Mechanical properties of the shoulder and pectoralis major in breast cancer patients undergoing breast-conserving surgery with axillary surgery and radiotherapy.

Breast-conserving surgery (BCS) and radiotherapy reduce breast cancer recurrence but can cause functional deficits in breast cancer survivors. A cross-sectional study quantified the long-term pathophysiological impact of these treatments on biomechanical measures of shoulder stiffness and ultrasound shear wave elastography measures of the shear elastic modulus of the pectoralis major (PM). Nine node-positive patients treated with radiotherapy to the breast and regional nodes after BCS and axillary lymph node dissection (Group 1) were compared to nine node-negative patients treated with radiotherapy to the breast alone after BCS and sentinel node biopsy (Group 2) and nine healthy age-matched controls. The mean follow-up for Group 1 and Group 2 patients was 988 days and 754 days, respectively. Shoulder stiffness did not differ between the treatment groups and healthy controls (p = 0.23). The PM shear elastic modulus differed between groups (p = 0.002), with Group 1 patients exhibiting a stiffer PM than Group 2 patients (p < 0.001) and healthy controls (p = 0.027). The mean prescribed radiotherapy dose to the PM was significantly correlated with passive shear elastic modulus (p = 0.018). Breast cancer patients undergoing more extensive axillary surgery and nodal radiotherapy did not experience long-term functional deficits to shoulder integrity but did experience long-term mechanical changes of the PM.

Alterations in pectoralis muscle cell characteristics after radiation of the human breast in situ.

The life-time risk of being diagnosed with breast cancer is ~12%, hence breast cancer is by far the most common cancer among women. The multimodal treatment concept of breast cancer often intends radiation. The utilized ionizing radiation leads changes in the tissue resulting in tissue damage due to an alteration of molecular factors. The goal of this study was to identify the role of muscle-catabolic proteins after radiation of human pectoralis major muscles in situ. Tissue of the pectoralis major muscle was collected in 12 breast cancer patients after radiation (maximum 3 years after radiation) undergoing a deep inferior epigastric perforator free-flap breast reconstruction. At the same time, an intraindividual comparison to rectus abdominis muscle was carried out upon free-flap elevation. Immunological properties, cell proliferation, differentiation as well as the expression profile of the muscle tissue were investigated through immunohistological reactions, a DNA-microarray and histology. We found significantly increased neutrophil immigration in the radiated muscle tissue. At the same time, proteins responsible for muscular atrophy and apoptosis were significantly elevated in immunohistochemistry. A DNA microarray detected immunological upregulation and myo-differentiative disorders in radiated muscle tissue. This novel study investigating catabolism in radiated muscle in situ can serve as a basis for the treatment of radiation-accompanied muscle disorders.

Changes in Pectoral Muscle Volume During Subacute Period after Radiation Therapy for Breast Cancer: A Retrospective up to 4-year Follow-up Study.

Radiotherapy (RT) is an effective treatment for managing breast cancer patients with breast conserving surgery, but patients may experience radiation-induced shoulder problems. Even though the course of shoulder morbidity is unknown, pectoral muscle changes after radiotherapy can be a major cause of shoulder problems. Twenty-two patients treated with RT for unilateral breast cancer were included in the study. All patients underwent serial computed tomography (CT) imaging before and immediately after RT, as well as 2 months, 6 months, 2 years, and 3-4 years after RT. These CT scans were used to compare muscle volume changes. The pectoral muscle volume and muscle volume surrounding the scapular measurement was performed using 3D modelling after segmentation of the CT scans. In all patients, the pectoral muscle volume increased during the 2 months after RT, and there was continuous volume reduction from 2-48 months after RT. Changes in muscle volume ratio over time were analysed by repeated measure ANOVA and it was found that there was a significant change in the pectoral muscle volume (p < 0.001) from Just before RT and Immediately after RT at 2 month after RT. On the other hand, the changes in the muscle volume of the surrounding scapular were not significant.

Pectoralis major radiation recall.

Radiation recall is an uncommon phenomenon describing an acute localised inflammatory toxicity affecting tissue previously exposed to radiotherapy. It is precipitated by administration of certain medications, including chemotherapy. We describe a case involving a 50-year-old Aboriginal male smoker from a remote community in Northern Australia who underwent treatment for stage IV non-small cell lung cancer with localised radiotherapy to the primary right upper lung lobe tumour. This was followed by a course of gemcitabine, which was ceased prematurely after four cycles when he presented with radiation recall to his right pectoralis major. Our case description is complemented with a brief review of current literature regarding our case and gemcitabine-related radiation recall. This was in the context of concurrent musculoskeletal strain, an as-yet unreported association with radiation recall. His condition settled with steroid administration and discontinuation of gemcitabine.

