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Objective:To describe a prospective study of pre-operative tumor-bed boost performed at the 1.5 T MR-Linac in combination with adjuvant whole breast irradiation, and a first case, with an accentuation on clinical feasibility and safety.Methods:A phase II, single arm study recruiting early stage patients follows a paradigm that first boosts the tumor bed and then undergoes breast conservative surgery in 2 weeks, and last irradiates the whole breast in 6 weeks. The primary endpoint is ≥ grade 2 acute breast toxicity. A 43 years old patient affected by a breast carcinoma, not special type of the right-sided lateral quadrant, staged cT 2N 0M 0, was planned and treated. The dose, 8 Gy for one time, was calculated by Monaco on CT simulation images. Both the air electron stream effect (ESE) and the electron return effect (ERE) at the presence of 1.5 T magnetic field were evaluated. During the pre-treatment evaluation, we carried out adaptation-to-position adjustment. Results:The normal organ dosimetry is within toleration. The Dmax to the skin, the chin and the right upper arm was 8.44 Gy, 28.5 cGy and 17.8 cGy, respectively. There was no increased toxicity from ERE and ESE, and the treatment was well tolerated without > grade 1 acute toxicity. The patient received breast conservative surgery on day 7 without delayed wound healing.Conclusions:This is the first case successfully treated within a clinical trial by pre-operative tumor-bed boost under 1.5 T MR-Linac in our institution. More participants are needed to validate and optimize the paradigm.
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Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed.The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis.The prognostic factors were identified by Log-rank test.Results Similar LC,DFS and OS rates were obtained between two groups (all P＞ O.05).The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts.Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy.Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS.Her-2 positive is an unfavorable prognostic factor for DFS and OS.The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.
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Objective To compare the clinical efficacy between breast-conserving surgery (BCS) plus radiotherapy (RT) and modified mastectomy in patients with stage Ⅰ breast cancer in clinical setting.Methods Clinical data of 6 137 patients diagnosed with pT1-2N0 breast cancer from 1999 to 2014 were retrospectively reviewed.Among them,1 296 patients received BCS plus RT (BCS group) and 4 841 cases underwent modified mastectomy alone (modified mastectomy group).Kaplan-Meier analysis was used for survival analysis.Log-rank test,single factor analysis and Cox's proportional hazards regression model were performed.The results were further confirmed with the propensity score-matching (PSM) method.Results Within a median follow-up period of 55.2 months (range,1-222 months),the 5-year locoregional recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),disease-free survival (DFS) and overall survival (OS) were 96.3％,93.7％,91.9％ and 96.9％,respectively.In the BCS plus RT group,the 5-year DMFS (96.9％ vs.92.9％,P＜0.001),DFS (94.9％ vs.91.2％,P=0.005) and OS (99.1％ vs.96.4％,P=0.001) were significantly higher than those in the mastectomy group.Multivariate analysis revealed that postoperative RT was an influencing factor of DMFS (P=0.003,HR=0.621;95％CI:0.455-0.849) and OS (P=0.036;HR=0.623;95％CI:0.401-0.969).For 1 252 pairs of patients matched by PSM,the 5-year OS (99.1％ vs.96.1％,P=0.001),DMFS (97.0％ vs.92.2％,P＜0.001) and DFS (95.3％ vs.90.2％,P=0.001) in the BCS plus RT group were significantly higher compared with those in the mastectomy group.Conclusion The long-term clinical prognosis of patients with stage Ⅰ breast cancer in the BCS plus RT group is better than that in the mastectomy group.BCS plus RT should be recommended for patients with stage Ⅰ breast cancer.
