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RESUMEN Antecedentes: los colgajos perforantes perimamarios son de gran utilidad en la reconstrucción mamaria inmediata en cirugía conservadora. Objetivo: describir los resultados del empleo de un algoritmo sobre colgajos perforantes perimamarios en la reconstrucción mamaria inmediata después de cirugía conservadora por cáncer de mama. Material y métodos: se llevó a cabo un estudio retrospectivo descriptivo. Se revisaron las historias clínicas de las pacientes operadas entre enero de 2020 y diciembre de 2022 por carcinoma de mama con cirugía conservadora y que requirieron reconstrucción con colgajos perimamarios. Las indicaciones incluyeron déficit de volumen, defecto de contorno y asimetría. Se evaluó el pedículo vascular del colgajo mediante Doppler color en todos los casos, lo que permitió seguir un algoritmo para la selección de la mejor opción de colgajo. Resultados: se realizaron 20 colgajos en 19 pacientes. Promedio de edad: 52 años ± 11 (rango 30-76). No existieron complicaciones intraoperatorias. Una paciente requirió reoperación por compresión del pedículo vascular del colgajo por hematoma, con la pérdida parcial, y otro colgajo sufrió epidermólisis superficial. No hubo pérdidas totales de ningún colgajo. Todas recibieron radioterapia posoperatoria y no experimentaron pérdida de volumen ni retracciones. Con un promedio de seguimiento de 15 meses, las pacientes valoraron los resultados a 6 meses como excelente en 7, bueno en 11 y regular en 2. Conclusión: la selección de colgajos perforantes locales para corregir defectos mamarios después de cirugía conservadora, mediante el examen con Doppler color preoperatorio para la identificación del pedículo vascular y un algoritmo específico, permitió obtener resultados estéticos satisfactorios sin requerir elementos aloplásticos ni revisiones posteriores.
ABSTRACT Background: Chest wall perforator flaps are a good option for immediate breast reconstruction after conservative surgery. Objective: The aim of this study was to describe the clinical results of an algorithm for using chest wall perforator flaps for breast reconstruction after breast-conserving surgery for breast cancer. Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from the medical records of the patients diagnosed with breast cancer who underwent breast-conserving surgery and required reconstruction using chest wall perforator flaps between January 2020 and March 2022. The indications included volume deficit, contour defect and asymmetry. The vascular pedicle of the flap was evaluated by color Doppler ultrasound in all cases, which allowed us to follow an algorithm for selecting the best flap option. Results: Twenty flaps were made in 19 patients. Mean age: 52 years ± 11 (range 30-76). There were no intraoperative complications. One patient required reoperation due to a hematoma with compression of the vascular pedicle of the flap with partial flap loss, and another flap presented superficial epidermolysis. There were no cases of complete flap loss. All the patients underwent postoperative radiation therapy without loss of volume or retractions. Mean follow-up was 15 months. At 6 months, patients rated the results as excellent, good, and fair in 7, 11, and 2 cases, respectively. Conclusion: The selection of local perforator flaps to correct breast defects after conservative surgery, using preoperative color Doppler ultrasound to identify the vascular pedicle and a specific algorithm, allowed us to obtain satisfactory aesthetic results without the need for alloplastic elements or subsequent revisions.
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Objective:To explore the predictive value of multimodal ultrasound features combined with serum matrix metalloproteinase-9 (MMP-9) detection for tumor recurrence of breast cancer after breast-conserving surgery.Methods:A total of 194 patients with breast cancer who underwent breast-conserving surgery in Affiliated Hospital of Jining Medical College from Jan. 2017 to May. 2018 were selected. Routine ultrasound, automated breast volume imaging and contrast-enhanced ultrasound were performed before surgery. Logistic regression equation was used to analyze the risk factors affecting local tumor recurrence after breast-conserving surgery, and ROC curve was drawn to analyze the predictive value of multimodal ultrasound features combined with serum MMP-9 for local tumor recurrence after breast-conserving surgery.Results:After 5 years of follow-up, 29 out of 194 breast cancer patients who underwent breast-conserving surgery had local recurrence and metastasis. There were no significant differences in tumor diameter, spiculation sign, convergence sign, Alder blood flow grade, enhancement sequence, pattern and enhancement intensity between the two groups ( P>0.05 t=1.48, P=1.451; χ2=0.55, P=0.460; χ2=0.50, P=0.478; χ2=0.60, P=0.439; χ2=0.50, P=0.780; χ2=0.04, P=0.981; χ2=0.13, P=0.716). Logistic regression analysis showed that irregular tumor shape, small calcification,Peripheral radial enhancement, perfusion defect and abnormal elevation of serum MMP-9 were independent risk factors for local recurrence of breast cancer after breast-conserving surgery ( P=0.034, 95%CI=1.177~62.266; P=0.048, 95%CI=1.022~58.397; P=0.045, 95%CI=1.100~56.756; P=0.043, 95%CI=1.079~ 60.937; P=0.044, 95%CI=1.000~1.026). ROC curve showed that the AUC of multimodal ultrasound features combined with serum MMP-9 in predicting local tumor recurrence after breast-conserving surgery was 0.970, and the sensitivity and specificity were 98.63% and 91.67%, respectively. Conclusions:Multimodal ultrasound features combined with serum MMP-9 detection have high application value in the evaluation of local tumor recurrence after breast-conserving surgery, and provide a new idea for the clinical diagnosis and treatment of breast cancer.
