Deep Learning-Aided Automatic Contouring of Clinical Target Volumes for Radiotherapy in Breast Cancer After 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.

Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana, India

Objective: The study was conducted to assess the Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana. Study objectives were to (i) Assess the upper limb function among the clients with Modified Radical Mastectomy before the intervention. (ii) Demonstrate post-operative upper limb function exercises to the clients with breast cancer posted for Modified Radical Mastectomy. (iii) Assess the effectiveness of post-operative exercises on upper limb function among clients with Modified Radical Mastectomy. (iv) Find out the association between the upper limb function among clients with Modified Radical Mastectomy and selected variables. Methodology: Quantitative evaluative research approach was used for this study. The study was conducted at selected cancer hospitals, Hyderabad, Telangana. Pre-test post-test group only design adopted. The sample comprised of 30, 15 sample taken as experimental group,15 sample taken as experimental group. Sample was selected by purposive sampling technique. The data was collected by observational checklist. Results: The results revealed that pretest mean score was 64.03 and after intervention the post-test mean score was 57.16 there was a significant difference between the pre-test and post test scores from day 1 to day 5 of the clients at the level of p= 0.05, computed ‘t’ value is more than table value hence null hypothesis was rejected. The obtained’ value was 8.15, found greater than ‘t’ table value. Conclusion: The study concluded that most of the sample was improved upper limb function from day 1to day 5. There is a significant difference between pretest and post- test scores, The findings point out that demonstration of teaching programme would improve the upper limb function of clients with Modified Radical Mastectomy.

Thoracic fascial planes blocks in operative bed of modified radical mastectomy and their role in alleviating post-mastectomy pain: a prospective randomized study

Background: Proper pain management after modified radical mastectomy is crucial for improving postoperative outcomes, reducing tumor recurrence, enhancing anti-metastatic activity and achieving excellent patient`s satisfaction. Thoracic fascial planes (TFP) blocks are novel, and safe analgesia modalities to control postmastectomy pain. This study was designed to assess the efficacy and safety of intraoperative TFP blocks for providing postoperative analgesia after modified radical mastectomy.Methods: During the period from March 2020 to April 2021, 30 females (ages 25–67 years) were scheduled for elective MRM and selected randomly to one of two groups; group-A included 15 patients who underwent MRM and anesthetized with both general anesthesia and regional anesthesia (TFP blocks), group-B included 15 patients who underwent MRM and anesthetized with only general anesthesia.Results: The group-A had statistically significantly lower pain scores. The time of first rescue nalbuphine dose post-operatively was statistically significantly longer in group-A compared to group-B. The total 24h nalbuphine consumption and postoperative non-steroidal ketorolac requirements/48h were significantly lower in group-A compared to group-B. Satisfaction score in group-A was statistically significantly better than that in group-B.Conclusions: Intraoperative thoracic fascial planes blocks are simple, safe, and highly effective analgesic modalities after breast surgery.

A COMPARISON OF POST-OPERATIVE ANALGESIA WITH INTRAOPERATIVE PECTORAL NERVE BLOCK VERSUS CONVENTIONAL TECHNIQUE IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED STUDY

Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient satisfaction score. “Mann–Whitney U test” and “Chi-square/Fischer exact test” were used for quantitative and categorical variables, respectively. Results: The mean time to the first rescue analgesia was 1175±120.21 and 1175±77.35 min and total analgesia requirement was equal (30.00±0.00 mg) in Group P and Group T, respectively. The mean VAS score over 24 h was comparable in both the groups. PECS block group had significantly less adverse effects and better satisfaction score. Conclusion: PECS block has similar analgesic efficacy as opioids but with better ability to mobilize the respective arm, better patient satisfaction score, and lesser adverse effects.

The Implication of Mastectomy Flap Fixation in Decreasing the Incidence of Seroma on Breast Cancer Patient

Highlight: Modification of radical mastectomy with flap fixation treatment in seroma production in breast cancer patients was analyzed.The number of seromas from the drain removal time in patients undergoing modified radical mastectomy with flap fixation was reduced. Abstract: Seroma is the most common complication after mastectomy procedure. This study was conducted to analyse the treatment of flap fixation in seroma production after modified radical mastectomy in breast cancer patients. An interventional prospective clinical study in 35 female patients with breast cancer who underwent modified radical mastectomy with flap fixation in the period August-December 2018 and 35 patients without flap fixation through historical data of patient who underwent modified radical mastectomy in the period 2016-2017 at RSUD Dr. Soetomo Surabaya. Data of characteristic patients will be presented descriptively and analyzed statistically using the appropriate test. The result of the statistical test using Chi Square with a 95% significance level obtained a value of p = 0.000 (p <0.05), it was said statistically that there was a significant relationship between the treatment of flap fixation and the time of releasing drain in this study. The treatment of flap fixation will reduce drainage time by <10 days. The results of the odds ratio (OR) obtained OR = 16 and CI: 95% (4.094 – 62.528) which means that the treatment of flap fixation will reduce the releasing time of the drain 16 times more effectively than not performing flap fixation. Correlation between the treatment of flap fixation and the time of releasing drain was considered to be moderately positive (Contingency Coefficient Chi Square = 0.476). There was a significant reduction in the number of seroma assessed from the time of releasing drain faster in patients who underwent modified radical mastectomy with flap fixation.

Prospective Study: The Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block versus Serratus Plane Block in Patients Undergoing Modified Radical Mastectomy

Background: Breast Cancer is the most commonly occurring cancer affecting ‎women undergoing modified radical mastectomy, causing acute pain, and in ‎high percentage of patients it progresses to chronic pain syndromes. The Erector Spinae Plane Block (ESPB) ‎and Serratus Anterior Plane Block (SAPB) are options of regional anesthesia that can produce reliable ‎analgesia. In this study we aimed to evaluate the analgesic efficacy of ‎ultrasound guided ESPB and SAPB in patients underwent modified radical ‎mastectomy operation. Patients and Methods: Patients were randomly classified using computer generated numbers ‎concealed in ‎ sealed opaque envelopes into three equal groups; 30 patients ‎were enrolled in each group. ‎Group I: Control Group (C): Patients received intravenous (IV) systemic analgesia only, Group II: ESPB group: Patients received ‎ipsilateral ultrasound guided ESPB using 20 ml bupivacaine 0.25% at the ‎level of the 4th thoracic segment (T4). and Group III: SPB group: Patients received ipsilateral ‎serratus plane block using 30 ml bupivacaine 0.25% at the level of the 5th rib.‎ Results: In this study, 113 patients were assessed for eligibility, 16 patients ‎did not meet the criteria and 7 patients refused to participate in the study. ‎The remaining 90 patients were randomly allocated into three groups (30 ‎patients in each). All patients (90) were followed-up and analyzed ‎statistically‎. Conclusion: Ultrasound-guided SAPB and ESPB provided effective post-‎operative analgesia in patients undergoing modified radical mastectomy with ‎lower pain scores, less peri operative analgesic consumption and longer ‎duration of analgesia in SAPB.