Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Wavelets for fault diagnosis of rotary machines: A review with applications

Study design A semi-prospective clinical study was conducted. Objectives To evaluate the accuracy of a revised scoring system predicting metastatic spinal tumor prognosis and the suitability of the subsequent treatment strategy. Summary of the background data We used a scoring system for the preoperative evaluation of the prognosis of metastatic spinal tumors and selected treatment methods for the predicted prognosis. In the previous version of our scoring system, the reliability of the predicting prognosis was 63.3% in 128 patients with metastatic spinal tumors. Methods The study participants were 164 patients who died after surgery and 82 who died after conservative treatment. Six parameters were used in the revised scoring system. Each parameter ranged from 0 to 5 points, and the total score was 15 points. In principle, conservative treatment or palliative procedures were indicated in patients with a total score of 8 or less (predicted survival period, less than 6 months) or those with multiple vertebral metastases, while excisional procedures were performed in patients with a total score of 12 or more (predicted survival period, 1 year or more) or those with a total score of 9 to 11 (predicted survival period, 6 months or more) and with metastasis in a single vertebra. The selection of treatment modality was followed faithfully according to the criteria of the revised scoring system after 1998. The prognosis predicted by the revised scoring system and the actual survival period after treatment were compared, and the reliability of the prognostic criteria was analyzed for the group subjected to it prospectively after 1998 (n = 118) and for all 246 patients it was applied to retrospectively. Results The total score for each patient could be correlated with the survival period. This correlation was also observed in each treatment group. The consistency rate between the predicted prognosis from the criteria of the total scores and the actual survival period was high in patients within each score range (0-8, 9-11, or 12-15), 86.4% in the 118 patients evaluated prospectively after 1998, and 82.5% in the 246 patients evaluated retrospectively. Furthermore, a similar result was also observed in both the surgical procedure group and conservative treatment group. The rate of consistency between the predicted prognosis and the actual survival period in each local extension of the lesion was 75% or more in all types, excluding Type 6 in the surgical classification of Tomita et al. Conclusion The prognostic criteria using the total scores from our revised scoring system were useful for the pretreatment evaluation of metastatic spinal tumor prognosis irrespective of treatment modality or local extension of the lesion.

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A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis

Study design Systematic review and modified Delphi technique. Objective To use an evidence-based medicine process using the best available literature and expert opinion consensus to develop a comprehensive classification system to diagnose neoplastic spinal instability. Summary of background data Spinal instability is poorly defined in the literature and presently there is a lack of guidelines available to aid in defining the degree of spinal instability in the setting of neoplastic spinal disease. The concept of spinal instability remains important in the clinical decision-making process for patients with spine tumors. Methods We have integrated the evidence provided by systematic reviews through a modified Delphi technique to generate a consensus of best evidence and expert opinion to develop a classification system to define neoplastic spinal instability. Results A comprehensive classification system based on patient symptoms and radiographic criteria of the spine was developed to aid in predicting spine stability of neoplastic lesions. The classification system includes global spinal location of the tumor, type and presence of pain, bone lesion quality, spinal alignment, extent of vertebral body collapse, and posterolateral spinal element involvement. Qualitative scores were assigned based on relative importance of particular factors gleaned from the literature and refined by expert consensus. Conclusion The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.

A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.

