Seventy-one dogs with histologically confirmed appendicular osteosarcoma were evaluated. Seventeen dogs were treated with amputation and two dogs received postoperative doses of IV cisplatin given 21 days apart (group 1). Nineteen dogs were treated with IV cisplatin 21 days before amputation, with a second dose given immediately after amputation (group 2). Thirty-five dogs were treated by amputation of the affected limb with no chemotherapy (group 3). The median disease-free interval for group 1 was 226 days, and 177 days for group 2. This was not significantly different. The median survival time was 262 days for group 1,282 days for group 2 and 119 days for group 3. Group 1 and 2 dogs had survival times that were significantly longer than for dogs in group 3. Two IV courses of cisplatin given before or after amputation appears to improve the survival of dogs with osteosarcoma. (Journal of Veterinary Internal Medicine 1991; 5205-210) OSTEOSARCOMA (0s) is the most common primary bone cancer in dogs.',2 It accounts for approximately 4% of all canine neoplasms and has been estimated to affect approximately 7.9/ 100,000 dogs annually.' Treatment has generally included amputation, which relieves local discomfort but rarely results in a cure, with reported mean or median survivals of 3.6 to 5.8 ~~~~~ ~
BackgroundDermatofibrosarcoma protuberans is a rare soft tissue malignancy that, if left untreated, can be locally destructive and life-threatening. Dermatofibrosarcoma protuberans is uncommon in the breast, and the similarity of its morphologic features with other spindle cell malignancies can make correct identification difficult. Immunohistochemistry and molecular testing can aid in the correct diagnosis when there is diagnostic uncertainty. Imatinib, a selective tyrosine kinase inhibitor, has been used for adjuvant treatment of dermatofibrosarcoma protuberans following surgical resection. When used as a neoadjuvant treatment, imatinib offers the opportunity to decrease tumor size prior to surgery to lessen the chance for disfigurement.Case presentationWe present the case of a Caucasian woman who was 46-year-old when she first noted a mass in her right breast in 2015; she was initially diagnosed as having metaplastic breast carcinoma. Mastectomy and systemic chemotherapy were planned; however, after review of pathology at a referral center, the diagnosis was changed to dermatofibrosarcoma protuberans. She was treated with 4 months of neoadjuvant imatinib with adequate tumor shrinkage to perform breast conservation.ConclusionThis patient’s case stresses the importance of correctly diagnosing this rare breast tumor through the histopathologic appearance of dermatofibrosarcoma protuberans, molecular pathogenesis, and immunohistochemistry. These techniques can help differentiate dermatofibrosarcoma protuberans from metaplastic breast carcinoma and other spindle cell lesions of the breast. This is critical, as the treatment options for metaplastic breast carcinoma significantly differ from treatment options for dermatofibrosarcoma protuberans. This case describes the use of imatinib as a neoadjuvant option to reduce preoperative tumor size and improve surgical outcomes.
e20537 Background: There are currently no clear national guidelines for management of in-situ (stage 0) non-small cell lung cancer (NSCLC). With no prospective clinical trial data, treatment strategies include both surgical resection and definitive radiation therapy (RT). We aimed to investigate survival outcomes in patients with stage 0 NSCLC who underwent surgery or RT. We also aimed to identify any differences in the treatments that the two groups received with respect to rural versus urban setting and racial variation. Methods: The 2016 National Cancer Data Base was reviewed from 2006-2015 for patients registered with a pathological diagnosis of Stage 0 NSCLC, based on the AJCC 7th edition classification for lung cancer. Patients with a prior history of malignancy, secondary malignancy other than lung, and contraindications to surgery were excluded. Univariate comparison and multivariate logistic regression modeling were utilized to identify factors associated with receipt of surgery. Patients were stratified into two groups, surgical resection and RT. Kaplan-Meier estimators and Cox proportional-hazards regression were used to compare overall survival(OS). Propensity score matching was performed using relevant demographic and clinical factors associated with receipt of surgery. All analysis was completed in SAS version 9.4 and p-values less than 0.05 were considered significant. Results: A total of 156 patients were identified with Stage 0 NSCLC who received surgery (n = 104) or RT (n = 52). Surgery was defined as lobectomy or less. Histologic subtypes were squamous cell carcinoma (54%), adenocarcinoma (45%), and bronchioloalveolar carcinoma (1%). Median age was 65 years for the surgical resection cohort and 70 years for the RT cohort. From diagnosis, median time to surgery was 21 days for the surgical resection cohort and 47 days to start of radiation for RT cohort. We did not identify any major differences with respect to rural versus urban setting or racial differences within the surgery and RT cohorts. Patients who underwent surgical resection had a superior 5 year overall survival 65% (CI, 43.49-80.56) when compared to patients who underwent RT 37% (CI, 10.63-65.05), hazard rate 0.403, p = 0.0009, 95% CI. 0.236 – 0.689). Conclusions: Our findings show a significant improved survival with surgical resection compared to RT in patients diagnosed with Stage 0 NSCLC.
e18718 Background: COVID-19-related physical distancing restrictions impacted the delivery of close-contact healthcare care in the initial months of the pandemic. To ascertain the effect of these changes on breast cancer (BC) care at Gundersen Health System (GHS), we compared stage at diagnosis (dx), interval between dx and initiation of treatment (tx), and modality of first tx offered to pts (pts) diagnosed with BC before, during, and after pandemic-related restrictions. Methods: We performed a retrospective review of the electronic health records of approximately 904 pts with a new BC dx at GHS. Based on the timing of COVID-19-related restrictions at GHS, we designated any date from January 1, 2019 - March 31, 2020 as “Pre-COVID”, April 1, 2020 - December 31, 2020 as “COVID”, and January 1, 2021 - March 31, 2022 as “Post-COVID”. The median time to first tx for each modality of tx was compared using Kruskal-Wallis tests. Cox proportional hazard models were used to investigate patterns in the time to tx for various tx modalities in the three time periods of interest while accounting for clinical stage at dx. Changes in the distribution of modality of first tx, cancer stage at dx, type of surgery, and mode of disease detection across the three time periods of interest were assessed using Chi-square tests of association. Results: The median time to surgery for pts with surgery as first tx modality was significantly different between time periods (p < 0.001) with time to surgery shortest pre-COVID and longest post-COVID. Significant differences in time to first chemotherapy tx were noted for clinical stage 2 pts (p = 0.002), but not for pts diagnosed at other stages. No differences were noted in times to first hormone therapy tx (p = 0.28). There were significant differences in the distribution of modality of first tx (p < 0.001), the clinical stage at dx (p = 0.01), and the mode of detection (p = 0.04) across the three time periods. These differences reveal a shift in the typical paradigm of BC care due to the pandemic; with a delay in detection and tx, change in clinical stage at dx, and a change in the modality of the first tx. Conclusions: Our data illustrate the effect the pandemic had on routine BC care during and after the pandemic-related restrictions regarding time to first tx, clinical stage at the time of dx, and initial tx modality. Furthermore, these pandemic changes are ongoing with the time to first tx longer in the post-pandemic period as compared to pre-pandemic period. This delay in return to pre-pandemic standards may be due to continued issues with supply chain and staffing shortages. Identifying differences attributable to the pandemic will help guide future decisions regarding BC care should conditions necessitate the reimplementation of strict infection-prevention measures. Identifying issues that continue post-COVID will help determine strategies to close those care gaps.
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