Postoperative Radiotherapy and the Pattern of Distant Spread in Breast Cancer

1993 ◽  
pp. 11-26 ◽  
Author(s):  
Maurice Tubiana
Keyword(s):  
Breast Cancer ◽  
Postoperative Radiotherapy ◽  
Distant Spread

scholarly journals A CROSS-SECTIONAL STUDY ON THE PREVALANCE AND RISK FACTORS OF LYMPHOEDEMA IN CARCINOMA BREAST

2017 ◽  
Vol 10 (6) ◽  
pp. 240
Author(s):  
Vishnu Gopal ◽  
Abhinabha Acharya ◽  
Vasudha Narayanaswamy ◽  
Santanu Pal
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Carcinoma ◽  
Upper Limb ◽  
Cancer Care ◽  
Postoperative Radiotherapy ◽  
Care Center ◽  
Locally Advanced ◽  
Significant Risk ◽  
Axillary Lymph

Objectives: Lymphedema of the arm is a devastating complication of breast carcinoma treatment. There is a lack of research on the risk factors and methods of preventing upper limb lymphedema after breast carcinoma treatment. The aims of the study are to identify the prevalence and risk factors for upper limb lymphedema in patients attending a tertiary cancer care center in India. Methods: 199 patients who attended the outpatient department of radiotherapy of IPGMER and SSKM, after undergoing surgical treatment for breast cancer between November 2014 to May 2016 were examined for the presence of lymphedema and its risk factors were analyzed. Lymphedema was defined as being present when there is an increase of >5% sum difference in the arm circumferences measured at different levels of both the upper limbs. Results: Of the 199 patients analyzed, 85 (42.7%) patients were found to have lymphedema. The prevalence of lymphedema was 25% in those who underwent surgery alone and 54% in those who underwent chest wall radiotherapy also. Locally advanced stage of the disease, body mass index >25 kg/m2, number of lymph nodes removed during surgery, and adjuvant radiotherapy were found to be significant risk factors for the development of lymphedema. Conclusion: Based on the results of this study, we recommend weight reduction and more judicious axillary lymph node dissection and use of postoperative radiotherapy as methods to prevent breast cancer-associated lymphedema in the tertiary cancer care centers in India.

scholarly journals Voluntary deep inspiration breath-hold reduces the heart dose without compromising the target volume coverage during radiotherapy for left-sided breast cancer

2018 ◽  
Vol 52 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Noora Al-Hammadi ◽  
Palmira Caparrotti ◽  
Carole Naim ◽  
Jillian Hayes ◽  
Katherine Rebecca Benson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Postoperative Radiotherapy ◽  
Target Volume ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Random Errors ◽  
Breast Cancer Patients ◽  
Regional Lymph Nodes ◽  
Deep Inspiration Breath Hold ◽  
Cardiac Dose

Abstract Background During radiotherapy of left-sided breast cancer, parts of the heart are irradiated, which may lead to late toxicity. We report on the experience of single institution with cardiac-sparing radiotherapy using voluntary deep inspiration breath hold (V-DIBH) and compare its dosimetric outcome with free breathing (FB) technique. Patients and methods Left-sided breast cancer patients, treated at our department with postoperative radiotherapy of breast/chest wall +/– regional lymph nodes between May 2015 and January 2017, were considered for inclusion. FB-computed tomography (CT) was obtained and dose-planning performed. Cases with cardiac V25Gy ≥ 5% or risk factors for heart disease were coached for V-DIBH. Compliant patients were included. They underwent additional CT in V-DIBH for planning, followed by V-DIBH radiotherapy. Dose volume histogram parameters for heart, lung and optimized planning target volume (OPTV) were compared between FB and BH. Treatment setup shifts and systematic and random errors for V-DIBH technique were compared with FB historic control. Results Sixty-three patients were considered for V-DIBH. Nine (14.3%) were non-compliant at coaching, leaving 54 cases for analysis. When compared with FB, V-DIBH resulted in a significant reduction of mean cardiac dose from 6.1 +/– 2.5 to 3.2 +/– 1.4 Gy (p < 0.001), maximum cardiac dose from 51.1 +/– 1.4 to 48.5 +/– 6.8 Gy (p = 0.005) and cardiac V25Gy from 8.5 +/– 4.2 to 3.2 +/– 2.5% (p < 0.001). Heart volumes receiving low (10–20 Gy) and high (30–50 Gy) doses were also significantly reduced. Mean dose to the left anterior coronary artery was 23.0 (+/– 6.7) Gy and 14.8 (+/– 7.6) Gy on FB and V-DIBH, respectively (p < 0.001). Differences between FB- and V-DIBH-derived mean lung dose (11.3 +/– 3.2 vs. 10.6 +/– 2.6 Gy), lung V20Gy (20.5 +/– 7 vs. 19.5 +/– 5.1 Gy) and V95% for the OPTV (95.6 +/– 4.1 vs. 95.2 +/– 6.3%) were non-significant. V-DIBH-derived mean shifts for initial patient setup were ≤ 2.7 mm. Random and systematic errors were ≤ 2.1 mm. These results did not differ significantly from historic FB controls. Conclusions When compared with FB, V-DIBH demonstrated high setup accuracy and enabled significant reduction of cardiac doses without compromising the target volume coverage. Differences in lung doses were non-significant.

Adequate locoregional treatment for early breast cancer may prevent secondary dissemination.

1995 ◽  
Vol 13 (12) ◽  
pp. 2869-2878 ◽  
Author(s):  
R Arriagada ◽  
L E Rutqvist ◽  
A Mattsson ◽  
A Kramar ◽  
S Rotstein
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Distant Metastasis ◽  
Preoperative Radiotherapy ◽  
Postoperative Radiotherapy ◽  
Radical Mastectomy ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients

PURPOSE To analyze different events that determine event-free survival (EFS) in a randomized trial on adjuvant radiotherapy in early breast cancer patients with more than 15 years of follow-up evaluation. PATIENTS AND METHODS The trial included 960 patients with a unilateral, operable breast cancer. Surgery consisted of a modified radical mastectomy. The trial compared three arms, as follows: preoperative radiotherapy, postoperative radiotherapy, and no adjuvant treatment. Events were analyzed by a competing-risk approach. A proportional hazards multiple regression model was used to analyze the effects of radiotherapy on the risk of distant metastasis. Similar analyses were performed separately for node-negative [N(-)] and node-positive [N(+)] patients in the two groups that did not include preoperative radiotherapy. RESULTS Radiotherapy produced a fivefold decrease of the risk of local recurrence (P < .0001). In N(+) patients, postoperative radiotherapy decreased the risk of distant dissemination (relative risk, 0.63). When local recurrence was introduced in the model as a time-dependent covariate, this factor was predictive of distant dissemination (P < .0001) and nullified the effect of postoperative radiotherapy. This finding suggests that the decrease of distant metastases was related to the prevention of local recurrence. A similar effect was found in models that used overall survival as an end point. CONCLUSION This study shows that postmastectomy radiotherapy in N(+) breast cancer patients may decrease the distant metastasis rate by preventing local recurrences and thus avoiding secondary dissemination.

scholarly journals Postoperative radiotherapy in breast cancer

BMJ ◽  
1981 ◽  
Vol 282 (6279) ◽  
pp. 1872-1872
Author(s):  
M Buttoo
Keyword(s):  
Breast Cancer ◽  
Postoperative Radiotherapy
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