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INTRODUCTION: The COVID 19 pandemic caused unprecedented changes in treatment of breast cancer. The aim of this IRB approved retrospective study was to assess trends in surgical management and reconstructive choice after mastectomy during the pandemic. Even as an epicenter at the start of COVID, our hospital prioritized the treatment of breast cancer patients facilitating timely care within accepted standards. METHOD(S): We compared female patients with breast cancer (BC) treated with either lumpectomy (L) or mastectomy (M) during a 12-month period in 2017 and 2020-2021. We stratified based on no reconstruction (NR) versus surgical reconstruction (R), reconstruction using autologous tissue (AT) or tissue expander/implant (TE/I), and age above or below 60 years (< 60, >60). RESULT(S): 399 total patients were treated surgically in 2017 and 2020. In 2017, there were 50 M and 115 L (30.3%/69.7%) versus in 2020, 113 M and 121 L (48.3%/51.7%). In 2017, 9 patients had NR (18.0%) while in 2020, 37 had NR (32.7%). In 2017, 41 had R (82.0%), with 24 receiving AT (58.5%) and 17 had TE/I (41.5%). In 2020, 76 had R (67.3%), with 34 receiving AT (44.7%) and 42 had TE/I (55.3%). For age < 60, 29 had R (70.7%) and 2 had NR (22.2%) in 2017;51 had R (67.1%) and 16 had NR (43.2%) in 2020. For age >60, 12 had R (29.2%) and 7 had NR (77.8%) in 2017;25 had R (32.9%) and 21 had NR (56.8%) in 2020. These data show a 13.8% shift towards TE/I over AT with a 14.7% increase in NR. CONCLUSION(S): Breast cancer patients were prioritized and surgically treated within quality standards. With the changes in availability of hospital resources, staff, and limiting viral exposure, mastectomy rates versus lumpectomy increased dramatically. These trends were possibly due to avoidance of daily facility trips for radiation treatment. Tissue expander/implant rates increased substantially possibly from avoidance of prolonged versus overnight hospital stay. Mastectomy without reconstruction also increased and future studies are needed to determine the number of delayed reconstruction in this group.
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Objectives: Breast cancer is increasing in Chile, and also the need for biopsies. We aim to identify the evolution of breast cancer diagnosis needs to be measured as Core Needle Biopsy (CNB), Stereotactic Biopsy (SB), Hematoxylin and Eosin staining Histopathological Study (H&ES), Immunohistochemical Study (IS) in relation to echography and mastectomy rates, to understand local needs of adopting innovative pathology technologies in public providers. Method(s): Time-series analysis, based on an open-access national database for the following variables: CNB, SB, H&ES, IS, echography, and mastectomy for a decade (2010-2021). The data is representative of the national activity in public providers, for which the intra-period variation and median-growth rate (MGR) were estimated. Result(s): CNB experimented a 630.7% increase in the period (MGR 19.8%). SB increased 92.3% at an MGR of 6.1%. H&ES and IS increased 19.1% and 379.4% (MRG 1.6% and 15.3% respectively). Lumpectomy and Radical Mastectomies (RM) behaved differently. Lumpectomy varied in 31.2% (MGR of 2.5%) whereas RM varied in -13.6% (negative MGR -1.3%). The covid-19 pandemic significantly decreased activity for SB, lumpectomies, and RM (p <0.05). Echography exhibits an increase of 27.5% (MGR 6.3% per year). The biopsy versus surgeries ratio was estimated, resulting in a variation from 0.537 in 2011 to 1.9 in 2021;this is 1.9 biopsies per surgery in the public system. Conclusion(s): Anatomic pathology based-analysis in breast cancer has increased in the last decade in Chile. The ratio of biopsy versus surgery has changed dramatically, pushing for innovation in the process of analysis of samples in a local setting of pathologist scarcity (1.22 pathologist per 100,000 public patients). Copyright © 2022
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The COVID-19 pandemic disrupted medical care and reduced access to elective procedures. While prior claims-based research has shown that patients received more conservative care, little is known about how radiation therapy (RT) ordering behavior changed during the pandemic. This study examines whether the rate at which orders for lumpectomy were followed by orders for RT changed from 2019 to 2020, and whether there were changes in the percentage of RT orders that were for hypofractionated (HF) RT, rather than conventional (CF) RT. Prior authorization order data pertaining to patients from one national organization's commercial and Medicare Advantage health plans were used to perform the analysis. Included patients were females, aged 18 to 89, who had an order for a lumpectomy in 2019 or 2020. Patients were excluded if they were not continuously enrolled in their health plan for 90 days following lumpectomy. Orders were reviewed to determine whether patients had an order for RT in the 90 days following lumpectomy. Orders were classified as HF if they were for 5 to 21 fractions, CF if they were for 28 or more fractions, and as neither if they were for other numbers of fractions. Univariate analyses were conducted using Chi-square tests, and adjusted analyses were conducted using multivariate logistic regression, controlling for patient age, urbanicity, local median income (<$40,000, $40,000-$80,000, or >$80,000), region (top four CMS regions by enrollment versus all other regions), if the designated lumpectomy facility's name implied an academic affiliation, and if the designated lumpectomy facility was a hospital. There were 4,689 patients meeting inclusion criteria in 2019 and 4,383 in 2020, for a total of 9,072. In 2019, 