Between 1971 and 1991, 247 patients with stage I osteosarcoma were treated at UCLA. Patients were treated in four sequential groups, with group 1 receiving surgery alone, and groups 2 through 4 receiving various adjuvant chemotherapeutic regimens. The incidence of lung metastases in these patients decreased from 92% (group 1) to 31% (group 4), while the proportion of patients undergoing pulmonary resection increased (17% vs 82%). Overall 5-year survival rate among patients with pulmonary metastases increased from 0 in group 1 to 41% (actuarial) in group 4. No clinical factor correlated significantly with outcome using univariate analysis, although there was a trend toward prolonged survival in those with longer disease-free intervals. Adjuvant chemotherapy and resection of pulmonary metastases have transformed a uniformly fatal condition into one with a reasonable expectation of long-term survival.

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Background: 5% of screening mammograms demonstrate intramammary lymph nodes (IMLN). Prior to breast-conserving therapy (BCT), patients with breast cancer underwent total mastectomy, which removed IMLN whether they contained metastatic foci or not; since BCT, patients underwent partial mastectomy, which may or may not have removed these nodes. The authors do not support this approach and excise all ipsilateral IMLNs in patients with breast cancer. This study exams the oncologic merits of this practice. Methods: Since 2007, the authors have kept prospective data on all patients with IMLNs. 18 patients were identified who: 1) were diagnosed with ductal carcinoma, 2) had IMLNs detected pre-or intra-operatively, 3) underwent surgery. Data on age, history, physical exam, workup, treatment, pathology, and follow-up were reviewed. Results: All patients were female. The median age was 54 (36-92). Median 5-year and lifetime risks of developing breast cancer were: 1.6% (0.4 — 2.8) and 11.4% (2.8 — 20.1) respectively. Compared to the general population, these represented increases in 5-year and lifetime risks of 0.1 % (-1.4 — 1.4) and 1.0% (-4.7 — 8.2) respectively. 1 patient carried a mutation in BRCA1. 53% presented with a palpable mass; 47% presented with a lesion on screening mammography. Tumors and IMLNs were located in all four quadrants. In 5 patients (28%), the primary tumor and IMLN were located within different quadrants. Despite this spatial separation, in 3 of these patients, IMLNs contained metastatic foci; moreover, in 2 of these patients, the IMLN was the only positive node. 56% of all patients were initially treated with lumpectomy. Of these, 20% ultimately underwent mastectomy. Thus, 44% of all patients were treated with BCT. The median primary tumor size was 2.2 cm (0.3 — 7.8). 89% of tumors were both ER/PR-positive; 11 % were both ER/PR-negative. In 1 patient (6%), the tumor was positive for Her2/Neu overexpression. 78% of all patients underwent sentinel-node biopsy. For each, a median of 2 sentinel nodes (1 - 5) were retrieved. In 4 of these patients (29%), the sentinel node was intramammary. Moreover, among all patients with positive nodes, in a third (4 of 12), the IMLN was the only positive node. Indeed, in 42% of patients, IMLNs were directly responsible for upstaging disease. 44% of all patients and 64% of BCT patients underwent adjuvant radiation therapy. 56% of all patients underwent adjuvant chemotherapy; 56%, adjuvant hormonal therapy. At a median follow-up of 18 months (1-38), 94% remained disease free; 1 patient (6%) developed bony disease. Conclusions: This small prospective analysis sought to answer the following: 1) can IMLNs be excised in the setting of BCT1 and 2) should IMLNs be excised? For 72% of all patients, the primary tumor and IMLN were located within the same quadrant. Therefore, excision of the former readily incorporated the latter. For other patients, numerous techniques — ultrasonography, pre-operative wire placement, or palpation through the surgical wound — facilitated localization and removal. The oncologic merits of IMLN excision are clear — in 29% of patients undergoing sentinel lymph-node biopsy, the IMLN was sentinel; in 42% of patients with positive lymph nodes, the IMLN was directly responsible for upstaging disease. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-19.

Introduction: Neoadjuvant chemotherapy is used in locally advanced breast cancer to downstage the tumor, facilitating surgical management. Oncotype DX (ODX) is used to estimate the risk of distant recurrence for ER-positive breast cancers, allowing selected patients to avoid the toxicity of chemotherapy. ODX is often not possible on the small core biopsy samples. Klein et al. have shown that standard histological variables, combined with semiquantitative ER, PR, HER-2, and Ki-67 results, can provide information similar to that with ODX, using equations derived by linear regression analysis (Magee equations). We applied a modification of these equations to pretreatment core biopsies in women who received neoadjuvant chemotherapy to determine if the risk scores were predictive of pathologic response. Methods: 25 patients who received chemotherapy for receptor positive locally advanced(21), inflammatory(3), or metastatic(1) breast cancer followed by surgical treatment of the primary site were identified from a prospective breast cancer database. Pretreatment core biopsies were reviewed by a breast pathologist and Nottingham grade, ER and PR status (% of cells staining and intensity of staining), and Her-2 status by IHC and/or FISH were recorded. Clinical tumor size was defined as the average of sizes derived from mammogram, ultrasound, MRI, PET-CT and clinical breast examination. Using these data in a modified Magee equation, the patient's recurrence score was calculated. 0-18 was considered low risk (LR), >18-<30 was considered intermediate risk (IR), and ≥30 was considered high risk (HR). Resection specimens were reviewed to define pathologic response. A good pathologic response to chemotherapy was defined as a complete pathologic response (3 cases), near complete response (2), or a response with one or more of the following; reduction in the post-treatment size of the tumor by greater than 50% compared with pretreatment imaging, a significant reduction in tumor cellularity in the tumor bed, and an inflammatory lymphohistiocytic infiltrate with tumor necrosis (6 cases). For the remaining 14 cases, the response was defined as poor (no histopathologic evidence of response to treatment). Risk scores were compared between good and poor responders using T-Test. Comparison between risk groups (HR vs IR vs LR) were made using Chi Square analysis. Results: Magee scores ranged from 13.8-41.6 (mean 27.4) and were significantly lower in the poor responders (mean = 23, range 13.8-41.6) compared to the good responders (mean = 33, range 22-41.3, p = 0.003). Table 1 shows the distribution of response by Risk Group (p = 0.018). Table 1: Response by Risk CategoryMagee Risk GroupLRIRHRPoor Response563Good Response038 73% of patients with high risk Magee scores had a good response to chemotherapy, compared to 21% of patient with low or intermediate scores (p = 0.01). Conclusions: Modified Magee equations applied to pretreatment core biopsies seem to predict pathologic response to neoadjuvant chemotherapy. Use of these equations to assign risk scores may be a useful tool in deciding which ER positive breast cancer patients are likely to benefit from preoperative chemotherapy for cytoreduction, and who should go directly to surgery. These findings need to be validated in larger studies. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-37.

AIM: To study the clinical and therapeutic aspects of cutaneous melanoma at the Joliot Curie Institute of Dakar. PATIENTS AND METHODS: We performed a retrospective, descriptive and critical study at the Joliot Curie Institute of Dakar including all histologically confirmed melanoma cases between January 2008 and December 2013. RESULTS: During the study period, 21 cases were managed. The location was plantar in 76% of cases. Acral type was found in 85.7% of cases. All patients had a Clark level of IV or higher with a Breslow index of more than two mm. Fourteen patients underwent excision surgery and 12 had inguinal lymph node dissection. The average follow-up was 16 months with an overall survival of 58.7% at six months and 51% at one year. CONCLUSION: The majority of patients have benefited from surgical treatment, without prescription of immunotherapy which to date has revolutionized the management of advanced melanoma.