Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype-dependent and that TTC within 30 days should be warranted in patients with triple-negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10-year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast-conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity-score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10-year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted.@en

Background: Initiation of adjuvant chemotherapy within 6–12 weeks after mastectomy is recommended by guidelines. The aim of this population-based study was to investigate whether immediate breast reconstruction (IBR) after mastectomy reduces the likelihood of timely initiation of adjuvant chemotherapy. Methods: All patients with breast cancer who had undergone mastectomy and adjuvant chemotherapy between 2012 and 2016 in the Netherlands were identified. Time from surgery to adjuvant chemotherapy was categorized as within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. The impact of IBR on the initiation of adjuvant chemotherapy for these three scenarios was estimated using propensity score matching to adjust for treatment by indication bias. Results: A total of 6300 patients had undergone primary mastectomy and adjuvant chemotherapy, of whom 1700 (27·0 per cent) had received IBR. Multivariable analysis revealed that IBR reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (odds ratio (OR) 0·76, 95 per cent c.i. 0·66 to 0·87) and 9 weeks (0·69, 0·54 to 0·87), but not within 12 weeks (OR 0·75, 0·48 to 1·17). Following propensity score matching, IBR only reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (OR 0·95, 0·90 to 0·99), but not within 9 weeks (OR 0·97, 0·95 to 1·00) or 12 weeks (OR 1·00, 0·99 to 1·01). Conclusion: Postmastectomy IBR marginally reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks, but not within 9 or 12 weeks. Thus, IBR is not contraindicated in patients who need adjuvant chemotherapy after mastectomy.@en

Diffuse reflectance spectroscopy (DRS) can discriminate different tissue types based on optical characteristics. Since this technology has the ability to detect tumor tissue, several groups have proposed to use DRS for margin assessment during breast-conserving surgery for breast cancer. Nowadays, an increasing number of patients with breast cancer are being treated by neoadjuvant chemotherapy. Limited research has been published on the influence of neoadjuvant chemotherapy on the optical characteristics of the tissue. Hence, it is unclear whether margin assessment based on DRS is feasible in this specific group of patients. We investigate whether there is an effect of neoadjuvant chemotherapy on optical measurements of breast tissue. To this end, DRS measurements were performed on 92 ex-vivo breast specimens from 92 patients, treated with neoadjuvant chemotherapy and without neoadjuvant chemotherapy. Generalized estimating equation (GEE) models were generated, comparing the measurements of patients with and without neoadjuvant chemotherapy in datasets of different tissue types using a significance level of 5%. As input for the GEE models, either the intensity at a specific wavelength or a fit parameter, derived from the spectrum, was used. In the evaluation of the intensity, no influence of neoadjuvant chemotherapy was found, since none of the wavelengths were significantly different between the measurements with and the measurements without neoadjuvant chemotherapy in any of the datasets. These results were confirmed by the analysis of the fit parameters, which showed a significant difference for the amount of collagen in only one dataset. All other fit parameters were not significant for any of the datasets. These findings may indicate that assessment of the resection margin with DRS is also feasible in the growing population of breast cancer patients who receive neoadjuvant chemotherapy. However, it is possible that we did not detect neoadjuvant chemotherapy effect in the some of the datasets due to the small number of measurements in those datasets.

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In 10 to 40% of breast cancer patients treated with breast conserving surgery, ductal carcinoma in situ (DCIS) or invasive carcinoma (IC) is present at the margin of the specimen. Diffuse Reflectance Spectroscopy (DRS) could potentially help the surgeon during surgery in avoiding these tumor positive resection margins. Here we assess the feasibility of DRS for discriminating healthy breast tissue from tumor. For this purpose, DRS measurements (400-1600nm) were obtained in 71 breast specimens. A custom-made grid was placed on top of a slice of the resection specimen to accurately correlate the DRS measurements with histopathology. To assess DRS for the discrimination between healthy and tumor tissue types, a support vector machine based classification algorithm was developed. A total of 1081 locations were included, of which 236 locations were considered homogenous (> 95% fat, connective tissue, IC, or DCIS) and 845 locations consisted of a mixture of tissue types. The spectra of pure DCIS locations were similar to the spectra of pure IC, suggesting that these tissue types could not be separated based on their spectra. In a first analysis it was found that locations of pure fat, pure connective, and pure tumor tissue (both DCIS and IC) could be discriminated with accuracies of 0.95, 0.95, and 0.79 respectively. Classification of mixture locations was more challenging. The accuracy for tumor detection depends on the amount of tumor present in the measurement volume. These results indicate that DRS can potentially be used for the detection of tumor at the resection margin.@en

Successful breast conserving surgery consists of complete removal of the tumor while sparing healthy surrounding tissue. Despite currently available imaging and margin assessment tools, recognizing tumor tissue at a resection margin during surgery is challenging. Diffuse reflectance spectroscopy (DRS), which uses light for tissue characterization, can potentially guide surgeons to prevent tumor positive margins. However, inter-patient variation and changes in tissue physiology occurring during the resection might hamper this light-based technology. Here we investigate how inter-patient variation and tissue status (in vivo vs ex vivo) affect the performance of the DRS optical parameters. In vivo and ex vivo measurements of 45 breast cancer patients were obtained and quantified with an analytical model to acquire the optical parameters. The optical parameter representing the ratio between fat and water provided the best discrimination between normal and tumor tissue, with an area under the receiver operating characteristic curve of 0.94. There was no substantial influence of other patient factors such as menopausal status on optical measurements. Contrary to expectations, normalization of the optical parameters did not improve the discriminative power. Furthermore, measurements taken in vivo were not significantly different from the measurements taken ex vivo. These findings indicate that DRS is a robust technology for the detection of tumor tissue during breast conserving surgery.

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There is more and more interest in the understanding and the monitoring of the physics and chemistry of the Earth's atmosphere and its impact on the climate change. There is currently a lack of sounders which provide a high vertical resolution in trace gas detection. ALTIUS (Atmospheric Limb Tracker for the Investigation of the Upcoming Stratosphere) is a remote sounding experiment proposed by the Belgian Institute for Space Aeronomy (BIRA/IASB). The mission scenario includes bright limb observations in basically all directions, solar occultations around the terminator passages and star occultations during eclipse. These observation modes allow imaging the atmosphere with a high vertical resolution. The spacecraft will be operated in a 10:00 sun-synchronous orbit at an altitude of 695 km, allowing a 3-day revisit time. The envisaged payload for the ALTIUS mission is an imaging spectrometer, observing in the UV, the VIS and the NIR spectral ranges. For each spectral range, an AOTF (Acousto-Optical Tunable Filter) will permit to perform observations of selectable small wavelength domains. A typical set of 10 wavelengths will be recorded within 1 second. The different operational modes impose a high agility capability on the platform. Furthermore, the quasicontinuous monitoring by the payload will drive the design of the platform in terms of power and downlink capabilities. ALTIUS is one of the mission which are currently envisaged to use the PROBA-NEXT platform, which is currently under development at QinetiQ Space. This paper will present the ALTIUS mission, the envisaged instrument and the spacecraft concept.@en