Conventional radiotherapy of localized right side breast cancer after radical mastectomy: development of innovative “field in field” technique

Introduction: The aim of this paper is to study the distribution of the therapy dosage applied by a modified conventional “field in field” technique and compare it to the distribution of the dosage applied by the standard conventional technique.Methods: The study included ten patients with right side breast cancer, after they were exposed to radical mastectomy and chemotherapy. Radiotherapy dosage of TD 50 Gy in 25 fractions was applied to the anterolateral side of the right thoracic wall, with two opposite conventional tangential fields by the linear accelerator Elekta Synergy and the energy of 6 megavolts (MV). A delineation of the target volume (CTV – Clinical Target Volume) was done within conventional fields. At the XiO system for planning we included additional fields within the existing conventional fields, which was the so called “field in field” technique. On the basis of CTV the Dose Volume Histogram (DVH) was calculated for conventional and “field in field” plans. VD90%, VD95%, VD107%, VD115%, CI and HI were calculated for both techniques. Means were pared with the paired Student's t-test. The results were considered significantly different if p<0.05.Results: VD90% and VD 95% were significantly higher for the “field in field” technique. Therefore, CI also favored the “field in field” technique (p=0.02). There was no difference in VD107% and VD115% between the compared groups. Consequently, there was no statistically significant difference in HI (1.13±0.03 vs.1.13±0.03, p=0.06).Conclusion: Conventional postoperative radiotherapy of localized right side breast cancer by “field in field” technique provides excellent coverage of the target volume by radiotherapy isodose.

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Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy

BioMed Research International ◽

10.1155/2020/7131590 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jian Hu ◽

Guang Han ◽

Yu Lei ◽

Ximing Xu ◽

Wei Ge ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Volumetric Modulated Arc Therapy ◽

Intensity Modulated Radiation Therapy ◽

Radical Mastectomy ◽

Target Volume ◽

Conformity Index ◽

Breast Cancer Patients ◽

Ipsilateral Lung ◽

Significant Difference

Introduction. This study is aimed at evaluating the dosimetric differences among target segmented planning (TSP), conventional 9-field intensity modulated radiation therapy (9FIMRT) planning, and volumetric modulated arc therapy (VMAT) planning for postmastectomy radiotherapy of left-sided breast cancer patients. Material and Methods. Fifteen left-sided breast cancer patients who underwent radical mastectomy were enrolled. In TSP, the planning target volume (PTV) was divided into four regions (supra/infraclavicular, chest wall, external mammary region, and internal mammary region), and each individual PTV region was treated with respective fixed fields. Results. The VMAT plans showed superior to PTV dose conformity index (CI), homogeneity index (HI), protection of the ipsilateral lung, monitor units (MUs), and maximum dose (Dmax) to the contralateral breast compared with TSP and 9FIMRT plans. The TSP provided better protection for Dmean of the heart and left ventricle (p<0.05). A dose for left anterior descending artery from the three techniques had no significant difference. Compared with the 9FIMRT plans, the V5Gy (%) and V10Gy (%) for the ipsilateral lung were significantly reduced with TSP and VMAT (p<0.05). The V5Gy (%) and V10Gy (%) for the ipsilateral lung turned out to be similar between VMAT and TSP techniques. Conclusions. Our study indicates that VMAT should be a better choice of radiotherapy for left-sided breast cancer patients after radical mastectomy. If VMAT is unavailable, 9FIMRT can achieve better CI and HI values and be more MU-efficient compared with TSP; however, TSP can effectively reduce the low dose volume of the ipsilateral lungs and heart.

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Comparison of the Effectiveness of Full Negative Pressure with Half Negative Pressure on Suction Drain in Reducing Post-Modified Radical Mastectomy Seroma

Sriwijaya Journal of Surgery ◽

10.37275/sjs.v2i2.18 ◽

2019 ◽

Vol 2 (2) ◽

pp. 24-31

Author(s):

Gulraj Singh ◽

Mulawan Umar ◽

Nur Qodir

Keyword(s):

Breast Cancer ◽

Negative Pressure ◽

Radical Mastectomy ◽

Control Group ◽

Breast Cancer Patients ◽

Modified Radical Mastectomy ◽

Pressure Groups ◽

Suction Drain ◽

Significant Difference ◽

June July

Abstract Introduction: Modified radical mastectomy (MRM) is a breast cancer treatment option that is still operable. One of the postoperative complications that can be found is the formation of seroma. High negative suction drain is done to treat seroma after surgery but it can contribute to increase the length of stay in hospital. Methods: This study was a clinical randomized control trial (cRCT) conducted on 30 breast cancer patients in June - July 2019 at Moehammad Hoesin Hospital in Palembang. This study divided the two sample groups, each group consisting of 15 patients. One group was given half negative pressure on suction drain (experimental group) and the other used full negative pressure on suction drain (control group). Results: There was a significant difference (p <0.005) between the full and half negative pressure groups where there were more seroma events in the full vacuum group in 9 (60%) cases and half vacuum in 2 (30%) but there were no significant differences in long period of stay (p> 0.005). Conclusion: Half negative pressure is more effective in treating seroma than full negative pressure.

