Brachial plexopathy in breast cancer: is it radiation related? An analysis technique and dose volume parameters to brachial plexus in breast cancer radiotherapy

Background: Brachial plexus dysfunction is a rare but well-recognized complication of breast cancer surgery and radiotherapy. Most of the time it presents as paraesthesia of the arm. In an earlier publication Dan Lundstedt et al from Sweden, quantitatively assessed the radiation related brachial plexopathy (mainly paraesthesia) with the help of dose volume histograms and its co relation between patient reported paraesthesia. Paraesthesia was reported by 25% after radiation therapy to the supraclavicular fossa, with a V40 Gy 13.5 cm3 and maximum dose to brachial plexus (Dmax) was not found to correlate with paraesthesia. In order to predict the risk brachial plexopathy in our patients we decided to analyze the dose volume parameters for brachial plexus in carcinoma breast patients treated at our institution with modern radiotherapy techniques.Methods: Twenty five consecutive patients who received post mastectomy radiation during the period September 2015 to January 2016 with a dose of 50Gy in 25 fractions were included for this analysis. Brachial plexus contoured using RTOG guidelines, and dose volume parameters for brachial plexus were documented from the existing treatment plans.Results: The maximum dose to the brachial plexus ranged from 5045cGy to 5679cGy with a mean value of 5312.8cGy. The mean dose received by the brachial plexus ranged from 3093cGy to 4714cGy and the mean value was 4137.28cGy. Volume receiving 40Gy, that is V40, ranged from 2.0078cc to 11.56cc with a mean value of 7.57cc.Conclusions: Maximum dose and V40 Gy values were well below the tolerance limit of plexus, and hence post mastectomy irradiation with modern techniques is unlikely to produce significant brachial plexus neuropathy.

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Correlation of AGR2 expression with the incidence of metastasis in luminal breast cancer

Breast Disease ◽

10.3233/bd-219015 ◽

2021 ◽

pp. 1-5

Author(s):

David Samuel Kereh ◽

John Pieter ◽

William Hamdani ◽

Haryasena Haryasena ◽

Daniel Sampepajung ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Mean Value ◽

Rank Test ◽

Luminal Breast Cancer ◽

P Value ◽

Strong Positive Correlation ◽

Breast Cancer Patients ◽

The Mean ◽

Spearman Test

BACKGROUND: AGR2 expression is associated with luminal breast cancer. Overexpression of AGR2 is a predictor of poor prognosis. Several studies have found correlations between AGR2 in disseminated tumor cells (DTCs) in breast cancer patients. OBJECTIVE: This study aims to determine the correlation between anterior Gradient2 (AGR2) expression with the incidence of distant metastases in luminal breast cancer. METHODS: This study was an observational study using a cross-sectional method and was conducted at Wahidin Sudirohusodo Hospital and the network. ELISA methods examine AGR2 expression from blood serum of breast cancer patients. To compare the AGR2 expression in metastatic patients and the non-metastatic patient was tested with Mann Whitney test. The correlation of AGR2 expression and metastasis was tested with the Rank Spearman test. RESULTS: The mean value of AGR2 antibody expression on ELISA in this study was 2.90 ± 1.82 ng/dl, and its cut-off point was 2.1 ng/dl. Based on this cut-off point value, 14 subjects (66.7%) had overexpression of AGR2 serum ELISA, and 7 subjects (33.3%) had not. The mean value AGR2 was significantly higher in metastatic than not metastatic, 3.77 versus 1.76 (p < 0.01). The Spearman rank test obtained a p-value for the 2 tail test of 0.003 (p < 0.05), which showed a significant correlation of both, while the correlation coefficient of 0.612 showed a strong positive correlation of AGR2 overexpression and metastasis. CONCLUSIONS: AGR2 expression is correlated with metastasis in Luminal breast cancer.

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Comparison of metabolic changes after neoadjuvant endocrine and chemotherapy in ER-positive, HER2-negative breast cancer

Scientific Reports ◽

10.1038/s41598-021-89651-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ho Hyun Ryu ◽

Sei Hyun Ahn ◽

Seon Ok Kim ◽

Jeong Eun Kim ◽

Ji sun Kim ◽

...