A review of vibration-based techniques for helicopter transmission diagnostics

Study design A new surgical strategy for treatment of patients with spinal metastases was designed, and 61 patients were treated based on this strategy. Objectives To propose a new surgical strategy for the treatment of patients with spinal metastases. Summary of background data A preoperative score composed of six parameters has been proposed by Tokuhashi et al for the prognostic assessment of patients with metastases to the spine. Their scoring system was designed for deciding between excisional or palliative procedures. Recently, aggressive surgery, such as total en bloc spondylectomy for spinal metastases, has been advocated for selected patients. Surgical strategies should include various treatments ranging from wide or marginal excision to palliative treatment with hospice care. Methods Sixty-seven patients with spinal metastases who had been treated from 1987-1991 were reviewed, and prognostic factors were evaluated retrospectively (phase 1). A new scoring system for spinal metastases that was designed based on these data consists of three prognostic factors: 1) grade of malignancy (slow growth, 1 point; moderate growth, 2 points; rapid growth, 4 points), 2) visceral metastases (no metastasis, 0 points; treatable, 2 points: untreatable, 4 points), and 3) bone metastases (solitary or isolated, 1 point; multiple, 2 points). These three factors were added together to give a prognostic score between 2-10. The treatment goal for each patient was set according to this prognostic score. The strategy for each patient was decided along with the treatment goal: a prognostic score of 2-3 points suggested a wide or marginal excision for long-term local control; 4-5 points indicated marginal or intralesional excision for middle-term local control; 6-7 points justified palliative surgery for short-term palliation; and 8-10 points indicated nonoperative supportive care. Sixty-one patients were treated prospectively according to this surgical strategy between 1993-1996 (phase 2). The extent of the spinal metastases was stratified using the surgical classification of spinal tumors, and technically appropriate and feasible surgery was performed, such as en bloc spondylectomy, piecemeal thorough excision, curettage, or palliative surgery. Results The mean survival time of the 28 patients treated with wide or marginal excision was 38.2 months (26 had successful local control). The mean survival time of the 13 patients treated with intralesional excision was 21.5 months (nine had successful local control). The mean survival time of the 11 patients treated with palliative surgery and stabilization was 10.1 months (eight had successful local control). The mean survival time of the patients with terminal care was 5.3 months. Conclusions A new surgical strategy for spinal metastases based on the prognostic scoring system is proposed. This strategy provides appropriate guidelines for treatment in all patients with spinal metastases.

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Surgical strategy for spinal metastases.

Study Design. The stresses exerted on the instrumentation and adjacent bone were evaluated for three reconstruction methods after a total sacrectomy: a modified Galveston reconstruction (MGR), a triangular frame reconstruction (TFR), and a novel reconstruction (NR). Objective. To perform finite-element analysis of reconstruction methods used after a total sacrectomy. Summary of Background Data. When a sacral tumor involves the first sacral vertebra, a total sacrectomy is necessary. It is mandatory to reconstruct the continuity between the spine and the pelvis after a total sacrectomy. However, no previous reports have described a biomechanical study of the reconstructed lumbosacral spine. Methods. A finite-element model of the lumbar spine and pelvis was constructed. Then three-dimensional MGR, TFR, and NR models were reconstructed, and a finite-element analysis was performed to account for the stresses on the bones and instrumentation. Results. With excessive stress concentrated at the spinal rod in MGR, there is a strong possibility that the rod between the spine and the pelvis may fail. Although there was no stress concentration on the instruments in TFR, excessive stress on the iliac bones around the sacral rod was above the yield stress of the iliac bone. Such stress may cause a loosening of the sacral rod from the iliac bone. In NR, excessive stress concentration was not detected in the rod or the bones. This reconstruction has a low risk of instrument failure and loosening. Conclusions. If the patient were to stand or sit immediately after MGR or TFR instrumentation, failure or loosening may occur. The NR has a low risk of instrument failure and loosening after a total sacrectomy.

Reconstruction after total sacrectomy using a new instrumentation technique: A biomechanical comparison

Purpose: Tumor-specific replication-selective oncolytic virotherapy is a promising antitumor therapy for induction of cell death in tumor cells but not of normal cells. We previously developed an oncolytic adenovirus, OBP-301, that kills human epithelial malignant cells in a telomerase-dependent manner. Recent evidence suggests that nonepithelial malignant cells, which have low telomerase activity, maintain telomere length through alternative lengthening of telomeres (ALT). However, it remains unclear whether OBP-301 is cytopathic for nonepithelial malignant cells. Here, we evaluated the antitumor effect of OBP-301 on human bone and soft tissue sarcoma cells. Experimental Design: The cytopathic activity of OBP-301, coxsackie and adenovirus receptor (CAR) expression, and telomerase activity were examined in 10 bone (OST, U2OS, HOS, HuO9, MNNG/HOS, SaOS-2, NOS-2, NOS-10, NDCS-1, and OUMS-27) and in 4 soft tissue (CCS, NMS-2, SYO-1, and NMFH-1) sarcoma cell lines. OBP-301 antitumor effects were assessed using orthotopic tumor xenograft models. The fiber-modified OBP-301 (termed OBP-405) was used to confirm an antitumor effect on OBP-301–resistant sarcomas. Results: OBP-301 was cytopathic for 12 sarcoma cell lines but not for the non–CAR-expressing OUMS-27 and NMFH-1 cells. Sensitivity to OBP-301 was dependent on CAR expression and not on telomerase activity. ALT-type sarcomas were also sensitive to OBP-301 because of upregulation of human telomerase reverse transcriptase ( hTERT ) mRNA following virus infection. Intratumoral injection of OBP-301 significantly suppressed the growth of OST and SYO-1 tumors. Furthermore, fiber-modified OBP-405 showed antitumor effects on OBP-301–resistant OUMS-27 and NMFH-1 cells. Conclusions: A telomerase-specific oncolytic adenovirus is a promising antitumor reagent for the treatment of bone and soft tissue sarcomas. Clin Cancer Res; 17(7); 1828–38. ©2011 AACR .

