Publications by authors named "Firas Eladoumikdachi"

10 Publications

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Durable Response to PD1 Inhibitor Pembrolizumab in a Metastatic, Metaplastic Breast Cancer.

Case Rep Oncol 2021 May-Aug;14(2):931-937. Epub 2021 Jun 18.

Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.

Metaplastic breast cancer (MBC) is a rare and aggressive subtype of breast cancer. Tumor characteristics typically feature estrogen receptor, progesterone receptor, and HER2-negative, triple-negative breast cancer (TNBC), with a poorer prognosis relative to pure invasive ductal or lobular disease. Resistance to chemotherapy often leads to local recurrence and distant metastasis. Genomic profiling has identified multiple molecular abnormalities that may translate to targetable therapies in MBC. These tumors are known to display higher PD-L1 expressivity than other subtypes of breast cancer, and disease control with pembrolizumab and chemotherapy has been documented. We identify a patient with metastatic, metaplastic TNBC, with mesenchymal components and osseous differentiation, who completed 2 years of pembrolizumab treatment and has remained without evidence of disease after 32 months of observation, while maintaining good quality of life. Future efforts should focus on immunotherapy response with respect to the various subtypes of MBC, and treatment should continue to be incorporated in clinical trials to maximize disease response.
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http://dx.doi.org/10.1159/000515510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255711PMC
June 2021

A Three-Dimensional Bioabsorbable Tissue Marker for Volume Replacement and Radiation Planning: A Multicenter Study of Surgical and Patient-Reported Outcomes for 818 Patients with Breast Cancer.

Ann Surg Oncol 2021 May 21;28(5):2529-2542. Epub 2020 Nov 21.

School of Oncoplastic Surgery, Reno, NV, USA.

Background: Accurate identification of the tumor bed after breast-conserving surgery (BCS) ensures appropriate radiation to the tumor bed while minimizing normal tissue exposure. The BioZorb three-dimensional (3D) bioabsorbable tissue marker provides a reliable target for radiation therapy (RT) planning and follow-up evaluation while serving as a scaffold to maintain breast contour.

Methods: After informed consent, 818 patients (826 breasts) implanted with the BioZorb at 14 U.S. sites were enrolled in a national registry. All the patients were prospectively followed with the BioZorb implant after BCS. The data collected at 3, 6, 12, and 24 months included all demographics, treatment parameters, and provider/patient-assessed cosmesis.

Results: The median follow-up period was 18.2 months (range, 0.2-53.4 months). The 30-day breast infection rate was 0.5 % of the patients (n = 4), and re-excision was performed for 8.1 % of the patients (n = 66), whereas 2.6 % of the patients (n = 21) underwent mastectomy. Two patients (0.2 %) had local recurrence. The patient-reported cosmetic outcomes at 6, 12, and 24 months were rated as good-to-excellent by 92.4 %, 90.6 %, and 87.3 % of the patients, respectively and similarly by the surgeons. The radiation oncologists reported planning of target volume (PTV) reduction for 46.2 % of the patients receiving radiation boost, with PTV reduction most commonly estimated at 30 %.

Conclusions: This report describes the first large multicenter study of 818 patients implanted with the BioZorb tissue marker during BCS. Radiation oncologists found that the device yielded reduced PTVs and that both the patients and the surgeons reported good-to-excellent long-term cosmetic outcomes, with low adverse effects. The BioZorb 3D tissue marker is a safe adjunct to BCS and may add benefits for both surgeons and radiation oncologists.
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http://dx.doi.org/10.1245/s10434-020-09271-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043870PMC
May 2021

5-Year Results of a Prospective Phase 2 Trial Evaluating 3-Week Hypofractionated Whole Breast Radiation Therapy Inclusive of a Sequential Boost.

Int J Radiat Oncol Biol Phys 2019 10 5;105(2):267-274. Epub 2019 Jun 5.

Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. Electronic address:

Purpose: To report 5-year outcomes of a phase 2 trial of hypofractionated whole breast irradiation (HF-WBI) completed in 3 weeks, inclusive of a sequential boost.

Methods And Materials: Women with stage 0-IIIA breast cancer (ductal carcinoma in situ through T2N2a) were enrolled on a prospective, phase 2 trial of accelerated HF-WBI. We delivered a whole breast dose of 36.63 Gy in 11 fractions of 3.33 Gy, with an equivalent dose to the regional nodes when indicated, followed by a tumor bed boost of 13.32 Gy in 4 fractions of 3.33 Gy over a total of 15 treatment days. The primary endpoint was locoregional control; secondary endpoints included acute/late toxicity and physician-assessed and patient-reported breast cosmesis.

