic chemotherapy combined with fractionated HDR brachytherapy (2 x 5 Gy/day, total dose 30 Gy). In cases, where breast-conserving surgery was performed, patients received additional external-beam radiotherapy (EBRT, 1.8 Gy/day, total dose 50.4 Gy). In patients, who underwent mastectomy but showed an initial tumor size of T3/T4 and/or more than three infiltrated lymph nodes, EBRT was also performed. RESULTS: In 30/53 patients (56.6%) breast-conserving surgery could be performed. The overall histopathologic response rate was 96.2% with a complete remission in 28.3% of patients. 49/53 patients were evaluable for follow-up. After a median of 58 months (45-72 months), one patient showed a mild fibrosis of the breast tissue, three patients had mild to moderate lymphatic edema of the arm. 6/49 (12.2%) patients died of distant metastases, 4/49 (8.2%) were alive with disease, and 39/49 (79.6%) were free from disease. Local recurrence was observed in only one case (2%) 40 months after primary therapy. After mastectomy, this patient is currently free from disease. CONCLUSION: The combination of interstitial HDR brachytherapy and chemotherapy is a well-tolerated and effective neoadjuvant treatment in patients with breast cancer. Compared to EBRT, treatment time is short. Postoperative EBRT of the whole breast -- if necessary -- is still possible after neoadjuvant brachytherapy. Even though the number of patients does not permit definite conclusions, the results are promising regarding survival and the very low rate of local recurrences.

Comparison of two non-bronchoscopic methods for evaluating inflammation in patients with acute hypoxaemic respiratory failure

INTRODUCTION: The simple bedside method for sampling undiluted distal pulmonary edema fluid through a normal suction catheter (s-Cath) has been experimentally and clinically validated. However, there are no data comparing non-bronchoscopic bronchoalveolar lavage (mini-BAL) and s-Cath for assessing lung inflammation in acute hypoxaemic respiratory failure. We designed a prospective study in two groups of patients, those with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and those with acute cardiogenic lung edema (ACLE), designed to investigate the clinical feasibility of these techniques and to evaluate inflammation in both groups using undiluted sampling obtained by s-Cath. To test the interchangeability of the two methods in the same patient for studying the inflammation response, we further compared mini-BAL and s-Cath for agreement of protein concentration and percentage of polymorphonuclear cells (PMNs). METHODS: Mini-BAL and s-Cath sampling was assessed in 30 mechanically ventilated patients, 21 with ALI/ARDS and 9 with ACLE. To analyse agreement between the two sampling techniques, we considered only simultaneously collected mini-BAL and s-Cath paired samples. The protein concentration and polymorphonuclear cell (PMN) count comparisons were performed using undiluted sampling. Bland-Altman plots were used for assessing the mean bias and the limits of agreement between the two sampling techniques; comparison between groups was performed by using the non-parametric Mann-Whitney-U test; continuous variables were compared by using the Student t-test, Wilcoxon signed rank test, analysis of variance or Student-Newman-Keuls test; and categorical variables were compared by using chi-square analysis or Fisher exact test. RESULTS: Using protein content and PMN percentage as parameters, we identified substantial variations between the two sampling techniques. When the protein concentration in the lung was high, the s-Cath was a more sensitive method; by contrast, as inflammation increased, both methods provided similar estimates of neutrophil percentages in the lung. The patients with ACLE showed an increased PMN count, suggesting that hydrostatic lung edema can be associated with a concomitant inflammatory process. CONCLUSIONS: There are significant differences between the s-Cath and mini-BAL sampling techniques, indicating that these procedures cannot be used interchangeably for studying the lung inflammatory response in patients with acute hypoxaemic lung injury.

The influence of recent major crater impacts on the surrounding surfaces of (21) Lutetia

We present 3-D simulations of impacts into Asteroid 21 Lutetia, the subject of a fly-by by the European Space Agency's Rosetta mission to Comet 67P/Churyumov-Gerasimenko. Using a 3-D shape model of the asteroid, impacts of sizes sufficient to reproduce the observed craters in Lutetia's North Polar Crater Cluster (NPCC) as observed by the OSIRIS experiment have been simulated using the Smoothed Particle Hydrodynamics technique. The asteroid itself has been modelled both as a homogeneous body and as a body with an iron core.

At surface behaviour of adult male southern elephant seals from King George Island from expedition JUB2000

Adult male southern elephant seals instrumented in 2000 on King George Island (n = 13), travelled both to the north (doi:10.1594/PANGAEA.231580, doi:10.1594/PANGAEA.231585) and to the east (doi:10.1594/PANGAEA.231571, doi:10.1594/PANGAEA.231579, doi:10.1594/PANGAEA.261708, doi:10.1594/PANGAEA.261709, doi:10.1594/PANGAEA.261710, doi:10.1594/PANGAEA.261711) of the Antarctic Peninsula. Five males (doi:10.1594/PANGAEA.231571, doi:10.1594/PANGAEA.231579, doi:10.1594/PANGAEA.231580, doi:10.1594/PANGAEA.261710, doi:10.1594/PANGAEA.231585) remained within 500 km of the island and focusing movements in the Bransfield Strait and around the Antarctic Peninsula. Sea-surface temperatures encountered by these animals showed little variation and they seemed to move about irrespective of sea ice cover, but frequented areas of shallow bathymetry. Three males (doi:10.1594/PANGAEA.261708, doi:10.1594/PANGAEA.261709, doi:10.1594/PANGAEA.261711) moved as far as 75°S to the east of the peninsula, into the Weddell Sea, with maximum distances of more than 1500 km from King George Island. They travelled into the Weddell Sea along the western continental shelf break until they reached the region of the Filchner Trough outflow. Here the bathymetry consists of canyons and ridges which support the intensive mixing between the warm saline waters of the Weddell Gyre and the very cold outflow waters with Ice Shelf water ingredients at the Antarctic Slope Front. Another five data sets were shorter then 40 days, and excluded from analyses (doi:10.1594/PANGAEA.231568, doi:10.1594/PANGAEA.231576, doi:10.1594/PANGAEA.231572, doi:10.1594/PANGAEA.231577, doi:10.1594/PANGAEA.264710). A computer animation was developed to visualize the animal movements in relation to the extent and concentration of sea ice (doi:10.1594/PANGAEA.509404). The need for re-instrumentation of adult males from King George Island is highlighted to investigate whether males continue to travel to similar areas and to obtain higher resolution data.