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Resumen OBJETIVO: Describir las características sociodemográficas, clínicas y patológicas y los resultados obtenidos con la técnica de ganglio centinela con azul patente en la cirugía de cáncer de mama temprano. Además, reportar la experiencia en la identificación del ganglio centinela en cáncer de mama temprano con la técnica con azul patente al 2.5%. MATERIALES Y MÉTODOS: Estudio retrospectivo y analítico consistente en la evaluación de los expedientes clínicos de pacientes diagnosticadas con cáncer de mama temprano, sin sospecha clínica o radiológica de afectación axilar, atendidas entre junio de 2022 y junio de 2023 en el servicio de Ginecología Oncológica de la UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente del IMSS. El sitio de inyección del colorante fue subdérmico periareolar, los ganglios identificados se estudiaron en el transoperatorio. Se analizaron el porcentaje de identificación, las tasas de falsos negativos y el valor predictivo negativo del método. RESULTADOS: Se analizaron 95 procedimientos de biopsia de ganglio centinela. Solo se practicó la linfadenectomía axilar en las pacientes con metástasis en el ganglio centinela comprobada en el estudio transoperatorio y en las que no se identificaron ganglios teñidos por no migración del colorante. La edad promedio de las pacientes fue de 57.1 años límites 25 y 78 años. El tamaño del tumor fue menor a 3 cm. A 64 67% pacientes se les hizo la mastectomía en comparación con 31 a quienes se efectuó cirugía conservadora de mama 33%. Se estadificaron como IA 57 de las 95 pacientes; el subtipo molecular más frecuente fue compatible con luminal A en 49%. CONCLUSIONES: La biopsia del ganglio centinela, con azul patente, es una técnica rápida, sencilla, precisa y de bajo costo para identificar daño axilar en etapas tempranas del cáncer de mama. Lo aquí reportado son resultados que corresponden a una primera evaluación de la técnica en nuestro servicio.
Abstract OBJECTIVE: To describe the sociodemographic, clinical and pathological characteristics and results of the patent blue sentinel lymph node technique in early breast cancer surgery. And to report the experience in identifying the sentinel lymph node in early breast cancer using the 2.5% patent blue technique. MATERIALS AND METHODS: Retrospective and analytical study consisting of the evaluation of the clinical records of patients diagnosed with early breast cancer, without clinical or radiological suspicion of axillary involvement, seen between June 2022 and June 2023 at the Oncological Gynaecology Service of the UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente of the IMSS. The dye injection site was subdermal periareolar, and the identified lumps were examined in the transoperative period. The percentage of identification, false negative rates and negative predictive value of the method were analysed. RESULTS: Ninety-five sentinel node biopsies were analysed. Axillary lymphadenectomy was performed only in patients with sentinel lymph node metastasis confirmed at surgery and in those in whom no stained nodes were identified due to non-migration of the dye. The mean age of the patients was 57.1 years range 25 to 78 years. The tumour size was less than 3 cm. Sixty-four patients 67% underwent mastectomy, compared with 31 who underwent breast-conserving surgery 33%. Fifty-seven of the 95 patients were staged as AI; the most common molecular subtype was compatible with luminal A in 49%. CONCLUSIONS: Sentinel lymph node biopsy with patent blue is a rapid, simple, accurate and inexpensive technique for identifying axillary disease in early breast cancer. The results reported here represent an initial evaluation of the technique in our service.