47.1% (2,208/4,689) of patients had an RT order following lumpectomy, versus 44.6% (1,953/4,383) in 2020, a significant difference (P=0.02). Of the patients receiving RT orders meeting the definition of HF or CF, 76.3% (1,475/1,933) of orders in 2019 were for HF, and 80.5% (1,383/1,719) of orders in 2020 were for HF, a significant difference (P<0.01). Adjusted analysis found that patients in 2020 were at significantly reduced odds (OR: 0.91;95% CI: 0.83-0.99) of receiving an order for RT following lumpectomy, and among orders meeting the definition of HF or CF, there were significantly increased odds that the order was for HF (OR: 1.29;95% CI: 1.10-1.52). Patient age, region, and receipt of an order for treatment at an academic facility were significantly associated with receipt of an order for RT. Patient age, local median income, and region were all significantly associated with whether CF versus HF RT was ordered. In the population examined, physicians were less likely to order RT following lumpectomy in 2020 than in 2019, and if they did, were more likely to order HF in 2020 than in 2019. This suggests that physician ordering became more conservative in response to the pandemic. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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FAST-Forward trial reported that five-fraction radiotherapy (5fx-RT) schedule with 26 Gy in adjuvant setting after breast-conserving surgery for early-breast cancer (BC) was non-inferior to the standard hypo-fx (SHfx) schedule with 40 Gy in 15fx in terms of local tumor control. Since the COVID-19 pandemic started RT expert groups encouraged professionals to implement hypo-fx schedules in order to decrease visits of patients to hospitals. The aim of this study is to help radiation oncologists choose the most suitable patients for 5fx-RT schedule according to anatomical features. Between March 2020 and December 2021, 239 patients suitable for 5fx-RT schedule were referred to our department. Prescribed RT dose was 26 Gy in 5fx to the whole breast plus a simultaneously integrated boost (SIB) up to 29 Gy to tumor bed if indicated. Patients were divided into 3 groups: Group A: Patients treated with 5fx-RT schedule that met all the FAST-Forward constraints for normal tissues;Group B: Patients treated with 5fx-RT schedule that slightly did not meet all constraints, Group C: Patients switched to SHfx schedule as they did not meet constraints in an acceptable way. For each patient, we draw an imaginary straight line connecting the medial and lateral borders of PTV in the axial slice of simulation CT where the longest anteroposterior diameter was found. From midpoint of this line, we measured the tangent distance to PTV margin and collected the data as medial-to-lateral tangent (MELT). Data was analyzed using statistical software. 150 patients were included in group A, 75 in group B and 14 in group C. The median MELT distance was: 1.91cm, 2.48cm and 3cm respectively. We found that the increase in MELT distance was significantly associated with a poorer compliance of normal tissue constraints (p<0.0001). Patient´s distribution among 3 groups for MELT distance intervals are shown in table 1. Median V8 for ipsilateral lung was: 13.1, 15.46 and 20.49% for groups A, B and C respectively. For the heart, median mean dose was: 1.06, 1.8 and 2.25 Gy for left breast cancer patients and 0.28, 0.33 and 0.48 Gy for right breast cancer patients for groups A, B and C respectively. We found a moderate positive correlation between MELT distance and dosimetric parameters assessed above (r=0.545, 0.475 and 0.418 respectively). According to laterality, for a higher MELT distance the % of left BC patients increased significantly (p=0.039). MELT distance is an easy tool that helps radiation oncologists predict which BC patients are the most suitable for 5fx-RT before RT planning begins. This could avoid delays in starting RT for patients with a high MELT distance directly planning them with the SHfx schedule. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.
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Purpose: The purpose of this study was to examine the effect of COVID-19 infection on the morbidity and mortality rates of breast cancer patients performed in the East Mediterranean region of Turkey during the COVID-19 pandemic and to share the results of those investigations. Methods: This retrospective study included all breast cancer patients that underwent surgery during the COVID-19 pandemic in the General Surgery Clinic of Adana City Training and Research Hospital, a regional pandemic hospital, between March 11, 2020 and December 25, 2020. The patients were evaluated preoperatively and postoperatively (the first 30 days) in terms of COVID-19 infection. Moreover, these patients were also evaluated in terms of admission to the hospital, length of hospital stay, and mortality due to COVID-19 infection during the follow-up period of the study. Results: Included in the study were 139 patients that underwent surgery for breast cancer during the pandemic period, with no observed mortality or morbidity associated with COVID-19 in any patient postoperatively within the first 30 days. In addition, within 121.22±70.05 days, the mean and standard deviation of the study's follow-up period, 19 patients (15.7%) were admitted to the hospital with a suspected COVID-19 infection (after the first 30 days postoperatively) and 6 of them (4.3%) returned a positive PCR test. All of the COVID-19 positive patients (6 patients, 4.3%) were hospitalised and 3 of them (2.2%) died due to the COVID-19 infection. Conclusions: Breast cancer surgery can be performed safely during the COVID-19 pandemic period after taking the necessary precautions.