Invasive Lobular Carcinoma Has Worse Outcome Compared with Invasive Ductal Carcinoma in Stage IV Breast Cancer with Bone-Only Metastasis

Background: Invasive lobular carcinoma (ILC) is more likely to be bone metastasis than invasive ductal carcinoma (IDC). However, the prognosis for bone metastasis in ILC and IDC is barely known. So, the aim of this study was to investigate the difference of prognosis between ILC and IDC accompany by bone metastasis. Methods: We evaluated the women with bone-only metastasis of defined IDC or ILC, reported to the Surveillance, Epidemiology and End Results program from 2010 to 2016. Pearson's chi-squared test was used to compare the difference of clinicopathologic factors between IDC and ILC. Univariate and multivariate analyses were performed to verify the effects of histological types (IDC and ILC) and other clinicopathologic factors on the overall survival (OS) and cancer-special survival (CSS). Results: Overall, 3647 patients with IDC and 945 patients with ILC met the inclusion criteria and were analyzed in our study. The patients with ILC were more likely to be older, lower histological grade and higher proportion of HR+/HER2- subtype. But less treatment was applied to ILC than IDC, such as surgery of the breast, radiation and chemotherapy. Compared patients with IDC, the patients with ILC showed worse OS (median OS 36 and 42 months respectively, p<0.001) and CSS (median CSS 39 and 45 months respectively, p<0.001), especially in subgroups with HR+/HER2- subtype [OS (Hazard ration: 1.501, 95% CI [1.270-1.773], p<0.001); CSS (Hazard ration: 1.529, 95% CI [1.281-1.825], p<0.001)], lower histological grade (Ⅰ-Ⅱ) [OS (Hazard ration: 1.411, 95% CI [1.184-1.683], p<0.001); CSS (Hazard ration: 1.488, 95% CI [1.235-1.791], p<0.001)] or tumor burden, such as T0-2 [OS (Hazard ration: 1.693, 95% CI [1.368-2.096], p<0.001); CSS (Hazard ration: 1.76, 95% CI [1.405-2.205], p<0.001)] and N1-2 [OS (Hazard ration: 1.451, 95% CI [1.171-1.799], p=0.001); CSS (Hazard ration: 1.488, 95% CI [1.187-1.865], p=0.001)]. Furthermore, older age, black race, unmarried status, higher tumor burden (T3-4 and N3), triple-negative subtype and higher histological grade were independent risk factors for both OS and CSS. Surgery of the breast and chemotherapy could significantly improve the prognosis for patients. Conclusion: The patients with ILC have worse outcomes compared with that of IDC when bone-only metastasis occurred to them, especially in subgroups with lower histological grade or tumor burden. More effective treatment measures may be needed for ILC, such as cyclin-dependent kinase 4/6 inhibitors (CDKs), new targeted drugs, etc.

Laparoscopic Gastrojejunostomy for the Treatment of SIRT-Induced Duodenal Ulcer Complicated by Gastric Outlet Obstruction

Selective internal radiation therapy (SIRT) is an emerging therapeutic modality in patients with unresectable hepatocellular carcinoma or liver metastases. However, complications can occur due to migration of radiation microspheres such as gastrointestinal ulcer, cholecystitis, bleeding, pancreatitis, and many others. A 50-year-old woman with stage IV breast cancer who underwent radioembolization for unresectable hepatic metastasis 6 months ago presented to our hospital with 1 month history of nausea, vomiting, with food intolerance, and weight loss. Esophagogastroduodenoscopy showed large deep duodenal bulbar ulcer along with antral ulcerations and edematous gastropathy. Biopsies revealed typical black, duodenal yttrium-90 sphere, documenting radiation injury. After she was discharged on proton pump inhibitor, the patient came back 1 month later for exacerbation of symptoms; computed tomography scan of the abdomen showed gastric outlet obstruction. Although there is no consensus in treating radiation-induced ulcers, physicians should be aware of this complication in patient who underwent SIRT presenting for abdominal pain.

INNV-01. THE CASE OF LEPTOMENINGEAL CARCINOMATOSIS RELATED HYDROCEPHALUS MANAGED WITH SYSTEMIC AND INTRATHECAL CHEMOTHERAPY

INTRODUCTION Leptomeningeal carcinomatosis (LC) is an end-stage sequela of metastatic cancer that commonly leads to severe neurological symptoms due to hydrocephalus and commonly treated with surgery or radiation. As these procedures are invasive and have associated risks, chemotherapy could be a great alternative. We report a case of a hydrocephalus related to LC in a patient with Stage IV breast cancer that resolved after the administration of HD-MTX and intrathecal cytarabine. CASE A 64-year-old right-handed woman with Stage IV ER positive, PR positive, HER2 negative invasive lobular carcinoma of the left breast on chemotherapy with palbociclib and alpelisib who presented with mild occipital headaches, diplopia and imbalance. Imaging revealed an extensive abnormal leptomeningeal enhancement withing the posterior fossa compatible with leptomeningeal carcinomatosis. CSF cytology was consistent with metastatic adenocarcinoma. Liquid biopsy detected circulating tumor cells. During the admission for the cycle 1 of systemic chemotherapy with HD-MTX and intrathecal cytarabine, neurological status deteriorated as she became stuporous due to the newly developed moderate obstructive and communicating hydrocephalus. Surgical innervation was considered but given her response to serial Ommaya taps and dexamethasone, we proceeded with observation. Symptomatic improvement was noted within few days and confirmed on imaging showing the resolution of previously seen hydrocephalus. DISCUSSION This case highlights the role of non-invasive combination of systemic and intrathecal chemotherapy in patients with LC-related hydrocephalus aimed to preserve patient’s quality of life. No relevant disclosures.

A 40-year-old Woman with Hypercalcemia Crisis Caused by Bone Metastasis in Stage IV Breast Cancer

Breast cancer is still global burden especially for woman with 2.3 million cases every year dan 15% mortality among cancer diseases. In developing countries, most of the cases are diagnosed at terminal stage when metastasis already found. Bone metastasis is the highest among other metastasis sites such as: lung, liver and brain. Bone metastasis will cause hypercalcemia and bone pain as complications. Both will gradually decrease patient’s quality of life. Comprehensive and holistic management for these complications will reduce deterioration and hopefully increase patient’s quality of life even they were at terminal stage. We describe a 40-year-old woman who got hypercalcemia crisis. Hypercalcemia usually manifest as a consequence of other diseases. Epidemiologically, majority come from metastasis, but can be other diseases, such as multiple myeloma. Interestingly, during medical investigation through her medical history, and physical examination, and laboratory examinations, we conclude that her hypercalcemia crisis was caused by bone metastasis from breast cancer.