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31723509
Purpose
There is growing interest in delivering radiation preoperatively (preopRT) rather than postoperatively (postopRT) for breast cancer. Using the National Cancer Database, we evaluated the use and outcomes of preopRT in breast cancer.
Methods
We identified adult females diagnosed with non-metastatic breast cancer treated with definitive surgery and radiation between 2004 and 2014. Logistic regression models evaluated factors associated with use of preopRT in early-stage (clinical T1-3/N0-1) and locally advanced (clinical T4/N2-3) disease. Rates of breast-conserving surgery, breast reconstruction, positive surgical margins, and 30-day surgical readmissions were compared between patients receiving preopRT and postopRT.
Results
Of 373,595 patients who met our inclusion criteria, 1,245 (0.3%) patients received preopRT. Patients receiving preopRT were more likely to be of lower socioeconomic status and have tumors with higher T stage. Younger age and N1 (vs N0) disease predicted for use of preopRT in early-stage disease, while older age and N0 disease predicted for use of preopRT in the locally advanced setting. PreopRT patients were less likely to undergo breast-conserving surgery and more likely to have positive surgical margins. Rates of unplanned readmissions within 30 days of surgery were similar among patients treated with preopRT and postopRT.
Conclusions
PreopRT is a new treatment strategy for patients with breast cancer with different clinical and sociodemographic drivers of its use in the early-stage and locally advanced settings. We await the results of clinical trials studying the efficacy of this approach.
preoperative radiation therapy, neoadjuvant treatment, breast cancer, national cancer database
Use of Preoperative Radiation Therapy in Early-stage and Locally Advanced Breast Cancer
Julie L Koenig, Margaret M Kozak, Aaron Sabolch, Kathleen Horst, Jillian Tsai, Irene L Wapnir, Erqi Pollom
2019 Sep;
30443401
Deliberate hydrolysis of lithium cyclopropylalkynylamidinates, Li[c-C3H5?C≡C(NR′)2] [R′ = iPr, Cy = cyclohexyl)], afforded the hitherto unknown neutral cyclopropylalkynylamidine derivatives c-C3H5?C≡C?C(NR′)(NHR′) [R′ = iPr (1), Cy (2)]. Subsequent reactions of 1 or 2 with metal(II) chlorides, MCl2 (M = Mn, Fe, Co), provided the title complexes dichloridobis(3-cyclopropyl-N,N′-diisopropylprop-2-ynamidine)manganese(II), [MnCl2(C12H20N2)2], (3), dichloridobis(3-cyclopropyl-N,N′-diisopropylprop-2-ynamidine)iron(II), [FeCl2(C12H20N2)2], (4), dichloridobis(N,N′-dicyclohexyl-3-cyclopropylprop-2-ynamidine)iron(II), [FeCl2(C18H28N2)2], (5), and dichloridobis(N,N′-dicyclohexyl-3-cyclopropylprop-2-ynamidine)cobalt(II), [CoCl2(C18H28N2)2], (6), or more generally MCl2[c-C3H5?C≡C?C(NR′)(NHR′)]2 [R′ = iPr, M = Mn (3), Fe (4); R′ = Cy, M = Fe (5), Co (6)] in moderate yields (30-39%). Besides their spectroscopic data (IR and MS) and elemental analyses, all complexes 3-6 were structurally characterized. The two isopropyl-substituted complexes 3 and 4 are isotypic, and so are the cyclohexyl-substituted complexes 5 and 6. In all cases, the central metal atom is coordinated by two Cl atoms and two N atoms in a distorted-tetrahedral fashion, and the structure is supported by intramolecular N?H?Cl hydrogen bonds.
amidinate ligand, amidine, manganese, iron, cobalt, crystal structure, hydrogen bonding
Synthesis and structural characterization of four dichloridobis(cyclopropylalkynylamidine)metal complexes
Sida Wang,a Phil Liebing,a Felix Engelhardt,a Liane Hilfert,a Sabine Busse,a and Frank T. Edelmanna,*
2018 Nov 1
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