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Objective@#To investigate the current status of breast reconstruction surgery in China and analyze the specific views of Chinese doctors on the relationship between radiotherapy and breast reconstruction surgery.@*Methods@#A total of 110 medical institutions nationwide with more than 200 cases of breast cancer surgery yearly were selected into this questionnaire survey. The questionnaire survey included basic information of the surgeons and their hospitals, information of breast cancer surgeries in 2017, types of reconstruction surgery and specific views on the relationship between radiotherapy and reconstruction surgery.@*Results@#In total, 110 hospitals participated in the survey, 96(87.3%) had undergone breast reconstruction surgery. Reconstruction with implants accounted for 65.7% of the total reconstruction surgery and the proportion of autologous reconstruction was 20.1%. For patients who probably required postoperative radiotherapy, the preferred surgical procedure in the surveyed hospitals was implant based reconstruction surgery. For those who were confirmed to receive postoperative radiotherapy or had undergone radiotherapy after total mastectomy, autologous tissue reconstruction was recommended. Postoperative radiotherapy was a negative factor for immediate breast reconstruction, and most hospitals believed that radiotherapy exerted slight effect on surgery. The proportion of delay-immediate breast reconstruction reached 66% and 86% of hospitals preferred to replace with the prosthesis at 6 months after radiotherapy. Patients with local recurrence after breast-conserving surgery could also receive immediate reconstruction and implant reconstruction was the preferred surgical procedure.@*Conclusions@#The proportion of breast reconstruction in China is relatively low and Chinese doctors still lack of technical mastery. In the face of conflict with radiotherapy, the regime selected by Chinese doctors is not in accordance with those recommended by the guideline and consensus, prompting that more professional training should be delivered for Chinese doctors to further promote the development of breast reconstruction in China.
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Objective@#To investigate the dosimetric characteristics of conventional two-dimensional radiotherapy of the chest wall, supra-and infra-clavicular regions, and the incidental irradiation dosage of the internal mammary region after modified mastectomy in breast cancer patients.@*Methods@#Clinical data of 20 breast cancer patients including 10 left and 10 right cases who received radiotherapy after modified mastectomy between 2015 and 2016 were retrospectively analyzed. All patients received irradiation to the chest wall, supra-and infraclavicular regions at a prescription dose of 43.5 Gy in 15 fractions with conventional technique. One anterior-posterior (AP) photon field irradiation was delivered for the supra-and infra-clavicular regions, and one electron field for the chest wall. The supra-and infraclavicular regions were re-planned by using two AP/PA fields and the doses of organ at risk were evaluated.@*Results@#With conventional radiotherapy, the D90 of the supra-and infra-clavicular regions were more than 39.15 Gy (EQD2≥45 Gy) in 17 patients (85%), and the median D90 of the chest wall was 35.38 Gy. The median dose of incidental internal mammary region was 13.65 Gy. Patients with lower body mass index (BMI) received higher D90 in both supra-and infra-clavicular and chest wall irradiation (P=0.039, 0.347).@*Conclusions@#Irradiation at D90 of 39.15 Gy to the supra-and infra-clavicular regions with AP/PA fields can meet the prescription dose requirement of ≥90% in most cases and does not increase the irradiation dose to normal tissues. The dose distribution of one electron field of the chest wall is poor. Incidental internal mammary region can be irradiated at a limited dosage. BMI is an influencing factor for dose distribution.
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Objective@#To compare the efficacy between hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer by a meta-analysis.@*Methods@#The controlled clinical trials of comparing hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer were searched from PubMed, EMbase, Cochrane Library, Wanfang database, VIP, CNKI, and CBM databases. The obtained data were analyzed using RevMan 5.3 and Stata 14.0 software. The differences between two groups were estimated by calculating the odds ratio (OR) with 95% confidence interval (CI).@*Results@#A total of 19 controlled clinical trials involving 2652 post-mastectomy breast cancer patients were selected in this meta-analysis according to the inclusion and exclusion criteria. The meta-analysis results demonstrated that no statistical significance was observed in the tumor-free survival (OR=1.10, 95%CI: 0.78-1.56, P=0.59), overall survival (OR=1.18, 95%CI: 0.92-1.53, P=0.19), locoregional recurrence (OR=1.01, 95%CI: 0.68-1.51, P=0.96), distant metastasis (OR=1.14, 95%CI: 0.82-1.59, P=0.43), skin toxicity (OR=1.01, 95%CI=0.80-2.16, P=0.96), cardiac toxicity (OR=1.17, 95%CI: 0.71-1.93, P=0.53) and pulmonary toxicity (OR=0.78, 95%CI: 0.44-1.37, P=0.38) between two groups.@*Conclusions@#Hypofractionated radiotherapy and conventionally fractionated radiotherapy post-mastectomy yield similar clinical efficacy, both of which are safe and efficacious radiotherapy patterns. However, the findings remain to be validated by large-scale randomized clinical trials with long-term follow-up of the advanced stage complications.
