The treatment results in 59 patients with extradural spinal cord compression (ESCC) who were treated with irradiation between April 1987 and December 1988 were analyzed prospectively. Eighty percent of the patients presented with back pain, which preceded ESCC by an average of 6 weeks. The most common primary tumor was lung cancer (27% of cases), followed by prostate cancer and breast cancer. The prognostic significance of pretreatment motor function, degree of spinal cord block, radiosensitivity of tumor, and radiation dose schedule was determined with multivariate analysis. Only pretreatment motor function was found to be a significant factor in determining functional prognosis (P = .0058). Even with the increasing clinical awareness of ESCC, 78% of the patients in the current series were nonambulatory at presentation. Therefore, computed tomographic myelography or magnetic resonance imaging is recommended for patients with back pain and bone destruction at the site of the complaint if local radiation treatment is not planned.

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The records were reviewed of 103 patients with low-lying pelvic malignancies irradiated with a skin-sparing technique involving use of a pair of anteroposterior-posteroanterior opposed ports and a direct perineal port. Patients had rectal, anal, cervical, vaginal, urethral, or vulvar cancer. Use of a special lead compensator allowed the three beams to be applied perpendicularly to the surface, while delivery of a homogeneous dose to the pelvis and perineum was maintained. Skin dose with this method was greatly reduced compared with that delivered with simple opposing or four-port techniques, in which irradiation is tangential to the surface at the perineum. Acute perineal skin irritation was assigned a grade between 0 and 3, with grade 0 representing the least amount of irritation. All patients were in the grade 0 or grade 1 category. Patients treated for low-lying rectal carcinoma showed no increase in perineal recurrences when compared with historic control subjects. Use of this approach allowed delivery of adequate doses to the pelvis and perineum and a definite decrease in local toxic effects, and local control was not compromised.

Introduction: Overexpression of vascular endothelial growth factor (VEGF) in breast cancer tumors has been associated with resistance to anti-estrogen adjuvant therapy. We designed a pilot study of neoadjuvant letrozole and bevacizumab (anti-VEGF) to assess feasibility and short term efficacy in post-menopausal women with stage II/III, ER/PR positive breast cancer. Patients and Methods: Patients were treated with a neoadjuvant regimen of letrozole, 2.5 mg/day (PO) and bevacizumab 15 mg/kg every 3 weeks (IV) for a total of 24 weeks prior to surgical treatment of their breast cancer. Patients were followed for toxicity at three week intervals and tumor assessment (physical exam and tumor ultrasound) at six week intervals. Results: Twenty-five evaluable patients were treated. The regimen was well tolerated except for two patients who were taken off-study for difficult to control hypertension. Objective clinical response occurred in 17/25 patients (68%) including 16% CR and 52% PR. The four patients with clinical CR had pathologic CR in their breasts (16%) although one had residual tumor cells in axillary nodes. Two of the 17 responding patients were lost to follow-up; with a median follow-up of 50 months, no relapses have been seen in the 15 responsive patients, including 10 patients who received no adjuvant chemotherapy. Two patients with progressive disease at 9 and 16 weeks received neoadjuvant chemotherapy, surgery and radiation. One of these patients relapsed at 35 months and the other is NED at 44 months. Four patients had stable disease and all received adjuvant chemotherapy; one patient relapsed at 25 months, and the reminder are NED at 44-52 months. Overall, 2 out of 21 patients with adequate follow-up had disease reoccurrence (9.5%) at a median follow-up of 45 months. Conclusion: Combination neoadjuvant therapy with letrozole and bevacizumab was well tolerated and resulted in impressive clinical and pathologic responses. Data suggest that patients having an objective response to neoadjuvant therapy had excellent 4 year disease-free survival (100%) while relapsed occurred in 2 out of 6 patients who failed to have an objective response despite additional neoadjuvant or adjuvant chemotherapy. The Breast Cancer Translational Research Consortium has an ongoing randomized phase II trial of letrozole ± bevacizumab in this patient population. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-12-04.

Background: Body mass index (BMI) has been correlated with risk of recurrence in invasive breast cancer, but the association between BMI and recurrence in ductal carcinoma in situ (DCIS) is less clear. Recent retrospective data indicates that local recurrence is not related to BMI at initial diagnosis. Here we examine the relationship between initial BMI and recurrence in a separate cohort of patients with DCIS. Methods: One hundred eighty-nine patients with DCIS treated between the years of 1999 and 2005 at the University of Alabama at Birmingham were analyzed. BMI was divided into 4 categories as follows: underweight (BMI <18.5 kg/m (2)), normal weight (BMI 18.5–24.9 kg/m (2)), overweight (BMI 25–29.9 kg/m (2)), and obese (BMI ≥30 kg/m (2)). Fisher's exact test was used to evaluate the association between likelihood of recurrence based on initial BMI and the log rank test was used to evaluate recurrence-free survival. Risk of both overall recurrence and specifically local recurrence were analyzed. Results: There were 199 cases of DCIS identified in our cohort of 189 patients (10 patients had bilateral disease). Of these 189 patients, 1.1% (2/189) were underweight, 31.2% (59/189) were normal weight, 22.7% (43/189) were overweight, and 21.7% (41/189) were obese. BMI could not be obtained for 23.3% (44/189) of patients. With a median follow-up of 87.2 months, there were 28 total recurrences identified in the 199 cases (14.1%) with 85.7% of these including a local recurrence. No significant associations were found between the likelihood of overall or local recurrence and any of the four BMI categories. Further, analysis of recurrence-free survival did not show any significant associations between BMI and recurrence. Conclusions: Our data supports recently reported evidence that BMI at diagnosis does not affect the risk of overall or local recurrence in patients with DCIS. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-37.