Search Results (3)

Objectives: To evaluate the neoadjuvant chemotherapy (NACTx) process in breast cancer (BC), its significant treatment-related adverse events (trAEs), tumor clinical response rates, and surgical and pathological outcomes, and to analyze factors influencing cavity shaving and axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB). Methods: A comprehensive retrospective study was conducted at a single center on patients who received NACTx for BC between 2015 and 2021. Results: Medical records of 242 patients were reviewed. Approximately one-fifth encountered grade ≥ 3 trAEs (21.5%), leading 3.3% to discontinue chemotherapy. Anthracycline cardiotoxicity (2.2%) caused one death (mortality rate = 0.4%). For clinical response and surgical and pathological outcomes, 229 patients were eligible. Clinical progression occurred in 3.9% of the patients (14% in triple-negative BC, p = 0.004). Breast-conserving surgery (BCS) was performed in 55% of the patients. There was no significant difference between the type of breast surgery (BCS vs. mastectomy) and molecular subtype, histology, tumor size, or tumor’s pathological response degree. Cavity shaving was required in one-fifth of the patients who underwent BCS (n = 134) due to an invasive tumor at the surgical margin (SM). Tumor histology (invasive ductal vs. invasive lobular carcinoma; OR: 4.962, 95% CI 1.007–24.441, p = 0.049) and tumor SUVMax value (OR: 0.866, 95% CI 0.755–0.993, p = 0.039) had significant independent efficacy on SM positivity. Initially, 75% underwent SLNB, but nearly half of them needed ALND. ALND rates were significantly higher in the luminal A and LB-HER2(−) groups (87% vs. 69%) than in the HER2(+) and TN groups (43% to 50%) (p = 0.001). All luminal A patients and those with lobular histology required ALND after SLNB, but no patients in the HER2-enriched group required ALND. ER positivity and higher PR expression levels were associated with an increased need for ALND after SLNB, whereas HER2 positivity and higher SUVMax values of LN(s) were associated with a significantly reduced need for ALND. About 27% of the patients achieved overall pCR. No pCR was achieved in the LA group. Conclusions: The BC NACTx process requires close monitoring due to severe AEs and disease progression. NACTx decisions must be made on experienced multidisciplinary tumor boards, considering tumor characteristics and expected targets. Full article

Background: Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision. Methods: A single center retrospective study which analyzed margins status, re-excision, and surgical time in patients who underwent breast conserving surgery and cavity shave or intraoperative evaluation of resection margins. Results: Between 2021 and 2023, 594 patients were enrolled in the study. In patients subjected to cavity shave, a significant reduction in positive, focally positive, or closer margins was reported 8.9% vs. 18.5% (p = 0.003). No difference was reported in terms of surgical re-excision (p < 0.846) (5% vs. 5.5%). Surgical time was lower in patients subjected to cavity shave (<0.001). The multivariate analysis intraoperative evaluation of sentinel lymph node OR 1.816 and cavity shave OR 2.909 were predictive factors for a shorter surgical time. Excluding patients subjected to intraoperative evaluation of sentinel lymph node and patients with ductal carcinoma in situ, patients that underwent the cavity shave presented a reduced surgical time (67.9 + 3.8 min vs. 81.6 + 2.8 min) (p = 0.006). Conclusions: Cavity shaving after lumpectomy reduced the rate of positive margins and it was associated with a significant reduction in surgical time compared to intraoperative evaluation of resection margins. Full article

Salt cavern gas storage has become the key project of current and future underground gas storage (UGS) facilities construction due to their efficient peak-shaving and supply assurance capacities. The Sanshui Basin in Guangdong Province, China, is rich in salt resources and has high-purity salt rock, which is a potential area for the construction of salt cavern underground gas storage. To speed up the large-scale construction of underground gas storage in China and promote the sustainable development of the natural gas market, it is very necessary to analyze the geomechanics of the target salt layer and study the feasibility of gas storage construction. Based on comprehensive experiments of rock mechanics and thermodynamics, the strength, creep and temperature-sensitive mechanical properties of the target rock in Sanshui Basin were studied. Then, according to the geological conditions of Sanshui salt formation, a three-dimensional geological model was established to analyze the stability of salt cavern gas storage under the injection-production operation. The results show that the average tensile strength and uniaxial compressive strength of salt rock are 1.51 MPa and 26.04 MPa, respectively, showing lower strength. However, under triaxial compression, the compressive strength of salt rock increases significantly, and there is no obvious shear failure phenomenon observed. Moreover, after the peak strength, the salt rock still has a large bearing capacity. In addition, under the confining pressure of 30 MPa, the strength of salt rock decreases by 8.3% at a temperature of 60 °C compared with that at room temperature, indicating that the temperature has a low, modest effect on the mechanical properties of salt rock. The stability analysis shows that, under an injection-production operating pressure of 10–23 MPa, the displacement, plastic zone range and volume convergence rate of single cavity and cavity group are small, and the cavity shows good stability. Overall, the target salt formation in Sanshui Basin, Guangdong Province, presents a good geomechanical condition suitable for the construction of underground salt cavern gas storage. This study can provide a reference for the development and design of salt cavern UGS. Full article