Clinical Outcome of Neoplastic Meningitis Associated with Breast Cancer

Background Neoplastic meningitis (NM) is considered as a terminal event with poor prognosis. Its impact in clinical oncology is growing. Objective To analyze the clinical outcome of patients with carcinoma breast diagnosed with NM. Materials and Methods This study was an observational study in breast cancer patients diagnosed with NM. Patients with typical clinical symptoms and signs with either presence of cerebrospinal fluid (CSF) cytology positive for neoplastic cells or typical radiological features of leptomeningeal involvement in the presence of neurological symptoms or signs were taken as leptomeningeal metastasis (LM) or NM. The estimation of survival was done by Kaplan–Meier method. Results Out of 1,200 patients diagnosed with carcinoma breast during the study period, 15 developed NM. The median age of study population was 51 (range: 44–55) years. Most common presentations were headache (47%), vomiting (47%), diplopia (20%), seizure (20%), and cerebellar signs (7%). Seven (46%) patients were hormone receptor positive, four (30%) were HER2 (Human epidermal growth factor receptor 2) positive and seven (46%) were triple-negative breast cancer. Median time to develop LM from the time of diagnosis of breast cancer was 6 (range: 3–8) months. Nine patients (90%) had features of NM in CSF cytology. Thirteen patients received palliative whole brain radiotherapy (20 Gy in five fractions). Nine out of 12 patients received single-agent Capecitabine as first-line chemotherapy after palliative radiation therapy (RT). Intrathecal methotrexate was given for seven patients. The median overall survival was 3 (range: 0.5–4) months. Conclusion LM is a very aggressive metastatic disease with poor outcome. There is an unmet need for proper guidelines and an overwhelming necessity for a better focus on research for new modalities of disease in this scenario.

Awareness Level of Nurses about Carcinoma Breast Risk Factors in Mayo Hospital Lahore

Aim: To assess level of awareness in nurses regarding risk factors related to carcinoma breast at a tertiary care public hospital Lahore Methods: It was a descriptive study. This study took place at Mayo Hospital Lahore. The nurses of different departments especially the oncology department were recruited. A sample of n=300 was recruited through random probability sampling methods. An adopted close ended questionnaire was applied. The data was interpreted and analyzed by SPSS version 25. The data was analyzed in the form of tables and graphs. Results: Of the participants nurses 67% knew that smoking is a risk factor for carcinoma breast. It was also found that 59% agreed that exposure to another person’s cigarettes smoke also can cause breast carcinoma. Results also suggest that 88% agreed that drinking more than one glass of alcohol a day also can cause breast cancer. Moreover results suggest 71% agreed that being overweight (BMI>25) also can cause breast carcinoma. Results also suggest that 54% agreed that being over 70 years old can lead to breast cancer. Conclusion: Overall knowledge related to risk factors of breast carcinoma among nurses was satisfactory. Top rating risk factors were, smoking cigarettes and family history. Moreover, nurses knowledge regarding breast carcinoma symptoms and signs was also good among participants MeSH: Carcinoma Breast, Awareness, Risk Factor

A Rare Case of Synchronous us Carcinoma Breast with Chronic Myeloid Leukemia

Chronic myeloid leukemia is an insidiously progressive condition and comparatively rare type of blood cell malignancy that begins in the bone marrow. Chronic myeloid leukemia typically affects adult population and is documented to be caused by chromosomal mutation that usually occurs spontaneously. Chronic myeloid leukemia is more common in males than in females (male: female ratio of 1.4:1) and appears more commonly in the elderly with a median age at diagnosis of 65 years [1] Exposure to ionising radiation is one of the risk factors, based on a 50 fold higher incidence of CML in Hiroshima and Nagasaki nuclear bombing survivors [1] The rate of CML in these individuals seems to reach at its peak about 10 years after the exposure [1]. Carcinoma breast on the other hand is one of the most common causes of death in middle aged women in western countries. There are numerous factors contributing as its etiological factors such as age, gender, diet, endocrinal factors, previous radiation exposure, genetic factors and geographical factors. We present a case report of a 44 old female who came to Acharya Vinoba Bhave Rural Hospital (Datta Meghe Institute of Medical Sciences and Research), with presenting complaint of lump in the left breast since 2 days and abdominal mass for 1 month. On investigations, patient was diagnosed with a rare case of chronic myeloid leukemia on the complete blood count and peripheral smear and the lump in the left breast also revealed invasive ductal carcinoma of the left breast.

Correlation of ER PR receptors with other prognostic parameters of breast carcinoma

To study the MRM specimens for size, grade of the tumor, LVI and LN metastases and the ER/PR receptors of the tumor. To study the association of ER/PR status with the above mentioned prognostic parameters. This three-year study includes 72 histopathologically confirmed cases of carcinoma breast. The tumor type, grade, LNM, LVE were reported on H & E. The ER-PR study was done of all 72 cases. The tumor size, grade, LNM, LVE were correlated with receptor status. Out of 72 cases majority (53%) of cases were in 41-50 years of age group, and tumor size was between 2-4 cm in (54.16%) cases; majority were of grade II carcinoma (60%) of which 59% were ER-PR positive. Out of 46 cases with negative LNM and LVE, 30 cases (65%) were ER-PR positive. In our observation there is no association between higher histological grade and ER-PR status. No obvious correlation with tumor size was noted. But increase in tumor size could also be a poor predictor of ER-PR status. LNM, LVE is poor predictor of ER-PR status.

COMPARISON OF POST-OPERATIVE VALUES WITH PRE OPERATIVE VALUES OF CA 15-3 AND ITS PROGNOSTIC VALUE

Objective: This study was designed and conducted to establish the relationship of biomarker CA 15-3 levels with tumor load in cases of carcinoma breast. Methods: Fifty female patients with confirmed diagnosis of breast malignancy were included in the study. CA 15-3 levels were measured before surgery and after surgery. Results: It was found that levels of the biomarker were increased in all the cases; the rise was higher in advance cases of carcinoma. Levels decreased after the surgery and this decrease was statistically significant. Conclusions: It was concluded that levels of CA 15-3 increase in cases of carcinoma breast; higher levels indicate advanced stage and that decrease in levels indicate effective treatment.

Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation

Aim: There are only limited studies available in literature that discuss methods to reduce the oesophageal dose and acute oesophagitis during breast cancer radiotherapy. The aim of this study is to compare dose volumetric parameters of oesophagus in radiation treatment of breast with and without oesophagus delineation. Methods: Treatment plans of 44 patients, who underwent chest wall and supraclavicular fossa irradiation, were selected for the study. Oesophagus was later delineated and treatment replanned using three-dimensional conformal radiotherapy (3DCRT) considering oesophagus as an organ at risk (OAR). The dose prescribed was 40 Gy/15 fractions to the planning target volume (PTV). Dose volumetric parameters of oesophagus such as maximum dose (Dmax), mean dose (Dmean), the percentage of oesophagus volume receiving ≥15Gy (V15), ≥25Gy(V25), ≥33Gy(V33) and ipsilateral lung volume parameters V4, V8 and V16 were compared with already executed plans in which oesophagus was not delineated. Results: Contouring the oesophagus as an OAR as a part of the radiotherapy treatment for Carcinoma Breast resulted in statistically significant reduction in dose to the oesophagus. No statistically significant change was found in the ipsilateral lung volume parameters. No compromise in plan quality was required as evident from the statistically non-significant differences in Homogeneity index and Conformity index. Findings: 3DCRT planning with oesophagus delineation can be considered as a method to reduce oesophageal dose and the acute oesophageal toxicity during radiotherapy for carcinoma breast.