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Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

Polish Journal of Medical Physics and Engineering ◽

10.2478/pjmpe-2021-0024 ◽

2021 ◽

Vol 27 (3) ◽

pp. 201-206

Author(s):

Özlem Mermut ◽

Aysun Ozsoy Ata ◽

Didem Can Trabulus

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Organs At Risk ◽

Bilateral Breast Cancer ◽

Radiotherapy Planning ◽

Conformity Index ◽

Treatment Unit ◽

Significant Difference ◽

Synchronous Bilateral Breast Cancer ◽

The Right

Abstract Objective: We compared mono-isocenter and dual-isocenter plans in synchronous bilateral breast cancer (SBBC), which is defined as tumours occurring simultaneously in both breasts, and evaluated the effects of these differences in plans on organs-at-risk (OARs). Materials and methods: We evaluated 10 women with early stage, nod negative (Tis-2N0M0) SBBC. The treatment dose was determined to be 50 Gy. We used mean dose and VXGy to evaluate the OARs. To evaluate the effectiveness of treatment plans, Homogeneity index (HI), conformity index (CI) and sigma index (SI) and monitor units (MU) of monoisocenter (MIT) and dual-isocenter (DIT) plans were compared. During bilateral breast planning, for the single-centre plan, the isocenter was placed at the center of both breasts at a depth of 3-4 cm. For the two-center plan, dual-isocenters were placed on the right and left breasts. Results: No significant difference between the techniques in terms of the scope of the target volume was observed. Statistically significant results were not achieved in MIT and DIT plans for OARs. Upon comparing MIT and DIT, the right-side monitor unit (MU) value in DIT (p = 0.011) was statistically significantly lower than that in MIT. Upon comparing right-left side MIT and DIT, the MU value (p = 0.028) was significantly lower in DIT than MIT. Conclusion: SBBC irradiation is more complex than unilateral breast radiotherapy. No significant difference between both techniques and OARs was observed. However, we recommend MIT as a priority technique due to the ability to protect OARs, ease of administration during treatment, and the fact that the patient stays in the treatment unit for a shorter period of time.

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MANDIBULAR CANINE INDEX (MCI)

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.03.2834 ◽

2010 ◽

Vol 17 (03) ◽

pp. 459-463

Author(s):

IRFAN AHMED MUGHAL ◽

ANWAR SAOOD SAQIB ◽

FARIDA MANZUR

Keyword(s):

Medical College ◽

Significant Difference ◽

Males And Females ◽

Mandibular Canine ◽

Student’S T ◽

Dental Evidence ◽

Aseptic Conditions ◽

Sexual Identification ◽

The Right ◽

Mass Disasters

Introduction: Dental evidence is valuable in identification of individuals, especially following mass disasters; estimation of age at death of skeletonised remains and establishing guilt in cases of criminal injury by biting. Mandibular canines are found to exhibit the greatest sexual dimorphism amongst all teeth. Objective: To investigate the accuracy with which gender can be differentiated by using the mandibular canine index in the Punjabi – Pakistani population. Setting: Independent Medical College and Punjab Medical College, aisalabad. Period: Dec. 2008 to Dec. 2009. Material and Methods: The present study was performed on 200 students, between the age group of 18-25 years, randomly sampled with informed consent (Through 3rd party). Mandibular canine width and intercanine distance were measured with the help of Vernier caliper after observing aseptic conditions. Mandibular canine index was calculated and the observed MCI was compared with the standard MCI value. The data was then analyzed using student’s “t” test. Results: No significant statistical difference was noted between the right and left mandibular canines amongst males and females (same sex) but when comparing between males and females, there was highly statistical significant difference (P < 0.001). The calculated standard MCI for canines of males and females found to be 0.2504. With these calculations we could predict sex correctly at 75.97% in this study (Male: 71.67% and Female: 78.72%). Conclusion: MCI is a quick and reliable method for sexual identification when a standard for the population is available. With these calculations, we could predict the sex correctly at 75.97 % in this study. This method can be used as adjunct to other available tools for sex determination. DNA studies can reveal sex accurately.Availability of comprehensive database with “NADRA” can also be used as adjunct to “MCI” to enhance the accuracy in determination of sex and identity of the person in Pakistan.

