The use of bioelectrical impedance spectroscopy (BIS) to detect subclinical changes potentially associated with the development of breast cancer-related lymphedema.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 89-89
Author(s):  
Frank Vicini ◽  
Douglas W. Arthur ◽  
Maureen Lyden ◽  
Chirag Shah
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Extracellular Fluid ◽  
Bioelectrical Impedance ◽  
Locoregional Therapy ◽  
Clinical Practices ◽  
Fluid Accumulation ◽  
The Mean ◽  
Breast Cancer Related Lymphedema ◽  
Clinical Changes

89 Background: The purpose of the study was to evaluate bioelectrical impedance spectroscopy's (BIS) ability to detect and monitor extracellular fluid accumulation of the upper limb as it relates to the extent of locoregional therapy for patients with breast cancer. Methods: A total of 125 patients from 4 clinical practices, with newly diagnosed breast cancer were evaluated at baseline and following locoregional procedures that could potentially affect fluid accumulation in the arm and signal the possible development of early lymphedema. In order to assess the ability of BIS to detect sub-clinical changes by treatment modality, the change in L-Dex score from baseline to measurements taken within 180 days following surgery were calculated. Results: Fifty-one patients (40.8%) underwent lumpectomy and 74 (59.2%) mastectomy; 68 patients (54.4%) underwent sentinel lymph node (SLN) sampling. Sixty-five patients underwent radiation therapy (RT) with RT patients being more likely to have undergone lumpectomy (66.2% v. 3.2%, p<0.001) and axillary dissection (41.5% v. 19.4%, p=0.04) compared with patients not receiving RT. However, no difference in the mean number of nodes sampled (7.7 v. 5.4, p=0.14) was noted for patients receiving RT compared with those not receiving RT. Patients receiving RT had a significantly increased change in L-Dex score (0.8 v. -2.5, p=0.03) compared with those patients not receiving RT. For all patients, ALND was associated with a significantly increased change in L-Dex score (5.0 v. 0.3, p=0.003) compared with SLN. When stratifying by the number of nodes removed, a statistically significant increase in the change in L-Dex score was noted (0.4 v. 0.4 v. 4.3 v. 6.4, p=0.04) for 0-3, 4-6, 7-10, and greater than 10 lymph nodes removed. Conclusions: In this limited analysis, L-Dex scores paralleled the extent of axillary sampling and the addition of radiation therapy; these results suggest that BIS can be used to monitor patients for the early onset of edema as differences emerged within 180 days of surgery.

The use of bioimpedance spectroscopy to monitor response to treatment interventions with breast cancer-related lymphedema.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 138-138
Author(s):  
Chirag Shah ◽  
Frank Vicini ◽  
Peter D. Beitsch ◽  
Beth Anglin ◽  
Alison Lisa Laidley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Extracellular Fluid ◽  
Response To Therapy ◽  
Response To Treatment ◽  
Bioimpedance Spectroscopy ◽  
Post Surgery ◽  
Before And After ◽  
The Mean ◽  
Breast Cancer Related Lymphedema ◽  
Pre Treatment

138 Background: Currently, limited tools are available to assess response to therapy in patients with breast cancer related lymphedema (BCRL). The purpose of this study was to perform an exploratory analysis to determine if, in clinical settings, bioimpedance spectroscopy (BIS) can detect changes in extracellular fluid volume in response to treatment of BCRL. Methods: Three centers that had experience with BIS (L-Dex U400, ImpediMed Limited, Brisbane, Australia) provided retrospective data on 50 patients with breast cancer who were evaluated with BIS at baseline and following loco-regional procedures. Patients had a pre-surgical L-Dex measurement as well as at least 2 post-surgical measurements (before and after BCRL intervention). Decisions regarding intervention were made by physicians with no L-Dex score cut-off utilized. An analysis was performed comparing changes in L-Dex scores for those patients undergoing treatment for BCRL (n=13) versus those not undergoing intervention (n=37). A second analysis was also performed on all patients with elevated L-Dex scores compared to baseline prior to intervention (n=32). Results: The mean age was 54 years old. Fifty four percent of patients underwent SLN biopsy with a mean of 7.9 nodes removed. The mean change in L-Dex score from baseline (pre-treatment) to the first post-surgical L-Dex score measurement was 3.3 +/- 6.8. When comparing the cohort treated for BCRL to those not treated, L-Dex scores were significantly reduced (-4.3 v. 0.1, p=0.005) following intervention. For the subset of patients with elevated L-Dex scores post-surgery, the change in L-Dex score following BCRL intervention was significantly reduced (-5.8 v. 0.1, p=0.001) compared with those observed. Conclusions: These results confirm that BIS can detect increases in L-Dex scores following breast surgery and can also detect reductions in L-Dex scores following intervention for early onset lymphedema. These results demonstrate that BIS has significant clinical utility as it can be used to monitor patients with early BCRL who undergo intervention and to follow these patients (through serial measurements) to document their short and long-term response to these treatments.

