A comparative study for surface dose evaluation in conventional treatment of carcinoma breast patients irradiated with Co-60 and 6 MV radiation beam

Aim: In the present study, surface doses within the target area and contralateral breast (CLB) received during conventional treatment of carcinoma breast are evaluate and compared for treatment on two different beam energies, i.e., Co-60 γ-ray and 6 MV X-ray beams with thermoluminescent dosimeter, LiF:Mg, Ti (TLD-100). Materials and Methods: The study includes a group of 23 patients comprising 11 patients treated with Co-60 γ-ray beam and 12 patients by 6 MV X-ray beam. Results and Discussion: The treatment using Co-60 γ-ray and 6 MV X-ray beams contributes an average percentage dose of 8.15% ± 0.56% and 4.73% ± 0.94%, respectively, to CLB in mastectomy patients. The contribution of tangential fields (mastectomy) to the CLB doses ranges between 12.71 and 16.40 cGy (5.45%–7.03%) for treatment with Co-60 γ-ray beam and 6.33–10.95 cGy (1.86–4.69%) for treatment with 6 MV X-ray beam. The supraclavicular field (SCF) contributes 1.45%–1.93% and 1.02%–1.43% for treatment with Co-60 γ-ray and 6 MV X-ray beams, respectively. The average surface dose (normalized with breast dose) 89.1% ± 8.5% for Co-60 beam in the SCF region differs significantly from the 60.2% ± 13.0% value for 6 MV X-ray beam. Conclusion: The CLB doses for mastectomy patients are higher for Co-60 beam as compared to 6 MV X-ray beam, and better dose homogeneity is achieved within the irradiated breast from 6 MV X-ray beam. The CLB doses are slightly higher for patients treated with breast conservative radiotherapy or lumpectomy. The average surface dose to SCF decreases by ~30% of treated breast dose for treatment with 6 MV X-ray beam

Measurement of the contralateral breast photon and neutron dose in breast cancer radiotherapy: A Monte Carlo study

Introduction: This study aimed to calculate the photon and neutron doses received to the contralateral breast (CB) during breast cancer radiotherapy for various field sizes in the presence of a physical wedge. Materials and Methods: Varian 2100 C/D linear accelerator was simulated using a MCNP4C Monte Carlo code. Then, a phantom of real female chest was simulated and the treatment planning was carried out on tumoral breast (left breast). Finally, the received photon and neutron doses to CB (right breast) were calculated in the presence of a physical wedge for 18 MV photon beam energy. These calculations were performed for different field sizes including 11 cm × 13 cm, 11 cm × 17 cm, and 11 cm × 21 cm. Results: The findings showed that the received doses (both of the photon and neutron) to CB in the presence of a physical wedge for 11 cm × 13 cm, 11 cm × 17 cm, and 11 cm × 21 cm field sizes were 9.87%, 12.91%, and 27.37% of the prescribed dose, respectively. In addition, the results showed that the received photon and neutron doses to CB increased with increment in the field size. Conclusion: From the results of this study, it is concluded that the received photon and neutron doses to CB in the presence of a physical wedge is relatively more, and therefore, they should be reduced to as low as possible. Therefore, using a dynamic wedge instead of a physical wedge or field-in-field technique is suggested

Mastectomía de Reducción de Riesgo Contralateral: impacto en la evolución de las pacientes. Experiencia del Hospital Británico de Buenos Aires / Contralateral prophylactic mastectomy: impact on the outcome of patients at the Buenos Aires British Hospital