Results: Between 2009 and 2017, we enrolled 150 patients, of whom 146 received the protocol treatment. Median age was 54 years (range, 33-82) and median follow-up was 62 months. Patients with higher-risk disease comprised 59% of the cohort, including features such as young age (33% ≤50 years), positive nodes (13%), triple-negative disease (11%), and treatment with regional nodal irradiation (11%) and/or neoadjuvant/adjuvant chemotherapy (36%). Five-year estimated locoregional and distant control were 97.7% (95% confidence interval [CI], 93.0%-99.3%) and 97.9% (95% CI, 93.6%-99.3%), respectively. Five-year breast cancer-specific and overall survival were 99.2% (95% CI, 94.6%-99.9%) and 97.3% (95% CI, 91.9%-99.1%), respectively. Acute/late grade 2 and 3 toxicities were observed in 30%/10% and 1%/3% of patients, respectively. There were no grade 4 or 5 toxicities. Physicians assessed breast cosmesis as good or excellent in 95% of patients; 85% of patients self-reported slight to no difference between the treated and untreated breast.

Conclusions: Our phase 2 trial offers one of the shortest courses of HF-WBI; at 5 years of follow-up there continues to be excellent locoregional control and low toxicity with favorable cosmetic outcomes in a heterogeneous cohort of patients.
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http://dx.doi.org/10.1016/j.ijrobp.2019.05.063DOI Listing
October 2019

Oncoplastic breast surgery in the setting of breast-conserving therapy: A systematic review.

Adv Radiat Oncol 2016 Oct-Dec;1(4):205-215. Epub 2016 Sep 21.

Department of Radiation Oncology, New Brunswick, New Jersey.

Breast-conserving therapy (BCT), or breast-conserving surgery with adjuvant radiation therapy, has become a standard treatment alternative to mastectomy for women with early-stage breast cancer after many long-term studies have reported comparable rates of overall survival and local control. Oncoplastic breast surgery in the setting of BCT consists of various techniques that allow for an excision with a wider margin and a simultaneous enhancement of cosmetic sequelae, making it an ideal breast cancer surgery. Because of the parenchymal rearrangement that is routinely involved in oncoplastic techniques, however, the targeted tissue can be relocated, thus posing a challenge to localize the tumor bed for radiation planning. The goals of this systematic review are to address the challenges, outcomes, and cosmesis of oncoplastic breast surgery in the setting of BCT.
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http://dx.doi.org/10.1016/j.adro.2016.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514175PMC
September 2016

Optimal surgical treatment of breast cancer: implications for local control and survival.

J Surg Oncol 2010 Jun;101(8):677-86

Department of Surgery and the Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60611, USA.

Improvements in the local control of primary breast cancer have been shown to improve long-term survival. The role of surgical therapy in maximizing local control includes: appropriate patient selection for breast conservation; tumor resection with pathologically free margins; careful staging with sentinel node biopsy; appropriate use of axillary dissection; and meticulous surgical technique to achieve these goals. Each component of surgical therapy has the potential for maximizing local control, and therefore for extending survival.
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http://dx.doi.org/10.1002/jso.21502DOI Listing
June 2010

Two case reports of pollicization of a previously syndactylized index finger for congenitally absent thumb.

Ann Plast Surg 2003 Dec;51(6):607-10; discussion 611-6

Division of Plastic Surgery, Baylor College of Medicine, 6560 Fannin, Suite 800, Houston, TX 77030, USA.

Two patients with absent thumbs and complicated syndactyly were successfully treated by pollicization of the index finger. Prior surgical release of the index finger syndactyly and then pollicization of that digit carries with it an increased risk of neurovascular compromise, adverse placement of surgical scars, and a stiff or unstable thumb. With caution, very satisfying reconstructive results can nonetheless be attained.
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http://dx.doi.org/10.1097/01.SAP.0000067962.03244.D6DOI Listing
December 2003

Sternal wound debridement and muscle flap reconstruction: functional implications.

Ann Plast Surg 2003 Aug;51(2):115-22; discussion 123-5

Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA.

The mortality rate for poststernotomy infection, which occurs in as many as 5% of median sternotomy incisions after cardiovascular surgery, was 37.5% until sternal debridement with muscle or omental flap reconstruction became the standard treatment for this postoperative complication and lowered the mortality rate to just more than 5%. There are few reports in the literature of physical functional deficits and long-term outcome resulting from such reconstruction. The authors evaluated two groups of patients who had undergone coronary bypass surgery at least 6 months earlier. One group had no postoperative complications; the other group had developed marked sternal wound infections that required debridement and pectoralis major or rectus abdominis muscle reconstruction. Both groups underwent pectoralis and rectus muscle strength testing, evaluation of pain and ability to perform those activities of daily living that are dependent on pectoral and rectus muscle function, and completed self-assessment questionnaires. Differences between the two groups were significant (p<0.05) with regard to pain and patient satisfaction with appearance and general functional capacity. Pectoral muscle function and strength were significantly different in patients in whom that muscle was transposed. Rectus muscle strength was not affected by the transposition of a single rectus muscle. Physical morbidity and loss of strength seemed to be related directly to loss of sternal stability stemming from marked infection and debridement rather than from loss of the muscles used in reconstruction.
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http://dx.doi.org/10.1097/01.SAP.0000058497.92264.E2DOI Listing
August 2003

Measuring normal hand dexterity values in normal 3-, 4-, and 5-year-old children and their relationship with grip and pinch strength.

