Factors influencing a woman’s choice to undergo breast-conserving surgery versus modified radical mastectomy

Purpose: The aim of this study is to develop a practicable automatic clinical target volume (CTV) delineation method for radiotherapy of breast cancer after modified radical mastectomy.Methods: Unlike breast conserving surgery, the radiotherapy CTV for modified radical mastectomy involves several regions, including CTV in the chest wall (CTVcw), supra- and infra-clavicular region (CTVsc), and internal mammary lymphatic region (CTVim). For accurate and efficient segmentation of the CTVs in radiotherapy of breast cancer after modified radical mastectomy, a multi-scale convolutional neural network with an orientation attention mechanism is proposed to capture the corresponding features in different perception fields. A channel-specific local Dice loss, alongside several data augmentation methods, is also designed specifically to stabilize the model training and improve the generalization performance of the model. The segmentation performance is quantitatively evaluated by statistical metrics and qualitatively evaluated by clinicians in terms of consistency and time efficiency.Results: The proposed method is trained and evaluated on the self-collected dataset, which contains 110 computed tomography scans from patients with breast cancer who underwent modified mastectomy. The experimental results show that the proposed segmentation method achieved superior performance in terms of Dice similarity coefficient (DSC), Hausdorff distance (HD) and Average symmetric surface distance (ASSD) compared with baseline approaches.Conclusion: Both quantitative and qualitative evaluation results demonstrated that the specifically designed method is practical and effective in automatic contouring of CTVs for radiotherapy of breast cancer after modified radical mastectomy. Clinicians can significantly save time on manual delineation while obtaining contouring results with high consistency by employing this method.

Download Full-text

Childhood And Adolescent Period Breast Cancer

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.08216 ◽

2021 ◽

Author(s):

Aysel Gül ◽

Dilek Aygın

Keyword(s):

Breast Cancer ◽

Children And Adolescents ◽

Treatment Process ◽

Radical Mastectomy ◽

Breast Conserving Surgery ◽

Mortality Rates ◽

Breast Cancers ◽

Modified Radical Mastectomy ◽

Secretory Carcinoma ◽

Adolescent Period

Objective: Breast cancer is a global public health problem which draws attention with the gradual increase in morbidity and mortality rates. Unlike adults, breast cancers in children and adolescents are rarely seen. Since the risk factors are not well defined, cancer findings are mixed with other disease findings and follow-up/treatment processes differ. As a result, childhood/adolescent breast cancers are ignored. It is stated that the prognosis of childhood and adolescent breast cancers is not good, although they are seen in a limited number of patients, the mortality rate is high and it significantly affects the life of the patient and his/her family. The main aim of this compilation is to examine the literature on the pediatric and adolescent breast cancers and the treatment process. Its secondary purpose is to increase the awareness of health professionals and the society and help to create a guideline in this regard to pediatric surgeons, and nurses. Methods: We identified 24 case reports comprising the data of 24 cases of childhood or adolescent breast cancers that were reported between 2000 and 2018. Results: Twenty-four cases (10 males, 14 females) published about breast cancer in children and adolescents were reached. Pathologies of the patients with a mean age of 12.19±4.13 have been reported as secretory carcinoma (70.8%), infiltrative secretory carcinoma (8.3%), malignant phyllodes tumor (8.3%), pleomorphic carcinoma (4.2%), invasive ductal carcinoma (4.2%), secretory adenocarcinoma (4.2%). Modified radical mastectomy was performed in 26.31% of patients with secretory carcinoma, mastectomy in 52.63%, breast-conserving surgery in 10.53%, and wide local excision in 10.53%. While 33.3% of the patients received adjuvant chemotherapy, 29.2% were given radiotherapy. Two patients had recurrence after surgery (3-17 months; median: 10 months). Three patients died due to postoperative metastases. Conclusion: Breast malignancies are relatively rare in the pediatric and adolescent period. However, mortality rates are quite significant contrary to what’s believed. In these patients, difficulties in diagnosing the disease may affect the treatment process negatively. While there isn’t a consensus about the treatment of the disease, the authors reported a wide range of treatments with different combinations of radiotherapy, chemotherapy, breast-conserving surgery, modified radical mastectomy and radical mastectomy.

Download Full-text