MRI in the Setting of Neoadjuvant Treatment of Breast Cancer

Neoadjuvant therapy may reduce tumor burden preoperatively, allowing breast conservation treatment for tumors previously unresectable or requiring mastectomy without reducing disease-free survival. Oncologists can also use the response of the tumor to neoadjuvant chemotherapy (NAC) to identify treatment likely to be successful against any unknown potential distant metastasis. Accurate preoperative estimations of tumor size are necessary to guide appropriate treatment with minimal delays and can provide prognostic information. Clinical breast examination and mammography are inaccurate methods for measuring tumor size after NAC and can over- and underestimate residual disease. While US is commonly used to measure changes in tumor size during NAC due to its availability and low cost, MRI remains more accurate and simultaneously images the entire breast and axilla. No method is sufficiently accurate at predicting complete pathological response that would obviate the need for surgery. Diffusion-weighted MRI, MR spectroscopy, and MRI-based radiomics are emerging fields that potentially increase the predictive accuracy of tumor response to NAC.

The case for breast-conservation treatment rates to be a quality metric

-

Complications of mastectomy for breast cancer in a tertiary care centre in South-west Nigeria

Background: An important aspect of the surgical management of breast cancer is loco-regional control which can be accomplished by either breast conservation surgery or mastectomy. Objective: To examine the outcome of the operation of mastectomy with respect to the complications of the procedure. Methods: This is a retrospective study of all the patients who had a mastectomy for breast cancer in a Nigerian tertiary care centre from 1st January 2012 to March 2019. The hospital records of the patients were retrieved. Demographic and relevant clinical characteristics of the patients were extracted. Results: A total of 77 cases were eligible, 76 women and one man. The age range was 28-76 years. Right mastectomy was performed in 54.5% cases. Preoperative comorbiditiesincludedobesity(34%), hypertension (31.2%), anaemia (6.5%) and Diabetes mellitus (7.8%). Modified radical mastectomy was done in 51.9% cases, simple mastectomy in 36.4%, “Toilet Mastectomy”in 9.1%, and mastectomy after breast conservation treatment in 2%. Twenty-eight percent of the cases required a blood transfusion, 31.2% received neoadjuvant chemotherapy while 58.2% had adjuvant therapy. The complications observed included: haemorrhage (7.8%), seroma (9.1%), flap necrosis (9.1%) andtumourrecurrence (7.8%). As at the time of the report, 41.6 % were alive, 19.4% were dead and 39.0% were lost to follow-up. Conclusion:The complications of mastectomy were mostly haemorrhage, seroma,and flap necrosis, similar to previous reports from other parts of the world.

Techniques for Treating Bilateral Breast Cancer Patients Using Pencil Beam Scanning Technology

Purpose: Patients with bilateral breast cancer (BBC), who require postmastectomy radiation therapy or radiation as part of breast conservation treatment, present a unique technical challenge. Even with modern techniques, such as intensity modulated radiation therapy or volumetric modulated arc therapy (VMAT), adequate target coverage is rarely achieved without the expense of increased integral dose to important organs at risk (OARs), such as the heart and lungs. Therefore, we present several BBC techniques and a treatment algorithm using intensity-modulated proton therapy (IMPT) for patients treated at our center. Materials and Methods: We describe 3 different BBC treatment techniques using IMPT on patients treated at our center, with comparison VMAT plans to demonstrate the dosimetric benefit of proton therapy in these patients. Following RADCOMP (Radiation Therapy Oncology Group, Philadelphia, Pennsylvania) guidelines, a single physician approved all target volumes and OARs. Plans were designed so that ≥ 95% of the prescribed dose covered ≥ 95% of all targets. Parameters for dosimetric volume histograms for the clinical targets and OARs are reported for the 2 radiation methods. Results: All methods demonstrated acceptable target coverage with 95% of the prescription planning target volume reaching a mean (± SD) of 98.0% (± 0.87%) and 97.5% (± 2.39%), for VMAT and IMPT plans, respectively. Conformity and homogeneity were also similar between the 2 techniques. Proton therapy provided observed improvements in mean heart dose (average heart mean [SD], 9.98 Gy [± 0.87 Gy] versus 2.12 Gy [± 0.96 Gy]) and total lung 5% prescription dose (V5; mean [SD] total lung V5, 97.9% [± 2.84%]), compared with 39.8% [± 9.39%]). All IMPT methods spared critical OARs; however, the single, 0° anterior-posterior plan allowed for the shortest treatment time. Conclusion: Both VMAT and all 3 IMPT techniques provided excellent target coverage in patients with BBC; however, proton therapy was superior in decreasing the dose to OARs. A single-field optimization approach should be the IMPT method of choice when feasible.

Proportions and reasons for breast conservation surgery and modified radical mastectomy in early breast carcinoma

Background: Breast cancer is a common cancer among women in India and its incidence is increasing in an alarming rate. There is a paradigm shift in the management of early breast cancer with more emphasis given to breast conservation treatments. This study aimed to assess the proportion of patient underwent breast conservation surgery and reasons to choose breast conservation surgery or modified radical mastectomy in early breast cancer.Methods: Information of 41 patients with early breast carcinoma who attended the institute during the study period and who can choose either modified radical mastectomy or breast conservation surgery depending on their wish are included in the study group and the data thus obtained was entered in MS Excel data sheet and analysed using SPSS 16 software.Results: It was observed that the proportion of women selecting breast conserving therapy increased with improved literacy status. Similarly, menstrual status and location of tumor do have an influence in choosing breast conserving surgery with significant statistical correlation. However, unlike the previous studies we did not find any statistically significant association between age and surgical decision. Similarly, place of residence, and employment status of the patient does not influence the decision to undergo breast conservation surgery.Conclusions: We have to create awareness in the society about the safety of breast conservation treatment to popularize this modality of treatment there by more and more organs can be preserved.