Keyword(s):

Breast Cancer ◽

Metabolic Profile ◽

Fasting Glucose ◽

Medical Center ◽

Mean Value ◽

Metabolic Changes ◽

Phase Iii ◽

Breast Cancer Patients ◽

Neoadjuvant Endocrine Therapy ◽

The Mean

AbstractSurvival of breast cancer patients has improved, and treatment-related changes regarding metabolic profile deterioration after neoadjuvant systemic treatment (NST) become important issues in cancer survivors. We sought to compare metabolic profile changes and the neutrophil-to-lymphocyte ratio (NLR) between patients undergoing neoadjuvant chemotherapy (NCT) and neoadjuvant endocrine therapy (NET) 3 years after the treatment. In a prospective, randomized, phase III trial which compared 24 weeks of NCT with adriamycin and cyclophosphamide followed by docetaxel and NET with goserelin and tamoxifen (NEST), 123 patients in the Asan Medical Center were retrospectively reviewed to evaluate metabolic changes, such as body mass index (BMI), blood pressure (BP), total cholesterol (TC), fasting glucose, and the NLR. The mean age of patients was 42 years. The changes in BMI, serum glucose, and TC during NST and after 3 years were significantly different between NCT and NET. The proportion of overweight + obese group and the mean BMI were significantly increased during NCT (26.6% to 37.5%, 22.84 kg/m2 to 23.87 kg/m2, p < 0.05), and these attributes found to have normalized at the 3-year follow-up. In the NET group, BMI changes were not observed (p > 0.05, all). There were no differences in changes over time among in the Hypertension group during NCT and NET (p = 0.96). The mean value of serum TC and fasting glucose significantly increased (< 0.05, both) during NCT and decreased 3 years after NCT (p < 0.05); however, no significant changes were observed in the NET group. The NLR was increased from 1.83 to 3.18 after NCT (p < 0.05) and decreased from 1.98 to 1.43 (p < 0.05) after NET. Compared with minimal metabolic effect of NET, NCT worsens metabolic profiles, which were recovered over 3 years. The NLR was increased after NCT but decreased after NET.

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Method of predicting the mean lung dose based on a patient׳s anatomy and dose-volume histograms

Medical Dosimetry ◽

10.1016/j.meddos.2016.12.001 ◽

2017 ◽

Vol 42 (1) ◽

pp. 57-62 ◽

Cited By ~ 5

Author(s):

Anna Zawadzka ◽

Marta Nesteruk ◽

Beata Brzozowska ◽

Paweł F. Kukołowicz

Keyword(s):

Lung Dose ◽

Dose Volume Histograms ◽

Dose Volume ◽

The Mean ◽

Mean Lung Dose

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Treatment planning comparison of volumetric modulated arc therapy with Trilogy and Halcyon for bilateral breast cancer

10.21203/rs.3.rs-92224/v2 ◽

2021 ◽

Author(s):

Tao Sun ◽

Xiutong Lin ◽

Guifang Zhang ◽

Qingtao Qiu ◽

Chengqiang Li ◽

...

Keyword(s):

Breast Cancer ◽

Treatment Planning ◽

Volumetric Modulated Arc Therapy ◽

Bilateral Breast Cancer ◽

Planning System ◽

Skin Dose ◽

Delivery Time ◽

Dose Volume ◽

Arc Therapy ◽

The Mean

Abstract Background: The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods: On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann-Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results:Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p<0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion: For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

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The mean absolute dose deviation–A common metric for the evaluation of dose-volume histograms in radiation therapy

Medical Dosimetry ◽

10.1016/j.meddos.2019.10.004 ◽

2020 ◽

Vol 45 (2) ◽

pp. 186-189 ◽

Cited By ~ 3

Author(s):

Vincent Vinh-Hung ◽

Nicolas Leduc ◽

Dirk Verellen ◽

Claire Verschraegen ◽

Giovanna Dipasquale ◽

...

Keyword(s):

Radiation Therapy ◽

Dose Volume Histograms ◽

Dose Volume ◽

The Mean

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Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer

Radiation Oncology ◽

10.1186/s13014-021-01763-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tao Sun ◽

Xiutong Lin ◽

Guifang Zhang ◽

Qingtao Qiu ◽

Chengqiang Li ◽

...

Keyword(s):

Breast Cancer ◽

Treatment Planning ◽

Volumetric Modulated Arc Therapy ◽

Bilateral Breast Cancer ◽

Planning System ◽

Skin Dose ◽

Delivery Time ◽

Dose Volume ◽

Arc Therapy ◽

The Mean

Abstract Background The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann–Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p < 0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

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What is the optimum number of beams and energy for IMRT boost in prostate cancer? A plan comparison study

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16158 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16158-e16158

Author(s):

H. Kunhiparambath ◽

R. Prabhakar ◽

G. K. Rath ◽

D. N. Sharma ◽

P. Heera ◽

...