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@#Objective To explore the surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection in the treatment of benign and malignant breast tumors. Methods The clinical data of 18 patients received endoscopic breast tumor resection from September 2020 to December 2021 in the Department of Breast Surgery, West China Hospital, Sichuan University, were retrospectively analyzed to evaluate the feasibility, tumor safety and postoperative cosmetic effect. There were 7 patients with benign breast tumors (a benign breast tumor group) and 11 patients with early breast cancer (a malignant breast tumor group). Breast-Q and Scar-Q questionnaires were used to evaluate postoperative quality of life and satisfaction of patients. Results Endoscopic breast tumor resection was performed successfully in 18 female patients, among whom 12 patients received day surgery. The mean age of benign and malignant breast tumor groups was 29.6±11.6 years and 46.7±14.3 years, the mean tumor size in pathological examination was 3.3±2.1 cm and 2.0±0.8 cm, and the operative time was 138.9±57.0 min and 177.3±46.3 min, respectively. One patient had positive resection margin and underwent intraoperative extended resection in the malignant breast tumor group. All the patients were successfully followed up, and the mean follow-up time of benign and malignant breast tumor groups was 6.8±4.0 months and 8.7±4.9 months, respectively. No complications or tumor recurrence occurred. The scores of psychosocial status, sexual well-being, chest wall status and breast satisfaction decreased one month after surgery and basically recovered to the preoperative level in one year, and the score of scar appearance increased to 64.6±5.9 points one year postoperatively. Conclusion Endoscopic assisted transaxillary breast tumor resection can effectively improve postoperative cosmetic effect and patient satisfaction on the premise of safety.
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Objective:To investigate the variations and related influencing factors of the volumes, positions, and morphologies of geometries formed by surgical clips in intensity-modulated radiation therapy (IMRT) for whole breasts after breast-conserving surgery.Methods:A retrospective analysis was conducted on 18 patients treated with IMRT from October 2021 to September 2022 after breast-conserving surgery. Set-up errors were obtained by reading the coordinate information of tumor bed surgical clips according to the cone beam CT (CBCT) images at 0, 10, 20, 30, 40, and 50 Gy sequentially. Geometries were constructed using the convex hull program, and the volumes ( Vct and V0-5) of geometries were then calculated based on the localization CT images and the six CBCT images, respectively. The centroid displacements ( D0-5) and degrees of inclusion ( DI0-5) of these geometries were compared. The t-test or rank-sum test was used to analyze the effects of radiation doses on V0-5, D0-5, and DI0-5. The Pearson correlation analysis was conducted to analyze the correlations between D0-5 and corresponding set-up errors in three-dimensional directions, and the correlations of average V0-5 variation ( AV), average D0-5 ( AD), and average DI0-5 ( ADI) with the body mass index (BMI), the volume of a breast ( VB), the breast axial height ( H), and the time interval from surgery to radiotherapy ( T) each. The influences of quadrants ( Q) where geometries are located and states ( S) of geometries adhering to or away from the chest walls on AV, AD, and ADI were analyzed through one-way ANOVA. Results:The differences between D5 and D0, between D5 and D1, and between D5 and D2 were statistically significant ( t = -3.27, -4.52, -3.38, P < 0.05), respectively. The differences between DI5 and DI0, between DI5 and DI1, between DI5 and DI2 were statistically significant ( t = 2.53, 2.70, 2.64, P < 0.05), respectively. D1 and D4 correlated with the set-up errors in the superior-inferior dimension, and D3 correlated with the set-up errors in the left-right dimension ( r = 0.50, 0.56, 0.53, P < 0.05). The AD was related to BMI, VB, and H ( r = 0.54, 0.48, 0.50, P < 0.05). There were statistically significant differences in AV and ADI of geometries away from ( S3) and near ( S2) chest walls ( F = 2.66, 3.83, P < 0.05). The AD differences of geometries between S3 and the state adhering to chest walls ( S1) and between S3 and S2 were statistically significant ( F = 7.46, P < 0.05), respectively. Conclusions:The geometries are relatively constant volumes during whole-breast radiotherapy. However, their positions and morphologies vary greatly in the late course. The volume variation ratios, centroid displacements, and degrees of inclusion of geometries are all affected by the states of their attachments to the chest walls. The centroid displacements correlate with breast morphologies and BMI. The radiotherapy plan modification can be individualized.
