Explore the vast range of titles available.

In luminal breast cancer, adjuvant CDK4/6 inhibitors (eg, abemaciclib) improve invasive disease-free survival. In patients with T1–2, grade 1–2 tumours, and one or two sentinel lymph node metastases, completion axillary lymph node dissection (cALND) is the only prognostic tool available that can reveal four or more nodal metastases (pN2–3), which is the only indication for adjuvant abemaciclib in this setting. However, this technique can lead to substantial arm morbidity in patients. We aimed to pragmatically describe the potential benefit and harm of this strategy on the individual patient level in patients from the ongoing SENOMAC trial. In the randomised, phase 3, SENOMAC trial, patients aged 18 years or older, of any performance status, with clinically node-negative T1–T3 breast cancer and one or two sentinel node macrometastases from 67 sites in five European countries (Denmark, Germany, Greece, Italy, and Sweden) were randomly assigned (1:1), via permutated block randomisation (random block size of 2 and 4) stratified by country, to either cALND or its omission (ie, they had a sentinel lymph node biopsy only). The primary outcome is overall survival, which is yet to be reported. In this post-hoc analysis, patients from the SENOMAC per-protocol population, with luminal oestrogen-receptor positive, HER2-negative, T1–2, histological grade 1–2 breast cancer, with tumour size of 5 cm or smaller were selected to match the characteristics of cohort 1 of the monarchE trial who would only have an indication for adjuvant abemaciclib if found to have 4 or more nodal metastases. The primary study objective was to determine the number of patients who developed patient-reported severe or very severe impairment of physical arm function after cALND (as measured by the Lymphedema Functioning, Disability, and Health [Lymph-ICF] Questionnaire) 1 year after surgery to avoid one invasive disease-free survival event at 5 years with 2 years of adjuvant abemaciclib, using invasive disease-free survival event data from cohort 1 of the monarchE trial. The SENOMAC trial is registered with ClincialTrials.gov, NCT02240472, and is closed to accrual and ongoing. Between Jan 31, 2015, and Dec 31, 2021, 2766 patients were enrolled in SENOMAC and randomly assigned to cALND (n=1384) or sentinel node biopsy only (n=1382), of whom 2540 were included in the per-protocol population. 1705 (67%) of 2540 patients met this post-hoc study's eligibility criteria, of whom 802 (47%) had a cALND and 903 (53%) had a sentinel lymph node biopsy only. Median age at randomisation was 62 years (IQR 52–71), 1699 (>99%) of 1705 patients were female, and six (<1%) were male. Among 1342 patients who responded to questionnaires, after a median follow-up of 45·2 months (IQR 25·6–59·8; data cutoff Nov 17, 2023), patient-reported severe or very severe impairment of physical arm function was reported in 84 (13%) of 634 patients who had cALND versus 30 (4%) of 708 who had sentinel lymph node biopsy only (χ2 test p<0·0001). To avoid one invasive disease-free survival event at 5 years with adjuvant abemaciclib, cALND would need to be performed in 104 patients, and would result in nine patients having severe or very severe impairment of physical arm function 1 year after surgery. As a method to potentially identify an indication for abemaciclib, and subsequently avoid invasive disease-free survival events at 5 years with 2 years of adjuvant abemaciclib, cALND carries a substantial risk of severe or very severe arm morbidity and so cALND should be discouraged for this purpose. Swedish Research Council, the Swedish Cancer Society, the Nordic Cancer Union, and the Swedish Breast Cancer Association.