scholarly journals Erratum to: Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis

2017 ◽  
Vol 162 (2) ◽  
pp. 217-217
Author(s):  
Simona F. Shaitelman ◽  
Yi-Ju Chiang ◽  
Kate D. Griffin ◽  
Sarah M. De Snyder ◽  
Benjamin D. Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Radiation Therapy ◽  
Meta Analysis ◽  
Therapy Targets ◽  
Breast Cancer Related Lymphedema

scholarly journals The Impact of Locoregional Therapy in Nonmetastatic Inflammatory Breast Cancer: A Population-Based Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Mahvish Muzaffar ◽  
Helen M. Johnson ◽  
Nasreen A. Vohra ◽  
Darla Liles ◽  
Jan H. Wong
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Inflammatory Breast Cancer ◽  
Proportional Hazards Model ◽  
Treatment Algorithm ◽  
Cox Proportional Hazards Model ◽  
Partial Mastectomy ◽  
Locoregional Therapy ◽  
Total Mastectomy ◽  
The Impact

Background.Inflammatory breast cancer (IBC) is a rare but most aggressive breast cancer subtype. The impact of locoregional therapy on survival in IBC is controversial.Methods.Patients with nonmetastatic IBC between 1988 and 2013 were identified in the Surveillance, Epidemiology, and End Results (SEER) registry.Results.We identified 7,304 female patients with nonmetastatic inflammatory breast cancer (IBC) who underwent primary tumor surgery. Most patients underwent total mastectomy with only 409 (5.6%) undergoing a partial mastectomy. In addition, 4,559 (62.4%) were also treated with radiation therapy. The patients who underwent mastectomy had better survival compared to partial mastectomy (49% versus 43%,p= 0.003). The addition of radiation therapy was also associated with improved 5-year survival (55% versus 40%,p< 0.001). Multivariate analysis showed that black race HR (1.22, 95% CI 1.18–1.35), ER negative status (HR 1.22, 95% CI 1.16–1.28), and higher grade (HR 1.14, 95% CI 1.07–1.20) were associated with poor outcome. Cox proportional hazards model showed that total mastectomy (HR 0.75, 95% CI 0.65–0.85) and radiation (HR 0.64, 95% CI 0.61–0.69) were associated with improved survival.Conclusions. Optimal locoregional therapy for women with nonmetastatic IBC continues to be mastectomy and radiation therapy. These data reinforce the prevailing treatment algorithm for nonmetastatic IBC.

scholarly journals Dose Volume Relationship in Estimating Cardiac Doses in Breast Cancer Radiotherapy

2020 ◽  
Author(s):  
Lucy Pattanayak ◽  
Swodeep Mohanty ◽  
Deepak Kumar Sahu ◽  
Tapas Kumar Dash ◽  
Itishree Priyadarsini
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Conformal Radiotherapy ◽  
Free Breathing ◽  
P Value ◽  
Carcinoma Breast ◽  
Heart Dose ◽  
Cardiac Dose ◽  
The Mean ◽  
Mean Heart Dose