In-ovo monochromatic green light photostimulation enhances embryonic somatotropic axis activity.

Previous studies demonstrated that in ovo photostimulation with monochromatic green light increases body weight and accelerates muscle development in broilers. The mechanism in which in ovo photostimulation accelerates growth and muscle development is not clearly understood. The objective of the current study was to define development of the somatotropic axis in the broiler embryo associated with in ovo green light photostimulation. Two-hundred-forty fertile broiler eggs were divided into 2 groups. The first group was incubated under intermittent monochromatic green light using light-emitting diode (LED) lamps with an intensity of 0.1 W\m2 at shell level, and the second group was incubated under dark conditions and served as control. In ovo green light photostimulation increased plasma growth hormone (GH) and prolactin (PRL) levels, as well as hypothalamic growth hormone releasing hormone (GHRH), liver growth hormone receptor (GHR), and insulin-like growth factor-1 (IGF-1) mRNA levels. The in ovo photostimulation did not, however, increase embryo's body weight, breast muscle weight, or liver weight. The results of this study suggest that stimulation with monochromatic green light during incubation increases somatotropic axis expression, as well as plasma prolactin levels, during embryonic development.

Evaluation of low-energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria.

OBJECTIVE: Contrast-enhanced spectral mammography (CESM) examination results in a low-energy (LE) and contrast-enhanced image. The LE appears similar to a full-field digital mammogram (FFDM). Our aim was to evaluate LE CESM image quality by comparing it to FFDM using criteria defined by the European Reference Organization for Quality Assured Breast Screening and Diagnostic Services (EUREF). METHODS: A total of 147 cases with both FFDM and LE images were independently scored by two experienced radiologists using these (20) EUREF criteria. Contrast detail measurements were performed using a dedicated phantom. Differences in image quality scores, average glandular dose, and contrast detail measurements between LE and FFDM were tested for statistical significance. RESULTS: No significant differences in image quality scores were observed between LE and FFDM images for 17 out of 20 criteria. LE scored significantly lower on one criterion regarding the sharpness of the pectoral muscle (p < 0.001), and significantly better on two criteria on the visualization of micro-calcifications (p = 0.02 and p = 0.034). Dose and contrast detail measurements did not reveal any physical explanation for these observed differences. CONCLUSIONS: Low-energy CESM images are non-inferior to FFDM images. From this perspective FFDM can be omitted in patients with an indication for CESM. KEY POINTS: • Low-energy CESM images are non-inferior to FFDM images. • Micro-calcifications are significantly more visible on LE CESM than on FFDM. • There is no physical explanation for this improved visibility of micro-calcifications. • There is no need for an extra FFDM when CESM is indicated.

Effect of high-dose irradiation on quality characteristics of ready-to-eat broiler breast fillets stored at room temperature.

The effect of high-dose irradiation on the physical, chemical, and bacteriological parameters of ready-to-eat vacuum-packed broiler breast meat after 430 d of storage at room temperature was investigated. Ready-to-eat broiler breast fillets were immersed in brine with garlic powder and then drained, grilled, and vacuum-packed (primary packaging). The high-dose irradiation used was approximately 48 kGy. The treatments were designated as A (irradiated samples stored at room temperature), B (irradiated samples stored at -25°C), and C (nonirradiated samples stored at -25°C). All samples were packaged in polyethylene bags containing aluminum to exclude light (secondary packaging). Proximate composition, pH, 2-thiobarbituric acid reactive substance (TBARS), and heterotrophic aerobic mesophilic bacteria were analyzed during 430 d of storage. Results were analyzed using 1-way ANOVA and the Tukey test. Linear regression was used to analyze the correlation between the results for each parameter and storage time of the different treatments. The gamma radiation caused slight changes (P < 0.05) in the moisture and fat content, regardless of storage temperature. After storage d 110, TBARS values remained stable (P > 0.05) in all the treatments. The preservation methods used were effective in maintaining the mesophilic counts below the detection level during the entire storage period. We concluded that, among the treatments studied, high-dose irradiation with storage at room temperature showed potential for the preservation of ready-to-eat products made from poultry meat, to provide foods safe for consumption.

Effects of ultraviolet light on biogenic amines and other quality indicators of chicken meat during refrigerated storage.