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Preclinical Evaluation of Telomerase-Specific Oncolytic Virotherapy for Human Bone and Soft Tissue Sarcomas

Study design A finite-element study of posterior alone or anterior/posterior combined instrumentation following total spondylectomy and replacement with a titanium mesh cage used as an anterior strut. Objectives To compare the effect of posterior instrumentation versus anterior/posterior instrumentation on transmission of the stress to grafted bone inside a titanium mesh cage following total spondylectomy. Summary of background data The most recent reconstruction techniques following total spondylectomy for malignant spinal tumor include a titanium mesh cage filled with autologous bone as an anterior strut. The need for additional anterior instrumentation with posterior pedicle screws and rods is controversial. Transmission of the mechanical stress to grafted bone inside a titanium mesh cage is important for fusion and remodeling. To our knowledge, there are no published reports comparing the load-sharing properties of the different reconstruction methods following total spondylectomy. Methods A 3-dimensional finite-element model of the reconstructed spine (T10-L4) following total spondylectomy at T12 was constructed. A Harms titanium mesh cage (DePuy Spine, Raynham, MA) was positioned as an anterior replacement, and 3 types of the reconstruction methods were compared: (1) multilevel posterior instrumentation (MPI) (i.e., posterior pedicle screws and rods at T10-L2 without anterior instrumentation); (2) MPI with anterior instrumentation (MPAI) (i.e., MPAI [Kaneda SR; DePuy Spine] at T11-L1); and (3) short posterior and anterior instrumentation (SPAI) (i.e., posterior pedicle screws and rods with anterior instrumentation at T11-L1). The mechanical energy stress distribution exerted inside the titanium mesh cage was evaluated and compared by finite-element analysis for the 3 different reconstruction methods. Simulated forces were applied to give axial compression, flexion, extension, and lateral bending. Results In flexion mode, the energy stress distribution in MPI was higher than 3.0 x 10 MPa in 73.0% of the total volume inside the titanium mesh cage, while 38.0% in MPAI, and 43.3% in SPAI. In axial compression and extension modes, there were no remarkable differences for each reconstruction method. In left-bending mode, there was little stress energy in the cancellous bone inside the titanium mesh cage in MPAI and SPAI. Conclusions This experiment shows that from the viewpoint of stress shielding, the reconstruction method, using additional anterior instrumentation with posterior pedicle screws (MPAI and SPAI), stress shields the cancellous bone inside the titanium mesh cage to a higher degree than does the system using posterior pedicle screw fixation alone (MPI). Thus, a reconstruction method with no anterior fixation should be better at allowing stress for remodeling of the bone graft inside the titanium mesh cage.

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The transmission of stress to grafted bone inside a titanium mesh cage used in anterior column reconstruction after total spondylectomy: a finite-element analysis.

Akira Yoshida

Papers

Surgical strategy for spinal metastases.

Reconstruction after total sacrectomy using a new instrumentation technique: A biomechanical comparison

Preclinical Evaluation of Telomerase-Specific Oncolytic Virotherapy for Human Bone and Soft Tissue Sarcomas

The transmission of stress to grafted bone inside a titanium mesh cage used in anterior column reconstruction after total spondylectomy: a finite-element analysis.

Influence of coating thickness on rolling contact fatigue of alumina ceramics thermally sprayed on steel roller