Introduction: Radiation therapy is an integral part of adjuvant treatment for breast cancer which reduces local recurrence and significantly increases survival. But, radiation therapy also has the propensity to increase cardiac morbidity and mortality due to dose received by the heart which is more in left-sided breast cancer. Mean Heart dose and Maximum Heart Distance (MHD) are two parameters to study dose received by the heart. Aim: The purpose of this study was to determine individual doses received by the heart and to correlate MHD with the mean heart dose received by heart in carcinoma breast patients receiving radiotherapy. Materials and Methods: Ninety patients of histologically proven carcinoma breast who attended the Department of Radiotherapy, Acharya Harihar Regional Cancer, Cuttack from January 2017 to January 2019 were selected for a prospective observational study. All patients were treated with 3D Conformal Radiotherapy technique using free breathing multi slice Computed Tomography (CT) scans to contour target and vital organs. Parallel opposed tangential treatment plans were generated for each patient. Individual dose received by the heart and MHD was assessed for each case. SPSS version 21 used for statistical analysis. The Spearman’s Rho test was used for correlation of MHD with Mean heart dose. The Mann-Whitney U test was used for comparing mean of MHD in left-sided and right-sided breast cancer. The Independent t-test was used for comparing means of Mean heart dose in left-sided and right-sided breast cancer. A p-value <0.05 was considered as statistically significant. Results: The Mean Heart Dose was 4.63 Gy for left-sided breast carcinoma patients and 0.846 Gy for right-sided breast cancer and there was a significant difference (p<0.001). Mean MHD for left-sided breast cancer was 2.974 cm while for right-sided it was 0.017 cm, the difference was statistically significant (p-value <0.001). MHD also correlated positively with Mean Heart Dose with correlation coefficient of 0.849 and p-value <0.001. Conclusion: MHD and Mean Heart dose were significantly higher in left-sided breast cancer receiving radiotherapy. MHD was also found to be positively related to Mean Heart dose and therefore found to be an important predictor of cardiac dose. For right-sided breast carcinoma receiving radiotherapy, free breathing technique using 3-Dimensional Conformal Radiotherapy (3DCRT) will suffice in terms of cardiac dose.

Breast Cancer-Related Lymphedema: a Review of Risk Factors, Radiation Therapy Contribution, and Management Strategies

2020 ◽  
Vol 12 (4) ◽  
pp. 305-316
Author(s):  
Tracy M. Nassif ◽  
Cheryl L. Brunelle ◽  
Tessa C. Gillespie ◽  
Madison C. Bernstein ◽  
Loryn K. Bucci ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Radiation Therapy ◽  
Management Strategies ◽  
Breast Cancer Related Lymphedema

Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

2020 ◽  
pp. 1-15
Author(s):  
Ernest Osei ◽  
Susan Dang ◽  
Johnson Darko ◽  
Katrina Fleming ◽  
Ramana Rachakonda
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Chest Wall ◽  
Treatment Plan ◽  
Breath Hold ◽  
Adjuvant Radiation ◽  
Node Positive ◽  
Treatment Plans ◽  
The Mean

Abstract Background: Breast cancer is the most commonly diagnosed cancer among women and the second leading cause of cancer-related death in Canadian women. Surgery is often the first line of treatment for low-risk early stage patients, followed by adjuvant radiation therapy to reduce the risk of local recurrence and prevent metastasis after lumpectomy or mastectomy. For high-risk patients with node positive disease or are at greater risk of nodal metastasis, radiation therapy will involve treatment of the intact breast or chest-wall as well as the regional lymph nodes. Materials and methods: We retrospectively evaluated the treatment plans of 354 patients with breast cancer with nodes positive or were at high risk of nodal involvement treated at our cancer centre. All patients were treated with a prescription dose of 50 Gy in 25 fractions to the intact breast or chest-wall and 50 Gy in 25 fractions to the supraclavicular region and, based on patient suitability and tolerance, were treated either using the deep inspiration breath hold (DIBH) or free-breathing (FB) techniques. Results: Based on patient suitability and tolerance, 130 (36·7%) patients were treated with DIBH and 224 (63·3%) with FB techniques. There were 169 (47·7%) patients treated with intact breast, whereas 185 (52·3%) were treated for post-mastectomy chest-wall. The mean PTV_eval V92%, V95%, V100% and V105% for all patients are 99·4 ± 0·7, 97·6 ± 1·6, 74·8 ± 7·9 and 1·5 ± 3·2%, respectively. The mean ipsilateral lung V10Gy, V20Gy and V30Gy are 30·0 ± 5·3, 22·4 ± 4·7 and 18·4 ± 4·3% for intact breast and 30·9 ± 5·8, 23·5 ± 5·4 and 19·4 ± 5·0% for post-mastectomy patients with FB, respectively. The corresponding values for patients treated using DIBH are 26·3 ± 5·9, 18·9 ± 5·0 and 15·6 ± 4·7% for intact breast and 27·5 ± 6·5, 20·6 ± 5·7 and 17·1 ± 5·2% for post-mastectomy patients, respectively. The mean heart V10Gy, V20Gy, is 1·8 ± 1·7, 0·9 ± 1·0 for intact breast and 3·1 ± 2·2, 1·7 ± 1·6 for post-mastectomy patients with FB, respectively. The corresponding values with the DIBH are 0·5 ± 0·7, 0·1 ± 0·4 for intact breast and 1·1 ± 1·4, 0·4 ± 0·7 for post-mastectomy patients, respectively. Conclusion: The use of 3 and/or 4 field hybrid intensity-modulated radiation therapy technique for radiation therapy of high-risk node positive breast cancer patients provides an efficient and reliable method for achieving superior dose uniformity, conformity and homogeneity in the breast or post-mastectomy chest-wall volume with minimal doses to the organs at risk. The development and implementation of a consistent treatment plan acceptability criteria in radiotherapy programmes would establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that would reduce significant variations in the acceptability of treatment plans.