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Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20173204 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2397 ◽

Cited By ~ 1

Author(s):

Ahmed Gaber ◽

Ahmed Fawzy ◽

Ahmed Sabry ◽

Alaa El sisi

Keyword(s):

Breast Cancer ◽

Radical Mastectomy ◽

Controlled Study ◽

Blue Dye ◽

Axillary Lymph ◽

Axillary Reverse Mapping ◽

Significant Difference ◽

Complications Rate ◽

And Control ◽

Reverse Mapping

Background: Breast cancer is one of the most leading causes of cancer deaths in female. Surgical treatment is considered the corner stone in its management. Axillary lymph node dissection (ALND) is an integral step in most of surgeries done, however it has many morbidities like prolonged seroma and lymphedema. Axillary reverse mapping (ARM) procedure was first described in 2007 in a trial to map the axillary lymphatics of the arm and avoid its injury therefore lymph complications.Methods: A prospective, randomized, controlled study over 72 female patients who underwent modified radical mastectomy (MRM). Patients were divided and randomized into study and control groups, thirty-six patients for each. In study group the ARM procedure was done by injecting 2.5 ml of methylen blue dye intra-dermally and subcutaneously in the upper inner ipsilateral arm along the medial intramuscular groove before ALND. Operative and post-operative results were recorded. Follow up was 6 to 24 months.Results: ARM procedure and successful visualization of arm lymphatics was achieved in 31 patients (86.1%). Statistically there was no significant difference between the two groups regarding patient and tumour characteristics, operative time and number of excised L.Ns. There was significant difference favouring the ARM group in decreasing the incidence of seroma (p= 0.040), lymphedema (p= 0.031) and time passed till remove drains (p <0.001).Conclusions: ARM procedure facilitated arm lymphatics visualization. It is easy non-time-consuming procedure. It resulted in significant reduction in incidence of seroma and lymphedema, with considerable reduction in the overall complications rate.

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Craniometric study of the Orbital Index in brazilian skulls

RGO - Revista Gaúcha de Odontologia ◽

10.1590/1981-86372021001320190115 ◽

2021 ◽

Vol 69 ◽

Author(s):

Larissa Chaves Cardoso FERNANDES ◽

Patrícia Moreira RABELLO ◽

Bianca Marques SANTIAGO ◽

Marcus Vitor Diniz de CARVALHO ◽

Manoel Raimundo de SENA JÚNIOR ◽

...

Keyword(s):

Mixed Race ◽

Cross Sectional Study ◽

Southeastern Brazil ◽

Cross Sectional ◽

Significance Level ◽

Brazilian Sample ◽

Significant Difference ◽

Student’S T ◽

The Right ◽

Student’S T Test

ABSTRACT Objetive To determine the percentage of correctness of the Orbital Index (OI) for estimation of sex, ancestry and age in Brazilian skulls. Methods Cross-sectional study of 183 human dry skulls from the southeastern Brazil. A total of 100 skeletons were males and 83 females; of which 36 were aged up to 39 years, 60 aged between 40 and 59 years, and 87 aged 60 years or older. As for ancestry, 103 were from white, 51 mixed race, and 29 black individuals. The OI was calculate by the formula = height/width x 100. The data were submitted to Student’s t test, F (ANOVA), Tukey and Kruskal Wallis tests as well as to discriminant analysis, with a 5% significance level. Results The sample was characterized as mesoseme, with a mean age of 56.62 (±19.97) years. No significant difference was observed (p=0.511) between the OI in females (right: 86.43 ± 6.58 and left: 86.70 ± 5.93) and males (right: 85.78 ± 6.69 and left: 86.37 ± 6.20). There were no significant differences between age, ancestry and the variables analyzed (p>0.05). The right and left orbital widths were significantly dimorphic between sexes (p<0.001). The percentage of correctness of the method for estimation of sex, age and ancestry was found to be 65.6%, 43.7%, and 43.6%, respectively. Conclusions The OI is not an appropriate method for estimation of sex, ancestry and estimation of age in this Brazilian sample. The methodology should be expanded to other population groups so that it can be improved.

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

Radiology and Oncology ◽

10.1515/raon-2018-0008 ◽

2018 ◽

Vol 52 (1) ◽

pp. 112-120 ◽

Cited By ~ 9

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.

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Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India

Quality of Life Research ◽

10.1007/s11136-019-02351-1 ◽

2019 ◽

Vol 29 (3) ◽

pp. 683-692

Author(s):

K. V. Deepa ◽

A. Gadgil ◽

Jenny Löfgren ◽

S. Mehare ◽

Prashant Bhandarkar ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Breast Conservation ◽

Radical Mastectomy ◽

Breast Conservation Surgery ◽

Breast Cancer Surgery ◽

Significant Difference ◽

Domain Scores

Abstract Purpose Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India. Methods We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed. Results We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores. Conclusion QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

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

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.12.2869 ◽

1995 ◽

Vol 13 (12) ◽

pp. 2869-2878 ◽

Cited By ~ 159

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.

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Influence of body mass index on the frequency of lymphedema and other complications after surgery for breast cancer

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/14743623012016 ◽

2016 ◽

Vol 23 (1) ◽

pp. 84-90 ◽

Cited By ~ 1

Author(s):

Riza Rute Oliveira ◽

Simony Lira Nascimento ◽

Maria Teresa Pace do Amaral ◽

Marcela Ponzio Pinto e Silva ◽

Mariana Maia Freire Oliveira

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Body Mass ◽

Upper Limb ◽

Radical Mastectomy ◽

Scar Tissue ◽

Obese Women ◽

Tissue Adhesion ◽

Significant Difference ◽

Second Year

ABSTRACT Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. José Aristodemo Pinotti Women's Hospital of the Center for Integral Women's Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.

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