ABSTR AC T Background Invasive lobular carcinoma (ILC) comprisesaround 10-15 % of invasive breast cancers. Few prior studies have demonstrated a unique pattern of metastases between ILC and the more common invasive ductal carcinoma (IDC).To our knowledge, such data is limited to first sites of distant recurrence. We aimed to perform a comparison of the metastatic pattern of ILC and IDC at first distant recurrence as well as over the entire course of metastatic disease.Methods We used a prospectively collated database of patients with metastatic breast cancer. Breast cancer recurrence or metastases were classified into various sites and a descriptive analysis was performed.Results Among 761 patients, 88 (11.6 %) were diagnosed with ILC and 673 (88.4 %) with IDC. Patients with ILC showed more frequent metastases to the bone (56.8 vs. 37.7 %, p = 0.001) and gastrointestinal (GI) tract (5.7 vs. 0.3 %, p < 0.001) as first site of distant recurrence, and less to organs such as lung (5.7 vs. 24.2 %, p < 0.001) and liver (4.6 vs. 11.4 %, p = 0.049). Over the entire course of metastatic disease, more patients with ILC had ovarian (5.7 vs. 2.1 %, p = 0.042) and GI tract metastases (8.0 vs. 0.6 %, p < 0.001), also demonstrating reduced tendency to metastasize to the liver (20.5 vs. 49.0 %, p < 0.001) and lung (23.9 vs. 51.9 %, p < 0.001). All associations but bone held after sensitivity analysis on hormonal status. Although patients presenting with ILC were noted to have more advanced stage at presentation, recurrence-free survival in these patients was increased (4.8 years vs. 3.2 years, p = 0.017). However, overall survival was not (2.5 vs. 2.0 years, p = 0.75).Conclusion After accounting for hormone receptor status, patients with IDC had greater lung/pleura and liver involvement, while patients with ILC had a greater propensity to develop ovarian and GI metastases both at first site and overall. Clinicians can use this information to provide more directed screening for metastases; it also adds to the argument that these two variants of breast cancer should be managed as unique diseases. ZUSAMMENFASSUNGEinleitung Invasiv-lobuläre Karzinome (ILC) machen rund

Background Cessation of chemotherapy in the last few weeks of life could be an important quality of care benchmark. Proportion of metastatic breast cancer patients who receive end of life chemotherapy is not well described. We aimed to determine the prevalence and determinants of end of life chemotherapy use in patients with metastatic breast cancer. Methods A retrospective cohort study using a prospectively collated database of patients with metastatic breast cancer who died between January 1, 2010 and September 30, 2014 was conducted. End of life chemotherapy (EOLC) use was defined as receipt of chemotherapy within 2 weeks of death (EOLC2), and receipt of chemotherapy within 4 weeks of death (EOLC4). Patients who did not receive any chemotherapy in the last 4 weeks before death were categorized as non-EOLC. Results We identified 274 patients with metastatic breast cancer, of whom 28 received EOLC2 (10.2%) and 62 received EOLC4 (22.6%). In comparison to non-EOLC, patients receiving EOLC4 were younger and had greater disease burden. Patients in EOLC4 group received more number of lines of chemotherapy. In a multivariable analysis, younger age at metastatic disease and greater number of metastatic organ systems involved were predictors of end of life chemotherapy use. Conclusions Prevalence of the use of end of life chemotherapy in our cohort was higher than previously described. More end of life chemotherapy was used in younger women, and those with greater disease burden. Earlier initiation of end of life discussions may be targeted to such patients.

Background and study aims  Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patients and methods  This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs). Results  Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing. Conclusions  Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding.

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