Keyword(s):

Prostate Cancer ◽

Maximum Dose ◽

Target Volume ◽

Seminal Vesicles ◽

Integral Dose ◽

Dose Volume ◽

Carcinoma Prostate ◽

Femoral Heads ◽

Dose Homogeneity ◽

The Mean

e16158 Background: Intensity Modulated Radiotherapy (IMRT) is used in carcinoma prostate to achieve better target coverage with less dose to critical organs thereby permitting dose escalation and eventually better therapeutic ratio. There is scarcity of literature evaluating beam number and energy in prostate cancer treated by IMRT. Aim of our study is to identify the optimal number of beams and energy in the boost treatment of prostate cancer by IMRT. Methods: Ten patients were included in this study. Initially a dose of 45 Gy in 25 fractions was delivered to the prostate, seminal vesicles and the nodes by 3DCRT. A boost dose of 27 Gy in 15 fractions was planned to the prostate and the seminal vesicles by sliding window IMRT. Four different sets of IMRT plans: 5, 7 and 9 field with 6 MV; 7 field with 15 MV were generated. The dose constraints to the critical structures and the target volume were based on standard guidelines. The mean dose, maximum dose, volume receiving the prescribed dose (V100), volume receiving > 107% and <95% of the prescribed dose were analyzed for CTV and planning target volume (PTV). The mean dose, volume receiving 100%, 50% and 30% of the prescribed dose were analyzed for the bladder and the rectum. Similarly, the mean dose and the maximum dose to the right and left femoral heads, monitor units (MU) and the integral dose were analyzed. SPSS V10.0 software was used for statistical analysis. Results: The seven beam plan provide better dose homogeneity to PTV and lesser doses to critical structures like bladder, rectum and femoral heads when 6 MV photon is used. 15 MV photons further improve the dose homogeneity and decrease the dose to critical structures. The Monitoring Units required to deliver the treatment and the Integral dose is significantly reduced by using 15 MV compared to 6 MV. Conclusions: The optimal IMRT plan for boost planning in carcinoma prostate is that uses 7 beams and higher energy. This yields lesser dose to surrounding critical structures with better target conformity. [Table: see text] No significant financial relationships to disclose.

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A Case of Suspected Breast Cancer Metastasis to Brachial Plexus Detected by Magnetic Resonance Neurography

Case Reports in Oncology ◽

10.1159/000447054 ◽

2016 ◽

Vol 9 (2) ◽

pp. 395-399 ◽

Cited By ~ 3

Author(s):

Atsushi Mizuma ◽

Chikage Kijima ◽

Eiichiro Nagata ◽

Shunya Takizawa

Keyword(s):

Breast Cancer ◽

Magnetic Resonance ◽

Brachial Plexus ◽

Cancer Metastasis ◽

Breast Cancer Metastasis ◽

Brachial Plexopathy ◽

Axillary Lymph ◽

Gallium Scintigraphy ◽

Mr Neurography ◽

Motor Weakness

Metastasis of breast cancer is often detected through a long-term course and difficult to diagnose. We report a case of brachial plexopathy suspected to be the initial lesion of breast cancer metastasis, which was only detected by magnetic resonance (MR) neurography. A 61-year-old woman was admitted to our hospital within 2 years after operation for breast cancer because of progressive dysesthesia and motor weakness initially in the upper limb on the affected side and subsequently on the contralateral side. Enhanced computed tomography, axillary lymph node echo, gallium scintigraphy, and short tau inversion recovery MR images showed no abnormalities. MR neurography revealed a swollen region in the left brachial plexus. We suspected neuralgic amyotrophy and initiated treatment with intravenous immunoglobulin therapy and steroid therapy. However, there was no improvement, and the progression of motor weakness in the bilateral lower limbs appeared over 4 years. Concomitant elevation of carbohydrate antigen 15-3 level (58.9 U/ml) led us to suspect breast cancer metastasis, which was associated with the worsening of neurological findings, although gallium scintigraphy and bone scintigraphy showed no inflammatory and metastatic lesions. Swelling of the cauda equina in enhanced lumbar MR imaging and abnormal accumulation at the brachial plexus and cervical spinal cord in positron-emission tomography were newly detected contrary to the normal findings on the gallium scintigraphy, which suggested cerebrospinal fluid seeding. We suspected breast cancer metastasis about the initial brachial plexopathy based on the clinical course. MR neurography may be a helpful tool to detect metastatic lesion, especially in nerve roots.