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Objective To investigate the dosimetric difference between volume modulated arc therapy(VMAT)and dynamic multi-leaf collimator intensity modulated radiation therapy(dMLC-IMRT)after breast-conserving surgery for left-sided breast cancer so as to optimize the treatment plan for the patient.Methods The clinical data of 15 patients admitted to the radiothe-rapy department of some hospital after breast-conserving surgery for left-sided breast cancer were selected retrospectively.Three groups of plans were designed for each patient,including continue volume modulated arc therapy(cVMAT),tangent volume modulated arc therapy(tVMAT)and dMLC-IMRT plans,and then compared in terms of the dosimetric parameters of the tumor target areas and organs at risk.SPSS 25.0 software was used for statistical analysis.Results The three groups had the dose distribution of the tumor target areas meet clinical requirements,which had significant differences between the values of D2,Dmean,conformity index(CI)and homogeneity index(HI),while the difference between the numbers of monitor units were not statistically significant.The dMLC-IMRT group had higher D2 value while lowerDmeanthan the cVMAT and tVMAT groups;for CI the cVMAT behaved the best in the three groups,followed by the tVMAT group.In the low-dose region,the cVMAT and tVMAT groups had larger illuminated volumes of the affected lung than the dMLC-IMRT group;the tVMAT group had the smallest illuminated volume of heart in the three groups,and the cVMAT group had the illuminated volume of heart slightly higher than that of the dMLC-IMRT group.In the high-dose region,the cVMAT and tVMAT groups had smaller illuminated volumes of the affected lung than the dMLC-IMRT group,and the illuminated volume of the affected lung of the tVMAT group was larger than that of the cVAMT group;the dMLC-IMAT group had the largest illuminated volume of heart in the three groups,and the differences between the tVMAT and cVMAT groups were not statistically significant.Conclusion In the design of intensity-modulated radiotherapy plans after breast-conserving surgery for left-sided breast cancer,VMAT behaves better than dMLC-IMRT in conformability to the tumor target area and protection of heart and lung at risk.[Chinese Medical Equipment Journal,2023,44(9):59-63]
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Near-infrared fluorescence imaging (NIRFI) is a new noninvasive detection and diagnosis technology, with the continuous development of NIRFI technology, now widely used in the clinic, characterized by high sensitivity, high penetration, no harmful radiation and simple equipment operation. This article describes the recent applications of NIRFI in the diagnosis and treatment of breast cancer and looks at future developments and perspectives in this field.
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Objective:To summarize the clinical data and experience of pure single-port lumpectomy non-lipolysis breast-conserving surgery (PSLN-BCS) in patients with early-stage breast cancer.Methods:A retrospective analysis was conducted on 400 patients who underwent breast-conserving surgery for early-stage breast cancer in the Second Department of Breast Surgery at Harbin Medical University Cancer Hospital from Jan. 2022 to Jan. 2023. Patients were divided into two groups: PSLN-BCS group ( n=200) and conventional breast-conserving surgery (C-BCS) group ( n=200). The surgical time, intraoperative blood loss, postoperative drainage within three days, and short-term (3 months to 6 months after surgery) complications, including the incidence of residual fluid after drain removal and incision infection were observed. Long-term (6 months after surgery) complications, including the incidence of skin and pectoralis major muscle adhesions in the surgical area and cosmetic results after breast-conserving surgery, were also evaluated. Statistical analysis was performed using R language, and quantitative data were expressed as mean ± standard deviation ( ± s) and analyzed using t-test, while count data were analyzed using χ2 test. A p-value less than 0.05 was considered statistically significant. Results:PSLN-BCS had a longer average surgical time than C-BCS (198.341min vs 62.961min, P<0.001, 95% CI:132.028 vs 138.732). PSLN-BCS had less intraoperative bleeding (18.824 ml vs 22.627 ml, P=0.003, 95% CI: -6.294 vs -1.311) and lower postoperative drainage volume (346.157 ml vs 406.191 ml, P<0.001, 95% CI: -70.571-a-49.496). There were no significant differences in short-term postoperative complications such as subcutaneous fluid accumulation ( χ2=2.33, P=0.127) or incisional infection ( χ2=0.14, P=0.708) between the two groups. The incidence of skin and muscle adhesions in the surgical area was lower in patients who underwent PSLN-BCS at 6 months postoperatively ( χ2=11.58, P<0.001). Patients who received PSLN-BCS achieved better cosmetic outcomes, with a statistically significant difference ( χ2=273.00, P<0.001) compared to those who received C-BCS. Conclusion:Pure single-port lumpectomy non-lipolysis breast-conserving surgery is a safe and effective treatment option for early-stage breast cancer and can be considered as a surgical option for patients with cosmetic requirements.