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Objective To investigate the dosimetric characteristics of conventional two-dimensional radiotherapy of the chest wall,supra-and infra-clavicular regions,and the incidental irradiation dosage of the internal mammary region after modified mastectomy in breast cancer patients.Methods Clinical data of 20 breast cancer patients including 10 left and 10 right cases who received radiotherapy after modified mastectomy between 2015 and 2016 were retrospectively analyzed.All patients received irradiation to the chest wall,supra-and infraclavicular regions at a prescription dose of 43.5 Gy in 15 fractions with conventional technique.One anterior-posterior (AP) photon field irradiation was delivered for the supra-and infra-clavicular regions,and one electron field for the chest wall.The supra-and infraclavicular regions were re-planned by using two AP/PA fields and the doses of organ at risk were evaluated.Results With conventional radiotherapy,the D90 of the supra-and infra-clavicular regions were more than 39.15 Gy (EQD2 ≥45 Gy) in 17 patients (85％),and the median D90 of the chest wall was 35.38 Gy.The median dose of incidental internal mammary region was 13.65 Gy.Patients with lower body mass index (BMI) received higher D90 in both supra-and infra-clavicular and chest wall irradiation (P=0.039,0.347).Conclusions Irradiation at D90 of 39.15 Gy to the supra-and infra-clavicular regions with AP/PA fields can meet the prescription dose requirement of ≥90％ in most cases and does not increase the irradiation dose to normal tissues.The dose distribution of one electron field of the chest wall is poor.Incidental internal mammary region can be irradiated at a limited dosage.BMI is an influencing factor for dose distribution.
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Objective To compare the efficacy between hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer by a meta-analysis.Methods The controlled clinical trials of comparing hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer were searched from PubMed,EMbase,Cochrane Library,Wanfang database,VIP,CNKI,and CBM databases.The obtained data were analyzed using RevMan 5.3 and Stata 14.0 software.The differences between two groups were estimated by calculating the odds ratio (OR) with 95％ confidence interval (CI).Results A total of 19 controlled clinical trials involving 2652 post-mastectomy breast cancer patients were selected in this meta-analysis according to the inclusion and exclusion criteria.The meta-analysis results demonstrated that no statistical significance was observed in the tumor-free survival (OR =1.10,95 ％ CI:0.78-1.56,P =0.59),overall survival (OR =1.18,95 ％ CI:0.92-1.53,P =0.19),locoregional recurrence (OR=1.01,95％CI:0.68-1.51,P=0.96),distant metastasis (OR=1.14,95％CI:0.82-1.59,P=0.43),skin toxicity (OR=1.01,95％CI=0.80-2.16,P=0.96),cardiac toxicity (OR=1.17,95％CI:0.71-1.93,P=0.53) and pulmonary toxicity (OR=0.78,95％CI:0.44-1.37,P=0.38) between two groups.Conclusions Hypofractionated radiotherapy and conventionally fractionated radiotherapy post-mastectomy yield similar clinical efficacy,both of which are safe and efficacious radiotherapy patterns.However,the findings remain to be validated by large-scale randomized clinical trials with long-term follow-up of the advanced stage complications.
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Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy,25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy,and 5 patients were not recommended by primary physicians for radiotherapy.In addition,3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclnsions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy,followed by the fear of radiation-induced toxicity and poor financial support.Patient education and medical insurance may improve the adjuvant radiotherapy compliance.