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Radiation-Induced Brachial Plexopathy in Breast Cancer and the Role of Surgical Treatment

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1712272 ◽

2020 ◽

Vol 9 (02) ◽

pp. 099-105

Author(s):

Kenan Kıbıcı ◽

Berrin Erok ◽

Ali Önder Atca

Keyword(s):

Breast Cancer ◽

Brachial Plexopathy ◽

Breast Cancer Patients ◽

Function Loss ◽

Radiation Induced ◽

The Mean ◽

Grade 3 ◽

Surgical Treatments ◽

Experienced Grade

Abstract Objective We aimed to evaluate improvement in the pain, motor, and sensory functions after neurosurgical intervention, by objective methods in patients with radiation-induced brachial plexopathy (RIBP), as a complication of radiotherapy (RT). Materials and Methods In our study, 11 patients, who experienced grade 3 or 4 brachial plexopathy according to the LENT-SOMA (late effects of normal tissue—subjective, objective, management, analytic) side-effect index, as a complication of RT which was performed after being operated for breast cancer, were included. In the postoperative period pain, sensation, and motor function loss were followed. Results There was apparent regression in the pain. The mean visual analogue scale (VAS) value decreased to 4 from the preoperative VAS value of 9.4. However, no significant improvement was observed in either sensory and motor functions. Conclusion RIBP is a progressive disease in breast cancer patients after radiotherapy. Evaluation of the results of applied surgical treatments and changes in the results with time is important to direct the treatment. Neurolysis should only be considered when other treatment methods fail and should be considered as an irreversible and potentially permanent procedure.

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Sociodemographic and Hematologic Profile of Breast Cancer Patients Attending a Tertiary Care Teaching Hospital in Ethiopia: Case Control Study

10.21203/rs.3.rs-60844/v1 ◽

2020 ◽

Author(s):

Fatuma Hassen Dejene ◽

Fikre Enqusilassie Gashe ◽

Ahmed Ali Ahmed ◽

Adamu Addise Nuramo ◽

Girma Taye aweke ◽

...

Keyword(s):

Breast Cancer ◽

Hematological Parameters ◽

Descriptive Analysis ◽

Tertiary Care ◽

Mean Value ◽

Diagnosis And Treatment ◽

Breast Cancer Patients ◽

The Mean ◽

Hematologic Profile ◽

Control Study

Abstract Background: Breast cancer is among the leading causes of cancer death in women. Different socio-demographic factors have impact on early diagnosis and treatment of breast cancer. Hematological abnormalities are also some of the conditions to be monitored during diagnosis and treatment of breast cancer.Objective: To describe socio demographic and hematologic profile of patients with breast cancer at Tikur Anbessa Specialized Hospital.Methods: Case control study was conducted from May 2018 to June 2019. A total of 230 cases and 230 controls participated in the study. Descriptive analysis was made to assess the socio demographic characteristics. Blood samples for hematological parameters were analyzed, using SYSMEXKX21N hematology analyzer. Independent student t- test was performed to compare the mean hematological parameters of cases and controls. Results: The mean age was 42.8 + 12.1 and 39.3 + 11.1 years for cases and controls, respectively. One hundred (43%) of cases and 34 (14.8%) of controls were illiterate. Moreover, 175 (76.1%) of cases and 155 (67.4%) of controls were married. The mean value of Hemoglobin, Red Blood cell, Packed Cell Volume (13.1 + 1.6g/dl, 4.6 + 0.54/1012/L , 38.7 + 4.5 %, respectively) of cases were significantly lower than the controls (14.0 + 1.3g/dl, 4.8 + 0.47 / 1012/L, 40.5 + 3.5% respectively). The mean platelet and total WBC count were 323.4+ 108.1 x 109/L and 7.1 + 2.8 x 109/L for cases and 282.0 +70.0 x 109/L, and 7.1 + 2.4 x 109/L for controls respectively. In addition, 20.4% of cases and 5.6 % of controls were anemic based on their hemoglobin value.Conclusion and recommendations: The majority of breast cancer cases were less than 40 years of age and illiterate. Most of the RBC parameters of cases were significantly lower than the controls. Therefore, attention should be given to those with the designated hematologic abnormalities.

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