Faculty Bibliography

BACKGROUND/UNASSIGNED:A current standard treatment for pre- or perimenopausal women with high-risk early-stage, hormone receptor-positive breast cancer who have undergone definitive surgery is adjuvant treatment with ovarian function suppression (OFS) with a GnRH agonist (leuprolide or goserelin) with endocrine therapy with an aromatase inhibitor or tamoxifen. Routine measurement of serum estradiol levels for monitoring of OFS during treatment is not a part of current NCCN guidelines. The frequency of estradiol monitoring is therefore often at the discretion of the clinician, and the goal estradiol level is not well established. CASE PRESENTATION/UNASSIGNED:We present the case of a 47-year-old female with high-risk early-stage hormone receptor-positive breast cancer who despite use of GnRH agonists did not achieve an estradiol level within the postmenopausal range. She had received two different GnRH agonists (leuprolide and goserelin) and later underwent a bilateral salpingo-oophorectomy (BSO). The pathology showed stromal hyperplasia in both ovaries. After the BSO in April 2024, the GnRH agonist was stopped. The serum estradiol level remained elevated (not in the postmenopausal range) after surgery for 12 months, prior to decreasing to the postmenopausal range. CONCLUSION/UNASSIGNED:Our patient's clinical course highlights the need for better understanding and establishment of monitoring guidelines for estradiol and the optimal degree of ovarian suppression for patients with breast cancer receiving OFS.

OBJECTIVE:Many patients with spasmodic dysphonia (SD) see consistent effects from botulinum toxin (BTX) injections of the same dose, whereas others require dosage changes over time. We sought to determine whether demographics (age and gender) or environmental factors (smoking) affect the long-term stability of BTX dosing in these patients. STUDY DESIGN/METHODS:Retrospective review. METHODS:Charts of all patients undergoing BTX injection for adductor SD were reviewed. Dosage change, defined as whether there was any difference in total dosage used between two beneficial injections, was used as a measure of dosing stability. Beneficial injections were indicated by a voice rating score of at least three of four and any non-zero duration of improved voice. Logistic regression analysis was performed to determine whether age, gender, smoking status, or duration of treatment correlated with odds of having a dosage change. RESULTS:A total of 211 patients were ultimately included. Age, gender, and smoking status were all found to have no correlative effect on dosing stability. The only factor that was predictive of dose stability was the number of previous beneficial injections, as every additional injection led to decreased odds of a change in dosage for the next injection (odds ratio=0.964; 95% confidence interval=0.947-0.981). CONCLUSIONS:Dosage of BTX injections for long-term treatment of SD has a significant propensity to remain stable over time. Factors such as age, gender, and smoking status do not appear to influence the dosage stability. These findings should allow for better patient counseling regarding expectations for their long-term treatment.