Purpose None of the key randomised trials on the omission of axillary lymph node dissection (ALND) in sentinel lymph-positive breast cancer have reported external validity, even though results indicate selection bias. Our aim was to assess the external validity of the ongoing randomised SENOMAC trial by comparing characteristics of Swedish SENOMAC trial participants with non-included eligible patients registered in the Swedish National Breast Cancer Register (NKBC). Methods In the ongoing non-inferiority European SENOMAC trial, clinically node-negative cT1–T3 breast cancer patients with up to two sentinel lymph node macrometastases are randomised to undergo completion ALND or not. Both breast-conserving surgery and mastectomy are eligible interventions. Data from NKBC were extracted for the years 2016 and 2017, and patient and tumour characteristics compared with Swedish trial participants from the same years. Results Overall, 306 NKBC cases from non-participating and 847 NKBC cases from participating sites (excluding SENOMAC participants) were compared with 463 SENOMAC trial participants. Patients belonging to the middle age groups ( p  = 0.015), with smaller tumours ( p  = 0.013) treated by breast-conserving therapy (50.3 versus 47.1 versus 65.2%, p  < 0.001) and less nodal tumour burden (only 1 macrometastasis in 78.8 versus 79.9 versus 87.3%, p  = 0.001) were over-represented in the trial population. Time trends indicated, however, that differences may be mitigated over time. Conclusions This interim external validity analysis specifically addresses selection mechanisms during an ongoing trial, potentially increasing generalisability by the time full accrual is reached. Similar validity checks should be an integral part of prospective clinical trials. Trial registration: NCT 02240472, retrospective registration date September 14, 2015 after trial initiation on January 31, 2015

Background The continuously increasing survivorship of female breast cancer makes the monitoring and improvement of patients’ quality of life ever so important. While globally there is a growing body of research on health-related quality of life 1 year after surgical treatment for non-metastatic breast cancer, up-to-date information regarding Greek patients is scarce. Objective To measure the level of QoL of non-metastatic BC survivors in Greece 1 year after surgery. Methods A sample of 200 female breast cancer survivors aged 18 to 75, who followed up as outpatients in five public hospitals were included in this cross-sectional study. All recruited patients agreed to participate in the study (100% response rate). Quality of life data were collected through the EORTC QLQ-C30 as well as BR23 questionnaires. Results Cronbach’s alpha for all scales of the two questionnaires was from 0.551 to 0.936 indicating very good reliability. According to the Multiple Linear Regression, older patients showed a lower future perspective ( p  = .031), with those living in rural areas, which was associated with more financial difficulties ( p  = .001). Women with tertiary education and those who had been hospitalized in a university hospital recorded better on global health status ( p  = .003 and .000 respectively). Patients who underwent chemotherapy reported better scores in the emotional function sub-scale ( p  = .025). Women with reconstruction and at least one complication appeared to have significantly better scores in future perspective and social function ( p  = .005, .002 respectively). Conclusions Breast cancer survivors were found to have an overall good quality of life, functioning/symptoms scores and were satisfied with the provided care.

The general purpose of this paper is to examine the US’ contemporary strategic approach on the Eastern Mediterranean in the analytical context of renewed great power tensions. Even though the Eastern Mediterranean does not constitute a high priority for Washington, following the 2017 strategic reorientation toward tackling rival great powers’ international influence US foreign and security policy in the region is organized according to a dual balancing strategy vis-à-vis Russia and China. To investigate this hypothesis, we focus on two relevant subjects: developments in relations among Turkey, Greece, and Cyprus in conjunction with Russia’s influence in the region and Europe’s energy security and China’s moves in the Eastern Mediterranean in the framework of the Belt and Road Initiative.

The general research purpose cf this article is to examine how civil society and opinion leaders in Cyprus incorporate affairs related to state power and inter-state power distribution in their beliefs and assessments. A very important aspect cfthis relation is Cyprus smallness vis-a-vis other parties involved in the Cyprus Corflict. In this context, the article discusses Greek Cypriot perceptions cfthe Cyprus Problem. More specfically, it examines Greek Cypriot perceptions on two particular issues: i) the uneven distribution cf capabilities between Cyprus and Turkey, and ii) the interaction among the directly-involved parties and other external actors, which forms a broader balance cfpower that impacts significantly on the structure cfthe Cyprus Problem.

This volume approaches foreign interventions in Cyprus from two different angles: a vertical angle, which corresponds to a case-by-case historical analysis of foreign interventions which have taken place throughout the modern history of Cyprus, and a horizontal angle, which corresponds to the implementation of systemic models of analysis in approaching foreign interventions in Cyprus. Furthermore, the volume deals with domestic perceptions formed as a result of foreign interventions in Cyprus.

