Brustzentrum Klinik St. Anna

Purpose:Accurate response assessment during neoadjuvant systemic treatment (NST) poses a clinical challenge. Therefore, a minimally invasive assessment of tumor response based on cell-free circulating tumor DNA (ctDNA) may be beneficial to guide treatment decisions.Experimental Design:We profiled 93 genes in tissue from 193 patients with early breast cancer. Patient-specific assays were designed for 145 patients to track ctDNA during NST in plasma. ctDNA presence and levels were correlated with complete pathological response (pCR) and residual cancer burden (RCB) as well as clinicopathologic characteristics of the tumor to identify potential proxies for ctDNA release.Results:At baseline, ctDNA could be detected in 63/145 (43.4%) patients and persisted in 25/63 (39.7%) patients at mid-therapy (MT) and 15/63 (23.8%) patients at the end of treatment. ctDNA detection at MT was significantly associated with higher RCB (OR = 0.062; 95% CI, 0.01–0.48; P = 0.0077). Of 31 patients with detectable ctDNA at MT, 30 patients (96.8%) were nonresponders (RCB II, n = 8; RCB III, n = 22) and only one patient responded to the treatment (RCB I). Considering all 145 patients with baseline (BL) plasma, none of the patients with RCB 0 and only 6.7% of patients with RCB I had ctDNA detectable at MT, whereas 30.6% and 29.6% of patients with RCB II/III, respectively, had a positive ctDNA result.Conclusions:Overall, our results demonstrate that the detection and persistence of ctDNA at MT may have the potential to negatively predict response to neoadjuvant treatment and identify patients who will not achieve pCR or be classified with RCB II/III.

This duoethnographic exploration expounds on the journeys of two women who pioneered music therapy in the NICUs in their respective countries. The dialogue uses their practice wisdom and research to illuminate core issues that have served the development of music as process and intervention for infants, families and those in the context of the NICU. They conclude with recommendations for the future.Monika Nöcker-Ribaupierre (MNR): I was a musician and I worked in the theatre. The premature birth of my daughter in the 1970s, experiencing my own helplessness and that of my family and friends, all of this led my life in an unexpected new direction: to music therapy in the NICU. My overall goal was to promote both the infant’s development in connection with support of the mother’s resilience – because there is no development without bonding. Next step was to open NICUs in my country to music therapy, also to strengthen our NICU music therapists and helping to develop an international network. Throughout all these years Helen Shoemark has been my most important and valuable colleague.Helen Shoemark (HS): I was a music therapist working in special education and early intervention for 15 years before. I started the program in the NICU at the Royal Children’s Hospital in 1994, and grew the role of music therapy in the pediatric NICU/ Newborn Surgical Unit through my research. Because of my experience in family-centered early intervention, my focus in the NICU is on supporting the expressive capacities of both infant and parents. My other focus is in supporting clinicians develop programs that are ecologically situated, theoretically- informed, and pragmatically realistic. Monika Nöcker-Ribaupierre was one of my earliest mentors, and I have always been inspired by the strength of her commitment, understanding, and support for the experience of the mothers in the NICU.

This project investigated the installation and performance of snowplowable reflective pavement markers (SRPMs) to determine optimum pavement marker solutions and policies for roadways

BackgroundOvarian carcinoma (OC) is the fifth most common female cancer and mostly diagnosed at an advanced stage. Surgical debulking is usually followed by adjuvant platinum-based chemotherapy. Only few biomarkers are known to be related to chemosensitivity. OX40 is a TNF receptor member and expressed on activated CD4+ and CD8+ T cells. It is known that OX40 signaling promotes survival and responds to various immune cells of the innate and adaptive immune system. Therefore we investigated the indicative value of OX40 expression for recurrence and survival in OC.MethodsA tissue microarray of biopsies of mostly high-grade primary serous OC and matched recurrences of 47 patients was stained with OX40. Recurrence within 6 months of the completion of platinum-based chemotherapy was defined as chemoresistance.ResultsChemosensitivity correlated significantly with high OX40 positive immune cell density in primary cancer biopsies (p = 0.027). Furthermore patients with a higher OX40 expression in recurrent cancer biopsies showed a better outcome in recurrence free survival (RFS) (p = 0.017) and high OX40 expression was associated with chemosensitivity (p = 0.008). OX40 positive TICI in recurrent carcinomas significantly correlated with IL-17 positive tumor infiltrating immune cells in primary carcinomas (rs = 0.34; p = 0.023). Univariate cox regression analysis revealed a significant longer RFS and higher numbers of chemotherapy cycles for high OX40 tumor cell expression in recurrent cancer biopsies (HR 0.39, 95%CI 0.16–0.94, p = 0.036 and 1.28, 95%CI 1.05–1.55; p = 0.013).ConclusionHigh OX40 expression in OC is correlated with chemosensitivity and improved RFS in OC. Patients might therefore benefit from a second line therapy.

Wir berichten von einer 66-jährigen Patientin, die sich im Rahmen des Mammografie-Screeningprogramms zur Früherkennungsmammografie vorgestellt hat. Dabei zeigte sich gegenüber den Voraufnahmen ein neu aufgetretener Herd links bei 3 Uhr, 100 mm Mamillenabstand von knapp 20 mm Größe mit angedeuteter Spikulierung und fraglichen, sehr flauen weiteren Läsionen in der unmittelbaren Nachbarschaft ([Abb. 1]).

518 Background: Bevacizumab combined with chemotherapy has been shown to improve response rate and PFS in metastatic breast cancer. The aim of our study was to demonstrate decreased toxicity of met...