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Objective@#To investigate the influencing factors of the dose coverage of unplanned internal mammary lymph node (IMN) irradiation in patients receiving chemotherapy after mastectomy.@*Methods@#Clinical data of 138 patients receiving radiotherapy in the upper and lower lymph node drainage area of the thoracic wall and clavicle [three-dimensional conformal radiotherapy (3DCRT), field-in-field forward intensity-modulated radiotherapy (F-IMRT) or inverse IMRT (I-IMRT)] were retrospectively analyzed. The IMN was delineated according to the Radiation Therapy Oncology Group (RTOG) criteria. The unplanned irradiation dose of the IMN was obtained. The correlation between the IMN irradiation dose, clinical characteristics and specific parameters of radiotherapy during the unplanned irradiation was statistically analysed.@*Results@#The mean dose of unplanned IMN irradiation was 32.85 Gy (range: 2.76-50.93 Gy). In total, 7.3% of breast cancer patients obtained the therapeutic dose of≥ 45 Gy. Body weight, body mass index (BMI), body surface area (BSA) and thoracic transverse diameter (DT) were lower, whereas the planning target volume of IMN (VIMN) included in the chest wall PTV (IMNin) and the ratio of IMNin to VIMN were higher compared with those of their counterparts with insufficient therapeutic dose. Multivariate regression analysis demonstrated that body weight, thoracic anteroposterior diameter (DAP), DT, RIMNin and PTV volume were the influencing factors of the dose coverage of unplanned IMN irradiation (P=0.000, 0.000, 0.001, 0.000 and 0.034).@*Conclusions@#For patients receiving chemotherapy after mastectomy, the dose coverage significantly varies when the IMN is the unplanned target. Partial patients achieve the therapeutic dose. The dose coverage of unplanned IMN irradiation is influenced by physical characteristics, anatomical features and technical parameters of radiotherapy, which should be emphasized during the study design and result analysis.
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OBJETIVO: Avaliar a frequência e os fatores de risco para o desenvolvimento da síndrome da mama fantasma em pacientes submetidas à mastectomia para o tratamento do câncer de mama.MÉTODOS: Estudo de coorte com mulheres atendidas em um hospital especializado da região sudeste do Brasil no período de setembro de 2008 a junho de 2009. Foram consideradas como tendo síndrome da mama fantasma pacientes com relato da presença de dor na mama fantasma e/ou sensação na mama fantasma. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) (015/08). Foi realizada análise descritiva por meio da frequência absoluta e relativa. Para avaliar a associação entre a SMF e os potenciais fatores de risco, foi realizada análise univariada, por meio de odds ratios(OR) com os respectivos intervalos com 95% de confiança (IC95%).RESULTADOS: Foram incluídas 88 pacientes. A frequência da SMF observada aos 45 dias (primeiro seguimento) foi de 44,3 e 18,2% aos 2 anos (último seguimento). A maioria das mulheres apresentou relato de sensação na mama fantasma em todos os seguimentos (37,1; 30,1 e 22%). No seguimento de 6 meses, mulheres com idade inferior a 60 anos apresentaram um risco 3,9 vezes maior de apresentar síndrome da mama fantasma (OR=3,9; IC95% 1,4-10,5) e aquelas com maior escolaridade (8 anos ou mais de estudo) apresentaram maior risco de desenvolver SMF (OR=2,6; I 95% 1,01-6,8).CONCLUSÃO: A população estudada apresentou alta frequência de SMF, com diminuição ao longo do seguimento pós-operatório. Sua ocorrência no seguimento de seis meses foi maior entre as mulheres mais jovens e com maior escolaridade.
PURPOSE: To evaluate the frequency and risk factors for the development of phantom breast syndrome in patients submitted to mastectomy after breast cancer treatment.METHODS: A cohort study of women undergoing treatment at the Hospital of Cancer III, National Cancer Institute José Alencar Gomes da Silva (INCA) from September 2008 to June 2009. PBS was considered based on report of phantom breast sensation and/or phantom breast pain. The study was approved by the Research Ethics Committee of the INCA (015/08). Descriptive analysis using absolute and relative frequency was performed. To evaluate the association between PBS and potential risk factors, univariate analysis was performed by means of odds ratios (OR) with respective 95% confidence intervals (95%CI).RESULTS: A total of 88 patients were included. The frequency of PBS observed was 44.3 at 45 days (first follow-up) and 18.2% at 2 years (last follow-up). Most women reported phantom breast syndrome in all segments (37.1; 30.1 and 22%). During the six month follow-up, women under the age of 60 years had a 3.93 times higher risk of PBS (OR=3.9; 95%CI 1.4-10.5) and those with higher education (8 years or more of study) had a higher risk of developing PBS (OR=2.6; 95%CI 1.01-6.8).CONCLUSION: The study population had a high frequency of PBS, which decreased over postoperative follow-up. Its occurrence after six months was higher among younger and more educated women.