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      On the way to specifically targeting minimal residual disease?

      editorial
      1 ,
      Breast Cancer Research : BCR
      BioMed Central

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          Abstract

          The target of all adjuvant systemic therapies after surgery in breast cancer is the eradication of a minimal subclinical residual disease. Although it is well known that tumor cell dissemination takes place already at an early stage of the disease, little is known about the tumorbiological parameters of these residual cells. Selection of patients eligible for adjuvant endocrine therapies is based on the analysis of receptor expression in the primary tumor – although the analysis is directed against disseminated tumor cells, these cells may vary in receptor expression in comparison with the primary tumor.

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          Most cited references7

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          Local therapy and survival in breast cancer.

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            Laboratory and clinical research in breast cancer--a personal adventure: the David A. Karnofsky memorial lecture.

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              Prediction of early relapse in patients with operable breast cancer by detection of occult bone marrow micrometastases.

              We used monoclonal antibodies to identify occult micrometastases in the bone marrow of 49 patients with operable (stage I and II) breast carcinoma. Follow-up (mean, 29 months; median, 30 months) revealed that 12 patients recurred. The presence of bone marrow micrometastases (BMM) was significantly associated with early recurrence (P less than .04). The estimated 2-year recurrence rate for patients with no BMM detected (BMM-) was 3%; in patients with BMM, the 2-year recurrence rate was 33%. When BMM and axillary lymph node (LN) status were combined, groups of patients at low risk (LN-, BMM-; 2-year recurrence rate, 0%) and high risk (LN+, BMM+; 2-year recurrence rate, 42%) for early recurrence were identified. Bone marrow tumor burden was related to early recurrence. Among patients with BMM, those who did not recur had on average fewer extrinsic cells in their marrow than those who recurred (15 v 43 cells, respectively). Multivariate analysis comparing BMM, LN+ versus LN-, and tumor size (less than or equal to 2 cm v greater than 2 cm) revealed no factor independently associated with early recurrence. Peripheral tumor burden of BMM (0 or less than 10 extrinsic cells v greater than or equal to 10 extrinsic cells) was the only independent predictor of early recurrence (P less than .003). In conjunction with conventional prognostic factors, particularly axillary LN status, evaluation for BMM might be used to stratify patients for adjuvant treatment programs. Because this pilot study involved few patients with short-term follow-up, the results should be interpreted with caution. The examination of bone marrow for micrometastases remains an experimental procedure; the clinical usefulness of the test will be established through larger studies with long-term follow-up.
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                Author and article information

                Journal
                Breast Cancer Res
                Breast Cancer Research : BCR
                BioMed Central
                1465-5411
                1465-542X
                2008
                7 October 2008
                : 10
                : 5
                : 112
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, University of Heidelberg, Vossstraße 9, D-69115 Heidelberg, Germany
                Article
                bcr2148
                10.1186/bcr2148
                2614514
                18947365
                c9ea911a-2ffa-45dd-aa68-437407b16aaf
                Copyright © 2008 BioMed Central Ltd
                History
                Categories
                Editorial

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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