scholarly journals Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation

2021 ◽  
Author(s):  
X. Li ◽  
J. Sanz ◽  
N. Argudo ◽  
M. Vernet-Tomas ◽  
N. Rodríguez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Partial Breast Irradiation ◽  
X Rays ◽  
Breast Irradiation ◽  
Intraoperative Irradiation ◽  
Patient Reported ◽  
First Results ◽  
Good Cosmesis

Abstract Purpose To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. Materials and methods Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. Results Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. Conclusion IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

scholarly journals Accelerated partial breast irradiation by brachytherapy: present evidence and future developments

2020 ◽  
Vol 50 (7) ◽  
pp. 743-752
Author(s):  
Razvan Galalae ◽  
Jean-Michel Hannoun-Lévi
Keyword(s):  
Alternative Methods ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Radiation Toxicity ◽  
X Rays ◽  
Breast Irradiation ◽  
Patient Reported ◽  
Conventionally Fractionated ◽  
3D Crt

Abstract Accelerated partial breast irradiation (APBI) delivers a short course of adjuvant RT after breast conserving surgery to only a limited part of the breast where the tumor was located. This procedure requires expertise, good communication, and close collaboration between specialized surgeons and attending radiation oncologists with adequate intraoperative tumor bed clip marking. However, APBI offers several intrinsic benefits when compared with whole breast irradiation (WBIR) including reduced treatment time (1 versus 4–6 weeks) and better sparing of surrounding healthy tissues. The present publication reviews the APBI level 1-evidence provided with various radiation techniques supplemented by long-term experience obtained from large multi-institutional phase II studies. Additionally, it offers an outlook on recent research with ultra-short or single-fraction APBI courses and new brachytherapy sources. Mature data from three randomized controlled trials (RCTs) clearly prove the noninferiority of APBI with ‘only two techniques—1/MIBT (multicatheter interstitial brachytherapy) (two trials) and 2/intensity modulated radiotherapy (one trial)’—in terms of equivalent local control/overall survival to the previous standard ‘conventionally fractionated WBIR’. However, MIBT-APBI techniques were superior in both toxicity and patient-reported outcomes (PROs) versus WBIR at long-term follow-up. Currently, in RCT-setting, alternative APBI techniques such as intraoperative electrons, 50-kV x-rays and three-dimensional conformal external beam radiotherapy (3D-CRT) failed to demonstrate noninferiority to conventionally fractionated WBIR. However, 3D-CRT-APBI compared noninferior to hypo-fractionated WBIR in preventing ipsilateral breast tumor recurrence (randomized RAPID-trial) but was associated with a higher rate of late radiation toxicity. Ultimately, MIBT remains the only APBI modality with noninferior survival/superior toxicity/PROs at 10-years and therefore should be prioritized over alternative methods in patients with breast cancer considered at low-risk for local recurrence according to recent international guidelines.

The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program

2019 ◽  
Vol 36 (10) ◽  
pp. 864-870 ◽  
Author(s):  
Victoria Reiser ◽  
Margaret Rosenzweig ◽  
Ann Welsh ◽  
Dianxu Ren ◽  
Barbara Usher
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Social Service ◽  
Patient Reported Outcomes ◽  
Metastatic Breast ◽  
Well Being ◽  
Mean Difference ◽  
Generalized Anxiety ◽  
Supportive Services ◽  
Patient Reported

Background: Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. Objective: This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. Design: An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. Setting/Participants: Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. Measurements: Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. Results: Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of −0.7 (95% CI: −1.3498 to −0.0570), P = .03. Conclusions: Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.