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SUMMARY OBJECTIVE: Breast cancer treatment has evolved significantly over the years, both in terms of local and systemic approaches. Halsted's radical mastectomy gave way to modified mastectomies and to conservative surgeries, along with breast reconstruction and repair. Although the use of new drugs has directly increased the survival of patients submitted to adjuvant or neoadjuvant systemic therapies, the de-escalation of drugs may also be beneficial in numerous cases. Therefore, breast cancer treatment must be increasingly customized and assessed using a multidisciplinary approach. This study aimed to review the concept and therapy of early breast cancer. METHODS: A narrative review of the literature was carried out in the PubMed database in December 2022, where the keywords for the searches were as follows: early breast cancer, surgical treatment of breast cancer, systemic treatment of breast cancer, neoadjuvant chemotherapy in breast cancer, adjuvant treatment of luminal breast cancer, early triple negative tumor, and early positive Her-2 tumor. Articles that were historically important in the treatment of breast cancer and articles that impacted management with scientific relevance were selected for this review. DISCUSSION: As new evidence continues to update existing knowledge, breast cancer treatment is becoming increasingly personalized and must now take into account the different tumor variants and their clinical stages, the age of patients and relevant comorbidities, as well as personal expectations and desires. CONCLUSION: This literature review of current studies shows that the primary therapy for patients with early breast cancer continues to be surgery, although a customized and multidisciplinary approach is now required.
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To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.
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Femelle , Humains , Tumeurs du sein/chirurgie , Mastectomie partielle , Organes à risque , Dosimétrie en radiothérapie , Planification de radiothérapie assistée par ordinateur , Radiothérapie conformationnelle avec modulation d'intensitéRÉSUMÉ
Whole breast radiotherapy after breast-conserving surgery for early-stage breast cancer increases local control rate and reduces postoperative recurrence. Compared to supine position, whole breast radiation therapy in the prone position provides dosimetric advantages and cosmetic outcomes in patients with large breasts. With the development of various radiotherapy techniques and tools, the radiation volume and dose for target and organs at risk (such as heart and lung) have changed. Models for the prediction of preferable treatment position in breast radiotherapy without the need for CT simulation and plan evaluation in both positions have been developed and implemented in radiotherapy practice. This paper briefly reviews the progression in the techniques and dosimetry of whole breast radiotherapy in prone position after breast-conserving surgery for early breast cancer.
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Radiotherapy is an important treatment modality in breast-conserving therapy of breast cancer. At present, hypofractionation has become the preferred dose schedule for whole breast irradiation. Tumor bed boost can further improve the local control, and sequential boost is recommended for high-risk patients. The widespread application of intensity-modulated radiation therapy provides dosimetric advantages and practical convenience for simultaneous integrated boost. In this review, the indications of tumor bed boost and recent research progress on simultaneous integrated boost were summarized, specifically focusing on the safety and efficacy of simultaneous integrated boost during conventional fractionated or hypofractionated whole breast radiotherapy. Ongoing phase Ⅲ randomized clinical trials of simultaneous integrated boost during hypofractionated whole breast radiotherapy were also illustrated.
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Hypofractionated radiotherapy, which provides equivalent efficacy and dose not increase toxicity compared with conventional fractionated radiotherapy following breast-conserving surgery, has become a preferred choice for whole breast irradiation. Given the low local recurrence risk and long survival time for early breast cancer survivors, radiation-associated toxicities are the focus of clinical practice. However, in the era of hypofractionated radiotherapy, the risk factors for radiation-associated toxicity remain undefined and further research is warranted. In this review, we aim to provide an overview of the toxicities of hypofractionated radiotherapy following breast-conserving surgery.
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Objective:To explore the clinical application of lateral thoracic artery perforator flap in repairing local defect after breast conserving surgery.Methods:The clinical data of 48 breast cancer patients planned to finish breast conserving surgery were retrospectively analyzed. The patients were divided into plastic breast-conserving group and routine breast conserving group. In the plastic breast-conserving group, 24 patients local defect repaired with the lateral thoracic artery perforator flap. In the routine breast conserving group, 24 patients local defect repaired with the fascial flap around the cutting edge. The operation related indexes and cosmetic effect from two groups were compared.Results:Both groups of patients successfully completed breast conserving surgery. The plastic breast-conserving group patients had significantly increased in operation time, operative blood loss, incision length and drainage tube indwelling time compared with the routine breast conserving group; the differences were statistically significant ( t=6.99, 9.37, 21.74, 8.80, P<0.05). The rate of secondary surgery enlarged was lower than fhat in the routine breast conserving group, and the difference was statistically significant (χ 2=4.76, P<0.05). There were 3 cases in the plastic breast conserving group and 1 case in the conventional breast conserving group. The skin at the edge of the flap was ischemic necrosis in the 4 cases, which healed after dressing change and drainage, and there was no significant difference ( P>0.05). The evaluation of postoperative cosmetic effect showed that the excellent and good rate of the observation group was 91.7%, compared with the routine breast conserving group (58.3%); the difference was statistically significant (χ 2=7.11, P<0.05). All patients were followed up for average 24 months, and local recurrence and distant metastasis were not observed. Conclusions:The lateral thoracic artery perforator flap for filling local defects in the lateral quadrant or central region of breast cancer is feasible, easy to operate, hides incision scar, better cosmetic effect and worthy of clinical promotion.
