ABSTRACT
Purpose: Breast-conserving surgery followed by several weeks of adjuvant radiotherapy is the current standard of care for low-risk breast cancer. A novel approach using single-fraction neoadjuvant radiotherapy is under study. We sought to investigate the rate of pathologic response, toxicities and cosmetic results related to this new treatment strategy. Material(s) and Method(s): Women 65 years of age or older with a new diagnosis of Stage I unifocal luminal A breast cancer were eligible for inclusion in this Phase I prospective trial. A single 20 Gy dose of radiotherapy to the breast tumour was given, followed by breast-conserving surgery three months later. The primary endpoint was the pathologic response rate assessed by microscopic evaluation using the Miller-Payne system. The secondary endpoints were the incidence of radiation toxicity and the cosmetic results, graded according to the Common Terminology Criteria for Adverse Events and the European Organisation for Research and Treatment of Cancer Cosmetic Rating System, respectively. Secondary outcomes were assessed at 6 weeks, 4 months and yearly after radiotherapy. Result(s): To date, 13 patients have been successfully treated with a median age of 71 years (range: 65-83 years). As previously reported, neoadjuvant radiotherapy resulted in a tumour pathologic response in 11 of 13 patients with a median residual cellularity of 1% (range: 0-10%). With an average follow-up of 31.9 months (range: 24.4- 39.2 months), no disease recurrences or deaths were recorded. Acute radiation toxicities were limited to Grade 1 dermatitis and breast pain. At the one-year follow-up, 11 patients had Grade 1 toxicities (dermatitis, fibrosis, breast pain and chest wall pain), one patient had a Grade 2 fatty necrosis, and two patients had Grade 3 toxicities (wound infection and hematoma). Only Grade 1 toxicities remained at the two-year follow-up. One-year cosmetic results were good or excellent in 46% of patients according to their self-assessment and in 54% of them according to the nurse's evaluation. Two-year cosmetic results were unavailable due to in-person visits cancellations during the COVID-19 pandemic. Conclusion(s): This study demonstrates that a single fraction of neoadjuvant radiotherapy preceding breast-conserving surgery is feasible, relatively well tolerated and leads to a high level of pathologic response for most patients. The Grade 3 toxicities and underwhelming cosmetic results may indicate that the 3-month interval after radiotherapy places surgery in a post-radiation inflammatory phase. Larger trials are needed to better assess the long-term toxicities as well as the optimal timing and fractionation of this novel technique in the management of early-stage breast cancer. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
ABSTRACT
The COVID-19 pandemic has presented school libraries with opportunities and challenges that are unprecedented in the history of humankind as evidenced by total shutdowns, lockdown rules and regulations, and adaptation of emerging technologies for supporting teaching and learning in educational institutions. This chapter provides a general overview of the experiences of school libraries in a selected district in Manicaland, Zimbabwe. It highlights how the digital divide disadvantages school libraries that are resource famished. Using a qualitative methodology, the chapter interrogates how the adaptation of social media platforms has helped school libraries to contribute towards learning amidst the complications of the COVID-19 pandemic. © 2022 by IGI Global. All rights reserved.