Radiation from UV-C has been demonstrated as a potential surface decontamination method in addition to several advantages over regular sanitation methods. However, UV-C radiation possibly affects the physicochemical properties of meat products. To determine the optimum exposure time for bacterial reduction, 39 chicken breasts, inoculated with a pool of Salmonella spp., were submitted to 3 levels of UV-C intensities (0.62, 1.13, and 1.95 mW/cm²) for up to 120 s. After the optimum exposure time of 90 s was determined, changes in the biogenic amines, total aerobic mesophilic bacteria, Enterobacteriaceae, lipid oxidation, pH, and instrumental color were evaluated in 84 chicken breasts that were irradiated (0.62, 1.13, and 1.95 mW/cm²) and stored at 4°C for 9 d. The groups treated with UV-C radiation exhibited an increase in tyramine, cadaverine, and putrescine contents (P < 0.05). The highest UV-C intensity (1.95 mW/cm²) promoted a decrease in the initial bacterial load, and extended the lag phase and the shelf life. The groups irradiated with 1.13 and 1.95 mW/cm² exhibited a more stable b* value than the other groups; similar trends for L*, a*, pH, and TBA reactive substance values were observed among all groups. The UV-C light was demonstrated to be an efficient alternative technology to improve the bacteriological quality of chicken meat without negatively affecting the physical and chemical parameters of chicken breast meat. Nonetheless, the increases on the biogenic amines content should be considered as an effect of the UV processing and not as an indicator of bacterial growth.

In vivo dosimetry with radiochromic films in low-voltage intraoperative radiotherapy of the breast.

PURPOSE: EBT2 radiochromic films were studied and used for in vivo dosimetry in targeted intraoperative radiotherapy (TARGIT), a technique in which the Intrabeam system (Carl Zeiss, Oberkochen, Germany) is used to perform intraoperative partial breast irradiation with x-rays of 50 kV(p). METHODS: The energy of the radiation emitted by the Intrabeam with the different spherical applicators, under 1 and 2 cm of solid water, and under the tungsten impregnated rubber used for shielding of the heart in TARGIT of the breast, was characterized with measurements of half-value layer (HVL). The stability of response of EBT2 was verified inside this range of energies. EBT2 films were calibrated using the red and green channels of the absorption spectrum in the 0-20 Gy dose range delivered by the Intrabeam x-rays. The dependence of film response on temperature during irradiation was measured. For in vivo dosimetry, pieces of radiochromic films wrapped in sterile envelopes were inserted after breast conserving surgery and before TARGIT into the excision cavity, on the skin and on the shielded pectoralis fascia for treatments of the left breast. RESULTS: HVLs of the Intrabeam in TARGIT of the breast correspond to effective energies of 20.7-36.3 keV. The response of EBT2 was constant inside this range of energies. We measured the dose to the target tissue and to organs at risk in 23 patients and obtained an average dose of 13.52 ± 1.21 Gy to the target tissue. Dose to the skin in close proximity to the applicator was 2.22 ± 0.97 Gy, 0.29 ± 0.17 Gy at 5-10 cm from the applicator, and 0.08 ± 0.07 Gy at more than 10 cm from the applicator. Dose to the pectoral muscle for left breast treatment was 0.57 ± 0.23 Gy. CONCLUSIONS: Our results show that EBT2 films are accurate at the beam energies, dose range, and irradiation temperature found in TARGIT and that in vivo dosimetry in TARGIT with EBT2 films wrapped in sterile envelopes is a feasible procedure. Measured dose to the organs at risk indicates that the technique is safe from side effects to the skin and the heart.

Subcutaneous calcification in the pectoralis major flap: a late complication of radiotherapy.

Heterotopic calcification following radiotherapy is a very rare event. Here, we report a case of a patient who underwent surgical intervention including pectoralis major flap reconstruction for locally advanced pharyngolaryngeal squamous cell carcinoma with skin invasion. He was followed up post-operatively with adjuvant radiotherapy. 13 years after the treatment, suspect resistance in the myocutaneous flap region appeared and was diagnosed as a calcification. To date, the occurrence of subcutaneous calcification in the myocutaneous flap in the neck has not been described as a late complication of neck irradiation.

Viabilidade anátomo-clínica da utilização dos vasos perfurantes do músculo peitoral maior como pedículo receptor na reconstrução mamária imediata e tardia com microcirurgia / Viability of utilizing the pectoralis major perforator muscular vessels as a recipient pedicle in immediate and late breast reconstruction with microsurgery