Introducción La Mastectomía de Reducción de Riesgo Contralateral (mrrc) se ha incrementado considerablemente en los últimos años. Este aumento llama la atención debido a que la incidencia del carcinoma de mama contralateral ha disminuido gracias al diagnóstico temprano y a los avances en los tratamientos adyuvantes. No se ha podido demostrar un claro beneficio de la mrrc en la Supervivencia Global (sg), en especial en las pacientes de bajo riesgo. Objetivos Describir la evolución y las características de las pacientes con diagnóstico de cáncer de mama unilateral que optaron por realizar mrrc en el Servicio de Mastología del Hospital Británico de Buenos Aires, analizando la aparición de carcinoma contralateral, la Supervivencia Libre de Enfermedad (sle) y la Supervivencia Global (sg), y compararla con un grupo de pacientes a quienes se les realizó Mastectomía Terapéutica Unilateral (mtu). Material y método Se realizó un estudio retrospectivo de pacientes con diagnóstico de cáncer de mama unilateral tratadas con mastectomía y sometidas a mrrc entre octubre de 2005 y noviembre de 2014. Se incluyeron 46 pacientes que recibieron mrrc, y en el grupo control a 140 pacientes a las que se les realizó mtu en el mismo período de tiempo y rango etario. El seguimiento medio en el grupo de mrrc fue de 49,3 meses y en el grupo de mtu de 43,3 meses. Resultados La incidencia anual del carcinoma contralateral fue de 0,5% en nuestra casuística. Las curvas de Kaplan Meier para supervivencia libre de enfermedad y supervivencia global no muestran diferencias significativas entre ambos grupos. Tampoco se observan diferencias en los subgrupos analizados de mujeres menores de 50 años y receptores estrogénicos (re) negativos. Conclusiones No hubo beneficio en cuanto a sle y sg en las pacientes sometidas a mrrc comparadas con el grupo de mtu, aun en los subgrupos considerados de mayor riesgo como aquellas pacientes menores de 50 años y Receptores de Estrógenos (re) negativos. No hubo desarrollo de carcinomas contralaterales en el grupo de mrrc. Al ser un procedimiento solicitado por las pacientes, es importante que el cirujano cuente con la información adecuada para poder brindar la mejor recomendación para cada una de ellas

Introduction Contralateral Prophylactic Mastectomy (cpm) has considerably increased in recent years. Such increase calls our attention, since the incidence of contralateral breast carcinoma has decreased as a result of early diagnosis and of the progress made with adjuvant therapies. No clear benefit in Overall Survival (os) was proven, particularly in low risk patients. Objectives To describe the evolution and characteristics of patients with unilateral breast cancer who decided to undergo cpm at the Buenos Aires British Hospital Breast Services Unit, analyzing the appearance of contralateral carcinoma, Disease-Free Survival (dfs) and Overall Survival (os), compared to a group of patients who underwent unilateral mastectomy. Materials and method A retrospective trial was conducted on patients diagnosed with unilateral breast cancer who underwent mastectomy and cpm between October 2005 and November 2014. During the same time period and among the same age group, 46 patients received cpm and 140 patients, from the control group, underwent unilateral mastectomy. The mean follow-up period was of 49.3 months for the cpm group, and of 43.3 months for the unilateral mastectomy group. Results The annual incidence of contralateral carcinoma was 0.5% in our cases. Kaplan Meier curves for disease-free survival (dfs) and overall survival (os) show no significant differences between both groups. The same is true for subgroups of women under 50 years old with negative estrogen receptors. Conclusions There was no benefit in terms of dfs and os in patients who underwent cpm against the unilateral mastectomy group, even in subgroups considered of higher risk, such as patients under 50 and with negative er. There were no contralateral carcinomas in the cpm group. Since this procedure is requested by patients, it is important for the surgeon to have the correct information to be able to provide the best recommendation in each case

Contralateral breast as the donor for immediate breast reconstruction or chest wall defect repair in breast cancer patients undegoing mastectomy / 中华内分泌外科杂志

Objective To explore the feasibility of using contralateral breast as the donor for immediately breast reconstruction or chest wall defect repair after mastectomy in breast cancer patients. Methods From Jul. 2013 to Mar. 2016, contralateral breast fat flap was used as the donor for 8 breast cancer patients with immediate autologous non-microsurgical breast reconstruction or chest wall defect repair after mastectomy. All participants in this study received preoperative oncological screening with ultrasound, mammography, and magnetic resonance imaging which revealed the absence of pathological abnormalities in the donor breast. Results Among the 8 pa-tients, 4 patients underwent immediate breast reconstruction and 4 received chest wall defect repair. Only 1 pa-tient undergoing breast reconstruction had minor complications with little or no effect on the final outcome. No patient undergoing chest wall defect repair had postoperative complications. The functional and aesthetic out-comes were very satisfactory. Regular follow-ups were from 3 to 34 months with no recurrence found up to the present. Conclusions This article presents the first case for immediately breast reconstruction or chest wall de-fect repair using contralateral breast as the donor. The surgical method has some complications but with good aesthetic outcomes, which can be an option for breast cancer patients with hypertrophic and ptotic breast.