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Objective:To investigate the feasibility and adverse reactions of simultaneous integrated boost (SIB) in volumetric modulated arc therapy (VMAT) for early breast cancer after breast-conserving surgery.Methods:A total of 67 patients with early breast cancer after breast-conserving surgery at Zhongshan People's Hospital from September 2019 to May 2021 were enrolled. All patients received VMAT-SIB to the whole breast and tumor bed. The total breast dose and tumor bed dose were 40.5Gy/15 times every 3 weeks and 48 Gy/15 every 3 weeks respectively. The exposure dose of organs at risk and acute adverse reactions of radiotherapy were evaluated.Results:The average doses of planning target volume of the whole brease (PTV WB) and planning target volume of the boost(PTV BOOST) were (42.0±2.1) Gy and (49.9±0.8) Gy, respectively. The V 95% and V 105% of PTV WB and PTV BOOST were (98.8±1.2)% and (31.4±11.3)%, (99.8±0.6)% and (22.9±10.2)%, respectively. The V 5Gy, V 20Gy, V 30Gy and mean dose (D mean) of ipsilateral lung were (52.4±12.0)%, (15.3±4.5)%, (6.7±2.2)% and (11.0±2.4) Gy respectively. The V 18Gy, V 40Gy and D mean of heart were 3.80% (0.48%,9.60%), 0 (0,0.16%) and (6.7±2.1) Gy respectively. At the end of radiotherapy, 19 patients (29%) of all 67 patients had no acute skin toxicity, 41 patients (61%) showed radiation erythema, 5 patients (7%) had radioactive dry peeling and 2 patients (3%) had wet peeling mainly located in the nipple, areola area and breast folds. None of the patients had grade 3-4 acute skin reactions. Breast swelling and breast pain were found respectively in 9 patients (13%) and 7 patients (10%). No local recurrence or distant metastases were observed during the follow-up period. The 2-year disease-free survival rate was 100%. Conclusions:VMAT combined with SIB is feasible in the treatment of early breast cancer. The adverse reactions of radiotherapy are mild and well tolerated.
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Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.
Sujet(s)
Femelle , Humains , Tumeurs du sein/chirurgie , Mammoplastie/méthodes , Mastectomie/méthodes , Mamelons/chirurgie , Études rétrospectivesRÉSUMÉ
Objective:To explore the dosimetry difference between volumetric modulated arc therapy (VMAT) and tomo direct (TD) in tumor bed simultaneous push radiotherapy after left breast-conserving surgery, and to provide more dosimetry reference for clinic.Methods:A total of 22 patients with left breast cancer who underwent simultaneous quantitative radiotherapy after breast-conserving surgery were selected from the Department of Radiation Oncology, Yunnan Cancer Hospital from December 2018 to June 2020. The localized CT images and target organs at risk and other structural data were collected. Two radiotherapy plans, VMAT and TD, were designed for the same patient, and the dosimetry differences of target areas and organs at risk were compared and analyzed between the two groups.Results:In terms of target dosimetry, there were statistically significant differences in the D 2% [ (59.99±0.19) Gy vs. (59.55±0.51) Gy, t=4.09, P<0.001], D 98% [ (57.19±0.08) Gy vs. (57.46±0.22) Gy, t=-5.10, P<0.001], conformal index (CI) (0.76±0.05 vs. 0.58±0.13, t=8.19, P<0.001) and homogeneity index (HI) (0.05±0.00 vs. 0.04±0.01, t=4.89, P<0.001) of the planning gross tumor volume (PGTV) between VMAT and TD plans. However, there was no statistically significant difference in the D 50% [ (58.73±0.10) Gy vs. (58.73±0.24) Gy, t=-0.03, P=0.974]. There were statistically significant differences in the D 50% [ (52.21±0.33) Gy vs. (53.00±0.72) Gy, t=-4.81, P<0.001], D 98% [ (48.44±0.43) Gy vs. (49.09±0.21) Gy, t=-6.80, P<0.001], CI (0.83±0.06 vs. 0.67±0.06, t=10.52, P<0.001) and HI (0.20±0.01 vs. 0.19±0.01, t=8.75, P<0.001) of the planned target volume (PTV) between the two plans. However, there was no statistically significant difference in the D 2% [ (59.01±0.45) Gy vs. (59.00±0.48) Gy, t=0.22, P=0.830]. In terms of organs at risk, there were statistically significant differences in the V 20 [ (18.81±2.86) % vs. (22.03±1.91) %, t=-5.36, P<0.001] and D mean [ (11.66±1.32) Gy vs. (12.85±1.46) Gy, t=-4.10, P=0.007] of left lung, V 5 [ (5.70±2.90) % vs. (0.30±0.13) %, t=16.44, P<0.001] and D mean [ (2.45±0.29) Gy vs. (0.43±0.14) Gy, t=9.09, P<0.001] of right lung, D mean [ (3.22±0.72) Gy vs. (1.69±0.80) Gy, t=5.41, P<0.001] of right breast, D 2% [ (5.37±1.97) Gy vs. (0.46±0.09) Gy, t=11.75, P<0.001] of cord between VMAT and TD plans. There were no significant differences in the V 5 of left lung [ (53.00±5.99) % vs. (50.00±7.69) %, t=1.91, P=0.061], V 5 of right breast [ (11.51±4.60) % vs. (8.06±3.49) %, t=1.59, P=0.120], V 30 [ (1.49±0.69) % vs. (1.51±0.71) %, t=-0.06, P=0.952] and D mean [ (3.99±0.97) Gy vs. (3.90±1.03) Gy, t=0.56, P=0.581] of heart between the two plans. Conclusion:TD and VMAT can meet the clinical dosimetry requirements for patients with left breast cancer after breast-conserving surgery. However, the two techniques have their own characteristics. VMAT has better conformity and TD has better uniformity. TD is significantly better than VMAT in protecting the right lung, right breast and spinal cord of healthy organs at risk. VMAT is better in protecting the left lung. Both VMAT and TD basically achieve the same protection for heart.
RÉSUMÉ
Breast oncoplastic surgery technique is a new technique in the surgical treatment of breast cancer. For tumors in different quadrants, volume displacement or volume replacement techniques can be used to obtain tumor safety while effectively reducing the occurrence of breast deformity and maximizing the aesthetic appearance of the breast. This article provides a comprehensive introduction of breast-conserving surgery for breast tumors, which can provide guidance and direction for breast surgeons to perform this technique in a more standardized and rational way in clinical practice, and ultimately allow patients to obtain satisfactory treatment results.
RÉSUMÉ
El estado axilar es un factor pronóstico para los estadios tempranos de cáncer de mama. Existen factores que podrían predecir riesgo de mayor enfermedad axilar. El objetivo es determinar cuáles son los factores predictivos independientes de alta carga residual ganglionar axilar (4 o más GNC comprometidos) luego de la BGC positiva. Estudio analítico, observacional, cohorte retrospectiva de pacientes con tumores T1-2, axila clínicamente negativa, a las que se les realizó cirugía conservadora (CC) y BGC con resultado positivo (marco o micrometástasis) y se les realizó posterior linfadenectomía axilar (LA). Del total de 325 pacientes, 96 tuvieron resultado positivo para metástasis en el ganglio centinela (29,5%) y también se les realizó LA. Se dividió a la población seleccionada en dos grupos según el compromiso de los GNC: baja carga axilar 0-3 GNC positivos, y alta carga axilar 4 o más GNC positivos. Se observaron como factores que demostraron mayor riesgo para alta carga axilar ganglionar residual al grado histológico, ki-67 y la invasión extracapsular en el GC; pero solamente la invasión extracapsular en el GC demostró ser significativa en el análisis multivariado. Probablemente con un mayor número de pacientes otras variables pudieran haber resultado factores de riesgo independiente