Feasibility of commercially available underwear during radiation therapy for breast cancer: build-up and surface dose measurements

2021 ◽  
pp. 1-2
Author(s):  
Yukihiro Hama
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Phantom Study ◽  
Surface Dose ◽  
Receive Radiation Therapy ◽  
Dose Increase ◽  
Increase Rate ◽  
The Mean ◽  
Skin Doses ◽  
Dose Measurements

Abstract Aim: When patients receive radiation therapy for breast cancer, they need to take off their underwear to avoid build-up effects. However, it is a mental burden for female patients to take off their underwear at every fraction of radiation therapy. The purpose of this study was to investigate whether commercially available thin underwear can be worn during radiation therapy for breast cancer. Materials and methods: In this phantom study, we investigated whether commercially available underwear can be worn during radiation therapy for breast cancer using six thin non-disposable brassieres and one disposable paper brassiere. The dose increase rate (ΔD) was calculated by measuring skin doses with or without each brassiere. Results: The mean ΔD values of six non-disposable brassieres were 13.5% (9.0–21.8%), whereas that of disposable ones was 2.0%. Findings: Due to the risk of excessive radiation to the skin, wearing commercially available underwear is not recommended during radiation therapy for breast cancer, but a thin disposable paper brassiere may be safe to be used.

scholarly journals Reference values of bioelectrical impedance analysis for detecting breast cancer-related lymphedema

Medicine ◽  
2018 ◽  
Vol 97 (44) ◽  
pp. e12945 ◽  
Author(s):  
Minji Jung ◽  
Jae Yong Jeon ◽  
Gi Jeong Yun ◽  
Seoyon Yang ◽  
Sara Kwon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Reference Values ◽  
Bioelectrical Impedance Analysis ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Breast Cancer Related Lymphedema

scholarly journals Who Will Continuously Depend on Compression to Control Persistent or Progressive Breast Cancer-Related Lymphedema Despite 2 Years of Conservative Care?

2020 ◽  
Vol 9 (11) ◽  
pp. 3640
Author(s):  
Chul Jung ◽  
JaYoung Kim ◽  
Yu Jin Seo ◽  
Kyeong Joo Song ◽  
Ma. Nessa Gelvosa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Interstitial Fluid ◽  
Early Stage ◽  
Early Prediction ◽  
Fluid Accumulation ◽  
Conservative Care ◽  
Delayed Onset ◽  
History Of ◽  
Breast Cancer Related Lymphedema

Background: When a patient with breast cancer-related lymphedema (BCRL) depends on continuous compression management, that is, when interstitial fluid accumulation is continuously ongoing, surgical treatment should be considered. Physiologic surgery is considered more effective for early-stage lymphedema. The purpose of this study was to identify predictors of patients with BCRL who will be compression-dependent despite 2 years of conservative care. Methods: This study included patients with BCRL who followed up for 2 years. Patients were classified into two groups (compression-dependent vs. compression-free). We identified the proportion of compression-dependent patients and predictors of compression dependence. Results: Among 208 patients, 125 (60.1%) were classified into the compression-dependent group. Compression dependence was higher in patients with direct radiotherapy to the lymph nodes (LNs), those with five or more LNs resections, and those with BCRL occurring at least 1 year after surgery. Conclusions: BCRL patients with direct radiotherapy to the LNs, extensive LN dissection, and delayed onset may be compression-dependent despite 2 years of conservative care. Initially moderate to severe BCRL and a history of cellulitis also seem to be strongly associated with compression dependence. Our results allow for the early prediction of compression-dependent patients who should be considered for physiologic surgery.

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