J Hand Ther 2003 Jan-Mar;16(1):22-8

Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA.

After surgery for trauma or correction of congenital anomaly, hand function is difficult to evaluate in children because there are no reference norms on children 3 to 5 years old. The purpose of this study was to determine whether reproducible normative values for hand dexterity and grip and pinch strength could be obtained in young children using simple tests that could be administered quickly within the attention span of a 3- to 5-year-old. The Functional Dexterity Test (FDT), a pegboard test validated for adults and older children, seemed to meet our requirements for dexterity. The FDT was administered to a convenience sample of normal children in a prekindergarten school who were grouped according to age: 3-year-olds (n = 17), 4-year-olds (n = 24), and 5-year-olds (n = 22). Hand dominance was determined. The task was demonstrated by 1 of the 2 testers. The child was asked to turn the pegs over in the pegboard without using the free hand or balancing the peg against the chest. Both hands were tested. Grip and pinch strengths were measured in both hands in a consistent manner. All the children were tested with the arm at the side and the elbow at 90 degrees. A dynamometer was used for grip strength and a pinch meter was used to measure key (lateral) and tripod pinch strengths. Means and SDs were calculated for each age group, and the dependent values of dexterity, strength, and dominance were correlated. Dexterity and strength scores were significantly different by age group. A good FDT score in the dominant hand was predictive of a good score in the nondominant hand. Grip and pinch strength correlated poorly with functional dexterity. The normative values established in this study for children in the 3- to 5-year-old range can be referenced for disability estimates and establishing goals for children after surgery or hand injury.
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http://dx.doi.org/10.1016/s0894-1130(03)80020-0DOI Listing
May 2003

Anatomy of the intrinsic hand muscles revisited: part II. Lumbricals.

Plast Reconstr Surg 2002 Oct;110(5):1225-31

Division of Plastic Surgery, Baylor College of Medicine, and the Department of Veterans Affairs Medical Center, Houston, TX, USA.

The authors discuss the anatomic variations and the precise origins and insertions of the lumbrical muscles, after dissecting 14 fresh cadavers (56 lumbrical muscles) and reviewing the scant published literature. They compare the findings with those of other investigators, and they describe the lumbrical muscle insertions discovered during the dissections. The authors conclude that descriptions of the origins and insertions of the lumbrical muscles have been oversimplified or not investigated at all, that lumbricals originate variably from the flexor digitorum profundus tendon and may even be bipinnate, and that three different major destinations exist for distal insertion of these intrinsic muscles: bone, volar plate, and extensor apparatus. Previous descriptions have focused only on the lumbrical continuation to the lateral band of the extensor mechanism.
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http://dx.doi.org/10.1097/00006534-200210000-00002DOI Listing
October 2002

Anatomy of the intrinsic hand muscles revisited: part I. Interossei.

Plast Reconstr Surg 2002 Oct;110(5):1211-24

Division of Plastic Surgery, Baylor College of Medicine, and the Department of Veterans Affairs Medical Center, Houston, TX, USA.

In this article, the anatomic variations in interosseous muscle insertions are described based on a review of the literature and 14 fresh cadaver hand dissections. The findings are correlated and compared with those of a number of other investigators, and the clinical implications are discussed (i.e., in the correction of ulnar deviation in arthritis patients and in the treatment of congenital anomalies of the hand). It is concluded that descriptions of insertion sites of the intrinsic muscles have been oversimplified by previous researchers, and a number of variations are identified through the cadaver dissections. The differing and confusing nomenclature used by other investigators is discussed and simplified. The results of this study indicate that not only are there important distal insertions onto bone and the extensor apparatus, but there is also an additional insertion onto the volar plate ("assemblage nucleus"), as Zancolli reported. It was found that the palmar interossei, generally thought to insert only onto the extensor apparatus, could also insert onto bone and onto the volar plate. Classic teaching is that all dorsal interossei (except the third) have two heads and that all palmar interossei have only one head. In this study, however, 38 percent of the palmar interossei and 75 percent of the dorsal interossei had more than one head. The complexity of the interossei is apparent when as many as three different muscle heads are present, each with a different distal destination.
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http://dx.doi.org/10.1097/01.PRS.0000024442.72140.56DOI Listing
October 2002
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