Patient-reported outcomes (PROs) in NRG oncology/NSABP B-39/RTOG 0413: A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) in stage 0, I, or II breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 508-508 ◽  
Author(s):  
Patricia A. Ganz ◽  
Reena S. Cecchini ◽  
Julia R. White ◽  
Frank Vicini ◽  
Thomas B. Julian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Outcomes ◽  
Pain Scale ◽  
Local Tumor Control ◽  
Phase Iii ◽  
Partial Breast Irradiation ◽  
Tumor Control ◽  
Breast Irradiation ◽  
Related Symptom ◽  
Patient Reported

508 Background: PBI is an alternative to WBI, with potentially greater therapy (tx) compliance, and better integration with chemotherapy (CTX). NSABP B-39/RTOG 0413 clinical outcome results from 2018 did not show equivalence of PBI to WBI in local tumor control; PBI was statistically inferior, but with clinically small differences. PBI may be an acceptable alternative to WBI for some women. Understanding cosmesis and quality of life (QOL) treatment outcomes is important. Methods: B-39/0413 included a prospective QOL substudy with PRO evaluation of breast cancer treatment outcomes (cosmesis, function, pain) and fatigue using BCTOS and SF-36 vitality scales. Secondary QOL parameters included treatment related symptoms, perceived convenience of care, and the BPI pain scale. The study sample was stratified by CTX or not, as CTX is given before WBI but after PBI. PRO assessments occurred before randomization, the last day of adjuvant tx [CTX or radiation], 4 wks later, and 6, 12, 24, and 36 mo later. Primary aims included comparisons of change in fatigue from baseline to end of tx and equivalency of change in cosmesis from baseline to 36 mo for PBI v WBI. Separate analyses were done for CTX and non-CTX pts, controlling for axillary dissection. Each comparison used α=0.0125. Planned sample size was 964. Results: From 3-23-05 to 5-27-09, 975 pts were enrolled in the PRO study; 950 had follow-up data. 504 did not receive CTX and 446 received CTX. In non-CTX pts, PBI had less fatigue (p=0.011) and did not meet criteria for cosmesis equivalence (97.5% CI, -0.02 to 0.22; ∆=0.20). In CTX pts, PBI had worse fatigue (p=0.011) and equivalent cosmesis to WBI (97.5% CI, -0.09 to 0.21; ∆=0.24). In both groups, PBI pts reported less pain at end of tx. In non-CTX pts, PBI had more pain at 36 mo but in CTX pts, there was no difference. Convenience of care and treatment related symptom outcomes will be presented. Conclusions: In non-CTX pts, PBI is more convenient with less fatigue and slightly poorer cosmesis at 36 mo. Cosmesis was equivalent at 36 mo in CTX pts. Support: U10CA180868, -180822, UG1CA189867. Clinical trial information: NCT00103181.

scholarly journals The impact of age on patient-reported outcomes after oncoplastic versus conventional breast cancer surgery

2021 ◽  
Author(s):  
M. Ritter ◽  
B. M. Ling ◽  
I. Oberhauser ◽  
G. Montagna ◽  
L. Zehnpfennig ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Breast Surgery ◽  
Perforator Flap ◽  
Well Being ◽  
Breast Cancer Surgery ◽  
Oncoplastic Breast Surgery ◽  
Age Related ◽  
Patient Reported ◽  
The Impact

Abstract Purpose Some studies have indicated age-specific differences in quality of life (QoL) among breast cancer (BC) patients. The aim of this study was to compare patient-reported outcomes after conventional and oncoplastic breast surgery in two distinct age groups. Methods Patients who underwent oncoplastic and conventional breast surgery for stage I-III BC, between 6/2011–3/2019, were identified from a prospectively maintained database. QoL was prospectively evaluated using the Breast-Q questionnaire. Comparisons were made between women < 60 and ≥ 60 years. Results One hundred thirty-three patients were included. Seventy-three of them were ≥ 60 years old. 15 (20.5%) of them received a round-block technique (RB) / oncoplastic breast-conserving surgeries (OBCS), 10 (13.7%) underwent nipple-sparing mastectomies (NSM) with deep inferior epigastric perforator flap (DIEP) reconstruction, 23 (31.5%) underwent conventional breast-conserving surgeries (CBCS), and 25 (34.2%) received total mastectomy (TM). Sixty patients were younger than 60 years, 15 (25%) thereof received RB/OBCS, 22 (36.7%) NSM/DIEP, 17 (28.3%) CBCS, and 6 (10%) TM. Physical well-being chest and psychosocial well-being scores were significantly higher in older women compared to younger patients (88.05 vs 75.10; p < 0.001 and 90.46 vs 80.71; p = 0.002, respectively). In multivariate linear regression, longer time intervals had a significantly positive effect on the scales Physical Well-being Chest (p = 0.014) and Satisfaction with Breasts (p = 0.004). No significant results were found concerning different types of surgery. Conclusion Our findings indicate that age does have a relevant impact on postoperative QoL. Patient counseling should include age-related considerations, however, age itself cannot be regarded as a contraindication for oncoplastic surgery.

