Quantitative expression of ER and PgR and HER-2 status did not identify patients with differential relative benefit from anastrozole over tamoxifen: TTR was longer for anastrozole than for tamoxifen in all molecular subgroups. Low ER or PgR or high HER-2 expression are associated with a high risk of recurrence with either anastrozole or tamoxifen.

Purpose Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). Methods MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper–Pearson estimation. Results Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0–97.5%) and 92.8% (95% CI 91.7–93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0–93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). Conclusions This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. Level of Evidence Level III, systematic review of retrospective cohort studies.

Implementation of a multifaceted change program reduced the number of D-dimer test requests in both hospitals and may have improved the diagnostic workup for PE at hospital 1. Processes that speed patient transit through the emergency department may impact negatively on other aspects of patient care. This should be the subject of further studies.

Traumatic pneumatocele is a recognized but uncommon complication of blunt thoracic trauma. Its clinical relevance lies in the difficulty the attending surgeon encounters in differentiating the x-ray appearances from more serious pathology requiring urgent surgical intervention. We document this case because it is important that surgeons be aware of this condition and of its benign course so as to avoid unnecessary diagnostic or operative procedures.

Background TARGIT-A, an international phase 3 randomised trial (Lancet 2010;376:91–102) compared outcomes in patients undergoing breast conserving surgery followed by either whole breast external beam radiotherapy (EBRT) over several weeks, or a risk-adaptive approach using single dose targeted intra-operative radiotherapy (TARGIT). Risk-adaptive approach meant that if the final pathology report demonstrated unpredicted pre-specified adverse features, then EBRT was to be added to TARGIT. Method 3451 women aged 45 years or older with invasive ductal carcinoma were enrolled from 33 centres in 10 countries between 2000 and 2012. Randomisation to TARGIT or EBRT arm was done either before lumpectomy (pre-pathology) or after lumpectomy (postpathology). If allocated to TARGIT, patients in the pre-pathology group received it immediately after surgical excision under the same anaesthesia; patients in the post-pathology group received it as a subsequent procedure. We pre-specified that analysis would be performed overall as the primary analysis and for these groups separately as a secondary analysis. The primary outcome was ipsilateral within breast recurrence (IBR) with an absolute non-inferiority margin of 2.5% at 5 years and secondary outcome was survival. We performed exploratory analyses for loco-regional recurrence, ‘all recurrence’ (ipsilateral or contralateral breast, axilla or distant), distant recurrence, and causes of death. Results 1721 patients were randomly allocated to receive TARGIT and 1730 to EBRT. 1010 patients have a minimum 4 years follow up and 611 patients have minimum 5 years follow up. Primary events have increased from 13 to 34 since 2010. For the primary outcome of ipsilateral breast recurrence, the absolute difference at 5-years was 2.0%, which was higher with TARGIT and reached the conventional levels of statistical significance (p = 0.042), but was within the pre-specified non-inferiority margin; in prepathology the absolute difference in 5-year IBR was 1%; in postpathology it was 3.7%. For the secondary outcome, there was a non-significant trend for improved overall survival with TARGIT (HR = 0.70(0.46–1.07)) due to fewer non-breast cancer deaths (17 vs. 35, HR 0.47 (0.26–0.84)). Cardiovascular deaths were 1 vs. 10 and deaths from cancers other than breast were 7 vs.16. Conclusion The risk-adapted approach using single dose TARGIT has a slightly higher local recurrence rate than EBRT for the primary endpoint of IBR, but was within the preset non-inferiority boundary, with the prepathology apparently performing better than the postpathology stratum. In addition there was a trend for improved overall survival in the TARGIT arm due to fewer non-breast cancer deaths. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S4-2.

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Hypnotizability, one’s ability to experience cognitive, emotional, behavioral, and physical changes in response to suggestions in the context of hypnosis, is a highly stable trait associated with increased functional connectivity between the left dorsolateral prefrontal cortex (L-DLPFC) and dorsal anterior cingulate cortex (dACC). We conducted a preregistered, triple-blinded, randomized controlled trial to test the ability of continuous theta-burst stimulation (cTBS) over a personalized neuroimaging-based L-DLPFC target to temporarily enhance hypnotizability. We tested our hypothesis in 78 patients with fibromyalgia syndrome (FMS), a functional pain disorder for which hypnosis has consistently been shown to be beneficial as a nonpharmacological treatment option. Pre-to-post cTBS change in Hypnotic Induction Profile scores (HIP; a standardized measure of hypnotizability) was significantly greater in the Active versus Sham group. Our findings suggest a causal relationship between L-DLPFC and dACC function and hypnotizability. Dose-response optimization should be further examined to formalize guidelines for future clinical utilization.Trial registrationClinicalTrials.govNCT02969707

Background: Photodynamic therapy (PDT) has been used to treat skin metastases from breast cancer. We investigated the use of PDT for the treatment of primary breast cancer. Trial design: Phase I/IIA, open label, non-randomised, single site, light dose escalation trial in patients with primary breast cancer using verteporfin as the photosensitiser. Verteporfin 0.4mg/kg bodyweight is injected intravenously 60-90 minutes before laser activation through a thin optical fibre inserted percutaneously through a needle positioned under ultrasound guidance under local anaesthesia. The light dose is escalated from 20J to a maximum of 50J in intervals of 10J. Eligibility criteria: Patients aged 30 or over and have opted for mastectomy or wide local excision as primary treatment are included. The tumour should be uni-focal invasive ductal breast carcinoma, or discrete uni-focal site, within a multifocal invasive ductal carcinoma, in a single breast. Participants should not have confirmed distant metastases. The exclusion criteria include: patients who are not undergoing surgery as their primary treatment; patients undergoing surgery for DCIS without invasive breast cancer; lobular cancers and necrotic tumours; patients who have porphyria or are sensitive to verteporfin; patients who have severe cardiovascular disease or severe uncontrolled systemic disease (e.g. hepatic impairment); male breast cancer patients; pregnant or lactating patients; patients taking primary endocrine therapy or taking an experimental medicine as a part of a trial. Aims: We aim to establish the minimum light dose required to induce an area of necrosis with a diameter of at least 12mm perpendicular to the optical fibre; or to achieve a plateau with no increase in diameter of necrosis with increasing light dose. Secondary objectives are to examine the effect of Photodynamic Therapy on the abnormal breast tissue and study if necrosis extends to normal breast tissue. We will be assessing the role of MRI in predicting the response to treatment by measuring the diameter of tumour and the zone of necrosis before and after PDT and confirming it with histological findings. We will be monitoring the number of adverse events arising from the PDT. Statistical Methods: The sample size of the study is based on a standard 3+3 dose-escalation algorithm.Statistical analysis will be descriptive in nature with no formal statistical inference. Summary statistics and analysis will be provided for all patients who receive the study treatment, by dose level for each dosing regimen. Accrual Results: 11 patients have been enroled and completed the trial up to June 2016 with primary end point achieved and no adverse side- effects to treatment seen. Target Accrual: 21 patients. Acknowledgement: Royal Free Charity. Citation Format: Banerjee SM, Malhotra A, El-Sheikh S, Tsukagoshi D, Tran-Dang M-a, Mosse A, Parker S, Davidson TI, Williams NR, Bown S, Keshtgar MR. Photodynamic therapy for the treatment of primary breast cancer: Preliminary results of a phase I/IIa clinical trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-02-01.