Contralateral Breast Management Related to Breast Reconstruction in Korean Females / 한국유방암학회지

PURPOSE: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. However, in cases where women have an unattractive breast, which may be small, ptotic or huge, remodeling of the contralateral breast may be desirable. Surgical options available for the contralateral breast included breast augmentation using implants, mastopexy, and reduction mammoplasty. METHODS: All patients who underwent unilateral breast reconstruction at Kyungpook National University Hospital from September of 2006 to February of 2008 were included in this study. The methods of reconstruction included transverse rectus abdominis musculocutaneous flap, latissimus dorsi flap, and the use of implants. Contralateral procedures to achieve symmetry included augmentation, mastopexy, and reduction. RESULTS: A total of 57 patients were evaluated, including 45 immediate, and 12 delayed reconstructions. Twenty-six of these patients underwent contralateral breast management (augmentation [12], mastopexy [11], and reduction [3]). The average age was 44.9 years and the mean follow up interval was 13 months. Most of the patients were satisfied with the symmetry, clothed appearance, nude appearance, aesthetics, and consistency. Sixty-six percent (8 of 12) of delayed reconstruction patients had a symmetry procedure performed on the opposite breast, compared with 40 percent (18 of 45) of the immediate-reconstruction patients. No complications were observed on the contralateral breasts undergoing symmetrization. CONCLUSION: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory results in a safe manner. Immediate symmetrization procedure also can avoid secondary operations and offer psychological benefits without delaying adjuvant therapy.

Risk Factors Affecting The Contralateral Breast Cancer after Treatment of Primary Breast Cancer / 中国普外基础与临床杂志

Objective To study the risk factors for contralateral breast cancer(CBC) in women after regular treatment of the primary breast cancer.Methods Between January 1997 to December 2002,the clinical data of 340 breast cancer patients at our institution were retrospectively analyzed.In all the patients a detailed analysis was carried out with respect to age,operation type,radiation therapy technique and dose,the use of chemotherapy or hormone therapy,and other clinicopathologic characteristics.The Kaplan-Meier method was used to estimate the actuarial rate of CBC.The Cox proportional hazard regression model was used to estimate the relative risk factors of CBC.Results Fourteen cases were diagnosed to be CBC,thus overall incidence of CBC was 4.1%.Ten-year CBC incidence(2.7%) was higher than 5-year incidence of CBC(1.4%).Univariate analysis showed that the risk factors of CBC at 5-year and 10-year included: ≤45 years old,medullary carcinoma,family history of breast cancer and being taken without endocrine therapy(P0.05).Mutivariate analysis showed that ≤ 45 years old and being internal breast radiotherapy were independent risk factors of CBC at 5-year and 10-year(P

Contralateral Breast Dose Reduction Using a Virtual Wedge / 대한방사선종양학회지

PURPOSE: To evaluate the contralateral breast dose using a virtual wedge compared with that using a physical wedge and an open beam in a Siemens linear accelerator. MATERIALS AND METHODS: The contralateral breast dose was measured using diodes placed on a humanoid phantom. Diodes were placed at 5.5 cm (position 1), 9.5 cm (position 2), and 14 cm (position 3) along the medial-lateral line from the medial edge of the treatment field. A 6-MV photon beam was used with tangential irradiation technique at 50 and 230 degrees of gantry angle. Asymmetrically collimated 17 x 10 cm field was used. For the first set of experiment, four treatment set-ups were used, which were an open medial beam with a 30-degree wedged lateral beam (physical and virtual wedges, respectively) and a 15-degree wedged medial beam with a 15-degree wedged lateral beam (physical and virtual wedges, respectively). The second set of experiment consists of setting with medial beam without wedge, a 15-degree wedge, and a 60-degree wedge (physical and virtual wedges, respectively). Identical monitor units were delivered. Each set of experiment was repeated for three times. RESULTS: In the first set of experiment, the contralateral breast dose was the highest at the position 1 and decreased in order of the position 2 and 3. The contralateral breast dose was reduced with open beam on the medial side (2.70+/-1.46%) compared to medial beam with a wedge (both physical and virtual) (3.25+/-1.59%). The differences were larger with a physical wedge (0.99+/-0.18%) than a virtual wedge (0.10+/-0.01%) at all positions. The use of a virtual wedge reduced the contralateral breast dose by 0.12% to 1.20% of the prescribed dose compared to a physical wedge with same technique. In the second experiment, the contralateral breast dose decreased in order of the open beam, the virtual wedge, and the physical wedge at the position 1, and it decreased in order of a physical wedge, an open beam, and a virtual wedge at the position 2 and 3. CONCLUSION: The virtual wedge equipped in a Siemens linear accelerator was found to be useful in reducing dose to the contralateral breast. Our additional finding was that the surface dose distribution from the Siemens accelerator was different from a Varian accelerator.