Long-Term Results of the TARGIT-A Trial: More Questions than Answers

Breast Care ◽  
2021 ◽  
pp. 1-4
Author(s):  
Marc D. Piroth ◽  
Vratislav Strnad ◽  
David Krug ◽  
Gerd Fastner ◽  
René Baumann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Intraoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Long Term Results ◽  
Partial Breast Irradiation ◽  
X Rays ◽  
Breast Irradiation ◽  
Number Of Patients

<b><i>Background:</i></b> During the last decade, partial breast irradiation (PBI) has gained traction as a relevant treatment option for patients with early-stage low-risk breast cancer after breast-conserving surgery. The TARGIT-A prospective randomized trial compared a “risk-adapted” intraoperative radiotherapy (IORT) approach with 50-kv X-rays (INTRABEAM®) as the PBI followed by optional whole-breast irradiation (WBI) and conventional adjuvant WBI in terms of observed 5-year in-breast recurrence rates. Recently, long-term data were published. Since the first publication of the TARGIT-A trial, a broad debate has been emerged regarding several uncertainties and limitations associated with data analysis and interpretation. Our main objective was to summarize the data, with an emphasis on the updated report and the resulting implications. <b><i>Summary:</i></b> From our point of view, the previously unresolved questions still remain and more have been added, especially with regard to the study design, a change in the primary outcome measure, the significant number of patients lost to follow-up, and the lack of a subgroup analysis according to risk factors and treatment specifications. <b><i>Key Message:</i></b> Taking into account the abovementioned limitations of the recently published long-term results of the TARGIT-A trial, the German Society of Radiation Oncology (DEGRO) Breast Cancer Expert Panel adheres to its recently published recommendations on PBI: “the 50-kV system (INTRABEAM) cannot be recommended for routine adjuvant PBI treatment after breast-conserving surgery.”

Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy

2016 ◽  
Vol 34 (13) ◽  
pp. 1518-1527 ◽  
Author(s):  
E. Shelley Hwang ◽  
Tracie D. Locklear ◽  
Christel N. Rushing ◽  
Greg Samsa ◽  
Amy P. Abernethy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Prophylactic Mastectomy ◽  
Multivariable Analysis ◽  
Contralateral Prophylactic Mastectomy ◽  
Well Being ◽  
Breast Cancer Surgery ◽  
Patient Reported ◽  
History Of

Purpose The rate of contralateral prophylactic mastectomies (CPMs) continues to rise, although there is little evidence to support improvement in quality of life (QOL) with CPM. We sought to ascertain whether patient-reported outcomes and, more specifically, QOL differed according to receipt of CPM. Methods Volunteers recruited from the Army of Women with a history of breast cancer surgery took an electronically administered survey, which included the BREAST-Q, a well-validated breast surgery outcomes patient-reporting tool, and demographic and treatment-related questions. Descriptive statistics, hypothesis testing, and regression analysis were used to evaluate the association of CPM with four BREAST-Q QOL domains. Results A total of 7,619 women completed questionnaires; of those eligible, 3,977 had a mastectomy and 1,598 reported receipt of CPM. Women undergoing CPM were younger than those who did not choose CPM. On unadjusted analysis, mean breast satisfaction was higher in the CPM group (60.4 v 57.9, P < .001) and mean physical well-being was lower in the CPM group (74.6 v 76.6, P < .001). On multivariable analysis, the CPM group continued to report higher breast satisfaction (P = .046) and psychosocial well-being (P = .017), but no difference was reported in the no-CPM group in the other QOL domains. Conclusion Choice for CPM was associated with an improvement in breast satisfaction and psychosocial well-being. However, the magnitude of the effect may be too small to be clinically meaningful. Such patient-reported outcomes data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.

