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Davide Mauri, Antonis Valachis, Nikolaos P. Polyzos, Lamprini Tsali, Dimitris Mavroudis, Vassilis Georgoulias and Giovanni Casazza

To address whether the use of bisphosphonates in the adjuvant setting of breast cancer might have any effect on the natural course of the disease, a meta-analysis was conducted of published and unpublished randomized controlled trials found in PubMed, the Cochrane Central Register of Controlled Trials, the ISI Web of Knowledge, and abstracts of major international conferences up to January 2009. All trials that randomized patients with primary breast cancer to undergo adjuvant treatment with any bisphosphonate versus non-use were considered eligible. Analysis included data from 13 eligible trials involving 6886 patients randomized to treatment with bisphosphonates (n = 3414) or either placebo or no treatment (n = 3472). Compared with no use, adjuvant breast cancer treatment with bisphosphonates did not reduce the overall number of deaths (odds ratio [OR], 0.708; 95% CI, 0.482–1.041; P = .079), bone metastases (OR, 0.925; 95% CI, 0.768–1.114; P = .413), overall disease recurrences (OR, 0.843; 95% CI, 0.602–1.181; P = .321), distant relapse (OR, 0.896; 95% CI, 0.674–1.192; P = .453), visceral recurrences (OR, 1.051; 95% CI, 0.686–1.609; P = .820), or local relapses (OR, 1.056; 95% CI, 0.750–1.487; P = .756). No significant heterogeneity was observed among the trials except for estimates of deaths and disease recurrences (P = .034 and P = .016, respectively). In subgroup analyses, use of zoledronic acid was associated with a statistically significant lower risk for disease recurrence (OR, 0.675; 95% CI, 0.479–0.952; P = .025). However, these results should be interpreted with caution because the statistical significance for this association was weak and might be attributed to chance from multi-test analyses. Use of zoledronic acid was not associated with any significant difference in death (OR, 0.642; 95% CI, 0.388–1.063) and bone metastasis rates (OR, 0.661; 95% CI, 0.379–1.151). Currently available evidence does not support the hypothesis that use of bisphosphonates in adjuvant treatment of early breast cancer will alter the natural course of the disease. Nonetheless, a nonsignificant trend seems to exist for better outcomes in patients undergoing bisphosphonate treatment. Until further evidence from new clinical trials becomes available, adjuvant bisphosphonates should not be recommended routinely.

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Matthew D. Callister and Leonard L. Gunderson

All but the earliest cases of nonmetastatic gastric cancer represent a therapeutic challenge given the high propensity of these patients to develop locoregional and distant relapse. Neoadjuvant or adjuvant strategies that include chemoradiotherapy or chemotherapy have been associated with significant toxicity, but also improvement in patient survival. Technologic advances in the planning and delivery of radiotherapy (RT) have enabled significant progress in the accuracy and conformality of radiation treatment. Four-dimensional CT and image-guided RT improve the accuracy of radiation treatment. Three-dimensional RT and intensity-modulated RT allow increased conformality of radiation dose distribution, sparing of normal organs, and providing opportunity for dose escalation. Initial clinical experience with these technologies shows favorable tolerance and outcomes.

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Jaffer A. Ajani

. That surveillance is a costly proposition should be clear, and the time to justify it has come. Studies suggest that more than 95% of the local and distant relapses occur within 3 years of completion of local therapy. 6 , 7 , 9 , 10 In patients

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: Assess the effectiveness of combination therapy in improving distant relapse-free survival of patients with STS from a historical control of 40%–60% at 2 years of follow up Secondary Objectives: Phase Ib: Determine pathologic response to

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Takashi Taketa, Kazuki Sudo, Arlene M. Correa, Roopma Wadhwa, Hironori Shiozaki, Elena Elimova, Maria-Claudia Campagna, Mariela A. Blum, Heath D. Skinner, Ritsuko U. Komaki, Jeffrey H. Lee, Manoop S. Bhutani, Brian R. Weston, David C. Rice, Stephen G. Swisher, Dipen M. Maru, Wayne L. Hofstetter and Jaffer A. Ajani

(range, 1.0-149.2 months), first relapse occurred in 215 patients (41.5%) after TMT. Among these, 27 (12.6%) had locoregional-only relapse and 188 (87.4%) had distant relapse with or without locoregional relapse. The timing, type, and frequency of first

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William R. Kennedy, Christopher Tricarico, Prashant Gabani, Ashley A. Weiner, Michael B. Altman, Laura L. Ochoa, Maria A. Thomas, Julie A. Margenthaler, Souzan Sanati, Lindsay L. Peterson, Cynthia X. Ma, Foluso O. Ademuyiwa and Imran Zoberi

decline in survival over time. 6 This is mirrored in their pattern of distant recurrence, in which distant failure is much more common during the first 5 years after diagnosis but then decreases and becomes less common than distant relapse in non

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Stephen B. Edge and David G. Sheldon

Klauber-DeMore N Borgen P . Is it really ductal carcinoma in situ? Ann Surg Oncol 2001 ; 8 : 617 – 619 . 35 Colpaert C Vermeulen P Jeuris W . Early distant relapse in “node-negative” breast cancer patients is not predicted by occult

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Katya Losk, Ines Vaz-Luis, Kristen Camuso, Rafael Batista, Max Lloyd, Mustafa Tukenmez, Mehra Golshan, Nancy U. Lin and Craig A. Bunnell

TNBC subtypes, or a high proliferative rate, delayed time from surgery to chemotherapy can adversely impact outcomes. 6 – 11 Gagliato et al 10 found that patients with stage II disease experienced an 18% increase in the risk of distant relapse

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William J. Gradishar

with HER2-positive T1a or T1b, node-negative disease tend to have good long-term outcomes, with distant relapse-free survival rates of 94% to 100% after chemotherapy plus trastuzumab. However, recurrences can be observed. The value of HER2-targeted

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Gayathri Nagaraj and Cynthia X. Ma

assessment for relapse. The performance of ROR score in predicting relapse-free survival and distant relapse-free survival in postmenopausal women with ER+ breast cancer treated with anastrozole or tamoxifen was compared with the performance of Onco type DX