Immediate breast reconstruction-impact on radiation management.

Breast reconstruction is an option for women undergoing modified radical mastectomy due to a diagnosis of breast cancer. In certain patients, breast reconstruction is performed by insertion of a temporary tissue expander prior to the placement of permanent breast implants. Some of these patients, following mastectomy, may require chest wall irradiation to prevent loco regional relapse. The compatibility of radiation and tissue expanders placed in the chest wall is of major concern to the radiation oncologist. Clinically undetectable changes can occur in the tissue expander during the course of radiation therapy. This can lead to radiation treatment set-up changes, variation in tissue expansion resulting in unwanted cosmesis, and deviation from the prescribed radiation dose leading to over and/or under dosing of tumor burden. At Howard University hospital, a CT scan was utilized to evaluate the status of the temporary tissue expander during radiation treatment to enable us to prevent radiation treatment related complications resulting from dosimetric discrepancies. CT images of the tissue expander were obtained through the course of treatment. To avoid a 'geographic miss' the amount of fluid injected into the tissue expander was kept constant following patient's satisfaction with the size of the breast mound. The CT scans allowed better visualization of the prosthesis and its relation to the surrounding tumor bed. This technique ensured that anatomical changes occurring during radiation treatment, if any, were minimized. Repeated dosimetry evaluations showed no changes to the prescribed dose distribution. A CT of the reconstructed breast provides an important quality control. Further studies with greater number of patients are required for confirming this impact on radiation treatment.

Retrospective analysis of breast cancer among young African American females.

PURPOSE: To evaluate the patterns of failure, relapse-free survival and overall survival among African American breast cancer patients younger than 40 years. PATIENTS AND METHODS: We retrospectively reviewed the records of 124 African American breast cancer patients younger than 40 years who were registered with the Howard University Cancer Center Database between 1990 and 1999. One hundred and six patients were found eligible and subsequently included in this analysis. Ninety-eight percent of these patients were pre-menopausal and 30% had a documented family history of breast cancer. Patient distribution per stage is as follows: 19%, stage I; 61%, stage II; 16%, stage III and 4%, stage IV. Surgery was a component of treatment for 98% of the patients. Forty-six percent underwent mastectomy, 47% had breast-conserving surgery and 5% underwent biopsy only. Fifty-nine percent of the patients received adjuvant radiation and 56% were also treated with adjuvant chemotherapy. Median follow-up was 35 months (range of 4-126 months). RESULTS: Locoregional only first failure rate was 6% while systemic failure occurred in 20% of these patients. Among 17 stage III patients, 50% developed distant metastasis. The 5-year overall survival for these patients was 73%, with relapse-free survival being numerically similar. Patients with early stage disease, stages I and II, were noted to have 5-year overall survival rates of 100 and 78-83%, respectively. Those who presented with stage III or stage IV disease had dismal 5-year overall survival rates of 25-29 and 0%, respectively. Multivariate analysis using the Cox proportional hazard model identified the presence of metastasis as a factor that significantly affects survival in these young African American females. CONCLUSION: These results show that African American females younger than 40 years with early stage breast cancer have local control and survival rates comparable to that of the general population. In contrast, young African American females in this study, with stages III and IV disease, appear to suffer a worse prognosis despite standard therapy. A larger series of young African American females with breast cancer, followed for a longer period of time, will be required to confirm a negative trend in survival.