Axillary status is a prognostic factor for early stages of breast cáncer. There are predictive factors that might indicate the risk of greater axilary disease. The aim is to determine which are the independent predictive factor sor a high residual axillary nodal burden (four or more non-sentinel lymph nodes involved) after a positive sentinel node biopsy. Retrospective cohort analytic observational study of patients with T1-2 tumors, negative axilla, who underwent breast conserving surgery and sentinel node biopsy with a positive result (macro or micro-metastasis) and later underwent lymph node dissection. Out of the total 325 patients, 96 got a positive result for metástasis in the sentinel lymph node (29.5%) and also underwent lymph node dissection. The selected population was divided into two groups according to the involvement of NSLNs: low axillary burden: 0-3 NSLNs, and high axillary burden: 4 or more positive NSLNs. Among the factors found to have a higher risk of high residual axillary nodal burden were the histologic grade, Ki-67 and the extracapsular invasión of the SLN, but only the extracapsular invasión of the SLN was found to be significant in the multivariate analysis. It is likely that with a higher number of patients, other variables might have been independent risk factors
Sujet(s)
Humains , Femelle , Noeud lymphatique sentinelle , Aisselle , Biopsie , Tumeurs du sein , Lymphadénectomie , Noeuds lymphatiquesRÉSUMÉ
Objective:To compare the dosimetric characteristics of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) after left breast conserving surgery.Methods:Twenty-four patients with left breast cancer after breast-conserving surgery who were admitted to the Department of Radiation Oncology of Tumor Hospital of Yunnan Province from May 2016 to May 2019 were selected. The HT plan and the VMAT plan were designed for the same patient. The target dose and the dose volume parameters of organs at risk were compared and analyzed in the two radiotherapy plans.Results:There were significant differences in the D 2% [(59.68±0.46) Gy vs. (60.06±0.20) Gy, t=-4.229, P<0.001], D 98% [(57.46±0.44) Gy vs. (57.20±0.07) Gy, t=2.912, P<0.001], conformity index (CI) (0.80±0.05 vs. 0.76±0.04, t=4.079, P<0.001) and homogeneity index (HI) (0.04±0.01 vs. 0.05±0.00, t=-5.505, P<0.001) of the planning gross tumor volume (PGTV) between the HT and VMAT plans. However, there was no significant difference in the D 50% [(58.77±0.46) Gy vs. (58.75±0.11) Gy, t=0.179, P=0.859]. There were significant differences in the D 50% [(51.99±0.39) Gy vs. (52.39±0.36) Gy, t=-5.278, P<0.001], D 98% [(49.46±0.29) Gy vs. (48.35±0.46) Gy, t=9.538, P<0.001] and HI (0.19±0.01 vs. 0.21±0.01, t=-7.538, P<0.001) of the planned target volume (PTV) between the two plans. However, there were no significant differences in the D 2% [(59.13±0.64) Gy vs. (59.09±0.46) Gy, t=0.511, P=0.614] and CI (0.83±0.04 vs. 0.82±0.04, t=1.637, P=0.115). In terms of organs at risk, there were significant differences in the V 5 [(57.90±1.42)% vs. (52.40±5.74)%, t=4.812, P<0.001], V 20 [(22.40±2.17)% vs. (18.40±3.16)%, t=5.573, P<0.001] and D mean [(12.71±0.55) Gy vs. (11.46±1.26) Gy, t=4.963, P<0.001] of left lung, D mean of right lung [(3.42±0.27) Gy vs. (2.49±0.24) Gy, t=13.310, P<0.001], D mean of right breast [(4.41±0.50) Gy vs. (3.12±0.65) Gy, t=10.326, P<0.001], V 30 [(0.55±0.37)% vs. (1.24±1.11)%, t=-4.020, P=0.001] and D mean of heart [(4.68±0.62) Gy vs. (3.83±0.88) Gy, t=7.335, P<0.001], D mean of left atrium [(2.53±0.31) Gy vs. (2.16±0.28) Gy, t=5.488, P<0.001], D mean of right atrium [(2.77±0.43) Gy vs. (2.20±0.30) Gy, t=7.103, P<0.001], D mean of right ventricle [(5.10±0.72) Gy vs. (3.72±0.94) Gy, t=9.802, P<0.001] and D 2% of spinal cord [(14.79±2.73) Gy vs. (5.42±2.23) Gy, t=14.788, P<0.001] between HT and VMAT plans. There was no significant difference in the D mean of left ventricle [(5.10±1.19) Gy vs. (4.80±1.54) Gy, t=1.250, P=0.224]. Conclusion:Both the HT plan and the VMAT plan can meet the treatment requirements. The HT plan can provide better target area conformity and dose uniformity. The VMAT plan has more advantages in terms of organs at risk. The HT plan shows an advantage only in exposure to high-dose area.