scholarly journals Sexual abuse in childhood and postoperative depression in women with breast cancer who opt for immediate reconstruction after mastectomy

2011 ◽  
Vol 93 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Louise Clark ◽  
Christopher Holcombe ◽  
Jonathan Hill ◽  
Margorit Rita Krespi-Boothby ◽  
Jean Fisher ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Sexual Abuse ◽  
Child Abuse ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Self Report ◽  
Immediate Reconstruction ◽  
Patient Reported ◽  
History Of

INTRODUCTION Breast reconstruction is routinely offered to women who undergo mastectomy for breast cancer. However, patient-reported outcomes are mixed. Child abuse has enduring effects on adults’ well-being and body image. As part of a study into damaging effects of abuse on adjustment to breast cancer, we examined: (i) whether women with history of abuse would be more likely than other women to opt for reconstruction; and (ii) whether mood problems in women opting for reconstruction can be explained by greater prevalence of abuse. PATIENTS AND METHODS We recruited 355 women within 2-4 days after surgery for primary breast cancer; 104 had mastectomy alone and 29 opted for reconstruction. Using standardised questionnaires, women self-reported emotional distress and recollections of childhood sexual abuse. Self-report of distress was repeated 12 months later. RESULTS Women who had reconstruction were younger than those who did not. Controlling for this, they reported greater prevalence of abuse and more distress than those having mastectomy alone. They were also more depressed postoperatively, and this effect remained significant after controlling for abuse. CONCLUSIONS One interpretation of these findings is that history of abuse influences women's decisions about responding to the threat of mastectomy, but it is premature to draw inferences for practice until the findings are replicated. If they are replicated, it will be important to recognise increased vulnerability of some patients who choose reconstruction. Studying the characteristics and needs of women who opt for immediate reconstruction and examining the implications for women's adjustment should be a priority for research.

Accelerated partial breast irradiation with interstitial brachytherapy as the sole modality of radiation for women with low risk early stage breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10661-10661 ◽  
Author(s):  
A. N. Budrukkar ◽  
R. Sarin ◽  
R. Jalali ◽  
R. Badwe ◽  
V. Parmar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Local Control ◽  
Interstitial Brachytherapy ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
High Dose ◽  
X Rays ◽  
Breast Irradiation

10661 Purpose: The aim of the study is to evaluate the safety and feasibility of radical brachytherapy for accelerated partial breast irradiation (APBI) and to study the outcome with respect to local control and survival. Materials and Methods: During May 2000 to December 2004, 115 women participated in the ongoing prospective study of APBI using interstitial brachytherapy as the sole modality of radiation for early breast cancer. Women with age > 40 years, single tumour up to 3 cm without diffuse microcalcification and clinically negative axilla were considered suitable. Brachytherapy was done either intraoperatively during the breast conserving surgery or postoperatively using 2–4 planes. Tumor bed demarcation was done with radiopaque clips placed during surgery, CT scans, ultrasonography and/or fluoroscopy. Cavity with 1cm margin was treated based on orthogonal pair of X rays to a dose of 34 Gy in 10 fractions over 1 week with twice daily fractionation using high dose rate iridium source. Results: Implant was done postoperatively in 35 patients while in remaining patients it was done intraoperatively. Implant procedure was tolerated well by all the patients. In 8 patients only 3 or 4 fractions of HDR Brachytherapy were delivered and this was followed by 45 Gy/25 # whole breast radiation therapy for following reasons: positive nodes (4), EIC positive (3) and poor implant coverage (1). At a median follow up of 23 months, the actuarial local control rate is 100%. Three year actuarial disease free survival is 93% while the overall survival is 100%. Complications included fat necrosis in 5 and wound gape in 4 patients. Cosmesis was good to excellent in 60% of the patients. Conclusion: In this ongoing prospective study, APBI using radical interstitial implant was well tolerated and appears to be safe and feasible in appropriately selected patients. Further follow up is needed for confirm the long term safety of the procedure. No significant financial relationships to disclose.

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