In today's world, the issue of Cyprus is notable for all the wrong reasons: because of the duration of the divisions in Cyprus itself between Greek-Cypriots and Turkish-Cypriots (formalized since 1983 by a disputed international border across the island); because of the involvement of Greece and Turkey, for which the \"hyphenated\" Cypriot communities form proxy battalions; and because of the failure of the United Nations' longstanding efforts to resolve the conflict.Much of the discussion in the book revolves around the difficulty of producing viable constitutional and civic arrangements in an ethnically-divided polity. It is clear that this issue dominates almost all discussions of the Cyprus Problem, from the drawing of internal borders, the conceptualization of identity of oneself and of the \"other,\" to the management of the natural resources with which the island is endowed.Containing chapters from both Turkish- and Greek-Cypriots, as well as outside scholars, the book covers four key themes, namely identity and perceptions; contemporary issues in the Greek- and Turkish-Cypriot communities; comparisons with divided polities elsewhere; and new approaches to resolving the Cyprus Problem.One of the key messages from this book is that people-to-people initiatives must supplement the plans (and posturing) of politicians in order to make progress towards an ultimate resolution of the Cyprus Problem. The book shows that human ingenuity is able to find a widely accepted and workable formula for a Cyprus that combines unity and diversity, acknowledges the worth of its different constituent communities, and addresses - or begins to move beyond - historical animosities and injustices.

Patients with sentinel-node metastasis at the time of breast-cancer surgery may undergo axillary dissection to remove more nodes, which can lead to side effects. In a trial, the additional surgery did not prolong survival.

PurposeAndrogen receptor (AR) is playing an important role in the progression of a subset of TNBC. We evaluated the impact of ERβ expression along with anti-AR drugs in AR-positive TNBC.MethodsERβ expression was examined in AR-positive TNBC cell line using MTT assay, scratch and Annexin V-FITC assay in the presence or absence of anti-androgens. Protein levels of involved molecules were assessed using Western blot. Receptors’ localization was detected by immunofluorescence and their physical association was examined using proximity ligation assay (PLA), which enables the visualization of interacting proteins in fixed cells and tissues.ResultsTransient transfection of ERβ in MDA-MB 453 AR-positive TNBC cell line significantly inhibited cell proliferation, metastatic potential and induced apoptosis. ERβ expression reversed the aggravating role of AR in both indirect and direct ways. Indirectly, ERβ decreased AR activation through the inhibition of PI3K/AKT signaling pathway. Directly, ERβ formed heterodimers with AR in MDA-MB 453 cells and in human tissue samples impeding AR from forming homodimers. Enzalutamide is a more potent anti-androgen in AR + TNBC compared to bicalutamide. ERβ expression increased the sensitivity of MDA-MB 453 cells to anti-androgens and especially to enzalutamide. The administration of enzalutamide enhanced AR:ERβ heterodimers formation increasing the anti-tumor capacity of ERβ.ConclusionsCollectively, our results provide evidence for a novel mechanism by which ERβ exerts oncosuppressive effect in AR-positive TBNC through direct and indirect interactions with AR. Moreover, ERβ expression may identify a new subset of TNBC that would respond more favorable to anti-androgens.

PurposeCurrently, various techniques are available to mark and selectively remove initially suspicious axillary lymph nodes (target lymph nodes, TLNs) in breast cancer patients receiving neoadjuvant chemotherapy (NACT). To date, limited data are available on whether the use of magnetic seeds (MS) is suitable for localizing TLNs. This study aimed to investigate the feasibility of MS in patients undergoing target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) after NACT.MethodsProspective data from the ongoing multicentric AXSANA study were extracted from selected patients in whom the TLN had been marked with an MS before NACT and who were enrolled from June 2020 to June 2023. The endpoints of the analysis were the detection rate, the rate of lost markers, and the potential impairment on magnetic resonance imaging (MRI) assessment.ResultsIn 187 patients from 27 study sites in seven countries, MS were placed into the TLN before NACT. In 151 of these, post-NACT surgery had been completed at the time of analysis. In 146 patients (96.0%), a TLN could successfully be detected. In three patients, the seed was removed but no lymphoid tissue was detected on histopathology. The rate of lost markers was 1.2% (2 out of 164 MS). In 15 out of 151 patients (9.9%), MRI assessment was reported to be compromised by MS placement.ConclusionMS show excellent applicability for TLNB/TAD when inserted before NACT with a high DR and a low rate of lost markers. Axillary MS can impair MRI assessment of the breast.Trial registration numberNCT04373655 (date of registration May 4, 2020).