Na reconstrução mamária com microcirurgia, a qualidade dos vasos, a proximidade com a região torácica e a anatomia constante são fatores relevantes na escolha do pedículo receptor. Apesar da grande aplicação clínica, os vasos toracodorsais e torácicos internos apresentam restrições como a imprevisibilidade da qualidade nas reconstruções tardias, as alterações do contorno do tórax e a inviabilidade de uma eventual revascularização futura do miocárdio. Com o desenvolvimento dos retalhos vascularizados por vasos perfurantes e o maior treinamento dos cirurgiões, novas alternativas de pedículos foram desenvolvidas. A preservação da cartilagem costal e dos vasos torácicos internos, bem como a maior exposição do campo operatório são mencionados como vantagens do emprego dos vasos perfurantes do músculo peitoral maior como receptor. Apesar da anatomia dos vasos perfurantes ter sido previamente estudada, são imprecisas as informações sobre sua origem e distribuição no tórax. Ademais, são escassos os dados relacionados à sua incidência e utilização nas reconstruções imediatas e tardias. Na presente investigação foram incluídos dois estudos: anatômico e clínico. No estudo anatômico avaliou-se a origem, distribuição e dimensões dos vasos perfurantes em 24 cadáveres frescos (48 regiões torácicas), por técnica de coloração e posterior dissecção. No estudo clínico analisou-se, 69 pacientes (77 reconstruções mamárias), sendo 46 imediatas e 31 tardias. Constatou-se no estudo anatômico 2,7 vasos perfurantes por região torácica, destes, 93% apresentaram pequeno e médio calibre e concentração preferencial no segundo espaço intercostal. Os vasos e o pedículo perfurante revelaram comprimento médio de 2,4 cm (1,0 a 3,2 cm) e 3,6 cm (2,1 a 4,5 cm), respectivamente. No estudo clínico, não foram observadas diferenças entre as pacientes submetidas à reconstrução imediata e tardia, quanto a idade (p=0,599), IMC (p=0,498), lateralidade da mama (p=0,671), hipertensão arterial...

In breast reconstruction with microsurgery, the proper selection of the recipient pedicle is a significant factor for success. The compatibility of caliber and the uniform anatomy are the chief relevant factors in the choice of recipient vessels. Regardless of their broad clinical application, the thoracodorsal and internal thoracic vessels demonstrate limitations such as the unpredictable quality of late reconstructions, the changes in thoracic contour and the impairment for future coronary bypass. The progress of microsurgical technique and the development of perforator flaps has led to new recipient pedicle alternatives. Thus, sparing of the costal cartilages and the internal thoracic vessels as well as the wide surgical exposure are the main advantages of using the pectoralis major perforator vessels as recipient pedicles. Although the anatomy of the perforator vessels has been previously studied, the data about their origin and distribution is inexact. In addition, the data concerning their incidence and quality of immediate and late reconstructions are not available. In the present investigation, an anatomical and clinical study were performed. In the anatomical study, the origin, distribution and size of perforator vessels were evaluated in 24 fresh cadavers (48 thoracic regions) by staining technique and posterior dissection. The clinical study analyzed 69 patients (77 reconstructions), 46 immediate and 31 late reconstructions. The anatomic study observed 2.7 perforator vessels per thoracic region, with 93% presenting small and medium caliber and major concentration in the second intercostal space. The vessels and the perforator pedicles demonstrated an average length of 2.4 cm (1.0 to 3.2 cm) and 3.6 cm (2.1 to 4.5 cm) respectively. In the clinical study, no differences were observed between the immediate and late reconstructions regarding age (p=0.599), BMI (p=0.498), breast side (p=0.671), hypertension (p=0.732), diabetes (p>0.999) and smoking...

[Techniques of radiotherapy in so-called operable carcinoma of the breast]. / Les techniques de la radiothérapie des cancers du sein dits opérables.

The techniques of radiotherapy alone in carcinoma of the breast are determined by the possibilities of durable cure of the tumoral process using locoregional treatment. It seems undisputable that the risk of metastases at a distance from the tumor is related to the topographical as well as volum extension of lymph node involvement. Such risk is low with N-; it rapidly increases with lower axillary N+; it predominates with medial mammary N+; it becomes almost constant with upper axillary (subclavian) and supraclavicular N+. This explains why dose distribution should aim at curing, even at the price of some cosmetic or functional risk, tumoral lesions of the mammary gland, of the lower axillary area and, to a certain extent, of the medial mammary area. On the contrary, it is illusory to deliver an overdosage at ultrahigh dose-rates to the sub- and supraclavicular areas, where the chances for durable cure are almost nul if lymph nodes are invaded. This explains why curative radiotherapy alone appears only indicated in little developed cancers in their mammary (T1 or T2) as well as lymph node (N0 or N1 a) aspects. This also explains why such a responsability implies for the radiotherapist absolutely perfect technical conditions of spotting, centring and dose-measurements; careful protection of all healthy structures surrounding the target-volumes should, in particular, be obtained (for instance, accurate delimitation of beams, use of lead shields or even compensatory wedges should provide appropriate protection to the lung parenchyma, pectoral muscle, head of the humerus, laryngotracheal system). Finally, it is in the axillary area that the major technical hazards are encountered with: an insufficient dose is liable to cause lymph node recurrence, an excessive dose is liable to provoke irreversible muscular, articular, vascular or nervous sequelae. Provided a high level of technicity, it should be admitted to-day that a durable locoregional cure can be obtained in the vast majority of cases with but minimal tissue sequelae.