Simultaneous TRAM Flap Breast Reconstruction with Contralateral Reduction Mammoplasty

Symmetry is an important parameter for breast reconstruction. Contralateral breast frequently provides model to be reconstructed. But hypertrophic and ptotic breast is aesthetically unacceptable. And if the contralateral breast is large, larger flap which is required to reconstruct the breast including the zone of poor vascularity. Therefore, reduction of hypertrophic breasts may be preferable. Many surgeons prefer to perform contralateral procedures at least several months after reconstruction. However authors performed simultaneous contralateral reduction mammoplasty in 18 patients at the same time as pedicled TRAM flap reconstruction. The expected disadvantages of the simultaneous operation are increased hospitalization time, blood loss, and complications. But according to our result, it showed that there was no significant difference in hopitalization time and hemoglobin-decrease. Furthermore, simultaneous operation showed lower complication rate because of the reduced size of the required flap. Our results revealed that TRAM flap breast reconstruction and simultaneous contralateral reduction mammoplasty is a safe procedure. And the results were aesthetically acceptable.

A Case of Small Cell Lung Cancer Metastastized to the Contralateral Breast / 결핵

Primary lung cancer frequently metastasizes to distant organs. But breast is a very rare site of metastasis. So, accurate diagnosis is essential to rule out primary breast cancer. A 62-year old woman who had complained of cough was diagnosed as small cell lung carcinoma of the right lower lobe. She had a 2.5cm sized lobular mass in left upper mid portion of breast. Sonoguided breast biopsy revealed small cell carcinoma consistent with metastatis from primary lung cancer. She also had bone metastses to the scapula and the vertebrae. We report the case of metastatic breast cancer from small cell lung carcinoma.

Dosimetric Characteristics of Dynamic Wedge Techinique / 대한치료방사선과학회지

PURPOSE: The wedge filter is the most commonly used beam modifying device during radiation therapy. Recently dynamic wedge technique is available through the computer controlled asymmetric collimator, independent jaw. But dosimetric characteristics of dynamic wedge technique is not well know. Therefore we evluate dosimetric characteristics of dynamic wedge compared to conventional fixed wedge. MATERIALS AND METHODS: We evaluated dosimetric characteristics of dynamic wedge and fixed wedge by ion chamber, film dosimetry and TLD in phantoms such as water, polystyrene and average breast phantom. Six MV x-ray was used in 15X15 cm field with 15,30 and 45 degree wedge of dynamic/fixed wedge system. Dosimetric characteristics are interpreted by wellhofer Dosimetrie system WP700/WP700i and contralateral breast dose(CBD) with tangential technique was confirmed by TLD. RESULTS: 1) Percent depth dose through the dynamic wedge technique in tissue equivalent phantom was similar to open field irradiation and there was no beam hardening effect compared to fixed wedge technique. 2) Isodose line composing wedge angle of dynamic wedge is more straight than hard wedge. And dynamic wedge technique was able to make any wedge angle on any depth and field size. 3) The contralateral breast dose in primary breast irradiation was reduced by dynamic wedge technique compared to fixed wedge. When the dynamic wedge technique was applied, the scatter dose was similar to that of open field irradiation. CONCLUSION: The dynamic wedge technique was superior to fixed wedge technique in dosimetric characteristics and may be more useful in the future.